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Histological features of oesophagus at the gastrooesophageal junction. In this specimen, histological features unique to the oesophagus are depicted; namely double muscularis mucosa consisting of the superficial muscularis mucosae (m) and the deep muscularis mucosae (M), squamous epithelium (S) and the duct (D) connected to the oesophageal submucosal gland (oesophageal gland proper; ESG). Note the right side of the epithelium is covered by columnar epithelium containing goblet cells. Presence of double muscularis mucosae, and the oesophageal submucosal gland underneath the epithelium indicate that the columnar epithelium is not gastric mucosa but metaplastic oesophageal mucosa. (This histology photo was provided by professor KM.).
Source publication
Objective
An international meeting was organised to develop consensus on (1) the landmarks to define the gastro-oesophageal junction (GOJ), (2) the occurrence and pathophysiological significance of the cardiac gland, (3) the definition of the gastro-oesophageal junctional zone (GOJZ) and (4) the causes of inflammation, metaplasia and neoplasia occu...
Context in source publication
Context 1
... distal end of the superficial MM connects with the deep MM in the GOJZ. Thus, BO should be understood as comprehensive changes that involve the epithelium, lamina propria and MM, rather than a change limited to the epithelium ( figure 3). However, no previous studies have investigated whether the columnar epithelium induces the stroma (lamina propria, MM) or vice versa. ...
Citations
... 12,13) Recently, an international consensus conference was held in Kyoto, Japan, and a new concept of EGJC has been proposed to define it as adenocarcinoma with a tumor epicenter within 1 cm from the EGJ. 14) Although surgery is currently the standard treatment for EGJC, there is no consensus on the optimal surgical approach, the extent of esophageal or gastric resection, or the range of lymph node dissection, the last of these due to the complex lymphatic flow and anatomical features of this region. 10) EGJC is recognized as a malignant disease with a poor prognosis that is a separate entity from both GC and EC. ...
Esophagogastric junction cancer (EGJC) is a rare malignant disease that occurs in the gastroesophageal transition zone. In recent years, its incidence has been rapidly increasing not only in Western countries but also in East Asia, and it has been attracting the attention of both clinicians and researchers. EGJC has a worse prognosis than gastric cancer (GC) and is characterized by complex lymphatic drainage pathways in the mediastinal and abdominal regions. EGJC was previously treated in the same way as GC or esophageal cancer, but, in recent years, it has been treated as an independent malignant disease, and treatment focusing only on EGJC has been developed. A recent multicenter prospective study revealed the frequency of lymph node metastasis by station and established the optimal extent of lymph node dissection. In perioperative treatment, the combination of multi-drug chemotherapy, radiation therapy, molecular targeted therapy, and immunotherapy is expected to improve the prognosis. In this review, we summarize previous clinical trials and their important evidence on surgical and perioperative treatments for EGJC.
... Esophagogastric junction cancer (EGC) is a malignant tumor that originates from the anatomical or histological junction between the esophagus and stomach. [1,2] The 2 primary histopathological subtypes are squamous cell carcinoma and adenocarcinoma, the latter being more prevalent. [3] Previously, due to its intricate tomographic anatomy, EGC was regarded as either esophageal adenocarcinoma or gastric carcinoma. ...
Numerous studies related to esophagogastric junction cancer (EGC) have been published, and bibliometric analysis of these publications may be able to identify research hotspots and frontiers of EGC. Studies published on EGC between 2002 and 2021 were retrieved from the Web of Science Core Collection. The collaboration network of countries/regions, institutions, authors, co-citation network of journals, co-occurrence network, and overlay visualization of keywords were analyzed using the VOSviewer software. Cluster and timeline analyses of references were performed using the CiteSpace software. A total of 5109 English articles were published across 691 journals by authors affiliated with 4727 institutions from 81 countries/regions. The annual number of publications related to EGC research has exhibited an increasing trend. The United States, China, and Japan emerged as the top 3 prolific countries/regions. Institutions in the United States, Japan, and South Korea exhibited significant collaboration with one another. Diseases of the Esophagus was the most prolific journal, and Annals of Surgical Oncology, World Journal of Gastroenterology, and Gastric Cancer had also published more than 100 studies. Jaffer A Ajani was the most productive author while David Cunningham ranked the first in terms of total citations and average citations per article. Barrett’s esophagus, gastroesophageal reflux disease, Helicobacter pylori, and obesity were common topics in earlier research, and recent years had seen a shift towards the topics of immunotherapy, targeted therapy, and neoadjuvant chemotherapy. In conclusion, growing attention is paid to EGC research, especially in terms of immunotherapy, targeted therapy, and neoadjuvant chemotherapy.
