Volume 16 Number 47December 21, 2010

World J Gastroenterol2010 December 21; 16(47): 5907-6034

Online Submissionswww.wjgnet.com/1007-9327office

www.wjgnet.com Printed on Acid-free Paper

Indexed and Abstracted in:Current Contents®/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch®), Journal Citation Reports®, Index Medicus, MEDLINE, PubMed, PubMed Central, and Digital Object Identifier. ISI, Thomson Reuters, 2009 Impact Factor: 2.092 (33/65 Gastroenterology and Hepatology).

World Journal of Gastroenterology

World Journal of Gastroenterology

World Journal of G

astroenterology ww

w.w

jgnet.com Volum

e 16 Num

ber 47 Dec 21 2010

Volume 16 Number 47December 21, 2010

ISSN 1007-9327 CN 14-1219/R Local Post Offices Code No. 82-261

ISSN 1007-9327ISSN 2219-2840 (online)

A Weekly Journal of Gastroenterology and Hepatology

Published by Baishideng Publishing Group Co., Limited,Room 1701, 17/F, Henan Building,

No. 90 Jaffe Road, Wanchai, Hong Kong, ChinaFax: +852-3115-8812

Telephone: +852-5804-2046E-mail: baishideng@wjgnet.com

http://www.wjgnet.com

ISSN 1007-9327 (print)ISSN 2219-2840 (online)

I S S N 1 0 0 7 - 9 3 2 7

9 7 7 1 0 07 9 3 2 0 45

4 7

The World Journal of Gastroenterology Editorial Board consists of 1144 members, representing a team of worldwide experts in gastroenterology and hepatology. They are from 60 countries, including Albania (1), Argentina (8), Australia (29), Austria (14), Belgium (12), Brazil (10), Brunei Darussalam (1), Bulgaria (2), Canada (20), Chile (3), China (69), Colombia (1), Croatia (2), Cuba (1), Czech (4), Denmark (8), Ecuador (1), Egypt (2), Estonia (2), Finland (8), France (24), Germany (75), Greece (14), Hungary (10), India (26), Iran (6), Ireland (7), Israel (12), Italy (101), Japan (112), Jordan (1), Kuwait (1), Lebanon (3), Lithuania (2), Malaysia (1), Mexico (10), Moldova (1), Netherlands (29), New Zealand (2), Norway (11), Pakistan (2), Poland (11), Portugal (4), Romania (3), Russia (1), Saudi Arabia (3), Serbia (3), Singapore (10), South Africa (2), South Korea (32), Spain (38), Sweden (18), Switzerland (11), Thailand (1), Trinidad and Tobago (1), Turkey (24), United Arab Emirates (2), United Kingdom (82), United States (249), and Uruguay (1).

Editorial Board2010-2013

HONORARY EDITORS-IN-CHIEFJames L Boyer, New HavenKe-Ji Chen, BeijingMartin H Floch, New HavenEmmet B Keeffe, Palo AltoGeng-Tao Liu, BeijingLein-Ray Mo, TainanEamonn M Quigley, CorkRafiq A Sheikh, SacramentoNicholas J Talley, RochesterMing-Lung Yu, Kaohsiung

PRESIDENT AND EDITOR-IN-CHIEFLian-Sheng Ma, Beijing

ACADEMIC EDITOR-IN-CHIEFTauseef Ali, Oklahoma CityMauro Bortolotti, BolognaTarkan Karakan, AnkaraWeekitt Kittisupamongkol, BangkokAnastasios Koulaouzidis, EdinburghBo-Rong Pan, Xi’anSylvia LF Pender, SouthamptonMax S Petrov, AucklandGeorge Y Wu, Farmington

STRATEGY ASSOCIATE EDITORS-IN-CHIEFPeter Draganov, FloridaHugh J Freeman, VancouverMaria C Gutiérrez-Ruiz, MexicoKazuhiro Hanazaki, KochiAkio Inui, KagoshimaKalpesh Jani, BarodaJavier S Martin, Punta del Este

Natalia A Osna, OmahaWei Tang, TokyoAlan BR Thomson, EdmontonHarry HX Xia, HanoverJesus K Yamamoto-Furusho, MexicoYoshio Yamaoka, Houston

ASSOCIATE EDITORS-IN-CHIEFYou-Yong Lu, BeijingJohn M Luk, SingaporeHiroshi Shimada, Yokohama

GUEST EDITORIAL BOARD MEMBERSChien-Jen Chen, TaipeiYang-Yuan Chen, ChanghuaJen-Hwey Chiu, TaipeiSeng-Kee Chuah, KaohsiungWan-Long Chuang, KaohsiunMing-Chih Hou, TaipeiKevin Cheng-Wen Hsiao, TaipeiPo-Shiuan Hsieh, TaipeiTsung-Hui Hu, KaohsiungWen-Hsin Huang, TaichungChao-Hung Hung, KaohsiungI-Rue Lai, TaipeiTeng-Yu Lee, TaichungChing Chung Lin, TaipeiHui-Kang Liu, TaipeiHon-Yi Shi, KaohsiungChih-Chi Wang, KaohsiungJin-Town Wang, TaipeiCheng-Shyong Wu, Chia-YiJaw-Ching Wu, TaipeiJiunn-Jong Wu, TainanMing-Shiang Wu, Taipei

