China guideline for the screening, early detection and early treatment of esophageal cancer (2022, Beijing) / 中华肿瘤杂志

Esophageal cancer (EC) is a major digestive tract malignancy in China, which seriously threatens the health of Chinese population. A large number of researches have demonstrated that screening and early detection are effective in reducing the incidence and mortality of EC. The development of the guideline for EC screening and early detection in line with epidemic characteristics of EC in China will greatly promote the homogeneity and standardization, and improve the effect of EC screening. This guideline was commissioned by the Bureau of Disease Control and Prevention of the National Health Commission. The National Cancer Center of China initiated and convened a working group comprising multidisciplinary experts. Following the World Health Organization Handbook for Guideline Development, this guideline combined the most up-to-date evidence of EC screening, China's national conditions, and practical experience in cancer screening. This guideline provided evidence-based recommendations with respect to the screening population, technology and procedure management, aiming to improve the effect of EC screening and provide scientific evidence for the EC prevention and control in China.

Caracterización de pacientes con lesiones premalignas de esófago / Characterization of patients with esophagus premalignant lesions

Introducción: Los tumores de esófago constituyen lesiones benignas o malignas, que afectan las diferentes capas del órgano. Objetivo: Caracterizar a pacientes con lesiones premalignas de esófago halladas en endoscopia bucal, según variables seleccionadas. Métodos: Se efectuó un estudio observacional, descriptivo y transversal en el Servicio de Gastroenterología del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, durante el 2015. El universo estuvo constituido por 57 pacientes de 20 años y más, con diagnóstico endoscópico e histológico de lesión premaligna de esófago. Las variables analizadas fueron: edad, sexo, lesiones premalignas de esófago, grado de esofagitis y diagnóstico histológico. Resultados: La endoscopia mostró un predominio de la esofagitis por reflujo en los pacientes de 62 años y más (61,7 %), así como del grado A de la clasificación de los Ángeles en ambos sexos (39,7 y 30,1 % de mujeres y hombres, respectivamente). Según el diagnóstico histológico primaron la esofagitis crónica (48,4 %) y la esofagitis crónica con displasia (17,1 %). Conclusiones: La identificación de pacientes con lesiones premalignas de esófago constituye el punto de partida para futuras acciones preventivas e intervencionistas, con vistas a disminuir la incidencia del cáncer de esófago.

Introduction: The esophagus malignancies constitute benign or malignant lesions that affect the different layers of the organ. Objective: To characterize patients with esophagus premalignant lesions found in oral endoscopy, according to selected variables. Methods: An observational, descriptive and cross-sectional study was carried out in the Gastroenterology Service of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, during 2015. The universe was constituted by 57 patients aged 20 and over, with endoscopic and histologic diagnosis of esophagus premalignant lesion. The analyzed variables were: age, sex, esophagus premalignant lesions, degree of esophagitis and histologic diagnosis. Results: The endoscopy showed a prevalence of the esophagitis by reflux in patients aged 62 and over (61.7 %), as well as of the grade A of Los Angeles classification in both sexes (39.7 and 30.1% of women and men, respectively). According to the histologic diagnosis there was a prevalence of chronic esophagitis (48.4 %) and chronic esophagitis with dysplasia (17.1 %). Conclusions: The identification of patients with esophagus premalignant lesions constitutes the starting point for future preventive and interventionists actions, aimed at diminishing the incidence of esophagus cancer.

