Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2017; 23(39): 7150-7159
Published online Oct 21, 2017. doi: 10.3748/wjg.v23.i39.7150
Presence of columnar-lined esophagus is negatively associated with the presence of esophageal varices in Japanese alcoholic men
Akira Yokoyama, Kenro Hirata, Rieko Nakamura, Tai Omori, Takeshi Mizukami, Junko Aida, Katsuya Maruyama, Tetsuji Yokoyama
Akira Yokoyama, Takeshi Mizukami, Katsuya Maruyama, National Hospital Organization Kurihama Medical and Addiction Center, Kanagawa 239-0541, Japan
Kenro Hirata, Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo 160-8582, Japan
Rieko Nakamura, Department of Surgery, School of Medicine, Keio University, Tokyo 160-8582, Japan
Tai Omori, Endoscopy Center, Kawasaki Municipal Ida Hospital, Kanagawa 211-0035, Japan
Junko Aida, Research Team for Geriatric Pathology, Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan
Tetsuji Yokoyama, Department of Health Promotion, National Institute of Public Health, Saitama 351-0104, Japan
Author contributions: Yokoyama A contributed to study concept and design, endoscopy, columnar-lined esophagus (CLE) diagnosis; Hirata K, Nakamura R, and Omori T contributed to CLE diagnosis, interpretation of data; Mizukami T contributed to endoscopy; Aida J contributed to interpretation of data; Mizukami T and Maruyama K contributed to patient enrollment; Yokoyama T contributed to statistical analysis; All authors participate in writing the manuscript.
Institutional review board statement: The study was reviewed and approved by the Kurihama Medical and Addiction Center Institutional Review Board.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflicts of interests related to the publication of this study.
Data sharing statement: No additional data was available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Akira Yokoyama, MD, PhD, National Hospital Organization Kurihama Medical and Addiction Center, 5-3-1 Nobi, Yokosuka, Kanagawa 239-0841, Japan. a_yokoyama@kurihama1.hosp.go.jp
Telephone: +81-46-8481550 Fax: +81-46-8497743
Received: August 2, 2017
Peer-review started: August 19, 2017
First decision: August 30, 2017
Revised: September 21, 2017
Accepted: September 28, 2017
Article in press: September 28, 2017
Published online: October 21, 2017
ARTICLE HIGHLIGHTS
Research background

Esophageal varices (EVs) develop as a result of portal hypertension, which is mainly due to liver cirrhosis (LC) in alcoholics. Excessive alcohol consumption has been reported to be associated with the presence of a short-segmental columnar-lined esophagus (CLE) in East-Asian studies. It has not been evaluated whether associations exist between the presence of EVs and the presence of CLE in alcoholics.

Research motivation

Our empirical impression based on the results of endoscopic screening examinations of Japanese alcoholic men is that EVs are less common among men with short-segmental CLE. The development of CLE is accompanied by several histological changes around the palisade vessels at the lower end of the esophagus. Some of the histological changes accompanying the development of CLE may protect against the development of EVs.

Research objectives

To determine whether and to what extent associations exist between the presence of EVs and the presence of CLE in Japanese alcoholic men based on the results of endoscopic screening examinations.

Research methods

The subjects were 1614 Japanese alcohol-dependent men (≥ 40 years of age) who had undergone upper gastrointestinal endoscopic screening. Digitalized records of high-quality endoscopic images that included the squamocolumnar junction and esophagogastric junction were retrospectively jointly reviewed by four expert endoscopists for the purpose of diagnosing CLE. The authors investigated whether and to what extent there were associations between the presence of CLE and the presence of EVs, especially in the group with LC.

Research results

CLE ≥ 5 mm in length was found in 355 subjects, LC without EVs in 152 subjects, LC with EVs in 174 subjects, and EVs without LC in 6 subjects. Advanced EVs, i.e., nodular, large or coiled forms, red color sign, or post-treatment, were found in 88 subjects. The incidence of CLE ≥ 5 mm decreased in the following order (P < 0.0001): 23.3% in the group without EVs, 17.4% in the group with small and straight EVs, and 5.7% in the group with advanced EVs. The multivariate ORs (95%CI) for EVs and advanced EVs in the group with LC were lower when CLE ≥ 5 mm was present [0.46 (0.23-0.93) and 0.24 (0.08-0.74), respectively, vs 0-4 mm CLE]. To clarify the pathological backgrounds of the negative association between the presence of CEL and the presence of EVs, the further pathological studies of autopsied cirrhotic subjects may be warranted.

Research conclusions

The presence of CLE was negatively associated with the presence of EVs, and even more negatively associated with the presence of advanced forms of EVs. Since the first resistance vessels to EVs are the mucosal palisade vessels and submucosal veins at the lower end of the esophagus, the development of CLE may impede the development of EVs. Helicobacter pylori infection and chronic atrophic gastritis protect against the development of GERD and CLE. If the observed associations between CLE and EVs and advanced EVs reflected causal relationships, the current trend toward to lower Helicobacter pylori infection rates in Japan may influence EV rates and advanced EV rates in the future, and examination for CLE may benefit alcoholics with advanced liver disease by identifying their risk for the development or progression of EVs. The further studies should be conducted prospectively in the longitudinal fashion to test this finding.