BACKGROUND & AIMS: IMPACT STATEMENT:The issue of classifying esophageal cancer at various developmental stages is crucial for determining the optimized treatment protocol for the patients, as well as the prognosis. Precision improvement in staging esophageal cancer keeps seeking quantitative and analytical imaging methods that could augment histopathological techniques. In this work, we used nonlinear optical microscopy for ratiometric analysis on the intrinsic signal of two-photon excited fluorescence (TPEF) and second harmonic generation (SHG) from single collagen fibers only in submucosa of esophageal squamous cell carcinoma (ESCC). The blind tests of TPEF/SHG and forward (F)/backward (B) SHG were demonstrated to compare with the histology conclusion. The discussion of sensitivity and specificity was provided via statistical comparison between the four stages of esophageal cancer. To the best of our knowledge, this is the first study of using these two ratios in combination for staging ESCC.

背景与目标： 影响陈述：在各个发展阶段对食道癌进行分类的问题对于确定患者的最佳治疗方案以及预后至关重要。食管癌分期的精确性提高一直在寻求可以增强组织病理学技术的定量和分析成像方法。在这项工作中，我们仅在食管鳞状细胞癌（ESCC）的粘膜下使用非线性光学显微镜对单胶原纤维的双光子激发荧光（TPEF）和二次谐波（SHG）的固有信号进行比例分析。 TPEF / SHG和向前（F）/向后（B）SHG的盲法测试可与组织学结论进行比较。食管癌四个阶段之间的统计比较提供了敏感性和特异性的讨论。据我们所知，这是首次结合使用这两个比率进行ESCC分期研究。

BACKGROUND & AIMS: :There has been no clear evidence demonstrating whether DNA hypermethylation can affect the prognosis of esophageal cancer. We collected tissue from 50 cases of squamous cell carcinoma of the esophagus and tested them for DNA hypermethylation using methylation-specific polymerase chain reaction. CpG island hypermethylations were observed in 10% for p16, 34% for RARbetaP2, 46% for adenomatosis polyposis coli (APC), 14% for RASSF1A, 84% for FHIT, and 8% for hMLH1. APC promoter hypermethylation was frequently found in patients without lymph node metastasis compared with those with lymph node metastasis (62.5% : 30.8%, P = 0.025). The number of metastatic lymph nodes were lower in patients with APC promoter hypermethylation (0.87 +/- 0.30 : 3.07 +/- 0.72, P = 0.008). Excluding operative mortalities and incomplete resections, 42 patients were analyzed for long-term outcome. During the mean follow-up period of 35 months, 17 developed recurrence and 14 died of cancer. Ten patients died of other causes. In univariable analysis, unmethylation of APC (P = 0.0015) and FHIT (P = 0.0044), as well as presence of lymph node metastasis (P = 0.0038), were risk factors for recurrence. In multivariable analysis, lymph nodes metastasis (P = 0.050) and unmethylation of APC promoter (P = 0.023) remained as significant risk factors. In conclusion, promoter hypermethylation of the APC gene is related to a lower number of metastatic lymph nodes and to superior prognosis in terms of recurrence, which suggests it might be involved in the process of lymph node metastasis in esophageal cancer.

背景与目标： ：尚无明确证据证明DNA甲基化过高是否会影响食道癌的预后。我们从50例食道鳞状细胞癌中收集了组织，并使用甲基化特异性聚合酶链反应检测了它们的DNA超甲基化程度。 CpG岛超甲基化在p16中为10％，在RARbetaP2中为34％，在腺瘤性息肉病（APC）中为46％，RASSF1A为14％，FHIT为84％，hMLH1为8％。与无淋巴结转移的患者相比，无淋巴结转移的患者经常发现APC启动子高甲基化（62.5％：30.8％，P = 0.025）。 APC启动子甲基化过高的患者转移淋巴结数目较少（0.87 /-0.30：3.07 /-0.72，P = 0.008）。除手术死亡率和不完全切除外，对42例患者的长期预后进行了分析。在平均35个月的随访期间，有17例复发，14例死于癌症。十名患者死于其他原因。在单变量分析中，APC（P = 0.0015）和FHIT（P = 0.0044）的甲基化以及淋巴结转移的存在（P = 0.0038）是复发的危险因素。在多变量分析中，淋巴结转移（P = 0.050）和APC启动子未甲基化（P = 0.023）仍然是重要的危险因素。总之，APC基因的启动子高甲基化与较少数量的转移性淋巴结和复发有关的预后有关，这表明它可能与食管癌的淋巴结转移过程有关。

