ENDOSCOPIC CHANGES RELATED TO GASTROESOPHAGEAL REFLUX DISEASE: COMPARATIVE STUDY AMONG BARIATRIC SURGERY PATIENTS.

BACKGROUND: Obesity is correlated with several comorbidities, including gastroesophageal reflux disease. Its main complications are detectable by endoscopy: erosive esophagitis and Barrett's esophagus. AIM: To correlate erosive esophagitis and hiatal hernia with the degree of body mass index (BMI). METHOD: Was performed a retrospective analysis of 717 preoperative endoscopic reports of bariatric patients. Fifty-six (8%) presented hiatal hernia, being 44 small, nine medium and five large. Esophagitis was classified by Los Angeles classification. RESULTS: There was no correlation between the presence and dimension of hiatal hernia with BMI. One hundred thirty-four (18.7%) patients presented erosive esophagitis. Among them, 104 (14.5%) had esophagitis grade A; 25 (3.5%) grade B; and five (0.7%) grade C. When considering only the patients with erosive esophagitis, 77.6% had esophagitis grade A, 18.7% grade B and 3.7% grade C. Were identified only two patients with Barrett's esophagus (0,28%). CONCLUSION: There was a positive correlation between the degree of esophagitis with increasing BMI.

ENDOSCOPIC CHANGES RELATED TO GASTROESOPHAGEAL REFLUX DISEASE: COMPARATIVE STUDY AMONG BARIATRIC SURGERY PATIENTS / ALTERAÇÕES ENDOSCÓPICAS RELACIONADAS À DOENÇA DO REFLUXO GASTROESOFÁGICO: ESTUDO COMPARATIVO ENTRE OBESOS SUBMETIDOS À CIRURGIA BARIÁTRICA

Background:Obesity is correlated with several comorbidities, including gastroesophageal reflux disease. Its main complications are detectable by endoscopy: erosive esophagitis and Barrett's esophagus.Aim: To correlate erosive esophagitis and hiatal hernia with the degree of body mass index (BMI).Method: Was performed a retrospective analysis of 717 preoperative endoscopic reports of bariatric patients. Fifty-six (8%) presented hiatal hernia, being 44 small, nine medium and five large. Esophagitis was classified by Los Angeles classification.Results: There was no correlation between the presence and dimension of hiatal hernia with BMI. One hundred thirty-four (18.7%) patients presented erosive esophagitis. Among them, 104 (14.5%) had esophagitis grade A; 25 (3.5%) grade B; and five (0.7%) grade C. When considering only the patients with erosive esophagitis, 77.6% had esophagitis grade A, 18.7% grade B and 3.7% grade C. Were identified only two patients with Barrett's esophagus (0,28%).Conclusion: There was a positive correlation between the degree of esophagitis with increasing BMI.

Racional:A obesidade está correlacionada com diversas comorbidades, dentre elas a doença do refluxo gastroesofágico. Ela tem como um de seus principais desencadeantes a hérnia do hiato, e como suas principais complicações a esofagite erosiva e o esôfago de Barrett.Objetivo: Correlacionar o grau do índice de massa corporal (IMC) com a presença e tamanho da hérnia hiatal, e com a presença e gravidade da esofagite erosiva e esôfago de Barrett.Método: Foi realizada análise retrospectiva de laudos endoscópicos pré-operatórios de 717 pacientes submetidos à cirurgia bariátrica. A hérnia de hiato esteve presente em 56 pacientes (8%), sendo que delas 44 eram pequenas, nove médias e cinco grandes. O grau da esofagite obedeceu o preconizado pela Classificação de Los Angeles.Resultados: Não houve correlação entre a presença ou tamanho da herniação hiatal com o IMC. Dos pacientes avaliados, 134 (18,7%) apresentavam esofagite erosiva. Dentre elas 104 (14,5%) eram grau A; 25 (3,5%) grau B e cinco (0,7%) grau C. Considerando-se apenas os portadores de esofagite erosiva, 77,6% eram grau A; 18,7% grau B; e 3,7% grau C. Foram identificados apenas dois casos de esôfago de Barrett (0,28% da amostra total).Conclusão: Observou-se correlação positiva entre o grau de esofagite com o aumento do IMC.

Hepatocyte transplantation: State of the art.

Advances in biotechnology have allowed hepatocyte transplantation as a relevant proposition to treat liver disease. This procedure may change the crescent mortality in liver transplantation waiting lists due global organ shortage. Recent clinical trials have described promising results of hepatocyte transplantation for acute, acute-on-chronic and metabolic liver disease. In this report, we discuss progresses regarding hepatocyte culture, cryopreservation systems, hepatocyte immortalization, suitable recipient site for hepatocyte engraftment, cell differentiation and fusion into hepatocytes, current clinical trials, and summarize the bioartificial liver systems. These progressions motivate expectation concerning hepatocyte transplantation as a consistent therapy for liver disease.

