| BE(Barrett esophagus) is the pathological phenomenon that the squamous epithelium is replaced by metaplasia columnar epithelium. BE may progress to EA through “ normal epithelium— columnar epithelium— dysplasia(neoplasia) — EA ” way. There are different types and grades of BE under endoscopy and the danger of developing EA is quite different. So it would be of most important clinical significance to make clear of diagnosing BE and make sure of the dangerous capability of progressing to EA so that proper measurements could be taken to preventing EA’ s taking place. DCAMKL-1 is a recognized biomarker in the stem cells of gastrointestinal adenocarcinoma. Up regulation of DCAMKL-1 has been particularly noted in the stromal desmoplastic compartment in many solid tumors and it is reported this correlates the progression. We aimed to implore the difference among different types and grades in aspects of clinical information and pathological behavior under endoscopy and the DCAMKL-1 protein expression(by immunohistochemical staining) to helping diagnosing the dangerous BE.Objective: To investigate the relationship among pathological types, degrees and sex, age, gastroesophageal reflux disease(GERD) questionnaire(Gerd Q) grade, diet, living environment and financial capacity, and pathological behaviors under-endoscopy. To implore the difference of the expression of DCAMKL-1 among different types and grades of BE.Methods: The four quadrant biopsy and hematoxylin-eosin staining(H.E.) were used to diagnosis Barrett esophagus(BE) and gastric type, intestinal type and the grades(non-neoplasia, low-grade neoplasia and high-grade neoplasia) were confirmed by pathology further. GERD was diagnosed among BE patients if one’s Gerd Q grade≥8. The basic information about sex, age(youth, middle-aged, elderly), diet(oily, salty, spicy), living environment and financial capacity(good, medium, poor) were also surveyed. We recorded the characteristics of the lesions including type(island, tongue, circumferential and mixed type) quadrant, location to dentate line(Z line), number and size. Further more, Immunohistochemical staining was performed in non-neoplasia, low-grade neoplasia, high-grade neoplasia in gastic and intestinal type, and EA as well for observing DCAMKL-1 protein expressing by immunohistochemical staining.Results:1 Comparison among different types and grades of BE in clinical information. The prevalence of the characteristics of male, female, oily-salty-spicy diet, sweet diet, mild diet, irregular diet, youth, middle-aged, elderly, poor, medium or good living environment and financial capacity in gastric type and in intestinal type were 53.85%, 46.15%, 73.08%, 11.54%, 11.54%, 3.84%, 26.92%, 53.85%, 19.23%, 3.84%, 84.62%, 11.54% and 40.00%, 60%, 80.00%, 0%, 20.00%, 0%, 0%, 40.00%, 60.00%, 0%,100.00%, and 0% respectively. It remained no statistically significance(P>0.05). The prevalence of GERD was 80% in intestinal type, which was significantly higher than that in gastric type(P = 0.042, P<0.05). There were 27 cases of non-neoplasia, 4 cases of low-grade neoplasia and 0 case of high-grade neoplasia. The prevalence of the fore-mentioned characteristics in non-neoplasia were 51.85%, 48.15%, 70.37%, 11.11%, 14.81%, 3.71%,37.04%, 62.96%, 18.52%, 55.56%, 25.92%, 11.11%, 85.19%, 3.70% and for low-grade neoplasia 50%, 50%, 25%, 75%, all of them are of oily-salty-spicy diet, the young 50%, the middle-aged 25.00%, the elderly 25.00%, and all of them have middle-level of living environment and financial capacity. Two grades showed no statistically difference in these characteristics(P>0.05).2 Comparison among different type-grades of BE in clinical characteristics. All BE cases were divided into non-neoplasia-gastric type, non-neoplasia-intestinal type, low-grade-neoplasia-gastric type and low-grade-neoplasia-intestinal type. The prevalence of the fore-mentioned characteristics were male 54.17%, female 45.83%, Gerd Q≥8 29.17%, <8 70.83%, oily-salty-spicy diet 70.83%, sweet diet 12.50%, mild diet 12.50%, irregular diet 4.17%, young 20.83%, the middle-aged 58.34%, the elderly 20.83%, poor, medium and good living environment and financial capacity 12.50%, 83.33% and 4.17% respectively in non-neoplasia-gastric type. The prevalence of the characteristics in the non-neoplasia-intestinal type are male 33.33%, female 66.67%, all of them are of Gerd Q≥8, oily-salty-spicy diet 66.67%, mild diet 33.33%, middle-aged 33.33%, elderly 66.67%, all are of medium and good living environment and financial capacity. The prevalence of the characteristics in the low-grade-neoplasia-gastric type are male 50%, female 50%, all are of Gerd Q<8, all prefered oily-salty-spicy diet, all are young ones, all are of medium living environment and financial capacity. The prevalence of the characteristics in the low-grade-neoplasia-intestinal type are male 50%, female 50%, Gerd Q ≥ 8 50%, < 8 50%, all prefered oily-salty-spicy diet, the middle-aged 50%, the elderly 50%, all are medium and good living environment and financial capacity. There was no statistically difference in these characteristics(P>0.05). All cases were divided into non-neoplasia including gastric type 88.89% and intestinal type 11.11% and low-grade neoplasia including both type 50%, there was no statistically difference(P>0.05).3 The prevalence of island, tongue, circumferential and mixed type in non-neoplasia were 59.26%, 11.11%, 25.93%, 3.70%, as for low-grade neoplasia it was 50%, 50% for island, tongue type respectively. There was no statistically difference in these characteristics(P>0.05). 