BACKGROUND & AIMS: CONTEXT:Primary esophageal melanoma (PEM) is a rare disease and is difficult to distinguish from other esophageal malignancies and from metastatic melanoma. OBJECTIVE:To develop diagnostic criteria for PEM, we compared the clinicopathologic features of 5 PEMs and 5 metastatic melanomas to esophagus. DESIGN:Ten cases of esophageal melanoma, including 4 surgically resected specimens, 2 autopsy cases, and 4 cases reported on mucosal biopsies, were reviewed. The histologic parameters used in this study were well-characterized features for cutaneous melanoma, including junctional component (in situ melanoma), radial growth phase, modified Breslow thickness, depth of invasion, lymphovascular invasion, satellitosis, predominant type of cytology, and regional lymph node metastasis. Clinical and follow-up information was obtained by reviewing patients' medical records. RESULTS:Previous history of cutaneous melanoma was present in all 5 cases of metastatic esophageal melanoma but was not present in the 5 patients with PEMs. In situ melanoma and/or radial growth phase were identified in all 5 PEMs but were not present in any of the metastatic cases. Among the 4 resected and 2 autopsy cases, melanocytosis and mixed epithelioid and spindle cell morphology was present in 2 (50%) of 4 PEMs but was not present in 2 (40%) of the metastatic melanomas. Melanin pigment was detectable in all cases. Patients with PEM had better survival than those who had metastatic melanoma to esophagus (P = .03). CONCLUSIONS:The presence of in situ melanoma, radial growth phase, melanocytosis, and mixed epithelioid and spindle cell morphology, in the context of no history of melanoma, distinguishes PEM from metastatic melanoma.

背景与目标： 背景：原发性食管黑色素瘤（PEM）是一种罕见的疾病，很难与其他食道恶性肿瘤和转移性黑色素瘤区分开。
目的：为制定PEM的诊断标准，我们比较了5种PEM和5种转移性黑色素瘤与食道的临床病理特征。
设计：对10例食管黑色素瘤病例进行了回顾性分析，其中包括4例手术切除的标本，2例尸检病例和4例经黏膜活检报告的病例。在这项研究中使用的组织学参数是皮肤黑色素瘤的特征，包括连接成分（原位黑色素瘤），放射状生长期，改良的Breslow厚度，浸润深度，淋巴血管浸润，黄变，主要的细胞学类型和局部淋巴结肿大淋巴结转移。通过回顾患者的病历获得临床和随访信息。
结果：所有5例转移性食管黑色素瘤均存在皮肤黑色素瘤的既往史，但在5例PEM患者中均未见。在所有5个PEM中均发现了原位黑素瘤和/或radial骨生长阶段，但在任何转移病例中均不存在。在4例切除和2例尸检病例中，黑素细胞增多症以及混合的上皮样和梭形细胞形态存在于4个PEM中的2个（50％）中，但不存在于2个（40％）的转移性黑色素瘤中。在所有情况下均可检测到黑色素。与患有转移性黑色素瘤至食管的患者相比，PEM患者的生存期更好（P = .03）。
结论：在无黑素瘤病史的情况下，原位黑素瘤，放射状生长期，黑素细胞增多以及混合的上皮样和梭形细胞形态的存在将PEM与转移性黑素瘤区分开。

BACKGROUND & AIMS: :Mutations in exons 4-8 of the p53 gene by the PCR-SSCP analysis in preneoplastic and neoplastic lesions of the colon (n=11) and esophagus (n=18) were screened. p53 overexpression by immunohistochemistry in 11 colonic lesions and 13 microsatellites, in all the patients (n=29), were also studied. A positive result concordancy between the three techniques was found in 1 adenoma and 2 adenocarcinomas of the colon, each with loss of heterozygocity of microsatellites. Metaplastic lesions of esophagus showed biallelic mutations and low frequency of microsatellite alterations. The relationship between genetic alterations in p53, microsatellites and type of colon and esophageal lesions is discussed.