Origin of adenocarcinoma in Barrett's esophagus: p53 and Ki67 expression and histopathologic background.

UNLABELLED: Barrett's esophagus is the substitution of squamous epithelium of the distal esophagus by columnar epithelium. Intestinal metaplasia in Barrett's esophagus is considered to be the main risk factor for the development of adenocarcinoma. Diffuse adenocarcinoma and Barrett's esophagus without intestinal metaplasia are rare, and reports on the subject are scarce. PURPOSE AND METHOD: To estimate the prevalence of adenocarcinoma in 297 patients with Barrett's esophagus, during the period of 1990 to 2002, and in 13 patients undergoing surgery, to conduct detailed macroscopic and microscopic analysis, with performance of immunohistochemical tests for p53 and Ki67, correlating the type of tumor with its adjacent epithelium. RESULTS: In our patients with Barrett's esophagus, there was a prevalence of 5.7% of adenocarcinoma. The tumors developed only when the Barrett's esophagus segment was long (>3.0 cm). Tumors were located close to the squamous-columnar junction. The histological study revealed 2 patients (15.4%) with Barrett's esophagus adjacent to a tumor with gastric metaplasia without the presence of intestinal metaplasia. Tumors were classified according to Nakamura's classification (23% differentiated pattern, and 77% undifferentiated pattern) and to Lauren's classification (61% intestinal and 39% diffuse). The difference is due to the migration of microtubular and foveolar tumors of undifferentiated (gastric) pattern in Nakamuras classification to the Lauren's intestinal type. The immunohistochemical test for Ki67 was strongly positive in all the patients, thus evidencing intense cell proliferation in both the columnar epithelium and tumor. Expression of p53 was negative in 67% of the adjacent columnar epithelia and 42% of the tumors, without any correlation between the tissue types. CONCLUSION: Adenocarcinoma develops from mixed columnar epithelium, either intestinal or gastric, showing both the gastric and the intestinal patterns; thus, tumors can also grow in columnar epithelium without intestinal metaplasia. Barrett's esophagus should be followed up for the possibility of progression to malignancy, especially when the segment is longer than 3 cm.

Origin of adenocarcinoma in Barrett's esophagus: P53 and Ki67 expression and histopathologic background

O esôfago de Barrett é definido como a substituição do epitélio escamoso do esôfago distal por epitélio colunar. A metaplasia intestinal no esôfago de Barrett é considerada por muitos como o principal fator de risco para o desenvolvimento do adenocarcinoma. Embora já descrito, o adenocarcinoma do tipo difuso e o esôfago de Barrett sem metaplasia intestinal, são raros e pouco estudados. OBJETIVO E MÉTODO: O presente estudo objetivou o cálculo da prevalência do adenocarcinoma no esôfago de Barrett, assim como a análise macroscópica e microscópica detalhada de treze pacientes operados no período de 1990 a 2002, com realização de estudo imunohistoquímico do p53 e Ki67, correlacionando o tipo de tumor com o epitélio adjacente a este. RESULTADOS: Obtivemos uma prevalência de 5,7% de adenocarcinoma em pacientes internados para tratamento cirúrgico de esôfago de Barrett . Encontraram-se tumores relativamente grandes, com média de 4,67 ± 2,28 cm, e sempre em esôfago de Barrett longo, com média de 7,71 ± 1,5 cm. Observou-se tendência de os tumores se localizarem próximos à transição escamo-colunar. O estudo histológico mostrou dois pacientes (15,4%) que apresentavam esôfago de Barrett adjacente ao tumor do tipo juncional sem presença de metaplasia intestinal. Classificaram-se os tumores segundo a classificação japonesa de Nakamura (23% de padrão diferenciado ou intestinal e 77% de padrão indiferenciado ou gástico) e pela classificação de Laurén (61% intestinais e 39% difusos). A diferença decorre da migração dos tumores microtubulares e foveolares do padrão gástrico para o tipo intestinal de Laurén. O estudo do Ki67 foi fortemente positivo em todos os pacientes, mostrando o alto índice de proliferação celular no epitélio colunar e no tumor. O p53 mostrou-se negativo em 66,7% dos pacientes no epitélio colunar e 41,7% no tumor, não mostrando correlação entre os dois materiais. CONCLUSAO: O adenocarcinoma se desenvolve sobre o esôfago de Barrett a partir do epitélio colunar misto, intestinal, bem como do juncional, apresentando padrão tanto gástrico como intestinal; portanto tumores podem se desenvolver em epitélio colunar sem metaplasia intestinal o qual também deve ser seguido, principalmente quando for extenso.