Presence of columnar-lined esophagus is negatively associated with the presence of esophageal varices in Japanese alcoholic men

doi:10.3748/wjg.v23.i39.7150

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World Journal of Gastroenterology

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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.

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
Processing time: 64 Days and 7.5 Hours

Abstract

AIM

To determine whether the presence of columnar-lined esophagus (CLE) is associated with the presence of esophageal varices (EVs) in male Japanese alcoholics.

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 liver cirrhosis (LC).

RESULTS

CLE ≥ 5 mm in length was found in 355 subjects (≥ 30 mm in 6 of them), 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 ≥ 5mm was present [0.46 (0.23-0.93) and 0.24 (0.08-0.74), respectively, vs 0-4 mm CLE].

CONCLUSION

The presence of CLE in male Japanese alcoholics was negatively associated with the presence of EVs.

Keywords: Alcohol; Columnar-lined esophagus; Hiatal hernia; Liver cirrhosis; Portal hypertension; Esophageal varices

Core tip: A positive association between excessive drinking and the presence of short-segmental columnar-lined esophagus (CLE) has been reported in Asians. Endoscopic screening of 1614 Japanese alcohol-dependent men revealed the presence of CLE ≥ 5 mm in length in 355 subjects and esophageal varices (EVs) in 180 subjects. 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.