Anthony I. Morris

New classification of oesophageal and gastric carcinomas derived from changing patterns in epidemiology

SummaryThe current ICD-O classification of carcinomas of the oesophagus and stomach causes epidemiological and clinical confusion. This study compares the epidemiological and clinical features of each subtype and subsite of adenocarcinomas of the oesophagus and stomach, to assess requirements for a new classification of these carcinomas. Data were extracted with appropriate validity checks on all cases of oesophageal and gastric carcinomas identified throughout the period 1974–1993 by the Merseyside and Cheshire Cancer Registry, which covers a population of 2.5 million. The incidence of adenocarcinomas of the lower oesophagus and cardia trebled in males, and doubled in females, whereas adenocarcinoma of the subcardia region of the stomach declined in both sexes. Adenocarcinomas of the lower oesophagus and of the cardia were similar for median age at diagnosis, male to female ratio, percentage of patients who smoked and survival; both were significantly different from carcinomas of the subcardia in these respects. These data imply that adenocarcinomas of the lower oesophagus and cardia are the same disease. A new subsite classification of oesophageal and gastric carcinomas is proposed that includes the gastro-oesophageal junction as a distinct subsite, to facilitate surveillance, management and research.

Effect of Systemic Corticosteroid Therapy on Risk for Intra- Abdominal or Pelvic Abscess in Non-operated Crohn's Disease

BACKGROUND & AIMS Systemic corticosteroid therapy increases risk of postoperative sepsis in Crohns disease. This study investigates its effect on risk for sepsis in non-operated patients. METHODS A retrospective case-control study was performed in 432 patients with Crohns disease (the 94% of our database for whom adequate documentation could be retrieved). Two analyses were performed. The first tested the hypothesis that patients with perforating Crohns disease (n = 86) were more likely to develop intra-abdominal or pelvic abscess (n = 29) if they had received systemic corticosteroids during the previous 3 months. The second analysis, confined to interventions since 1998, tested the hypothesis that corticosteroid therapy was more common during the 3 months before presentation with intra-abdominal or pelvic abscess (n = 12) than during the 3 months after presentation with a relapse of nonperforating disease (n = 24 consecutive patients). In both analyses adjustment was made for any other significant variable. RESULTS Systemic corticosteroid therapy was associated with an adjusted odds ratio (OR) for intra-abdominal or pelvic abscess of 9.03 (95% confidence interval [CI], 2.40-33.98) in patients with perforating Crohns disease. Patients receiving prednisolone > or = 20 mg per day had an OR of 2.81 (95% CI, 0.99-7.99) for abscess compared with those receiving a lower dose. In patients with relapsed active disease, corticosteroid therapy was associated with an unadjusted OR of 9.31 (95% CI, 1.03-83.91) for intra-abdominal or pelvic abscess. Neither smoking nor azathioprine usage was associated with increased risk for abscess. CONCLUSIONS Systemic corticosteroid therapy for Crohns disease is associated with increased risk for intra-abdominal or pelvic abscess.

Clinical trial: randomized study of clarithromycin versus placebo in active Crohn's disease

Background  Crohn’s disease is characterized by defective innate immune responses to intestinal bacteria. Clarithromycin is a broad‐spectrum antibiotic that has good penetration into macrophages.

Biphasic synovial sarcoma in the small intestinal mesentery

Background. A 46‐year‐old man presented with recurrent anemia and polyarthralgia. Investigations revealed a mass in the ileal mesentery, which was resected. Results of routine histologic examination suggested a diagnosis of synovial sarcoma, a rare malignancy usually not reported at this site.

Loss of heterozygosity on chromosome 17p predicts neoplastic progression in Barrett's esophagus

Background and Aim: Endoscopic surveillance for adenocarcinoma in patients with Barretts esophagus is costly, with one cancer detected every 48–441 patient years of follow up. Genetic abnormalities, including loss of heterozygosity at sites of tumor suppressor genes, have been detected in malignant and premalignant Barretts esophagus. The aim of this prospective study was to determine if loss of heterozygosity analysis could identify patients with Barretts esophagus at greatest risk of adenocarcinoma, for whom endoscopic surveillance is most appropriate.

Review article: controversy in the therapy of gastro‐oesophageal reflux disease—long‐term proton pump inhibition or laparoscopic anti‐reflux surgery?

The treatment of gastro‐oesophageal reflux disease is controversial. Whilst medical treatment is successful in patients with mild to moderate disease, the threshold of severity above which an operation should be contemplated remains a matter for debate. Laparoscopic anti‐reflux surgery may be lowering this threshold, as this form of therapy provides several advantages over its open counterpart, but it is not without risk, and few long‐term results are available. This article reviews treatment options for reflux disease and examines the relative position of current medical and surgical therapies.

Three different subsite classification systems for carcinomas in the proximity of the GEJ, but is it all one disease?

Background and Aim:  Currently there are three different subsite classification systems for carcinomas in the region of the gastroesophaeal junction (GEJ), namely ICD‐O, Munich and Liverpool. The aim of the present study was to compare clinicoepidemiological, pathological and molecular features of adenocarcinomas in the proximity of the GEJ, classified according to their position with respect to the GEJ initially, and then classified according to ICD‐O, Munich and Liverpool classifications.

Effects of niacin on biliary lipid output in the rat

Abstract The mechanisms for the hypocholesterolaemic action of niacin (nicotinic acid) were examined in rats administered niacin at a dose of 400 mg/kg body wt/day for either 2 or 4 weeks. Another group of rats were administered diosgenin, an inhibitor of acyl-CoAxholesterol acyltransferase, as a 1% (w/w) supplement in the diet for 7 days. Both agents produced small increases in bile flow rates (up to 40%) and mild hepatotoxicity evidenced by small increases in serum transaminase activities. Niacin treatment for 2 or 4 weeks lowered serum cholesterol concentrations by 13% or 29%, respectively, with the greatest decrease occurring in the low density lipoprotein fraction. This was accompanied by relatively large increases in biliary cholesterol output (114% and 130% after 2 and 4 weeks treatment, respectively) with smaller increases in the biliary output of phospholipid (18% and 45%) and bile acid (26% and 14%). Diosgenin treatment increased serum cholesterol by 29% and increased the biliary output of cholesterol, phospholipid and bile add by 800%, 10% and 45%, respectively. Thus, both agents increased the cholesterol saturation of bile (100% by niacin, 500% by diosgenin). Cholesterol and phospholipid in fistula bile from control rats were present in lamellar and micellar forms. Niacin treatment did not alter the physical form of biliary lipids whilst diosgenin caused the appearance of vesicular lipid in fistula bile. Thus, increased biliary secretion of cholesterol explains, at least in part, the hypocholesterolaemic action of niacin. In addition, since aggregation of biliary vesicles is involved in cholesterol gallstone formation in humans, the non-appearance of vesicular material in fistula bile from niacin-treated rats may be of some importance.

Unique Expression of Human Papilloma Virus Type 5 and Type 16 in Esophageal Squamous Cell Carcinoma—A Case Report

The role of human papilloma virus (HPV) in esophageal cancers from the low-incidence area (Western population) is unclear. We report a case of esophageal squamous papillomatosis associated with underlying esophageal squamous cell carcinoma (OSCC). The esophagectomy specimen confirmed presence of HPV-5 and HPV-16 suggesting a viral etiology. The significance of this dual infection is not known, but it suggests that esophageal papillomatosis is premalignant and should receive regular endoscopic follow-up. This is the first report of both HPV-5 and HPV-16 DNA detected in an esophageal cancer occurring in the Western population.