204 ENDOSCOPIC EVIDENCE OF BILE REFLUX IS A STRONG INDEPENDENT FACTOR ASSOCIATED WITH THE PRESENCE OF BARRETT’S ESOPHAGUS

Abstract Several basic researches have indicated that there is a significant relationship between bile reflux and the pathogenesis of Barrett’s esophagus (BE). However, only few clinical studies have been reported regarding the endoscopic finding of bile reflux and Barrett’s esophagus. Our objective is to evaluate whether the endoscopic evidence of bile reflux is an independent factor associated with the presence of BE. Methods We conducted a retrospective analysis of a prospectively maintained database comprised of consecutive Japanese patients who underwent screening gastroscopy. Endoscopic findings of BE, reflux esophagitis, atrophic gastritis and sliding hernia were recorded. Evaluation of a BE was based on the Prague criteria. Endoscopic evidence of bile reflux was defined as the presence of yellow or green juice observed by white light image or red juice by narrow band image (NBI) in the gastric fundus. Univariate and multivariate analyses were performed to identify factors that differed significantly between patients with or without BE. Results A total of 454 patients were enrolled; 124 (27%) had BE and 126 (28%) had endoscopic evidence of bile reflux. Compared to patients without BE, patients with BE were more likely to be old, male and to have sliding hernia and endoscopic evidence of bile reflux on univariate analysis. On multivariate analysis, endoscopic evidence of bile reflux was a stronger independent factor associated with BE (odds ratio(OR) 11.3, 95% confidence interval(CI) 6.56–19.4) compared to the presence of sliding hernia (OR 3.58, 95%CI 2.14–6.0). Conclusion Endoscopic evidence of bile reflux identified by white light or NBI is a strong independent factor associated with the presence of BE, implying that this finding should be considered as an important parameter to determine the surveillance strategy for gastroesophageal reflux disease patients same as the presence of sliding hernia.

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Multiple-Band Imaging Provides Better Value Than White-light Endoscopy in Detection of Dysplasia in Patients With Barrett's Esophagus

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2014.12.007 ◽

2015 ◽

Vol 13 (6) ◽

pp. 1068-1074.e2 ◽

Cited By ~ 3

Author(s):

Svein Olav Bratlie ◽

Erik Johnsson ◽

Claes Jönsson ◽

Lars Fändriks ◽

Anders Edebo

Keyword(s):

Barrett’S Esophagus ◽

White Light ◽

Barrett's Esophagus ◽

White Light Endoscopy ◽

Multiple Band

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BarrettNET—a prospective registry for risk estimation of patients with Barrett's esophagus to progress to adenocarcinoma

Diseases of the Esophagus ◽

10.1093/dote/doz024 ◽

2019 ◽

Vol 32 (8) ◽

Cited By ~ 2

Author(s):

Maria Wiethaler ◽

Julia Slotta-Huspenina ◽

Anna Brandtner ◽

Julia Horstmann ◽

Frederik Wein ◽

...

Keyword(s):

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Risk Estimation ◽

Disease Status ◽

Epidemiological Data ◽

Low Grade ◽

Sample Collection ◽

Surveillance Strategy ◽

Clinical Biomarkers

SUMMARYRisk stratification in patients with Barrett's esophagus (BE) to prevent the development of esophageal adenocarcinoma (EAC) is an unsolved task. The incidence of EAC and BE is increasing and patients are still at unknown risk. BarrettNET is an ongoing multicenter prospective cohort study initiated to identify and validate molecular and clinical biomarkers that allow a more personalized surveillance strategy for patients with BE. For BarrettNET participants are recruited in 20 study centers throughout Germany, to be followed for progression to dysplasia (low-grade dysplasia or high-grade dysplasia) or EAC for >10 years. The study instruments comprise self-administered epidemiological information (containing data on demographics, lifestyle factors, and health), as well as biological specimens, i.e., blood-based samples, esophageal tissue biopsies, and feces and saliva samples. In follow-up visits according to the individual surveillance plan of the participants, sample collection is repeated. The standardized collection and processing of the specimen guarantee the highest sample quality. Via a mobile accessible database, the documentation of inclusion, epidemiological data, and pathological disease status are recorded subsequently. Currently the BarrettNET registry includes 560 participants (23.1% women and 76.9% men, aged 22–92 years) with a median follow-up of 951 days. Both the design and the size of BarrettNET offer the advantage of answering research questions regarding potential causes of disease progression from BE to EAC. Here all the integrated methods and materials of BarrettNET are presented and reviewed to introduce this valuable German registry.

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Bile salts induce or blunt cell proliferation in Barrett's esophagus in an acid-dependent fashion

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.2000.278.6.g1000 ◽

2000 ◽

Vol 278 (6) ◽

pp. G1000-G1009 ◽

Cited By ~ 55

Author(s):

Baljeet S. Kaur ◽

Rodica Ouatu-Lascar ◽

M. Bishr Omary ◽

George Triadafilopoulos

Keyword(s):

Cell Proliferation ◽

Bile Salt ◽

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Bile Salts ◽

Bile Reflux ◽

Salt Mixture ◽

Complete Obliteration ◽

Protein Kinase C Inhibitor ◽

Incorporation Assay

Barrett's esophagus (BE) results from acid and bile reflux and predisposes to cancer. We investigated the effect of bile salts, with or without acid, on cell proliferation in BE and assessed mechanism(s) involved. To mimic physiological conditions, biopsies of esophagus, BE, and duodenum were exposed to a bile salt mixture, either continuously or as a 1-h pulse, and were compared with control media without bile salts (pH 7.4) for ≤24 h. Similar experiments were also performed with acidified media (pH 3.5) combined with the bile salt mixture as a 1-h pulse. Cell proliferation was assessed by a [3H]thymidine incorporation assay with or without bisindolylmaleimide (BIM), a selective protein kinase C inhibitor. Bile salt pulses enhanced cell proliferation in BE without affecting cell proliferation in esophageal or duodenal epithelia. In the presence of BIM, there was complete obliteration of the bile salt-induced BE hyperproliferation. In contrast, 1-h pulses of bile salts in combination with acid significantly inhibited proliferation in BE but had no effect on esophagus or duodenum. We conclude that in BE explants, brief exposure to bile salts, in the absence of acid, increases proliferation, whereas exposure to a combination of bile salts and acid together inhibits proliferation.

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