Ta-Sen Yeh, TaoyuanHsu-Heng Yen, ChanghuaMing-Whei Yu, Taipei

MEMBERS OF THE EDITORIAL BOARD

Albania

Bashkim Resuli, Tirana

Argentina

Julio H Carri, CórdobaEduardo de Santibañes, Buenos AiresBernardo Frider, Buenos AiresCarlos J Pirola, Buenos AiresBernabe Matias Quesada, Buenos AiresSilvia Sookoian, Buenos AiresAdriana M Torres, RosarioMaria Ines Vaccaro, Buenos Aires

Australia

Leon Anton Adams, NedlandsRichard Anderson, VictoriaMinoti V Apte, New South WalesAndrew V Biankin, SydneyFilip Braet, SydneyChristopher Christophi, MelbournePhilip G Dinning, KoagarahGuy D Eslick, SydneyMichael A Fink, Melbourne

January 7, 2010IWJG|www.wjgnet.com

Robert JL Fraser, Daw ParkJacob George, WestmeadMark D Gorrell, SydneyAlexander G Heriot, MelbourneMichael Horowitz, AdelaideJohn E Kellow, SydneyWilliam Kemp, MelbourneFinlay A Macrae, VictoriaDaniel Markovich, BrisbaneVance Matthews, MelbournePhillip S Oates, PerthShan Rajendra, TasmaniaRajvinder Singh, Elizabeth ValeRoss C Smith, SydneyKevin J Spring, BrisbaneNathan Subramaniam, BrisbanePhil Sutton, MelbourneCuong D Tran, North AdelaideDebbie Trinder, FremantleDavid Ian Watson, Bedford Park

Austria

Herwig R Cerwenka, GrazAshraf Dahaba, GrazPeter Ferenci, ViennaValentin Fuhrmann, ViennaAlfred Gangl, ViennaAlexander M Hirschl, WienKurt Lenz, LinzDietmar Öfner, SalzburgMarkus Peck-Radosavljevic, ViennaMarkus Raderer, ViennaStefan Riss, ViennaGeorg Roth, ViennaMichael Trauner, GrazThomas Wild, Kapellerfeld

Belgium

Rudi Beyaert, GentBenedicte Y De Winter, AntwerpInge I Depoortere, LeuvenOlivier Detry, LiègePhilip Meuleman, GhentMarc Peeters, De PintelaanFreddy Penninckx, LeuvenJean-Yves L Reginster, LiègeMark De Ridder, BrusselsEtienne M Sokal, BrusselsKristin Verbeke, LeuvenEddie Wisse, Keerbergen

Brazil

José LF Caboclo, São José do Rio PretoRoberto J Carvalho-Filho, São PauloJaime Natan Eisig, São PauloAndre Castro Lyra, SalvadorMarcelo Lima Ribeiro, Braganca Paulista Joao Batista Teixeira Rocha, Santa MariaHeitor Rosa, GoianiaDamiao C Moraes Santos, Rio de JaneiroAna Cristina Simões e Silva, Belo HorizonteEduardo Garcia Vilela, Belo Horizonte

Brunei Darussalam

Vui Heng Chong, Bandar Seri Begawan

Bulgaria

Zahariy Krastev, SofiaMihaela Petrova, Sofia

Canada

Alain Bitton, MontrealMichael F Byrne, VancouverKris Chadee, CalgaryWangxue Chen, OttawaRam Prakash Galwa, OttawaPhilip H Gordon, MontrealWaliul Khan, OntarioQiang Liu, SaskatoonJohn K Marshall, OntarioAndrew L Mason, AlbertaKostas Pantopoulos, QuebecNathalie Perreault, SherbrookeBaljinder Singh Salh, VancouverEldon Shaffer, CalgaryMartin Storr, CalgaryPingchang Yang, HamiltonEric M Yoshida, VancouverClaudia Zwingmann, Montreal

Chile

Marcelo A Beltran, La SerenaXabier De Aretxabala, SantiagoSilvana Zanlungo, Santiago

China

Hui-Jie Bian, Xi’anSan-Jun Cai, ShanghaiGuang-Wen Cao, ShanghaiXiao-Ping Chen, WuhanChi-Hin Cho, Hong KongZong-Jie Cui, Beijing Jing-Yuan Fang, ShanghaiDe-Liang Fu, ShanghaiZe-Guang Han, ShanghaiChun-Yi Hao, BeijingMing-Liang He, Hong KongChing-Lung Lai, Hong KongSimon Law, Hong KongYuk-Tong Lee, Hong KongEn-Min Li, ShantouFei Li, BeijingYu-Yuan Li, GuangzhouZhao-Shen Li, ShanghaiXing-Hua Lu, BeijingYi-Min Mao, ShanghaiQin Su, BeijingPaul Kwong-Hang Tam, Hong KongYuk Him Tam, Hong KongRen-Xiang Tan, NanjingWei-Dong Tong, ChongqingEric WC Tse, Hong Kong