Epidemiological profile of esophageal cancer mortality in Rio Grande do Sul and its health regions

Introduction: Malignant esophageal neoplasia is a rare tumor, but it has high morbidity and mortality. Early diagnosis and intensive treatment associated with surgical approach remains the best treatment for the disease. Its epidemiology is extremely diverse in the world, even in the same country. Methods: This was a retrospective analysis made from 2000-2015, analyzing the mortality rates of malignant esophageal neoplasia in the state of Rio Grande do Sul (RS) in its 30 Health Regions and in Brazil. The mortality data were collected in the Mortality Information System (SIM) and the population data in the Brazilian Institute of Geography and Statistics (IBGE). Results: The esophageal cancer mortality rate was 8.61 (95% CI, 8.49-8.73) per 100,000 inhabitants in RS, while the national rate was 3.66 (95% CI, 3, 49-3.82), with a significant difference (p <0.0001). The regional distribution was variable, and the West Border region presented the highest rate, 12.91 (95% CI, 12.05-13.77). However, even regions with lower mortality presented twice as much deaths than the national rate. Mortality increased with aging, with the oldest age groups (≥80 years) presenting 69.62 (95% CI, 64.9-74) deaths per 100,000 inhabitants. Conclusion: Esophageal neoplasia is still a very serious condition in the state of RS, being associated with an almost 3-fold higher mortality rate compared to the national rate. Even within the state different epidemiological patterns are found. (AU)

Displasia de alto grado en esófago de Barrett: ¿ablación, mucosectomía o cirugía? / High-grade dysplasia in Barrett's oesophagus: ablation, mucosectomy or surgery?

Barrett's esophagus has a risk of developing esophageal adenocarcinoma and it increases when dysplasia is present. For this reason, its diagnosis requires endoscopic surveillance or eradication if dysplasia or cancer appears. In the past, high-grade dysplasia and intramucosal esophageal adenocarcinoma were routinely treated with esophagectomy, but with considerable morbidity and mortality. This has led to the development of new alternatives as less invasive endoscopic treatments for both dysplastic lesion and total eradication of the remaining metaplastic mucosa. The most commonly used treatment options include cryotherapy, radiofrequency ablation, endoscopic resection (mucosal resection or endoscopic submucosal dissection) or a combination of these (multimodal endoscopic eradication). For patients with low-grade dysplasia still some international guides suggest keeping endoscopic follow up; however, considering the good results of endoscopic ablation and new evidence about the course of this disease, this concept has changed towards the therapeutic approach. For Barrett´s esophagus without any complication, endoscopic therapy is not recommended, but endoscopic surveillance. In this article we will review the endoscopic therapeutic alternatives to Barrett's esophagus, its scientific basis and how they have evolved in recent times.

El Esófago de Barrett es una lesión adquirida que tiene riesgo de desarrollar adenocarcinoma esofágico. Su presencia obliga, por lo tanto, a la vigilancia endoscópica y erradicación cuando aparece displasia sobre este epitelio, pues aumenta la probabilidad de progresar a cáncer. Antes de la aparición de la terapia endoscópica estos casos con displasia de alto grado y adenocarcinoma esofágico independiente de su estadío, eran sometidos a una esofagectomía. Sin embargo, esta intervención se asocia a una morbimortalidad importante. De esta manera, los avances en la cirugía endoscópica también han sido traspasados al manejo del Esófago de Barrett con displasia o cáncer intramucoso, que incluyen en estos casos la erradicación del epitelio columnar en su totalidad. Las alternativas terapéuticas más utilizadas son la crioterapia, ablación por radiofrecuencia, resección endoscópica (mucosectomía o disección submucosa endoscópica) o una combinación de éstas (erradicación endoscópica multimodal). Para pacientes portadores de Barrett con displasia de bajo grado, la recomendación de la mayoría de las guías internacionales sigue siendo la vigilancia endoscópica. Sin embargo, dado los buenos resultados de la ablación endoscópica y nuevas evidencias respecto al curso de esta patología, este concepto ha ido cambiando hacia tomar una conducta terapéutica. En caso de ausencia de displasia no se recomienda la terapia endoscópica de regla sino la vigilancia endoscópica. En el presente artículo revisaremos las alternativas terapéuticas endoscópicas frente al esófago de Barrett, su sustento científico y cómo han evolucionado en el último tiempo.