背景与目标： ：通过PCR-SSCP分析筛选了结肠（n = 11）和食道（n = 18）的肿瘤前和肿瘤病变中p53基因外显子4-8的突变。还对所有患者（n = 29）中的11个结肠病变和13个微卫星中的免疫组化p53过表达进行了研究。在1例结肠腺瘤和2例结肠腺癌中发现了这三种技术之间的阳性结果一致性，每一种都丧失了微卫星的杂合性。食管的化生病变显示双等位基因突变和微卫星改变的频率低。讨论了p53基因改变，微卫星与结肠和食道病变类型之间的关系。

BACKGROUND & AIMS: BACKGROUND AND STUDY AIMS:Endoscopic submucosal dissection (ESD) of early gastrointestinal tumors has been shown to achieve complete resection rates superior to endoscopic mucosal resection (EMR), but at the cost of higher risk. The aim of this study was to prospectively assess the feasibility and oncological results of ESD in patients with neoplastic Barrett's esophagus in conjunction with subsequent radiofrequency ablation (RFA). METHODS:Patients with Barrett's esophagus who had visible lesions containing high grade intraepithelial neoplasia (HGIN) or mucosal adenocarcinoma (MAC) up to 3 cm in diameter were included in the study. ESD was performed using a new waterjet-assisted system (WESD) with a HybridKnife (Erbe Elektromedizin GmbH, Tübingen, Germany). Primary outcome was the rate of complete tumor resection. RFA of residual intestinal metaplasia was offered to all patients with at least two negative follow-up endoscopies. RESULTS:Of 30 patients (m:f = 21:9; median age 60 years) with biopsy-proven MAC (n = 24) or HGIN (n = 6) with a median diameter of 2 cm, complete resection of the targeted area was achieved in 29 patients (96.7 %; 95 % confidence interval [CI] 82 % - 99 %); en bloc resection was achieved in 27 of these patients (90.0 %; 95 %CI 74 % - 97 %). Minor delayed bleedings occurred in two patients. One patient died due to a sudden cardiac death 7 days after an uneventful WESD. Specimen histology (n = 29) revealed no neoplasia in 3 patients, HGIN in 2, MAC in 21, and submucosal cancer in 3; complete resection was histologically confirmed in only 10 of the 26 patients with HGIN or adenocarcinoma (38.5 %; 95 %CI 22 % - 57 %). However, endoscopic follow-up (median 17 months) showed complete remission of neoplasia in 27 /28 (96.4 %; 95 %CI 81 % - 99 %) patients who underwent successful WESD and were alive at 30 days. One patient underwent EMR of residual tumor. All Barrett's tissue was eradicated by ESD alone in 15 cases and by additional RFA in 8 /10 cases (not done in three patients). CONCLUSIONS:ESD of Barrett's neoplasia is feasible and safe, but does not achieve sufficient R0 resection rates to warrant its recommended use over piecemeal EMR. In combination with RFA it can achieve complete eradication of neoplastic and non-neoplastic Barrett's epithelium. The discrepancy between insufficient oncological resection and good medium-term results needs to be studied further.

背景与目标： 背景与研究目的：早期胃肠道肿瘤的内镜黏膜下剥离术（ESD）已被证明具有比内镜黏膜切除术（EMR）更高的完全切除率，但代价是较高的风险。这项研究的目的是前瞻性评估ESD治疗肿瘤Barrett食管患者并结合随后的射频消融（RFA）的可行性和肿瘤学结果。
方法：本研究纳入了Barrett食管的患者，其可见的病灶包括高度上皮内瘤变（HGIN）或粘膜腺癌（MAC）直径不超过3 cm。 ESD使用带有HybridKnife（Erbe Elektromedizin GmbH，图宾根，德国）的新型水刀辅助系统（WESD）进行。主要结局为肿瘤完全切除率。向至少两次阴性随访内镜检查的所有患者提供残留肠上皮化生的RFA。
结果：30名患者（m：f = 21：9;中位年龄60岁）行活检证实的MAC（n = 24）或HGIN（n = 6），中位直径为2 cm，完全切除了目标区域29例患者达到（96.7％； 95％置信区间[CI] 82％-99％）；这些患者中有27例获得了整块切除（90.0％; 95 %% CI 74 %%-97 %%）。两名患者发生了轻微的延迟性出血。正常WESD后7天，一名患者因心脏猝死而死亡。标本组织学检查（n = 29）3例未见肿瘤，HGIN 2例，MAC 21例，黏膜下癌3例；在26例HGIN或腺癌患者中，只有10例经组织学证实完全切除（38.5％； 95 %% CI 22％-57％）。然而，内镜随访（中位17个月）显示，在成功进行WESD并存活30天的27/28名患者中，瘤形成完全缓解（96.4％； 95 %% CI 81 %%-99％）。一名患者接受了残留肿瘤的EMR。仅Barrett的所有组织就被ESD消灭了15例，另外的RFA消灭了8/10例（三例未做）。
结论：Barrett瘤形成的ESD是可行和安全的，但不能达到足够的R0切除率，不能保证推荐其用于零碎的EMR。结合RFA，可以完全根除肿瘤和非肿瘤性Barrett上皮。肿瘤切除不足与中期效果良好之间的差异有待进一步研究。