Fu-Sheng Wang, BeijingXiang-Dong Wang, ShanghaiNathalie Wong, Hong KongJustin CY Wu, Hong KongWen-Rong Xu, ZhenjiangAn-Gang Yang, Xi’an Wei-Cheng You, BeijingChun-Qing Zhang, JinanJian-Zhong Zhang, Beijing Xiao-Peng Zhang, BeijingXuan Zhang, Beijing

Colombia

Germán Campuzano-Maya, Medellín

Croatia

Tamara Cacev, ZagrebMarko Duvnjak, Zagreb

Cuba

Damian C Rodriguez, Havana

Czech

Jan Bures, Hradec KraloveMilan Jirsa, PrahaMarcela Kopacova, Hradec KralovePavel Trunečka, Prague

Denmark

Leif Percival Andersen, CopenhagenAsbjørn M Drewes, AalborgMorten Frisch, CopenhagenJan Mollenhauer, OdenseMorten Hylander Møller, HolteSøren Rafaelsen, VejleJorgen Rask-Madsen, SkodsborgPeer Wille-Jørgensen, Copenhagen

Ecuador

Fernando E Sempértegui, Quito

Egypt

Zeinab Nabil Ahmed, CairoHussein M Atta, El-Minia

Estonia

Riina Salupere, TartuTamara Vorobjova, Tartu

Finland

Saila Kauhanen, Turku

January 7, 2010IIWJG|www.wjgnet.com

Thomas Kietzmann, OuluKaija-Leena Kolho, HelsinkiJukka-Pekka Mecklin, JyvaskylaMinna Nyström, HelsinkiPauli Antero Puolakkainen, TurkuJuhani Sand, TampereLea Veijola, Helsinki

France

Claire Bonithon-Kopp, DijonLionel Bueno, ToulouseSabine Colnot, ParisCatherine Daniel, Lille CedexAlexis Desmoulière, LimogesThabut Dominique, ParisFrancoise L Fabiani, AngersJean-Luc Faucheron, GrenobleJean Paul Galmiche, Nantes cedexBoris Guiu, DijonPaul Hofman, NiceLaurent Huwart, ParisJuan Iovanna, MarseilleAbdel-Majid Khatib, ParisPhilippe Lehours, BordeauxFlavio Maina, MarseillePatrick Marcellin, ParisRene Gerolami Santandera, MarseilleAnnie Schmid-Alliana, Nice cedexAlain L Servin, Châtenay-MalabryStephane Supiot, NantesBaumert F Thomas, StrasbourgJean-Jacques Tuech, RouenFrank Zerbib, Bordeaux Cedex

Germany

Erwin Biecker, SiegburgHubert Blum, Freiburg Thomas Bock, TuebingenDean Bogoevski, HamburgElfriede Bollschweiler, KölnJürgen Borlak, HannoverChrista Buechler, RegensburgJürgen Büning, LübeckElke Cario, EssenBruno Christ, Halle/SaaleChristoph F Dietrich, Bad Mergentheim Ulrich R Fölsch, Kiel Nikolaus Gassler, AachenMarkus Gerhard, MunichDieter Glebe, GiessenRalph Graeser, FreiburgAxel M Gressner, AachenNils Habbe, MarburgThilo Hackert, HeidelbergWolfgang Hagmann, HeidelbergDirk Haller, FreisingPhilip D Hard, GiessenClaus Hellerbrand, RegensburgKlaus R Herrlinger, StuttgartEberhard Hildt, BerlinAndrea Hille, GoettingenJoerg C Hoffmann, BerlinPhilipe N Khalil, MunichAndrej Khandoga, MunichJorg Kleeff, MunichIngmar Königsrainer, TübingenPeter Konturek, Erlangen

Stefan Kubicka, HannoverJoachim Labenz, SiegenMichael Linnebacher, RostockJutta Elisabeth Lüttges, RiegelsbergPeter Malfertheiner, MagdeburgOliver Mann, HamburgPeter N Meier, HannoverSabine Mihm, GöttingenKlaus Mönkemüller, BottropJonas Mudter, ErlangenSebastian Mueller, HeidelbergRobert Obermaier, FreiburgMatthias Ocker, ErlangenStephan Johannes Ott, KielGustav Paumgartner, MunichChristoph Reichel, Bad Brückenau Markus Reiser, BochumSteffen Rickes, MagdeburgElke Roeb, GiessenChristian Rust, MunichHans Scherubl, BerlinMartin K Schilling, HomburgJoerg F Schlaak, EssenRene Schmidt, FreiburgAndreas G Schreyer, RegensburgKarsten Schulmann, BochumHenning Schulze-Bergkamen, MainzManfred V Singer, MannheimJens Standop, BonnJurgen M Stein, Frankfurt Ulrike S Stein, BerlinWolfgang R Stremmel, Heidelberg Harald F Teutsch, Ulm Hans L Tillmann, LeipzigChristian Trautwein, AachenJoerg Trojan, FrankfurtArndt Vogel, HannoverSiegfried Wagner, DeggendorfFrank Ulrich Weiss, GreifswaldFritz von Weizsäcker, BerlinThomas Wex, MagdeburgStefan Wirth, WuppertalMarty Zdichavsky, Tübingen

