Asymmetrical circumferential distribution of esophagogastric junctional lesions: anatomical and physiological considerations

Kinoshita, Yoshikazu; Furuta, K.; Adachi, Kyoichi; Amano, Yuji

doi:10.1007/s00535-009-0092-0

Cited by 21 publications

(26 citation statements)

References 25 publications

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“…An interesting observation in this study is that the esophageal cardiac glands were found to be primarily located on the left-posterior side of the esophageal wall, which is opposite the main site of mucosal injury in patients with LAclassification A and B grade reflux esophagitis (25,26). The circumferential localization of mucosal injury in cases of A and B grade reflux esophagitis was shown to largely fit the direction of prolonged acid exposure in a study that used a recently developed 8-channel device with radially arrayed pH sensors (27).…”

Section: Discussionmentioning

confidence: 79%

Relationship between Esophageal Cardiac Glands and Gastroesophageal Reflux Disease

et al. 2015

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Objective The role of esophageal cardiac glands has not been fully determined. This study was performed to clarify the protective role of esophageal cardiac glands against the development of gastroesophageal reflux disease (GERD). Methods The subjects included 2,656 Japanese individuals who visited our institution for a detailed medical checkup. GERD symptoms were assessed using the Japanese version of the Carlsson-Dent selfadministered questionnaire (QUEST) and an upper gastrointestinal endoscopy examination in each subject. The presence of reflux esophagitis, size of diaphragmatic hiatus, degree of gastric mucosal atrophy and existence of visible esophageal cardiac glands in the distal esophagus, based on the detection of yellowish elevated areas, were determined using endoscopy. Results Esophageal cardiac glands were observed in 355 cases (13.4%). Reflux esophagitis was significantly less frequent in the cases with esophageal cardiac glands than in those without. The esophageal cardiac glands were mainly located on the left-posterior side of the esophageal wall of the distal esophagus. A multiple regression analysis showed that the presence of esophageal cardiac glands was an independent factor for preventing reflux esophagitis. On the other hand, the existence of these glands did not correlate with the presence of GERD symptoms (QUEST score of 6 or more). Conclusion The presence of visible esophageal cardiac glands may have a protective role against the development of reflux esophagitis.

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Section: Discussionmentioning

confidence: 79%

Relationship between Esophageal Cardiac Glands and Gastroesophageal Reflux Disease

et al. 2015

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“…Interestingly, SIM was frequently found in the 0-3 o'clock area, which was a similar location to where EAC was most preferentially found [6-9]. The presence of SIM can be limited by sampling error in mucosal biopsies and shows a patchy distribution in the BE mucosa; however, one of the goals of the “Seattle” protocol is to detect dysplasia or SIM [10].…”

Section: Discussionmentioning

confidence: 99%

“…Also, we did not analyze the association between the localization of SIM, molecular alterations or mAb Das-1 reactivity, and acid reflux to the esophagus using a circumferential pH sensor array catheter [6]. It has been reported that acid reflux in BE patients predominantly occurs in the right anterior side (0-3 o'clock quadrant) of the distal esophagus [6]. Additionally, four-quadrant biopsies were not obtained from the patients with EAC prior to endoscopic resection.…”

Section: Discussionmentioning

confidence: 99%

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Localization of specialized intestinal metaplasia and the molecular alterations in Barrett esophagus in a Japanese population: an analysis of biopsy samples based on the “Seattle” biopsy protocol

et al. 2016

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Summary It remains unclear why Barrett's esophagus (BE)-associated adenocarcinoma (EAC) frequently occurs in the 0-3 o'clock area of the BE. The aims of this study were to clarify the localization of specialized intestinal metaplasia (SIM) as a precancerous lesion and of molecular alterations among different locations using four-quadrant biopsies based on the “Seattle” protocol. We prospectively evaluated microsatellite instability, methylation status at the APC, CDKN2A, hMLH1, RUNX3 and MGMT genes, the immunoreactivity of the monoclonal antibody Das-1 for the colonic phenotype, and Ki-67 staining in 10 early EACs and 128 biopsy samples from 32 BE patients. Among the molecular changes, only APC gene hypermethylation was an independent predictive marker of EAC (OR=24.4, p=0.01). SIM was more frequently identified in the 0-3 o'clock quadrant than in the 6-9 o'clock quadrant (p=0.08). The Ki-67 index was higher in SIM than in the columnar-lined epithelium (CLE) without goblet cells (p<0.0001), and in both SIM and CLE with Das-1 reactivity than in those without (p=0.04 and p=0.06, respectively). Furthermore, the index was relatively higher in the 0-3 o'clock quadrant than in the 6-9 o'clock quadrant in cases with Das-1 reactivity. RUNX3 methylation was more frequently found in SIM than in CLE (p=0.04), while the incidence of the other biomarkers did not show a significant difference between the 0-3 o'clock and 6-9 o'clock areas, nor between SIM and CLE. SIM with Das-1 reactivity, but not molecular alterations, in the 0-3 o'clock quadrant may have higher proliferative activity compared to the other areas of the BE.

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“…Esophagogastric junctional lesions, including reflux esophagitis, ruptured esophageal varices, Mallory-Weiss tears, BE, and BE-associated neoplasia, have been frequently recognized to have a unique asymmetrical circumferential distribution, likely due to their anatomical and physiological properties [25]. To date, several reports have demonstrated the circumferential distribution of BE-associated neoplasia.…”

Section: Circumferential Localization Of Be-associated Neoplasiamentioning

confidence: 99%

Pathophysiology of Barrett's Esophagus-Associated Neoplasia: Circumferential Spatial Predilection

et al. 2014

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The prevalence rates of Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC) arising from BE show striking geographic patterns as they are much more common in Western as compared with Asian countries. However, recent epidemiological studies indicate that the number of patients with BE and EAC are gradually increasing in Asia including Japan, corresponding to the increase in prevalence of gastroesophageal reflux disease (GERD). Because the prognosis of patients with advanced-stage EAC remains poor, early detection of neoplastic lesion in those with BE has led to recent interest in effective treatment. Several promising studies have revealed that early neoplasia in BE is mainly located in the right anterior wall of the distal esophagus. Interestingly, this endoscopic characteristic has been found in both Western and Japanese populations. Potential pathophysiologic explanations underlying the circumferential distribution of neoplasia in BE include a nonuniform asymmetric distribution of esophageal acid exposure, with a tendency toward mucosal acid-related injury on the right side of the esophageal wall in patients with GERD, and the functional structure of the lower esophageal sphincter. Findings of the present study should improve lesion detection and aid in developing a target biopsy protocol for surveillance of BE.

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Asymmetrical circumferential distribution of esophagogastric junctional lesions: anatomical and physiological considerations

Cited by 21 publications

References 25 publications

Relationship between Esophageal Cardiac Glands and Gastroesophageal Reflux Disease

Relationship between Esophageal Cardiac Glands and Gastroesophageal Reflux Disease

Localization of specialized intestinal metaplasia and the molecular alterations in Barrett esophagus in a Japanese population: an analysis of biopsy samples based on the “Seattle” biopsy protocol

Pathophysiology of Barrett's Esophagus-Associated Neoplasia: Circumferential Spatial Predilection

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