18 cases of island type were divided into non-neoplasia and low-grade neoplasia. The prevalence in non-neoplasia of locating in front quadrant, back quadrant, left quadrant, right quadrant were 12.5%, 12.5%, 62.5%, 12.5%, being above Z-line in 0~1 cm 43.75%, 1~2 cm 56.25%, the number of the lesion being 1 was 81.25%, more than 2 was 18.75%, the diameter<0.5 cm or≥0.5 cm were 81.25%, 18.75% respectively. As for low-grade neoplasia, there are two cases and one at the back quadrant, the other the right and both being above Z-line in 0~1 cm with only one lesion and the diameter<0.5 cm. There was no statistically difference in these characteristics(P > 0.05). The prevalence of non-neoplasia-gastric in the fore-mentioned characteristics under endoscopy were 14.29%, 14.29%, 57.13%, 14.29%, 42.86%, 57.14%, 78.57%, 21.43%, 92.86%, 7.14%, and for non-neoplasia-intestinal the prevalence were all at left quadrant, being above Z-line in 0~1 cm 50%, 1~2 cm 50%, both cases have only one lesion and the diameter≥0.5 cm. As for low-grade-gastric there is only one case with only one lesion whose diameter<0.5 cm locating at the back quadrant above the Z-line in 0~1cm. As for low-grade-intestinal there is only one case with only one lesion whose diameter<0.5 cm locating at the right quadrant above the Z-line in 0~1 cm. There was no statistically difference in these characteristics(P>0.05 or P>0.0083). 5 cases of tongue type were divided into non-neoplasia and low-grade neoplasia. The prevalence of locating in front quadrant, back quadrant, left quadrant, right quadrant were 66.67%, 33.33%, 0%, 0%, extending above Z-line<3 cm and≥3 cm were 0% and 100%, the width being≤1 cm, exactly 2 cm, 3 cm were all 33.33% respectively. It was 50%, 50%,0%, 0%, 50%, 50%, 50%, 50% and 0% respectively. No statistically difference in these characteristics were showed(P>0.05). Divided tongue type into three branches as non-neoplasia-gastric type, low-grade-neoplasia-gastric type and low-grade-neoplasia-intestinal type. The prevalence of the non-neoplasia-gastric type in the fore-mentioned characteristics were the front quadrant 66.67%, the back quadrant 33.33%, length≥3 cm 100%, the width≤1 cm, exactly 2 cm and 3 cm are 33.33%, 33.33% and 33.33% respectively and as for low-grade-neoplasia-gastric type there is only one case at the front quadrant with length<3 cm, width≤1 cm and as for neoplasia-intestinal type there is only one case at the back quadrant with length≥3 cm, width exactly is 1 cm. No statistically difference in these characteristics were showed(P>0.05).4 The Immunohistochemical staining results showed that DCAMKL-1 protein expressing could be observed in all types and grades of BE and EA as well. They exited in the squamous epithelium, metaplasia epithelium and the stromal cells by different degrees. In gastric type without neoplasia we observed minimal DCAMKL-1 expression in squamous epithelium while increased expression in the metaplasia epithelium and very little expression in the stromal cells. In intestinal type without neoplasia we observed increased expression of DCAMKL-1 in all metaplasia, squamous and stromal epithelium, especially the former two. Little expression was observed in both gastric and intestinal types without neoplasia. As for intestinal type with low-grade neoplasia, we didn’t observed the apparently more expression in the mentioned cells above compared to the one without neoplasia. But we observed increased expression in stromal cells and the whole nuclei. In gastric and intestinal type with low-grade neoplasia, we observed more expression in the nuclei as well as in the squamous, metaplasia and stromal cells. It was interesting that DCAMKL-1 was observed expressed specially around karyotheca. In intestinal type with high-grade neoplasia, we observed further more expression in the nuclei, especially around the karyotheca. More expression was also observed in the squamous and stromal cells. As for EA, further expression was observed in all kinds of cell mentioned above but outstanding expression around the karytheca.Conclusion:1 Gastric type tended to be with Gerd Q < 8 frequently, while the intestinal type≥8, it reminded that intestinal type was more likely to be accompanied with GERD. So more attention should be paid to find BE when GERD was observed under endoscopy, and if there was BE biopsy must be taken because the possibility of the lesion being intestinal type was lifted. It showed that Gerd Q grade analysis may be of certain value as a potential tool revealing the high risk of BE(intestinal type).2 There was no evidence that the characteristics of lesions under endoscopy could be used to value the danger of BE because no statistically difference in these characteristics were showed between different lesion types and grades.3 DCAMKL-1 expression could be observed in different types and grades of BE and EA. The expression increased correlated with the progression from BE with no neoplasia to BE with neoplasia and EA. In stromal cells little expression was observed in BE with no neoplasia, while obviously increased expression in BE with neoplasia, and further more in EA. No obviously increased expression in nuclei was observed in either gastric or intestinal type without neoplasia, but apparently high expression was observed in gastric and intestinal neoplasia with low-grade, especially around the karytheca in the metaplasia cell of the gastric-intestinal type. We observed further increased DCAMKL-1 expression around the karytheca in the high-grade neoplasia BE. This reminded us the specificity of the expression in the nuclei of metalpasia cell with neoplasia, and the amount of expression especially the location around the karytheca, may be a tool to distinct non-neoplasia from high-grade neoplasia for early recognizing of premalignant lesion. |
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