Greece

Helen Christopoulou-Aletra, ThessalonikiT Choli-Papadopoulou, ThessalonikiTsianos Epameinondas, IoanninaIoannis Kanellos, ThessalonikiElias A Kouroumalis, Heraklion Ioannis E Koutroubakis, HeraklionMichael Koutsilieris, AthensAndreas Larentzakis, AthensEmanuel K Manesis, AthensSpilios Manolakopoulos, AthensKonstantinos Mimidis, AlexandroupolisGeorge Papatheodoridis, AthensSpiros Sgouros, Athens Evangelos Tsiambas, Ag Paraskevi Attiki

Hungary

György M Buzás, BudapestLászló Czakó, SzegedGyula Farkas, SzegedPeter Hegyi, SzegedPeter L Lakatos, Budapest

Yvette Mándi, SzegedZoltan Rakonczay, SzegedFerenc Sipos, BudapestZsuzsa Szondy, DebrecenGabor Veres, Budapest

India

Philip Abraham, MumbaiVineet Ahuja, New DelhiGiriraj Ratan Chandak, HyderabadDevinder Kumar Dhawan, ChandigarhRadha K Dhiman, Chandigarh Pankaj Garg, PanchkulaPramod Kumar Garg, New DelhiDebidas Ghosh, MidnporeUday C Ghoshal, LucknowBhupendra Kumar Jain, DelhiAshok Kumar, LucknowBikash Medhi, ChandigarhSri P Misra, Allahabad Gopal Nath, VaranasiSamiran Nundy, New DelhiJagannath Palepu, MumbaiVandana Panda, MumbaiBenjamin Perakath, Tamil NaduRamesh Roop Rai, JaipurNageshwar D Reddy, HyderabadBarjesh Chander Sharma, New DelhiVirendra Singh, ChandigarhRupjyoti Talukdar, GuwahatiRakesh Kumar Tandon, New DelhiJai Dev Wig, Chandigarh

Iran

Mohammad Abdollahi, TehranPeyman Adibi, IsfahanSeyed-Moayed Alavian, TehranSeyed Mohsen Dehghani, ShirazReza Malekzadeh, TehranAlireza Mani, Tehran

Ireland

Billy Bourke, DublinTed Dinan, CorkCatherine Greene, DublinRoss McManus, DublinAnthony P Moran, GalwayMarion Rowland, Dublin

Israel

Simon Bar-Meir, HashomerAlexander Becker, AfulaAbraham R Eliakim, Haifa Sigal Fishman, Tel AvivBoris Kirshtein, Beer ShevaEli Magen, AshdodMenachem Moshkowitz, Tel-AvivAssy Nimer, SafedShmuel Odes, Beer ShevaMark Pines, Bet DaganRon Shaoul, HaifaAmi D Sperber, Beer-Sheva

January 7, 2010IIIWJG|www.wjgnet.com

Italy

Donato F Altomare, BariPiero Amodio, PadovaAngelo Andriulli, San Giovanni RotondoPaolo Angeli, PadovaBruno Annibale, RomePaolo Aurello, RomeSalvatore Auricchio, NaplesAntonio Basoli, RomeClaudio Bassi, VeronaGabrio Bassotti, Perugia Mauro Bernardi, BolognaAlberto Biondi, RomeLuigi Bonavina, Milano Guglielmo Borgia, NaplesRoberto Berni Canani, NaplesMaria Gabriella Caruso, BariFausto Catena, BolognaGiuseppe Chiarioni, ValeggioMichele Cicala, RomeDario Conte, Milano Francesco Costa, PisaAntonio Craxì, PalermoSalvatore Cucchiara, RomeGiuseppe Currò, MessinaMario M D’Elios, FlorenceMirko D’Onofrio, VeronaSilvio Danese, MilanoRoberto de Franchis, MilanoPaola De Nardi, MilanGiovanni D De Palma, NaplesGiuliana Decorti, TriesteGianlorenzo Dionigi, VareseMassimo Falconi, VeronaSilvia Fargion, MilanGiammarco Fava, AnconaFrancesco Feo, SassariAlessandra Ferlini, FerraraAlessandro Ferrero, TorinoMirella Fraquelli, MilanLuca Frulloni, VeronaGiovanni B Gaeta, NapoliAntonio Gasbarrini, RomeEdoardo G Giannini, Genoa Alessandro Granito, BolognaFabio Grizzi, MilanSalvatore Gruttadauria, PalermoPietro Invernizzi, MilanAchille Iolascon, NaplesAngelo A Izzo, NaplesEzio Laconi, CagliariGiovanni Latella, L’AquilaMassimo Levrero, RomeFrancesco Luzza, CatanzaroLucia Malaguarnera, CataniaFrancesco Manguso, NapoliPier Mannuccio Mannucci, MilanGiancarlo Mansueto, VeronaGiulio Marchesini, Bologna Mara Massimi, CoppitoGiovanni Milito, RomeGiuseppe Montalto, Palermo Giovanni Monteleone, RomeLuca Morelli, TrentoGiovanni Musso, TorinoMario Nano, TorinoGerardo Nardone, NapoliRiccardo Nascimbeni, BresciaValerio Nobili, RomeFabio Pace, MilanNadia Peparini, Rome