BACKGROUND & AIMS: OBJECTIVE:To determine whether extended transthoracic esophagectomy for adenocarcinoma of the mid/distal esophagus improves long-term survival. BACKGROUND:A randomized trial was performed to compare surgical techniques. Complete 5-year survival data are now available. METHODS:A total of 220 patients with adenocarcinoma of the distal esophagus (type I) or gastric cardia involving the distal esophagus (type II) were randomly assigned to limited transhiatal esophagectomy or to extended transthoracic esophagectomy with en bloc lymphadenectomy. Patients with peroperatively irresectable/incurable cancer were excluded from this analysis (n = 15). A total of 95 patients underwent transhiatal esophagectomy and 110 patients underwent transthoracic esophagectomy. RESULTS:After transhiatal and transthoracic resection, 5-year survival was 34% and 36%, respectively (P = 0.71, per protocol analysis). In a subgroup analysis, based on the location of the primary tumor according to the resection specimen, no overall survival benefit for either surgical approach was seen in 115 patients with a type II tumor (P = 0.81). In 90 patients with a type I tumor, a survival benefit of 14% was seen with the transthoracic approach (51% vs. 37%, P = 0.33). There was evidence that the treatment effect differed depending on the number of positive lymph nodes in the resection specimen (test for interaction P = 0.06). In patients (n = 55) without positive nodes locoregional disease-free survival after transhiatal esophagectomy was comparable to that after transthoracic esophagectomy (86% and 89%, respectively). The same was true for patients (n = 46) with more than 8 positive nodes (0% in both groups). Patients (n = 104) with 1 to 8 positive lymph nodes in the resection specimen showed a 5-year locoregional disease-free survival advantage if operated via the transthoracic route (23% vs. 64%, P = 0.02). CONCLUSION:There is no significant overall survival benefit for either approach. However, compared with limited transhiatal resection extended transthoracic esophagectomy for type I esophageal adenocarcinoma shows an ongoing trend towards better 5-year survival. Moreover, patients with a limited number of positive lymph nodes in the resection specimen seem to benefit from an extended transthoracic esophagectomy.

背景与目标： 目的：探讨扩大经胸食管切除术治疗中/远端食道腺癌是否能提高长期生存率。
背景：进行了一项随机试验以比较手术技术。现在可以获取完整的5年生存数据。
方法：将220例远端食管腺癌（I型）或累及远端食道（II型）的胃card门腺癌患者随机分配至经限制的经食管食管切除术或经整体淋巴结清扫的经胸经食道切除术。患有无法手术切除/无法治愈的癌症的患者被排除在本分析之外（n = 15）。共有95例行经食管食管切除术，110例行经胸食管切除术。
结果：经食管和胸腔切除后，5年生存率分别为34％和36％（根据方案分析，P = 0.71）。在亚组分析中，根据切除标本中原发肿瘤的位置，在115例II型肿瘤患者中，两种手术方法均未发现总体生存获益（P = 0.81）。在90例I型肿瘤患者中，经胸腔入路的生存获益为14％（51％对37％，P = 0.33）。有证据表明，根据切除标本中阳性淋巴结的数量，治疗效果会有所不同（相互作用测试P = 0.06）。在无阳性淋巴结转移的患者（n = 55）中，经食管食管切除术后的无局部区域生存率与经胸食管切除术后的无局部生存率相当（分别为86％和89％）。对于阳性淋巴结多于8个（两组均为0％）的患者（n = 46）也是如此。切除标本中有1至8个阳性淋巴结的患者（n = 104）通过经胸腔手术进行手术可显示5年无局部区域疾病生存优势（23％vs. 64％，P = 0.02）。
结论：这两种方法均没有显着的总体生存获益。然而，与有限的经食管切除相比，扩大的经胸食管切除术治疗I型食管腺癌显示出一种持续的向5年生存的趋势。此外，切除标本中淋巴结阳性的患者数量有限，似乎可以从扩大的经胸食管切除术中受益。