... Esophagogastroduodenoscopy was performed in all patients with the execution of two antrum and two body biopsy samples, oriented by [49][50][51]. Then, the samples were embedded in formalin and analyzed by a dedicated pathologist, using hematoxylin eosin and Giemsa staining for the identification of H. pylori. ...
Concomitant therapy (CT) and bismuth quadruple therapy (BQT) are recommended in geographical areas with high clarithromycin resistance for Helicobacter pylori (H. pylori) eradication. We compared CT and BQT as the first lines of treatment in a randomized controlled trial. Consecutive patients with H. pylori diagnosed by concordance of both a urea breath test and histology were recruited. For BQT, patients received 3 PyleraTM capsules q.i.d.; for CT, 1000 mg of amoxicillin b.i.d, 500 mg of clarithromycin b.i.d and 500 mg of metronidazole b.i.d. As a proton pump inhibitor, 40 mg of pantoprazole b.i.d was administered. Both regimens lasted 10 days. In total, 46 patients received CT and 38 BQT. Both groups were comparable for age (p = 0.27) and sex (p = 0.36). We did not record any drop outs; therefore, the intention to treat and per protocol rates coincided. The most common symptoms were heartburn and post-prandial fullness, which were equally present in both groups. The success rate was 95.6% for CT and 100% for BQT (p = 0.56). Side effects were recorded in 23.9% and 31.6% of patients in the CT and BQT arms, respectively (p = 0.47). The most common ones were abdominal pain (8) and diarrhea (6). In conclusion, CT and BQT are equally effective in our area with high clarithromycin resistance, southern Italy, and showed comparable safety.
... Нормальная эндоскопическая картина может быть трудноопределимой, и отсутствие поражений или изменений обычно считается адекватным синонимом. Однако существует признак, заключающийся в регулярном расположении собирательных венул в дистальном отделе желудка при использовании стандартной эндоскопии высокого разрешениябелым светом или интегрированной эндоскопии в виде регулярно распределенных красных точек или сосудистых структур типа «морской звезды» [13]. Наличие таких признаков имеет положительную прогностическую ценность более 90% в отношении наличия нормальной кислотопродуцирующей слизистой желудка и надежно исключает инфекцию H. pylori [14]. ...
... Морфологически различают два основных типа СОЖ: кислотопродуцирующую и слизепродуцирующую -пилорическую [15]. Третий тип слизистой оболочки расположен дистальнее пищеводно-желудочного соединения [13]. Граница между кислотопродуцирующей и антральной слизистой представляет собой так называемый переходный фенотип слизистой оболочки с перемежающимися железами (см. ...
The most relevant topics related to gastritis were addressed in the work of the international group for the study of gastritis in clinical practice – Real-World Gastritis Initiative (RE.GA.IN.), from the revision of the definition of the disease to clinical diagnosis and assessment of prognosis. The RE.GA.IN. interdisciplinary consensus brought together gastritis scholars from five continents. After active debates on the most controversial aspects, the RE.GA.IN. consensus summarised the existing scientific evidence in order to develop patient-centred, evidence-based key messages to assist specialist physicians in their daily clinical practice. The ultimate goal of RE.GA.IN. was and remains to contribute to the further improvement of the clinical management of patients with gastritis. This article presents the RE.GA.IN. consensus statements defining the concepts of normality, current concepts of H. pylori-associated gastritis and autoimmune gastritis.
... These findings underscore the importance of reducing the proportion of oesophageal cancers with unspecified morphology, given the different treatment strategies for OAC and OSCC (6,(35)(36)(37)(38)(39). ...