Marcello Persico, NaplesMario Pescatori, RomeRaffaele Pezzilli, Bologna Alberto Piperno, MonzaAnna C Piscaglia, RomePiero Portincasa, Bari Michele Reni, MilanVittorio Ricci, PaviaOliviero Riggio, RomeMario Rizzetto, TorinoBallarin Roberto, ModenaGerardo Rosati, PotenzaFranco Roviello, SienaCesare Ruffolo, TrevisoMassimo Rugge, PadovaMarco Scarpa, PadovaC armelo Scarpignato, ParmaGiuseppe Sica, RomeMarco Silano, RomePierpaolo Sileri, RomeVincenzo Stanghellini, BolognaFiorucci Stefano, PerugiaGiovanni Tarantino, NaplesAlberto Tommasini, TriesteGuido Torzilli, Rozzano MilanCesare Tosetti, Porretta TermeAntonello Trecca, RomeVincenzo Villanacci, BresciaLucia Ricci Vitiani, RomeMarco Vivarelli, Bologna

Japan

Kyoichi Adachi, Izumo Yasushi Adachi, SapporoTakafumi Ando, Nagoya Akira Andoh, OtsuMasahiro Arai, Tokyo Hitoshi Asakura, TokyoKazuo Chijiiwa, MiyazakiYuichiro Eguchi, SagaItaru Endo, YokohamaMunechika Enjoji, FukuokaYasuhiro Fujino, AkashiMitsuhiro Fujishiro, TokyoKouhei Fukushima, SendaiMasanori Hatakeyama, TokyoKeiji Hirata, KitakyushuToru Hiyama, HigashihiroshimaMasahiro Iizuka, Akita Susumu Ikehara, OsakaKenichi Ikejima, Bunkyo-kuYutaka Inagaki, KanagawaHiromi Ishibashi, Nagasaki Shunji Ishihara, Izumo Toru Ishikawa, Niigata Toshiyuki Ishiwata, Tokyo Hajime Isomoto, NagasakiYoshiaki Iwasaki, OkayamaSatoru Kakizaki, GunmaTerumi Kamisawa, TokyoMototsugu Kato, Sapporo Naoya Kato, TokyoTakumi Kawaguchi, KurumeYohei Kida, KainanShogo Kikuchi, AichiTsuneo Kitamura, Chiba Takashi Kobayashi, TokyoYasuhiro Koga, IseharaTakashi Kojima, SapporoNorihiro Kokudo, TokyoMasatoshi Kudo, OsakaShin Maeda, Tokyo

Satoshi Mamori, HyogoAtsushi Masamune, SendaiYasushi Matsuzaki, Tsukuba Kenji Miki, TokyoToshihiro Mitaka, SapporoHiroto Miwa, Hyogo Kotaro Miyake, TokushimaManabu Morimoto, YokohamaYoshiharu Motoo, Kanazawa Yoshiaki Murakami, HiroshimaYoshiki Murakami, KyotoKunihiko Murase, Tusima Akihito Nagahara, TokyoYuji Naito, Kyoto Atsushi Nakajima, YokohamaHisato Nakajima, Tokyo Hiroki Nakamura, Yamaguchi Shotaro Nakamura, FukuokaAkimasa Nakao, NagogyaShuhei Nishiguchi, HyogoMikio Nishioka, Niihama Keiji Ogura, TokyoSusumu Ohmada, Maebashi Hirohide Ohnishi, AkitaKenji Okajima, NagoyaKazuichi Okazaki, OsakaMorikazu Onji, EhimeSatoshi Osawa, Hamamatsu Hidetsugu Saito, TokyoYutaka Saito, TokyoNaoaki Sakata, SendaiYasushi Sano, ChibaTokihiko Sawada, TochigiTomohiko Shimatan, HiroshimaYukihiro Shimizu, KyotoShinji Shimoda, FukuokaYoshio Shirai, Niigata Masayuki Sho, NaraShoichiro Sumi, KyotoHidekazu Suzuki, TokyoMasahiro Tajika, NagoyaYoshihisa Takahashi, TokyoToshinari Takamura, KanazawaHiroaki Takeuchi, KochiYoshitaka Takuma, OkayamaAkihiro Tamori, OsakaAtsushi Tanaka, TokyoShinji Tanaka, Hiroshima Satoshi Tanno, HokkaidoShinji Togo, YokohamaHitoshi Tsuda, TokyoHiroyuki Uehara, OsakaMasahito Uemura, KashiharaYoshiyuki Ueno, SendaiMitsuyoshi Urashima, TokyoTakuya Watanabe, NiigataSatoshi Yamagiwa, NiigataTaketo Yamaguchi, ChibaMitsunori Yamakawa, YamagataTakayuki Yamamoto, Yokkaichi Yutaka Yata, MaebashiHiroshi Yoshida, Tokyo Norimasa Yoshida, Kyoto Yuichi Yoshida, OsakaKentaro Yoshika, ToyoakeHitoshi Yoshiji, NaraKatsutoshi Yoshizato, HigashihiroshimaTomoharu Yoshizumi, Fukuoka