Risk factors for esophageal cancer in a low-incidence area of Brazil / Fatores de risco para o câncer de esôfago em uma área de baixa incidência no Brasil

Esophageal cancer is the eighth commonest type of cancer worldwide, occupying sixth place in terms of mortality. Smoking and alcohol use are known risk factors for this type of cancer. The aim here was to evaluate the risk factors for esophageal cancer in a low-incidence area.

Case-control study in Goiânia, with 99 cases of esophageal cancer and 223 controls.

The variables were sociodemographic, dietary, occupational and lifestyle data. The sample was analyzed using the chi-square test, Mann-Whitney test and Mantel-Haenszel approach for multivariate analysis. Odds ratios (OR) were calculated with 5% significance and 95% confidence intervals.

The risk of esophageal cancer was higher in patients ≥ 55 years (OR = 1.95; P < 0.001). Patients from rural areas were at greater risk of esophageal cancer (OR = 4.9; P < 0.001). Smoking was a risk factor among the cases (OR = 3.8; P < 0.001), as was exposure to woodstoves (OR = 4.42; P < 0.001). The practice of oral sex was not a risk factor (OR = 0.45; P = 0.04). Consumption of apples, pears, vegetables, cruciferous vegetables and fruit juices were protective against esophageal cancer.

In a region in which the incidence of esophageal cancer is low, the most significant risk factors were exposure to woodstoves, smoking and living in rural areas. .

O câncer de esôfago é o oitavo tipo mais comum em todo o mundo, ocupando o sexto lugar em termos de mortalidade. Fatores de risco conhecidos para esse tipo de câncer são o consumo de tabaco e o álcool. O objetivo foi avaliar os fatores de risco para câncer de esôfago em uma área de baixa incidência.

Estudo caso-controle em Goiânia, com 99 casos de câncer de esôfago e 223 controles.

As variáveis foram dados sociodemográficos, alimentares, ocupacionais e de estilo de vida. A amostra foi analisada pelo teste do qui-quadrado, Mann-Whitney e de Mantel-Haenszel para análise multivariada. Foram calculados a odds ratio (OR) com significância em 5% e o intervalo de confiança de 95%.

O risco de câncer de esôfago foi maior em pacientes ≥ 55 anos (OR = 1,95, P < 0,001). Pacientes de áreas rurais estavam em risco maior de câncer de esôfago (OR = 4,9; P < 0,001). O tabagismo foi um fator de risco entre os casos (OR = 3,8; P < 0,001), bem como exposição ao fogão a lenha (OR = 4,42; P < 0,001). A prática do sexo oral não foi fator de risco (OR = 0.45; P = 0,04). Consumo de maçãs, peras, legumes, vegetais crucíferos e sucos de frutas foi protetor contra o câncer de esôfago.

Em uma região em que a incidência de câncer de esôfago é baixa, os fatores de risco mais significativos foram a exposição a fogão a lenha, tabagismo e viver em zona rural. .

Folate and vitamin B12 intake and risk of squamous-cell carcinoma of the esophagus

Esophageal cancer is one of the most common cancers in Iran and has a high mortality rate. The aim of this study was to assess the association between folate and vitamin B12 intake and risk of squamous-cell carcinoma of the esophagus cancer. In this case-control study, cases [n=47] were patients diagnosed with squamous-cell carcinoma of the esophagus [SCCE] in main hospital Kurdistan and controls [matched with cases by age and sex] were patients with acute non-cancer diseases at the same hospitals [n=96]. Demographic data and physical activity were collected using questionnaires. A semi-quantitative food frequency questionnaire used for nutritional information and folate and vitamin B12 intake were calculated with Nutritionst IV [N4]. Thirty eight percent of cases and 40% of controls were males. Mean age of cases and controls were 58 +/- 18 and 58 +/- 17 years respectively. Mean folate intake among cases was 152.1 microg/day, which was less than in the controls. After adjustment for confounders, folate intake was inversely related with SCCE [OR=0.03, 95% Cl 0.00, 0.12]. The association between vitamin B[12] intake and SCCE was not significant [p=0.46]. Folate intake was inversely related with SCCE: however, there was not a significant association between vitamin 612 intake and SCCE