Background
Gastric and oesophageal cancers pose a serious public health concern. In 2020 a total of 189,031 incident cases (136,038 stomach, 52,993 oesophagus) and 142,508 deaths (96,997 stomach, 45,511 oesophagus) were estimated in Europe. Oesophago-gastric cancers are a heterogeneous disease, with different aetiology and epidemiology for the various topographic subsites and main histopathological types. Topography subsite and morphology is key information to allow differentiating oesophago-gastric cancers. Correct registration and coding of such variables are fundamental in allowing proper description of the epidemiology of different subsites and histopathological types of oesophago-gastric cancers. The aim of this article is to highlight geographical and temporal variability in topography and morphology of oesophago-gastric cancers observed in Europe in the considered period.
Methods
Data collected in the framework of the ENCR-JRC (European Commission’s Joint Research Centre) data call and feeding the European Cancer Information System (ECIS) were used to assess the variability of topography and morphology registration of gastric and oesophageal cancer in Europe in the period 1995-2014. Malignant cancers of the stomach and the oesophagus were selected following, respectively, topography codes C16 and C15 of the International Classification of Diseases for Oncology, third edition (ICD-O-3). Analyses were performed by subsite, morphology group, year, sex, and European region.
Results
A total of 840,464 incident cases occurring in the period 1995-2014 – 579,264 gastric (67.2%) and 276,260 (32.8%) oesophageal carcinomas – was selected for the analysis. Data was recorded by 53 PBCRs (9 based in Northern Europe, 14 in Western Europe, 3 in Eastern Europe and 27 in Southern Europe) from 19 countries.
Conclusion
A wide variability in oesophago-gastric cancers topographic subsites and histopathological types patterns was observed, with a corresponding improvement in accuracy of registration in the analysis period. PBCRs are ideally placed to guide the epidemiological evaluations of such a complex group of diseases, in collaboration with clinicians, patients and other public health stakeholders.
... Studying the SCJ using mouse models may be particularly compelling because of the recognition of GEJ tumors as an important subgroup of gastroesophageal adenocarcinomas. 130 Human studies suggest that in addition to the role of stem and progenitor cells from the SCJ in the pathogenesis of BE and EAC, ESMGs may play an important role in normal healing to squamous epithelium and in the pathogenesis of BE. 7,13 Thus, large animal models such as porcine models as well as research programs using patient-derived samples will remain important within the field of esophageal research. There is also an ongoing role for understanding the role of systemic factors and exposures such as the high circulating gastrin levels associated with PPIs and as well for preclinical studies determining the effects of chemopreventive agents and assessing safety. ...
Background & Aims
This review was developed to provide a thorough and effective update on models relevant to esophageal metaplasia, dysplasia, and carcinogenesis, focusing on the advantages and limitations of different models of Barrett’s esophagus (BE) and esophageal adenocarcinoma (EAC).
Methods
This expert review was written on the basis of a thorough review of the literature combined with expert interpretation of the state of the field. We emphasized advances over the years 2012–2023 and provided detailed information related to the characterization of established human esophageal cell lines.
Results
New insights have been gained into the pathogenesis of BE and EAC using patient-derived samples and single-cell approaches. Relevant animal models include genetic as well as surgical mouse models and emphasize the development of lesions at the squamocolumnar junction in the mouse stomach. Rat models are generated using surgical approaches that directly connect the small intestine and esophagus. Large animal models have the advantage of including features in human esophagus such as esophageal submucosal glands. Alternatively, cell culture approaches remain important in the field and allow for personalized approaches, and scientific rigor can be ensured by authentication of cell lines.
Conclusions
Research in BE and EAC remains highly relevant given the morbidity and mortality associated with cancers of the tubular esophagus and gastroesophageal junction. Careful selection of models and inclusion of human samples whenever possible will ensure relevance to human health and disease.
... This allows distinction between an irregular Z-line, i.e., tongues of columnar lined mucosa <1 cm in length and no circumferential columnar mucosa, vs. Barrett's, which, by definition, is ≥1 cm in length. The recent Kyoto consensus on the anatomy, pathophysiology and clinical significance of the gastrooesophageal junction recommended that the junction be redefined as that 1 cm above and below the distal end of the palisade vessels [17]. Any columnar epithelium above the middle of this zone is considered to be Barrett's epithelium. ...