Jordan

Ismail Matalka, Irbid

January 7, 2010IVWJG|www.wjgnet.com

Kuwait

Islam Khan, Safat

Lebanon

Bassam N Abboud, BeirutAla I Sharara, BeirutRita Slim, Beirut

Lithuania

Giedrius Barauskas, KaunasLimas Kupcinskas, Kaunas

Malaysia

Andrew Seng Boon Chua, Ipoh

Mexico

Richard A Awad, MexicoAldo Torre Delgadillo, MexicoDiego Garcia-Compean, MonterreyPaulino M Hernández Magro, CelayaMiguel Angel Mercado, Distrito FederalArturo Panduro, JaliscoOmar Vergara-Fernandez, TlalpanSaúl Villa-Trevio, Mexico

Moldova

Igor Mishin, Kishinev

Netherlands

Ulrich Beuers, AmsterdamLee Bouwman, LeidenAlbert J Bredenoord, NieuwegeinLodewijk AA Brosens, UtrechtJ Bart A Crusius, AmsterdamWouter de Herder, RotterdamPieter JF de Jonge, RotterdamRobert J de Knegt, RotterdamWendy W Johanna de Leng, UtrechtAnnemarie de Vries, RotterdamJames CH Hardwick, LeidenFrank Hoentjen, HaarlemMisha Luyer, SittardJeroen Maljaars, MaastrichtGerrit A Meijer, AmsterdamServaas Morré, AmsterdamChris JJ Mulder, Amsterdam John Plukker, Groningen Albert Frederik Pull ter Gunne, TilburgPaul E Sijens, GroningenBW Marcel Spanier, ArnhemShiri Sverdlov, MaastrichtMaarten Tushuizen, AmsterdamJantine van Baal, HeidelberglaanAstrid van der Velde, The HagueKarel van Erpecum, Utrecht Loes van Keimpema, Nijmegen

Robert Christiaan Verdonk, GroningenErwin G Zoetendal, Wageningen

New Zealand

Andrew S Day, Christchurch

Norway

Olav Dalgard, OsloTrond Peder Flaten, TrondheimReidar Fossmark, TrondheimRasmus Goll, TromsoOle Høie, ArendalAsle W Medhus, OsloEspen Melum, OsloTrine Olsen, TromsoEyvind J Paulssen, TromsoJon Arne Søreide, StavangerKjetil Soreide, Stavanger

Pakistan

Shahab Abid, KarachiSyed MW Jafri, Karachi

Poland

Marek Bebenek, WroclawTomasz Brzozowski, Cracow Halina Cichoż-Lach, LublinAndrzej Dabrowski, BialystokHanna Gregorek, WarsawMarek Hartleb, KatowiceBeata Jolanta Jablońska, KatowiceStanislaw J Konturek, KrakowJan Kulig, KrakowDariusz M Lebensztejn, BialystokJulian Swierczynski, Gdansk

Portugal

Raquel Almeida, PortoAna Isabel Lopes, Lisboa CodexRicardo Marcos, PortoGuida Portela-Gomes, Estoril

Romania

Dan L Dumitrascu, ClujAdrian Saftoiu, CraiovaAndrada Seicean, Cluj-Napoca

Russia

Vasiliy I Reshetnyak, Moscow

Saudi Arabia

Ibrahim A Al Mofleh, RiyadhAbdul-Wahed Meshikhes, QatifFaisal Sanai, Riyadh

Serbia

Tamara M Alempijevic, BelgradeDusan M Jovanovic, Sremska KamenicaZoran Krivokapic, Belgrade

Singapore

Madhav Bhatia, SingaporeKong Weng Eu, SingaporeBrian Kim Poh Goh, SingaporeKhek-Yu Ho, Singapore Kok Sun Ho, SingaporeFock Kwong Ming, SingaporeLondon Lucien Ooi, SingaporeNagarajan Perumal, SingaporeFrancis Seow-Choen, Singapore

South Africa

Rosemary Joyce Burnett, PretoriaMichael Kew, Cape Town

South Korea

Sang Hoon Ahn, SeoulSung-Gil Chi, SeoulMyung-Gyu Choi, SeoulHoon Jai Chun, SeoulYeun-Jun Chung, SeoulYoung-Hwa Chung, SeoulKim Donghee, SeoulKi-Baik Hahm, IncheonSun Pyo Hong, Geonggi-doSeong Gyu Hwang, SeongnamHong Joo Kim, SeoulJae J Kim, SeoulJin-Hong Kim, Suwon Nayoung Kim, Seongnam-siSang Geon Kim, SeoulSeon Hahn Kim, SeoulSung Kim, SeoulWon Ho Kim, SeoulJeong Min Lee, SeoulKyu Taek Lee, Seoul Sang Kil Lee, SeoulSang Yeoup Lee, Gyeongsangnam-doYong Chan Lee, SeoulEun-Yi Moon, SeoulHyoung-Chul Oh, SeoulSeung Woon Paik, SeoulJoong-Won Park, GoyangJi Kon Ryu, SeoulSi Young Song, SeoulMarie Yeo, Suwon Byung Chul Yoo, SeoulDae-Yeul Yu, Daejeon

Spain

Maria-Angeles Aller, MadridRaul J Andrade, MálagaLuis Aparisi, ValenciaGloria González Aseguinolaza, NavarraMatias A Avila, Pamplona