BACKGROUND & AIMS: :We present a 47-year-old patient with progressive dysphagia. Upper gastro intestinal endoscopy revealed middle third esophageal ulcer, the histology of which was moderately differentiated carcinoma. The patient underwent 3-stage esophagectomy with cervical gastro esophageal anastomosis. The histopathology revealed Crohn's disease of the esophagus. The clinical features and diagnosis of this rare condition are described, with review of the literature.

背景与目标： ：我们介绍了一名47岁的进行性吞咽困难患者。上消化道内镜检查发现中段食管溃疡，其组织学为中度分化癌。该患者接受了三阶段食管切除术并进行了胃食管颈吻合术。组织病理学揭示了食道的克罗恩氏病。结合文献回顾，描述了这种罕见病的临床特征和诊断。

BACKGROUND & AIMS: :The present study was designated to analyze correlation between the presence and extent of peritumoral retraction clefting and various clinicopathologic features in esophageal squamous cell carcinoma (ESCC), and to possibly establish the significance of this phenomenon in ESCC. Fifty-four consecutive patients with advanced ESCC were included in the study. The presence of peritumoral retraction clefting was classified on the basis of the proportion of tumor nests exhibiting this phenomenon. Tumors with clefts that affected up to 25% of tumor nests were classified as group I; with clefts that affected >25% to 50% of tumor nests as group II; with clefts that affected >50% to 75% of tumor nests as group III; and tumors with clefts that affected more than 75% of tumor nests were classified as group IV. Statistical analysis showed a correlation between presence and extent of peritumoral clefting and lymph node metastasis. T3 tumors and tumors with lymph node metastasis had significantly more pronounced peritumoral clefting compared with T2 tumors and tumors without lymph node metastasis. The presence of peritumoral clefting was not associated with the number of affected lymph nodes. There was no correlation between the presence and extent of peritumoral clefting with patient age and sex, and tumor location, diameter and grade. The association of peritumoral retraction clefting in ESCC with local invasiveness and lymph node metastasis indicated that peritumoral clefting could be a simple and useful morphological feature of tumor aggressiveness and may contribute to the pathological and clinical assessment of patients with ESCC.

背景与目标： ：本研究旨在分析食管鳞状细胞癌（ESCC）肿瘤周围回缩裂隙的存在和程度与各种临床病理特征之间的相关性，并可能确定这种现象在ESCC中的意义。这项研究包括了54名连续的晚期ESCC患者。根据表现出这种现象的肿瘤巢的比例，对肿瘤周围收缩性裂隙的存在进行分类。裂隙最多影响25％的肿瘤巢的肿瘤被归为第一组。 II组裂隙影响大于2​​5％至50％的肿瘤巢；第三组裂隙影响> 50％至75％的肿瘤巢；裂隙累及超过75％肿瘤巢的肿瘤被归为IV组。统计分析表明，肿瘤周围裂隙的存在与程度与淋巴结转移之间存在相关性。与T2肿瘤和无淋巴结转移的肿瘤相比，T3肿瘤和有淋巴结转移的肿瘤的肿瘤周裂明显更为明显。肿瘤周围裂隙的存在与受影响的淋巴结数目无关。肿瘤周裂的存在与程度，患者年龄和性别与肿瘤的位置，直径和等级之间没有相关性。 ESCC肿瘤周围收缩traction裂与局部浸润性和淋巴结转移的关系表明，肿瘤周围裂隙可能是肿瘤侵袭性的一种简单而有用的形态学特征，可能有助于ESCC患者的病理和临床评估。