Endoscopy is the gold standard for the diagnosis of cancers and cancer precursors in the oesophagus and stomach. Early detection of upper GI cancers requires high-quality endoscopy and awareness of the subtle features these lesions carry. Endoscopists performing surveillance of high-risk patients including those with Barrett’s oesophagus, previous squamous neoplasia or chronic atrophic gastritis should be familiar with endoscopic features, classification systems and sampling techniques to maximise the detection of early cancer. In this article, we review the current approach to diagnosis of these conditions and the latest advanced imaging and diagnostic techniques.
... 4,5 In Japan as well,there is growing interest in how to manage BE. 6 The guidelines in Western countries have standardized the definition of BE by requiring at least a ≥ 1 cm length of columnar-lined esophagus and/or histological confirmation of intestinal metaplasia. 7 However, there is no such restriction in the definition of BE in Japan, where BE is generously diagnosed solely based on the endoscopic identification of columnarlined esophagus at any length without the need for a cumbersome histological confirmation. 7,8 Consequently, shorter forms of tiny BE are very frequently diagnosed, being detected in 15%-80% of operated endoscopic examinations in Japan, 9 whereas this rate is only 5%-20% in Western countries. ...
... 7 However, there is no such restriction in the definition of BE in Japan, where BE is generously diagnosed solely based on the endoscopic identification of columnarlined esophagus at any length without the need for a cumbersome histological confirmation. 7,8 Consequently, shorter forms of tiny BE are very frequently diagnosed, being detected in 15%-80% of operated endoscopic examinations in Japan, 9 whereas this rate is only 5%-20% in Western countries. 10 Given that the incidence of EAC is much lower in Japan at present than in Western countries, 11 BE as a premalignant lesion for EAC is clearly overdiagnosed in Japan. ...
Objectives
Although Barrett's esophagus (BE), especially ultra‐short‐segment BE (USSBE), is very frequently diagnosed in Japan, how subjects feel about receiving a diagnosis of BE is unclear. We therefore prospectively investigated cancer worry in subjects who received a BE diagnosis.
Methods
Self‐administered questionnaires were sent to subjects who were diagnosed with BE at three health checkup institutes in Akita Prefecture, Japan. The cancer worry scale (CWS) was used to quantitatively assess the fear of developing cancer. The BE subjects were classified into USSBE <1 cm and non‐USSBE ≥1 cm groups. Factors associated with the CWS were investigated using logistic regression analyses.
Results
A total of 325 (31%) subjects, comprising 229 USSBE and 96 non‐USSBE patients were included in this study. Compared with the USSBE group, the non‐USSBE group had a significantly higher frequency of a history of a BE diagnosis and perception of carcinogenesis. However, the CWS was similar between the USSBE and non‐USSBE groups, with a median CWS of 12.5 (3.75) versus 12.7 (3.65). A multivariate logistic regression analysis revealed that while positive reflux symptoms were significantly associated with a positive CWS, the BE length was not significantly associated with it, with an odds ratio (95% confidence interval) of 1.3 (0.75–2.2).
Conclusions
A BE diagnosis promotes a similar level of worry about cancer among subjects, irrespective of the length of BE. In Japan, since USSBE poses a much lower cancer risk than non‐USSBE, the former may frequently be associated with a disproportionate cancer worry relative to the latter. (UMIN000044010)
... During the recent Kyoto international consensus meeting, some significant issues were addressed to standardize the diagnosis of BO worldwide. As an endoscopic landmark, the consensus meeting adopted DEPV as more appropriate for defining GEJ since it has a more valid anatomical basis than the landmark [34]. ...
... The Kyoto International Consensus Meeting discarded IM for the assessment of BE histological diagnosis [34]. ...