January 7, 2010VWJG|www.wjgnet.com

Fernando Azpiroz, Barcelona Ramon Bataller, BarcelonaBelén Beltrán, ValenciaAdolfo Benages, ValenciaJosep M Bordas, Barcelona Lisardo Boscá, MadridLuis Bujanda, San SebastiánJuli Busquets, BarcelonaMatilde Bustos, PamplonaJosé Julián calvo Andrés, SalamancaAndres Cardenas, BarcelonaAntoni Castells, Barcelona Fernando J Corrales, PamplonaJ E Domínguez-Muñoz, Santiago de CompostelaJuan Carlos Laguna Egea, BarcelonaIsabel Fabregat, BarcelonaAntoni Farré, BarcelonaVicente Felipo, ValenciaLaureano Fernández-Cruz, BarcelonaLuis Grande, BarcelonaAngel Lanas, Zaragoza Juan-Ramón Larrubia, GuadalajaraMaría IT López, JaénJuan Macías, SevilleJavier Martin, GranadaJosé Manuel Martin-Villa, MadridJulio Mayol, MadridMireia Miquel, SabadellAlbert Parés, BarcelonaJesús M Prieto, Pamplona Pedro L Majano Rodriguez, MadridJoan Roselló-Catafau, BarcelonaEva Vaquero, Barcelona

Sweden

Lars Erik Agréus, StockholmMats Andersson, StockholmRoland Andersson, LundMauro D’Amato, HuddingeEvangelos Kalaitzakis, GothenburgGreger Lindberg, Stockholm Annika Lindblom, StockholmSara Lindén, GöteborgHanns-Ulrich Marschall, StockholmPär Erik Myrelid, LinköpingÅke Nilsson, LundHelena Nordenstedt, StockholmKjell Öberg, UppsalaLars A Pahlman, UppsalaStefan G Pierzynowski, LundSara Regnér, MalmöBobby Tingstedt, LundZongli Zheng, Stockholm

Switzerland

Pascal Bucher, GenevaMichelangelo Foti, GenevaJean L Frossard, GenevaAndreas Geier, ZürichPascal Gervaz, GenevaGerd A Kullak-Ublick, ZürichFabrizio Montecucco, GenevaPaul M Schneider, ZürichFelix Stickel, BerneBruno Stieger, ZürichInti Zlobec, Basel

Trinidad and Tobago

Shivananda Nayak, Mount Hope

Turkey

Sinan Akay, TekirdagMetin Basaranoglu, IstanbulYusuf Bayraktar, AnkaraA Mithat Bozdayi, AnkaraHayrullah Derici, BalıkesirEren Ersoy, AnkaraMukaddes Esrefoglu, MalatyaCan Goen, KutahyaSelin Kapan, IstanbulAydin Karabacakoglu, KonyaCuneyt Kayaalp, MalatyaKemal Kismet, AnkaraSeyfettin Köklü, AnkaraMehmet Refik Mas, Etlik-AnkaraOsman C Ozdogan, IstanbulBülent Salman, AnkaraOrhan Sezgin, MersinIlker Tasci, AnkaraMüge Tecder-Ünal, AnkaraAhmet Tekin, MersinMesut Tez, AnkaraEkmel Tezel, AnkaraÖzlem Yilmaz, Izmir

United Arab Emirates

Fikri M Abu-Zidan, Al-AinSherif M Karam, Al-Ain

United Kingdom

Simon Afford, BirminghamNavneet K Ahluwalia, StockportMohamed H Ahmed, SouthamptonBasil Ammori, SalfordLesley A Anderson, BelfastChin Wee Ang, LiverpoolYeng S Ang, WiganAnthony TR Axon, Leeds Kathleen B Bamford, LondonJim D Bell, LondonJohn Beynon, SwanseaChris Briggs, SheffieldGeoffrey Burnstock, LondonAlastair D Burt, NewcastleJeff Butterworth, ShrewsburyJeremy FL Cobbold, LondonJean E Crabtree, LeedsTatjana Crnogorac-Jurcevic, LondonWilliam Dickey, LondonderrySunil Dolwani, Cardiff Emad M El-Omar, AberdeenA M El-Tawil, BirminghamCharles B Ferguson, BelfastAndrew Fowell, SouthamptonPiers Gatenby, LondonDaniel R Gaya, EdinburghAnil George, LondonRob Glynne-Jones, NorthwoodJason CB Goh, BirminghamGianpiero Gravante, Leicester

