Background Radiofrequency ablation (RFA) is an effective means of eradicating Barrett's esophagus (BE), both with and without associated dysplasia. Several studies have documented high initial success rates with RFA. However, there is limited data on IM detection rates after eradication. Aims To determine the rate of detection of intestinal metaplasia (IM) after successful eradication of Barrett's esophagus. Methods BE patients with and without dysplasia who had undergone RFA were retrospectively identified. Only those who had complete eradication as documented on the initial post-ablation endoscopy, and had minimum two surveillance endoscopies, were included in the analyses. Clinical, demographic, and endoscopic data were collected. Cumulative incidence of IM detection was calculated by the Kaplan–Meier method. Results Forty-seven patients underwent RFA and had complete eradication of Barrett's epithelium. The majority of patients were male (76.6%), and the mean age was 64.2 years. The cumulative incidence of newly detected IM at 1 year was 25.9% (95% CI 15.1–42.1%). Dysplasia was detected at the time of recurrence in four patients, and all cases were detected at the GE junction in the absence of visible BE. Patients with recurrent IM had longer baseline segments of BE (median, 4 cm vs. 2 cm, p = 0.03). Conclusions The rate of detection of new IM is high in patients who have undergone successful eradication of BE by RFA. Additionally, dysplasia can recur at the GE junction in the absence of visible BE. Future studies are warranted to identify those patients at increased risk for the development of recurrent intestinal metaplasia.

SUMMARY Background Racial and ethnic differences in the risk of premalignant colorectal neoplasia have not been extensively studied. Aim To measure adenoma prevalence among asymptomatic white, black and Hispanic patients undergoing screening colonoscopy. Methods In this cross sectional cohort study, data from individuals ≥50 years undergoing first-time colonoscopy since 2006 at a single tertiary-care medical centre were obtained from the electronic medical record. Adenoma prevalence among whites, blacks and Hispanics was calculated; multivariate Poisson and logistic regression were used to identify factors independently associated with adenoma rates and the presence of advanced adenomas. Results We identified 5075 eligible subjects: 3542 (70%) whites, 942 (18%) Hispanics and 591 (12%) blacks. The mean age was 62.2 years with 58% women. At least one adenoma was detected in 19%, 22% and 26% of whites, Hispanics and blacks respectively (Hispanics vs. whites P = 0.09; blacks vs. whites P = 0.0001). Isolated proximal adenomas were present in 9% of whites, 11% of Hispanics (P = 0.03) and 11% of blacks (P = 0.03). In multivariate analyses, a higher rate of adenomas was present in Hispanics (RR: 1.37, 95% CI: 1.20–1.57) and blacks (RR: 1.76, 95% CI: 1.52–2.04) than whites. Hispanics and blacks also had an increased risk of advanced adenomas compared to whites (ORHispanics: 2.25, 95% CI: 1.62–3.11; ORblacks: 1.91, 95% CI: 1.27–2.86). Conclusions Adenoma prevalence was higher in blacks and Hispanics than in whites. Both groups were at greater risk of having proximal adenomas in the absence of any distal pathology than whites, where these lesions would have only been detected by colonoscopy. Efforts to promote screening are necessary among diverse, under-represented populations.

PN is more often found in patients with CD and/or IBD than in the general population.

Our results suggest that experts are more comfortable using a broader array of medical therapy than non-expert physicians. Although both groups had similar concerns regarding side-effects of anti-TNFα therapy, expert physicians were much more likely to have managed a broad range of complications in their patient population.

In nondysplastic BE patients on PPI therapy, serum gastrin levels were significantly correlated with cellular proliferation. These pilot data lend support to a potential causal effect of gastrin on neoplastic progression in BE. Longitudinal studies of patients with BE are needed to determine whether hypergastrinemia is a risk factor for the development of dysplasia and adenocarcinoma or could be used as a biomarker for disease progression.