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Optical coherence microscopy (OCM) can deliver high resolution images of living, thick tissue samples. Should this method be able to distinguish between squamous and columnar epithelium, this would have implications on its qualification as a diagnostic tool for early stage metaplasia and Barrett's esophagus. Fresh esophageal and gastric epithelium taken from rats were imaged with OCM a few micrometers below the tissue surface. A discrimination between the epithelium types was possible from both the image morphology and the power spectral densities. Considerations on the design of an endoluminal OCM-applicator based on a micro-machined gimballed mirror will be discussed.

Summary Chronic Helicobacter pylori infection is the strongest known risk factor for the development of gastric cancer. In order to survive and propagate under the harsh conditions of the gastric niche, this pathogen has evolved numerous means to interact with host epithelium. In this issue, Mimuro et al. shed light on mechanisms by which Helicobacter pylori attenuates apoptosis in the gastric epithelium to facilitate its persistence within the human stomach.

Foregut duplication cysts of the hypopharynx are extremely rare, and only 6 cases, all of which have been described as solid lesions and contained heterotopic gastric epithelium, could be found during our literature review. We present a unique case of a hypopharyngeal foregut duplication cyst that was grossly cystic and had no heterotopic epithelium microscopically. The present case required intubation for stridor and airway obstruction shortly after birth. Congenital laryngeal cysts can appear similar to this lesion. However, the hypopharyngeal location of a cyst is a clue for the diagnosis of duplication on endoscopic examination.

One hundred eighty-nine consecutive gastric biopsies showing colonization by Helicobacter pylori (HP) were studied. Epigastric pain and bleeding were the clinical presentations in 167 cases (88.4%). Major endoscopic findings were gastritis (n = 72, 38.1%) and ulceration (n = 101, 53.4%). Duodenal ulcer was associated with 32 (44.4%) and 29 (28.7%) cases of gastritis and gastric ulcer, respectively. Histologically, the HP-colonized gastric epithelium showed characteristic degenerative changes that were topographically related to the bacteria but unrelated to the inflammatory infiltrate. Disintegration and loss of apical mucus with formation of epithelial pits was seen in nearly all cases. Other changes included microerosion, conventional erosion, and frank ulceration. Only the disintegration of apical mucus, epithelial pit, and microerosion were specific for HP colonization. These conditions were absent in areas not colonized by HP and in 79 consecutive HP-negative gastric biopsies seen during the same study period. The epithelial degenerative changes in HP-colonized gastric mucosa are easy to recognize in routine hematoxylin-eosin-stained sections and they could serve as histologic guides to the localization of the bacteria. It is proposed that HP-colonized gastric mucosa is a distinct pathologic entity with a pathologic spectrum ranging from active chronic gastritis to erosion and frank ulcer. Damage to the mucin-containing portion of the gastric epithelial cells appears to be the basic cytopathologic effect of HP on the gastric mucosa. As effective specific treatment for HP infection is available, identification of HP colonization in gastric biopsies should be attempted in all cases of gastritis and gastric ulcer.

high-quality one-to-one correlated histology-VLE images for identification of VLE features of early BE neoplasia. Methods: An ex-vivo VLE scan of endoscopic resection (ER) specimens including reference markers from BE patients with and without neoplasia was performed. Tissue blocks were carefully sectioned from the ER specimens alongside the reference markers. Histology slides were sectioned from each tissue block and when necessary extensive sectioning of tissue blocks was performed in order to visualize all markers. All histology slides were evaluated by an expert BE pathologist and annotated using a custommade program for epithelium type, grade of dysplasia and (sub)mucosal structures. All VLE scans and corresponding histology slides were evaluated by 2 observers and considered a match when on both modalitiesR 2 reference markers were visible and mucosal patterns matched. In each match areas of interest (AoIs) were identified based on the histological diagnosis and division of the match by the reference markers. In an unblinded learning phase all AoIs were evaluated for potential VLE features predictive of dysplasia. Results: In total 42 ER specimens were obtained in 23 BE patients ((66 yrs, 19 male, overall histological diagnosis 11 early adenocarcinoma (EAC), 5 high-grade dysplasia (HGD), 1 low-grade dysplasia (LGD) , 6 non-dysplastic (ND)BE)). 65 histology-VLE matches were constructed including 142 AoIs (24 squamous epithelium, 31 gastric epithelium, 37 NDBE, 16 LGD, 15 HGD, 19 EAC. In a first evaluation the following VLE features were identified as potentially predictive for dysplasia: homogeneity ,surface maturation, irregular tissue surface and dilated cancerous duct with intraluminal debris. Conclusion: This study presents the first atlas of high-quality histology-VLE correlations of BE and neoplasia, allowing further research on development of VLE features to distinguish early neoplasia in BE. The learning phase identified several potential VLE features for early BE neoplasia, which is the first step towards validation of VLE for detection of early BE neoplasia. Three examples of high-quality one-to-one correlated histology-VLE