BACKGROUND & AIMS: BACKGROUND AND GOALS:Acute food bolus impaction is a common emergency in gastrointestinal practice. Management previously used the endoscope with an overtube to allow retrieval of the bolus per os. The push technique using air insufflation and gentle pressure on the bolus provides an alternative approach. Esophageal mucosal biopsy at the time of the initial endoscopy has not been a part of traditional practice. In view of the increasing recognition of eosinophilic esophagitis (EE) as a cause of dysphagia and food bolus obstruction in adults the etiology needs to be reassessed. STUDY:Forty-three consecutive adults presenting with acute dysphagia secondary to food bolus obstruction of the esophagus were studied. The bolus was advanced into the stomach with the push technique or removed per os with a retrieval net. Protocol biopsies from the proximal and distal esophagus were obtained in 29 patients. Biopsies were contraindicated or not obtained in the remainder. RESULTS:Forty-one patients were successfully treated at endoscopy. Two subjects with a food bolus impacted at the crico-pharyngeal region required general anesthesia with endotracheal intubation for safe removal. Of 29 patients biopsied, 15 had peptic esophageal stricture as the cause. Fourteen patients (all males, mean age 32 y, range 19 to 62 y) had EE identified histologically. This represents 50% of those biopsied. Patients with EE had typical endoscopic features of linear furrows, mucosal rings, or narrow bore esophagus. Most had prior episodes of food bolus obstruction. CONCLUSIONS:Food bolus obstruction can be safely managed by the push technique. EE is an important cause of food bolus obstruction that can be suspected on history and endoscopic appearance and confirmed on histology.

背景与目标： 背景与目标：急性食物推注撞击是胃肠道实践中的常见紧急情况。管理层先前将内窥镜与套管配合使用，以允许每OS取出弹丸。使用充气和轻推推注的推压技术提供了另一种方法。初次内镜检查时的食管粘膜活检尚未成为传统做法的一部分。鉴于越来越多的人认识到嗜酸性粒细胞性食管炎（EE）是导致吞咽困难和食物弹药阻塞的原因，因此需要重新评估病因。
研究：研究了连续四十三名因食管食物团阻塞而继发急性吞咽困难的成年人。通过推挤技术将大丸药推入胃中，或通过回弹网将其快速清除。 29例患者从近端食管和远端食管获得了活检标本。在其余患者中禁用或未获得活检标本。
结果：在内窥镜检查中成功治疗了41例患者。两名在食管咽部区域受到食物推注的受试者需要使用气管插管进行全身麻醉，以安全移除。在29例活检患者中，有15例是由于消化道食管狭窄引起的。 14例患者（均为男性，平均年龄32岁，范围19至62岁）在组织学上被确定为EE。这占活检样本的50％。 EE患者的典型内窥镜特征为线性犁沟，粘膜环或狭窄口食管。多数患者以前曾发生过食物弹药阻塞。
结论：推药技术可以安全地控制食物团。 EE是食物团阻塞的重要原因，可在病史和内窥镜外观上被怀疑并在组织学上得到证实。

BACKGROUND & AIMS: AIM:To clarify risk based upon segment length, diagnostic histological findings, patient age and year of surveillance, duration of surveillance and gender. METHODS:Patients registered with the United Kingdom Barrett's Oesophagus Registry from 9 United Kingdom centers were included. The outcome measures were (1) development of all grades of dysplasia; (2) development of high-grade of dysplasia or adenocarcinoma; and (3) development of adenocarcinoma. Prevalent cases and subjects with < 1 year of follow-up were excluded. The covariates examined were segment length, previous biopsy findings, age at surveillance, duration of surveillance, year of surveillance and gender. RESULTS:One thousand and one hundred thirty six patients were included (total 6474 patient-years). Fifty-four patients developed adenocarcinoma (0.83% per annum), 70 developed high-grade dysplasia/adenocarcinoma (1.1% per annum) and 190 developed any grade of dysplasia (3.5% per annum). High grade dysplasia and adenocarcinoma increased with age and duration of surveillance. The risk of low-grade dysplasia development was not dependent on age at surveillance. Segment length and previous biopsy findings were also significant factors for development of dysplasia and adenocarcinoma. CONCLUSION:The risk of development of low-grade dysplasia is independent of age at surveillance, but high-grade dysplasia and adenocarcinoma were more commonly found at older age. Segment length and previous biopsy findings are also markers of risk. This study did not demonstrate stabilisation of the metaplastic segment with prolonged surveillance.