Esophageal cancer in Iran: a review

Esophageal cancer is the second and third most common malignancy in Iranian males and females, respectively, claiming lives of approximately 5800 Iranians each year. Squamous cell carcinoma [SCC] is presently the most common type accounting for about 90% of all esophageal cancers in Iran. Recent studies have shown that there is a gradual increase in the incidence of adenocarcinoma of the distal esophagus along with gastric cardia adenocarcinoma. Thirty-five years ago, the age standardizied rate [ASR] of esophageal SCC in the city of Gonbad [Golestan Province, northeast of Iran] was found to be one of the highest rates for any single cancer that had been reported worldwide [ASR >100/10[5]/year]. Recent studies have shown that the incidence of SCC in Gonbad has declined to less than half of what it was in the past. This decline in the incidence of esophageal SCC parallels an improvement in the socioeconomic situation of people living in this region. According to recent cancer registry data in Iran there is still an obvious intracountry variability between the incidence of esophageal cancer in the south with an ASR of 3 for males and 2 for females in Kerman and 43 and 36 in the northeastern province of Golestan. The reasons for this very high rate of SCC in northeastern Iran have been the subject of several studies during the past 35 years. According to results of these studies the suspected risk factors are: low intake of fruits and vegetables, drinking hot tea, consumption of opium products and tobacco, H.pylori infection in the stomach, using unhealthy drinking water from cisterns and genetic susceptibility. The main suspected mutagens are polycyclic aromatic hydrocarbons [PAH] and N-nitroso compounds. In order to embark primary and secondary prevention of this fatal cancer, further prospective studies are presently underway in the region. The Golestan esophageal cancer cohort study which follows of 50,000 subjects is on going. We expect simple and feasible evidence based preventive strategies to be implemented in the future according to the results of this study

Role of the vitamin C in diethylnitrosamine-induced esophageal cancer in Wistar rats / O efeito inibidor da vitamina C na carcinogênese esofágica induzida pela dietilnitrosamina em ratos Wistar

PURPOSE: To evaluate the inhibitory effect of vitamin C on the experimental esophageal carcinogenesis induced by diethylnitrosamine (NDEA). METHODS: Sixty Wistar male rats aged three months, with mean weight of 210 g were employed in the study and were divided into four different groups according to the drinking drugs: group I - controls: only water, seven days a week; group II - only vitamin C, seven days a week; group III - NDEA, three days a week and water during the other four days; group IV - NDEA, three days a week and vitamin C during the other four days; group V - NDEA together with vitamin C three days a week, and only water during the other four days and group VI - NDEA together with vitamin C three days a week and vitamin C during the other four days. The dosages of NDEA were: - 10 mg. / Kg / day and vitamin C - 200 mg / animal / day, dissolved in drinking water. The animals were observed during 180 days and after that each one was sacrificed and its esophagus and the stomach were removed together and macro and microscopically analyzed to identify any tumors. RESULTS: The largest number of tumors was observed in the group III: 48 macroscopic lesions (4.8 lesions per animal) and 23 microscopic lesions (2.3 lesions per animal). The groups that received vitamin C (groups IV, V and VI) showed smaller number of tumors: group V - 0.5 macroscopic lesions and 0.3 microscopic lesions per animal and group VI - 0.1 macroscopic lesions and 0.1 microscopic lesions per animal. The incidence of tumors in the groups V and VI showed statistical significance (p<0.05), when compared to the other groups. CONCLUSION: The vitamin C administered together with diethylnitrosamine showed an inhibitory effect on the experimental esophageal carcinogenesis in Wistar rats.