Furthermore, the diagnostic performance was less than 50%, even by chromoendoscopy with indigo carmine dye or acetic acid alone. Thus, there should be a relatively high possibility of overlooking a superficial gastric cancer without a combination of these 2 methods, ‘‘bi-chromoendoscopy.’’ In our previous article, we obtained the clear demarcation around the tumor by using a mixed solution with indigo carmine dye and acetic acid in chromoendoscopy. Among 27 patients in our series, 39 lesions were identified with spraying the mixed solution of indigo carmine dye and acetic acid, 6 of which were overlooked by conventional endoscopy and chromoendoscopy with indigo carmine dye alone. In addition, when this technique was applied for the preoperative evaluation of gastric cancer in the lower stomach, additional cancerous lesions were detected at the upper area in 2 patients. The information is very important for the suitable treatment for these patients. Therefore, we totally agree with the conclusion by Sakai et al that ‘‘bichromoendoscopy’’ is clinically useful to detect small-sized early gastric cancer. The 2 substances should be sprayed sequentially, as in their method, or simultaneously, as in ours, because clear demarcation is probably because of a dynamic chemical response of gastric epithelium to acetic acid. In our experience, the best demarcation line of the neoplastic lesions is obtained at 3 to 4 minutes but gradually disappears thereafter, but we would like to know the exact time course of the visualization of target lesions in their method. In general, these 2 techniques might be separately applied based on the aim of endoscopy: routine observation, preoperative close examination, or marking, before endoscopic resection.

Immunofluorescence studies showed that human gastric M 1 antigens and intestinal M 3 antigen are associated respectively with the mucus cells of surface gastric epithelium and with the intestinal goblet cells of the normal adult gastrointestinal tract. In the fetus and new born, it was possible to demonstrate by use of double labeling (fluorescein and rhodamine) that some goblet cells of colonic glands contain both the M 1 and M 3 antigens. This ‘fetal-type’ association of M antigens, which could not be found in the normal adult colonic mucosa, was observed in some goblet cells of the transitional mucosa adjacent to human colonic adenocarcinomas. Probably it represents the reappearance of a fetal-type pattern associated with the tumors.

The role of mucus in protecting the underlying gastric epithelium is unknown. We investigated the pH gradient and thickness of the mucus gel layer in in vitro gastric fundic mucosa mounted in a special chamber using an antimony microelectrode, a slit lamp, and a dissecting microscope (× 40). This system allowed visualization of the tip of the electrode as it entered the mucus gel and as it reached the mucosa. With luminal pH maintained at 3.0-3.5, the maximum pH at interface between mucus and cells was 6.50 ± 0.10 (n = 9). At luminal pH 3.0-3.5, an increase in nutrient [HCO3-] from 17.8 to 47.8 δM resulted in an increase in maximum pH within the mucus from 6.80 ± 0.20 to 7.60 ± 0.20 (p

Progressive deviation of the squamocolumnar junction in the rat stomach was produced by repeated, asymmetrical, deep mucosal wounding about this junction. When such a wound included predominantly squamous or glandular mucosa, the junction was moved toward the area where more mucosa had been removed. Further wounds across a projection of migrated epithelium formed in this way allowed surrounding epithelium of another type to grow in and completely isolate the tip of the projection as an island. Glandular islands were more easily produced than squamous islands, but in both types of ectopia the newly formed mucosa failed to assume a completely normal appearance, even after 20 weeks of observation. Another pattern of wounding resulted in the encirclement of portions of glandular mucosa by squamous epithelium, thus forming "pseudoectopias." By contrast with the true ectopias, such areas had normal histological appearances and acid secretion. These results suggest that, in human beings, heterotopias and ectopias at the lower end of the esophagus may be acquired and the result of repeated damage by reflux esophagitis followed by abnormal patterns of healing.

Summary Because intraluminal gastric potential is usually negative with respect to skin, and esophageal potential positive, the site of maximal potential change, determined on withdrawing an electrode from the stomach to the esophagus, has been used to identify the gastroesophageal mucosal junction. To ascertain whether this practice is valid in man, we took simultaneous mucosal biopsies proximal and just distal to the point where maximal change in potential difference (PD) was recorded on withdrawing an electrode from stomach to esophagus. In 18 subjects in whom a clearly defined change in PD could be recorded, the end point of maximal PD change correlated 12 times with the presence of stratified squamous epithelium, 6 times with j unctional columnar epithelium devoid of parietal cells. From the other biopsy site, 25 mm distal, gastric mucosa with parietal cells was consistently obtained. Changes in PD appeared to correlate better with the presence or absence of parietal cells than with the actual junction of columnar gastric and squamous esophageal epithelium. However, since parietal cell-containing gastric epithelium and squamous epithelium were not widely separated in most cases, changes in PD identified the location of the mucosal gastroesophageal junction accurately in 2 out of 3 instances.

Summary A method is described of performing acute total gastric pouch secretory studies in anesthetized cats. The maximal secretory capacity of the gastric epithelium in these preparations was influenced by the duration of histamine administration as well as the dose. It is possible to obtain a larger output of gastric juice for a short period by doubling the dose of histamine each 2 hours than by giving a larger dose over a prolonged test. The correlations between the ionic concentrations in the stimulated and in the unstimulated cats are on the whole consistent with Hollander's two-component theory of gastric secretion. The composition of the two components differs in the two states, the chief difference being an increase in the K concentration in the nonparietal cell secretion on stimulation, with a corresponding decrease in the K in the parietal cell secretion. Histamine increases the rates of both secretions with a greater increase in the parietal cell secretion. The reason for the K content of parietal secretion, which is at variance with the Hollander theory, is not clear but may be due to species difference, to retained innervation of the stomach or to the anesthetic.