背景与目标： 目的：根据段长，诊断组织学发现，患者年龄和监测年限，监测持续时间和性别来明确风险。
方法：包括来自英国9个中心的英国Barrett食管登记处注册的患者。结局指标包括：（1）所有级别的发育异常的发展； （2）发展为高度不典型增生或腺癌； （3）腺癌的发展。排除＜1年随访的普遍病例和受试者。检验的协变量是节段长度，既往活检结果，监测年龄，监测持续时间，监测年份和性别。
结果：共纳入136例患者（总计6474例患者-年）。 54名患者发展为腺癌（每年0.83％），70名发展为高度不典型增生/腺癌（每年1.1％），190个发展为任何等级的不典型增生（每年3.5％）。高度不典型增生和腺癌随着年龄和监测持续时间的增加而增加。低度发育异常发展的风险不取决于监测时的年龄。节段长度和先前的活检结果也是发育异常和腺癌发展的重要因素。
结论：在监测时，低度发育不良的发展风险与年龄无关，但高度发育异常和腺癌在老年人中更为常见。节段长度和先前的活检结果也是危险的标志。这项研究没有证明通过长时间的监测可以稳定化生段。

BACKGROUND & AIMS: :The reproducibility of ambulatory 24-h esophageal pH monitoring was evaluated in 16 consecutive patients by comparing the difference in two consecutive 24-h periods. The study group included 8 patients with scleroderma esophagus and 8 treated achalasia patients. The amount of reflux was expressed as the percentage of time the pH was < 4.0. Both groups demonstrated excellent intrapatient reproducibility overall: 96% in scleroderma patients and 95% in those patients with achalasia. The least concordance was found in the lengths of the longest reflux events-70% when supine in scleroderma patients and 59% when upright in patients with achalasia. There was no significant difference (p > 0.05) between day 1 and day 2 for either group of patients for any of the elements studied. These results indicate that intrapatient variability of gastroesophageal reflux in patients with scleroderma esophagus and treated patients with achalasia is very low and following therapeutic intervention, a high level of confidence can be placed in subsequent pH monitoring as an indicator of treatment effect.

背景与目标： ：通过比较两个连续的24小时内的差异，对16例连续患者进行了动态24小时食管pH监测的可重复性。研究组包括8例食管硬皮病患者和8例接受治疗的门失弛缓患者。回流量表示为pH ＜4.0的时间百分比。两组患者总体上均具有出色的可重复性：硬皮病患者中96％，门失弛缓患者中95％。在最长的反流事件的时间长度上发现的一致性最低—硬皮病患者仰卧时为70％，门失弛缓患者为直立时为59％。两组患者在第1天和第2天之间没有任何显着差异（p> 0.05）。这些结果表明，食管硬皮病患者和经治疗的treated门失弛缓患者的胃食管反流患者的变异性非常低，在进行治疗干预后，可以在随后的pH监测中置信度高，作为治疗效果的指标。

BACKGROUND & AIMS: :Esophageal involvement of pemphigus vulgaris (PV) had been considered an exceptional event. We present the case of a woman with PV who developed esophageal involvement while being treated with azathioprine and resolved after steroid therapy. This case highlights that esophageal involvement of PV might be resistant to immunosuppressive therapy other than steroids.

背景与目标： ：寻常性天疱疮（PV）的食道受累被认为是例外事件。我们介绍了一名患有PV的妇女，该妇女在接受硫唑嘌呤治疗时出现食管受累，并在类固醇治疗后消退。该病例表明，食管PV的介入除类固醇外可能对免疫抑制疗法有抵抗力。

BACKGROUND & AIMS: :Barrett's esophagus (BE) refers to an abnormal change (metaplasia) in the cells of the inferior portion of the esophagus. About 10% of patients with symptomatic gastroesophageal reflux disease (GERD) have BE. In some cases, BE develops as an advanced stage of erosive esophagitis. The risk of esophageal cancer appears to be increased in patients with BE. The only way to diagnose BE is by endoscopy and histology. Some studies suggest that intensive treatment of Barrett's esophagus with effective acid suppression can reduce the amount of abnormal lining in the esophagus. It is not clear whether such treatment also prevents esophageal cancer. Generally, the cancer starts out as carcinoma of the esophagus on the surface, and then invades the surrounding tissue. Surgery offers the best chance of long-term survival. There are many events that occur in Barrett's esophagus that lead to the development of cancer and most of them appear to occur early, before high-grade dysplasia or cancer develops. No one knows what the late events are and how cells acquire the ability to leave their normal growth boundaries. It is now widely accepted that the development of most cancers is due to something called genomic or genetic instability. The aim of this review is to show BE pathology in its progression to cancer looking for new biomarkers to distinguish between BE -dysplasia (low grade and high grade)- adenocarcinoma (ADC) and to characterize the ADC, giving more hope for its treatment.