OBJETIVO: Avaliar o efeito inibidor da vitamina C na carcinogênese esofágica experimental induzida pela dietilnitrosamina (DEN). MÉTODOS: Sessenta ratos Wistar, com idade de três meses, machos, com peso médio de 210 g foram utilizados no estudo e divididos em quatro grupos diferentes, conforme ingestão das drogas: grupo I - controles: ingerindo água sete dias por semana; grupo II - só vitamina C, sete dias por semana; grupo III - DEN, três dias por semana e água durante os outros quatro dias; grupo IV - DEN, três dias por semana e vitamina C durante os outros quatro dias; grupo V - DEN junto com vitamina C três dias por semana, e água os outros quatro dias e grupo VI - DEN junto com vitamina C três dias por semana e só vitamina C durante os outros quatro dias. As dosagens de DEN empregadas foram - 10 mg. / Kg / dia e de vitamina C - 200 mg / animal / dia, dissolvidos na água de beber. Os animais foram observados durante 180 dias e depois disso sacrificados, tiveram o seu esôfago e o estômago retirados, e macro e microscòpicamente analisados para identificar qualquer tumor. RESULTADOS: O número maior de tumores foi observado no grupo III: 48 lesões macroscópicas (4.8 lesões por animal) e 23 lesões microscópicas (2.3 lesões por animal). Os grupos que receberam vitamina C (grupos IV, V e VI) evidenciaram número menor de tumores: grupo V - 0.5 lesões macroscópicas e 0.3 lesões microscópicas por animal e grupo VI - 0.1 lesões macroscópicas e 0.1 lesões microscópicas por animal. A incidência de tumores nos grupos V e VI mostraram diferença estatística significa (p <0.05), quando comparados aos outros grupos. CONCLUSÃO: A vitamina C administrada junto com dietilnitrosamina mostrou efeito inibidor no aparecimento de tumores esofágicos.

Oral snuff and carcinoma oesophagus

Carcinoma oesophagus is known to occur worldwide. Various dietary, environmental and genetic factors and certain pre-malignant conditions have been blamed in the causation of carcinoma oesophagus but the exact cause in unknown. This study was conducted to find out the possible role of oral snuff to carcinoma oesophagus. This descriptive analytical study was carried out in Medical, Surgical and ENT units of Khyber Teaching Hospital and Cardiothoracic unit of Lady Reading Hospital Peshawar from 1995 to 2005. Relation of oral snuff use to carcinoma oesophagus was studied in 100 patients confirmed on endoscopy and biopsy and histopathology. Oral snuff use was found to have very strong correlation [P<0.001] with carcinoma oesophagus. The effect of ingesting snuff also had very strong correlation [P<0.001] and so was the duration [more than 10 years] of use [P=0.004], however, the frequency of snuff use [i.e. number of time per day] did not have any significant effect [P=0.08]. A strong correlation of snuff use was also found with squamous cell carcinoma [P=0.001]. Oral snuff use is a risk factor for carcinoma oesophagus. Carcinoma oesophagus can be prevented by discouraging its use. Educating people against snuff use may prevent this harmful and lethal disease. This should be done on individual level by the doctors and on mass level through public media

Effect of black tea in diethylnitrosamine-induced esophageal carcinogenesis in mice / Efeito do chá preto sobre a carcinogênese esofágica induzida por dietilnitrosamina em camundongos

PURPOSE: To evaluate the effect of black tea on esophageal carcinogenesis induced by the oral administration of diethylnitrosamine (DEN). METHODS: A population of 120 female mice (Mus musculus, strain CF1) were studied for 160 days. The animals were assigned to two control groups and three treatment groups. The control groups received water or tea throughout the study period, while the three experimental groups received DEN weekly, for three consecutive days, and water, tea, or both, in the other days of the week. On completion of the 160-day period, the animals were killed and their esophagi promptly examined macroscopically and subsequently submitted to histopathology (using the hematoxylin-eosin technique). RESULTS: In the comparative analysis between the treatment groups, tumor incidence (macroscopy) was significantly lower in those animals that received black tea besides the carcinogen. As regards the histopathologic changes, there was a greater number of low grade epithelial lesions in the same groups (p < 0.001). CONCLUSION: The animals that received black tea had a lower incidence of effects related to the carcinogen's action, thus indicating that, in this model, the infusion had a significant chemoprophylactic effect on experimental diethylnitrosamine-induced carcinogenesis.