... In Barrett's esophagus, differentiated cells can regress to become immature progenitor cells, leading to increased expression of genes such as CDX1 and c-Myc, compared to the normal epithelium of the esophagus (Campo, 33). CDX2, a transcription factor belonging to the caudal-related homeobox gene family, is thought to be an early marker of intestinal differentiation and may play a role in the development of intestinal metaplasia (Campo, 34). Transdifferentiation in the esophagus may occur in two stages: first, completely differentiated, mature, squamous cells acquire progenitor cell-like plasticity; secondly, they can re-enter the cell cycle to repair injured tissues by transforming into a metaplastic tissue that might be more resistant to GERD. ...
Simple Summary
A diagnosis of Barrett’s esophagus (BE) requires the macroscopic visualization of gastric-appearing mucosa in the esophagus and the identification of intestinal metaplasia on histologic examination. Histologic diagnosis of BE dysplasia can be challenging due to sampling error, pathologists’ experience, interobserver variation, and difficulty in histologic interpretation: all these problems complicate patient management. In intestinal metaplasia, which occurs because of chronic gastresophageal reflux disease (GERD), the squamous epithelium converts to columnar epithelium, which is initially of the cardia type and devoid of goblet cells; it later develops goblet cell metaplasia and eventually dysplasia, which develops and progresses to adenocarcinoma because of the accumulation of multiple genetic and epigenetic alterations. Therefore, this review aims to provide an up-to-date and clear diagnostic approach to Barrett’s esophagus and an overview of dysplasia’s development’s pathogenetic and molecular mechanisms.
Abstract
Barrett’s esophagus (BE) was initially defined in the 1950s as the visualization of gastric-like mucosa in the esophagus. Over time, the definition has evolved to include the identification of goblet cells, which confirm the presence of intestinal metaplasia within the esophagus. Chronic gastro-esophageal reflux disease (GERD) is a significant risk factor for adenocarcinoma of the esophagus, as intestinal metaplasia can develop due to GERD. The development of adenocarcinomas related to BE progresses in sequence from inflammation to metaplasia, dysplasia, and ultimately carcinoma. In the presence of GERD, the squamous epithelium changes to columnar epithelium, which initially lacks goblet cells, but later develops goblet cell metaplasia and eventually dysplasia. The accumulation of multiple genetic and epigenetic alterations leads to the development and progression of dysplasia. The diagnosis of BE requires the identification of intestinal metaplasia on histologic examination, which has thus become an essential tool both in the diagnosis and in the assessment of dysplasia’s presence and degree. The histologic diagnosis of BE dysplasia can be challenging due to sampling error, pathologists’ experience, interobserver variation, and difficulty in histologic interpretation: all these problems complicate patient management. The development and progression of Barrett’s esophagus (BE) depend on various molecular events that involve changes in cell-cycle regulatory genes, apoptosis, cell signaling, and adhesion pathways. In advanced stages, there are widespread genomic abnormalities with losses and gains in chromosome function, and DNA instability. This review aims to provide an updated and comprehensible diagnostic approach to BE based on the most recent guidelines available in the literature, and an overview of the pathogenetic and molecular mechanisms of its development.
... Национальная школа гастроэнтерологии, гепатологии National college of gastroenterology, hepatology В 2022 г. в журнале «Gut» были опубликованы материалы Киотского международного согласительного совещания, посвященного анатомии, патофизиологии и клиническому значению пищеводно-желудочного перехода [1]. Необходимость проведения такого совещания была продиктована наличием разных подходов к определению пищеводно-желудочного перехода (ПЖП), зоны ПЖП, а также пищевода Баррета (ПБ). ...
Aim : to present the main statements of Kyoto International Consensus report on anatomy, pathophysiology, and clinical significance of the gastroesophageal junction.
Key points. The experts reviewed and adopted 28 statements concerning (1) the definition of the gastroesophageal junction (GEJ); (2) the definition of the GEJ zone, covering the area located 1 cm proximal and 1 cm distal in relation to gastroesophageal junction; (3) the assessment of chemical and bacterial (Helicobacter pylori) factors leading to the development of inflammation, metaplasia and neoplasia of the mucosa of the GEJ; and (4) a new definition of Barrett’s esophagus.
Conclusion . The new definitions of GEJ, GEJ zone and Barrett’s esophagus adopted by the International Consensus will be used in subsequent studies, which will contribute to improving the results of treatment of diseases of this area.