背景与目标： ：Barrett食道（BE）是指食道下半部分细胞的异常变化（异化症）。有症状的胃食管反流病（GERD）的患者中约有10％患有BE。在某些情况下，BE发展为糜烂性食管炎的晚期。 BE患者食管癌的风险似乎增加。诊断BE的唯一方法是通过内窥镜检查和组织学检查。一些研究表明，用有效的抑酸剂对巴雷特食管进行强化治疗可以减少食管中异常内膜的数量。尚不清楚这种治疗方法是否还可以预防食道癌。通常，癌症从表面食道癌开始，然后侵入周围组织。手术提供了长期生存的最佳机会。在巴雷特食管中发生了许多事件，导致癌症的发展，并且大多数事件似乎发生在严重的不典型增生或癌症发展之前。没有人知道晚期事件是什么，以及细胞如何获得脱离正常生长边界的能力。现在已被广泛接受，大多数癌症的发生是由于所谓的基因组或遗传不稳定性。这篇综述的目的是展示BE病理学向癌症发展的过程，以寻找新的生物标志物来区分BE-发育异常（低度和高度）-腺癌（ADC）并鉴定ADC的特征，从而为其治疗带来更多希望。

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: Background/Aims:The aim of this study is to investigate the degree of delayed gastric emptying (DGE) and evaluate how the severity of DGE affects gastroesophageal reflux disease (GERD) in neurologically impaired (NI) patients utilizing 24-hour multichannel intraluminal impedance pH measurements (pH/MII) and 13C-acetate breath test (13C-ABT) analyses. Methods:13C-ABT and pH/MII were conducted in 26 NI patients who were referred to our institution due to suspected GERD. At first, correlation analyses were performed to investigate the correlation between the 13C-ABT parameters and the clinical or pH/MII parameters. Thereafter, all patients were divided into 2 groups (DGE and severe DGE [SDGE] group) according to each cut off half emptying time (t1/2, 90-170 minutes). Each pH/MII parameter was compared between the 2 groups in each set-up cutoff t1/2. Results:The mean t1/2 of all patients was 215.5 ± 237.2 minutes and the t1/2 of 24 (92.3%) patients were > 100 minutes. Significant moderate positive correlations were observed between both t1/2 and lag phase time and the non-acid reflux related parameters. Furthermore, the patients in the SDGE group demonstrated higher non-acid reflux related parameters than those of the DGE groups when the cutoff was t1/2 ≥ 140 minutes. Conclusion:The present study demonstrated that GE with t1/2 ≥ 140 minutes was related to an increase of non-acid exposure reaching up to the proximal esophagus in NI patients, and indicating that NI patients with SDGE might have a high risk of non-acid GERD.

背景与目标： 背景/目的：本研究的目的是研究延迟胃排空的程度（DGE），并评估DGE的严重程度如何利用24小时多通道腔内阻抗pH对神经功能障碍（NI）患者的胃食管反流病（GERD）产生影响测量（pH / MII）和13C醋酸呼气试验（13C-ABT）分析。
方法：对26例因疑似GERD而转入本院的NI患者进行了13C-ABT和pH / MII检查。首先，进行相关分析以研究13C-ABT参数与临床或pH / MII参数之间的相关性。此后，根据每个患者的半个排空时间（t1 / 2、90-170分钟）将所有患者分为2组（DGE和严重DGE [SDGE]组）。在每个设定截止时间t1 / 2中，将两组的每个pH / MII参数进行了比较。
结果：所有患者的平均t1 / 2为215.5±237.2分钟，而24位患者（92.3％）的t1 / 2为> 100分钟。在t1 / 2和滞后时间与非酸回流相关参数之间均观察到显着的正相关。此外，当截断时间为t1 / 2≥140分钟时，SDGE组的患者显示出比DGE组更高的非酸性反流相关参数。
结论：本研究表明，t1 / 2≥140分钟的GE与NI患者中非酸暴露至食管近端的增加有关，并且表明SDGE的NI患者可能具有较高的非酸暴露风险。酸GERD。