OBJETIVO: Avaliar o efeito do chá preto sobre a carcinogênese esofágica experimental induzida pela administração oral de dietilnitrosamina (DEN). MÉTODOS: Durante 160 dias foi estudada uma população de 120 camundongos fêmeas, gênero Mus musculus, da cepa CF1, dividida em dois grupos controles e três grupos de tratamento. Os grupos controles receberam água ou chá durante todo o período do estudo. Os três grupos tratados receberam DEN semanalmente, durante três dias consecutivos, e água, chá ou ambos, nos demais dias da semana. Ao completar o período de 160 dias foram efetuadas as eutanásias dos animais e seus esôfagos foram analisados macroscopicamente (a fresco) e, posteriormente, à histopatologia (empregando a técnica da hematoxilina e eosina - HE). RESULTADOS: Na análise comparativa entre os grupos de tratamento, a incidência tumoral (macroscopia) foi significativamente menor naqueles animais que receberam chá preto, além do carcinógeno. No que se refere às alterações histopatológicas, houve maior número de lesões epiteliais de baixo grau nesses mesmos grupos (p < 0,001). CONCLUSÃO: Os animais que receberam chá preto apresentaram menor incidência dos efeitos relacionados à ação do carcinógeno, indicando que, neste modelo, a infusão apresentou efeito quimioprofilático significativo sobre a carcinogênese experimental induzida pela dietilnitrosamina.

Quimioprevención en adenocarcinoma de esófago / Chemoprevention in adenocarcinoma of the esophagus

The incidence of the adenocarcinoma of the esophagus (ACE) has dramatically for the last decades in western countries, which has been associated with a parallel increase in the incidence and prevalence of symptoms associated with gastroesophageal reflux diseases (GERD) and Barrett's esophagus (BE). Both conditions are now considered risk factors for ACE. Different pathways, including overexpression of cyclooxygenase (COX) isoenzymes, has been proposed to explain the carcinogenic process leading from normal esophagus to esophagitis, BE and ACE. The survival rate in patients with ACE is very low because of the poor outcomes of surgery and the limited benefits obtained with concomitant chemo-radiotherapy Several strategies based on early detection and surveillance of preneoplastic lessions have failed to have a global and significant impact on the prognosis of the ACE. Recent epidemiological and experimental studies suggest that chemoprevention could be useful in the management of patients with GERD and especially in those with BE. The current therapy with protom pump inhibitors (PPI) is effective to reduce the esophageal acid exposure, to improve reflux symptoms, and to heal inflammatory injuries, but probably is not enough to avoid the dysplastic progression of the metaplastic epithelium. Regular use of COX inhibitors (aspirin and other non steroid antiinflamatory drugs) has been associated with reduction of the risk of ACE and to decrease the incidence of ACE in animal models. In humans, the association of PPI with COX inhibitors could be a cost-effectiveness strategy but direct evidence is lacking. Other potential agents that have shown some chemoprevention potential include troglitazone, free radical scavengers, tamoxifen or prostaglandin receptor blockers, but the available scientific evidence is still poor and not ready to be tested in humans.

El adenocarcinoma de esófago (ACE) ha aumentado notablemente su incidencia en las últimas décadas, en los países occidentales; lo que se ha asociado a un crecimiento paralelo de la incidencia y prevalencia de los síntomas atribuibles a la Enfermedad por Reflujo Gastroesofágico (ERGE) y a un aumento de los diagnósticos de esófago de Barrett (EB). Ambas situaciones sonconsideradas como factores de riesgo para el desarrollo de ACE. Se han propuesto diferentes vías, incluyendola sobreexpresión de los isoenzimas de la ciclooxigenasa (COX), para explicar el proceso de carcinogénesis quetranscurre entre la mucosa esofágica normal, la esofagitis, el EB y el ACE.La tasa de supervivencia en pacientes con ACE es muy baja, debido a los deficientes resultados del tratamientoquirúrgico, así como a los escasos beneficios aportados por la quimio y radioterapia concomitantes. Diversasestrategias basadas en el diagnóstico precoz y seguimiento de las lesiones preneoplásicas han fracasado enconseguir un impacto global y significativo sobre el pronósticodel ACE. Estudios epidemiológicos y experimentales recientes sugierenque la quimioprevención podría ser útil en el manejo de los pacientes con ERGE, y especialmente en aquellos con EB. La terapia convencional con inhibidoresde la bomba de protones (IBP) es eficaz para reducir la exposición ácida esofágica, mejorar los síntomas por el reflujo y curar las lesiones inflamatorias, pero probablemente no es suficiente para evitar la progresión displásica del epitelio con metaplasia. El uso regular de inhibidores de la COX (aspirina y otros antiinflamatoriosno esteroides) es capaz de bloquear vías decarcinogénesis y disminuir la incidencia de ACE en modelos animales. En humanos, la asociación de IBPcon inhibidores de la COX podría ser una estrategia segura y coste-efectiva, aunque no existen evidencias directasque lo corroboren. En lo que respecta a...

Esófago de Barrett: estado actual del tratamiento quirúrgico / Barrett Esophagus: present status of the surgical management

El esófago de Barrett (EB) es una complicación de la enfermedad por reflujo gastroesofágico, yse define como el esófago inferior recubierto de epitelio columnar con metaplasia intestinal producto del reflujo crónico... El objetivo de esta comunicación es desarrollar el estado actual del tratamiento quirúrgico en pacientes con EB respecto de: el control del reflujo, su efecto sobre la metaplasia intestinal y en la prevención del adenocarcinoma

Is the presence or absence of Helicobacter pylori in gastric mucosa a greater risk?

Helicobacter pylori is a unique organism which is pathogenic for stomach-duodenum (chronic gastritis, duodenal ulcer, gastric ulcer, gastric malignancy, mucosa-associated lymphoid tissue (MALT) lymphoma) and protective for oesophagus (Barrett's oesophagus, oesophageal adenocarcinoma) at the same time in an individual. For prevention of diseases, the necessity of presence of some bacteria throughout the gastrointestinal lumen needs to be emphasized. The concept--only good Helicobacter pylori is a dead Helicobacter pylori, is dangerous and humans should learn to live in harmony with a few bacteria throughout the gastrointestinal tract.

Oesophageal cancer in Bahrain

Data from all 148 cases of oesophageal cancer in Bahrain during 1952-99 were analysed according to patient sex and age and site and histological pattern of tumour, and compared with other Gulf countries. In Bahrain, oesophageal cancer accounted for 2.6% of malignant neoplasms. The female:male ratio was 1.8:1, and the majority of patients were >/=51 years and

Ingestäo de broto de samambaia e risco de câncer de esôfago e estômago na regiäo de Ouro Preto, MG / Ingestion of bracken and risk of oesophageal and stomach cancer in the region of Ouro Preto, Minas Gerais, Brazil

A populaçäo da regiäo de Ouro Preto, MG, tem o hábito de consumir as folhas jovens de uma planta (Pteridium aquilinum), chamada popularmente de broto de samambaia (BS). A alta incidência de câncer de esôfago e estômago na regiäo, em relaçÝo a outras áreas do estado onde o consumo de BS näo se verifica, levou-nos a investigar a possível influênciada da ingestäo do vegetal na ocorrência daquelas patologias. Foi desenvolvido um estudo retrospectivo de casos e controles baseado em esquema de vigilância epidemiológica estabelecido nos dois únicos serviços de endoscopia da regiäo. Quarenta e seis casos confirmados histologicamente foram pareados com 40 controles que näo apresentavam alteraçöes ao exame endoscópico. O consumo de BS foi identificado através de entrevista com os pacientes próximos, em caso de morte. Os hábitos de fumar e de consumir bebida alcoólica foram também considerados. A medida de associaçäo utilizada foi a "Razäo das Chances" ("Odds Ratio", OR). Pacientes que ingeriam BS apresentaram aumento de 5,47 vezes na "Razäo de Chances" para câncer de trato digestivo alto (esôfago e estômago), em comparaçäo com os controles. Na análise multivariada, controlando-se os fatores de confusäo como álcool, fumo, sexo e idade, encontrou-se ainda OR de 3,63 vezes para os dois tipos de câncer citados. Calcularam-se ainda os riscos separadamente para cada tipo de câncer, sendo os resultados ainda significativos, ou seja, OR de 3,40 para câncer de asôfago e de 3,45 para câncer de estômago, valores esses que passam para 3,93 e 3,51 respectivamente quando controlados os fatores de confusäo acima mencionados.

Carcinoma de esofago toracico e metastase intramural / Oesophageal thoracic carcinoma and intramural metastasis

Embora nao se tenha uma definicao precisa de metastase intramural (MIM), originaria de tumores de esofago, estas tem recebido maior atencao recentemente. O objetivo deste trabalho foi o de determinar as caracteristicas clinico-patologicas das MIMs e suas implicacoes prognosticas. Este estudo incluiu 107 pacientes com carcinoma epidermoide de esofago intratoracico tratados com intencao curativa entre janeiro 1985 e janeiro 1992. A idade media dos pacientes fo de 64 (36-81) anos; 84 homens e 23 mulheres. MIM's estavam presentes em 14 (13 por cento ) dos pacientes. Em resumo, MIM's apresentam uma media de 3 lesoes por paciente, tem em media (s.d.) 10 (0,4) mm de diametro, sao predominantementes superficiais, invadindo ate a camada submucosa, e tendem a localizar distalmente ao tumor primario, dentro do limite das margens de resseccao (aproximadamente 5 cm). Os resultados comparativos do grupo de pacientes com MIM's (COMMIM) e os sem MIM's (SEMMIM) demonstrou que o grupo COMMIM apresenta maior incidencia de tumores avancados (P>0,05), metastase linfonodal (P>0,01) e uma sobrevida de 5 anos (Kaplan-Meier) significativamente pior (21 por cento vs 7 por cento , P>0,01). Estes resultados indicam a necessidade de margens ampliadas de resseccao na presenca de MIM, como tambem sugere-se uso de terapia adjuvante. Porem, estudos subsequentes sao necessarios para melhor se determinar o seu mecanismo de formacao, bem como o papel da terapia adjuvante a longo prazo

Adenocarcinoma en esófago de Barrett / Adenocarcinoma en Barrett's esophagus

Serie de 43 pacientes operados entre 1979 y 1988 de adenocarcinoma asentado en esófago de Barrett. Se utilizó clasificación de la Japanese Society for Esophageal Disease : 14 pacientes en estadío 0,I y II y 29 en III o IV. Mortalidad operatoria fue de 9,3% y la sobrevida a 5 años de 32%. En los casos presuntamente curativos, el grupo de pacientes con estadío 0,I y II tuvo 75% de sobrevida a los 5 años y los de III y IV sólo 9%. Se sugiere controles regulares a pacientes portadores de esófago de Barrett para identificar grupos de riesgo.