Brian Green, BelfastWilliam Greenhalf, Liverpool Indra N Guha, NottinghamStefan G Hübscher, BirminghamRobin Hughes, LondonPali Hungin, StocktonNawfal Hussein, NottinghamClement W Imrie, GlasgowJanusz AZ Jankowski, Oxford Sharad Karandikar, BirminghamPeter Karayiannis, LondonShahid A Khan, LondonPatricia F Lalor, BirminghamJohn S Leeds, SheffieldIan Lindsey, OxfordHong-Xiang Liu, Cambridge Dileep N Lobo, NottinghamGraham MacKay, GlasgowMark Edward McAlindon, SheffieldAnne McCune, BristolDonald Campbell McMillan, GlasgowGiorgina Mieli-Vergani, London Jamie Murphy, LondonGuy Fairbairn Nash, PooleJames Neuberger, Birmingham Patrick O’Dwyer, GlasgowChristos Paraskeva, BristolRichard Parker, North StaffordshireThamara Perera, BirminghamKondragunta Rajendra Prasad, LeedsD Mark Pritchard, LiverpoolAlberto Quaglia, LondonAkhilesh B Reddy, CambridgeKevin Robertson, GlasgowSanchoy Sarkar, LiverpoolJohn B Schofield, KentMarco Senzolo, PadovaVenkatesh Shanmugam, DerbyPaul Sharp, LondonChew Thean Soon, ManchesterAravind Suppiah, East YorkshireNoriko Suzuki, MiddlesexSimon D Taylor-Robinson, London Frank I Tovey, LondonA McCulloch Veitch, WolverhamptonVamsi R Velchuru, LowestoftSumita Verma, BrightonCatherine Walter, CheltenhamJulian RF Walters, LondonRoger Williams, London

United States

Kareem M Abu-Elmagd, PittsburghSami R Achem, FloridaGolo Ahlenstiel, BethesdaBhupinder S Anand, HoustonM Ananthanarayanan, New YorkBalamurugan N Appakalal, MinneapolisDimitrios V Avgerinos, New YorkShashi Bala, WorcesterAnthony J Bauer, PittsburghKevin E Behrns, GainesvilleRoberto Bergamaschi, New York Henry J Binder, New HavenEdmund J Bini, New YorkWojciech Blonski, PhiladelphiaMark Bloomston, ColumbusEdward L Bradley III, SarasotaCarla W Brady, Durham

January 7, 2010VIWJG|www.wjgnet.com

David A Brenner, San DiegoAdeel A Butt, PittsburghShi-Ying Cai, New HavenJustin MM Cates, NashvilleEugene P Ceppa, DurhamJianyuan Chai, Long BeachRonald S Chamberlain, LivingstonFei Chen, MorgantownXian-Ming Chen, Omaha Ramsey Chi-man Cheung, Palo AltoDenesh Chitkara, East BrunswickClifford S Cho, MadisonParimal Chowdhury, ArkansasJohn David Christein, BirminghamThomas Clancy, BostonAna J Coito, Los AngelesRicardo Alberto Cruciani, New YorkJoseph J Cullen, Iowa CityMark J Czaja, New YorkMariana D Dabeva, BronxJessica A Davila, HoustonConor P Delaney, ClevelandLaurie DeLeve, Los AngelesAnthony J Demetris, PittsburghSharon DeMorrow, TempleBijan Eghtesad, ClevelandYoram Elitsur, HuntingtonMohamad A Eloubeidi, AlabamaWael El-Rifai, NashvilleSukru H Emre, New HavenGiamila Fantuzzi, ChicagoAshkan Farhadi, Irvine Ronnie Fass, TucsonMartín E Fernández-Zapico, RochesterAlessandro Fichera, ChicagoJosef E Fischer, BostonPiero Marco Fisichella, Maywood Fritz Francois, New YorkGlenn T Furuta, AuroraT Clark Gamblin, Pittsburgh Henning Gerke, Iowa CityJean-Francois Geschwind, BaltimoreR Mark Ghobrial, TexasJohn F Gibbs, BuffaloShannon S Glaser, TempleAjay Goel, DallasJon C Gould, MadisonEileen F Grady, San FranciscoJames H Grendell, New YorkJohn R Grider, RichmondAnna S Gukovskaya, Los Angeles Chakshu Gupta, St. JosephGrigoriy E Gurvits, New YorkHai-Yong Han, PhoenixYuan-Ping Han, Los AngelesImran Hassan, SpringfieldCharles P Heise, MadisonLisa J Herrinton, OaklandOscar Joe Hines, Los AngelesSamuel B Ho, San DiegoSteven Hochwald, GainesvilleRichard Hu, Los AngelesEric S Hungness, ChicagoJamal A Ibdah, ColumbiaAtif Iqbal, Omaha Hartmut Jaeschke, TucsonDonald M Jensen, ChicagoRobert Jensen, BethesdaLeonard R Johnson, MemphisAndreas M Kaiser, Los AngelesJingXuan Kang, CharlestownJohn Y Kao, MichiganRandeep Singh Kashyap, New YorkRashmi Kaul, Tulsa

Jonathan D Kaunitz, Los AngelesStephen M Kavic, BaltimoreAli Keshavarzian, ChicagoAmir Maqbul Khan, MarshallKusum K Kharbanda, OmahaChang Kim, West LafayetteDean Y Kim, DetroitMiran Kim, ProvidenceBurton I Korelitz, New York Josh Korzenik, BostonRichard A Kozarek, Seattle Alyssa M Krasinskas, PittsburghShiu-Ming Kuo, Buffalo Michelle Lai, BostonMichael Leitman, New YorkDong-Hui Li, HoustonMing Li, New Orleans Zhiping Li, BaltimoreGary R Lichtenstein, Philadelphia Chen Liu, GainesvilleZhang-Xu Liu, Los AngelesCraig D Logsdon, HoustonKaye M Reid Lombardo, RochesterMichael R Lucey, MadisonKirk Ludwig, WisconsinJames D Luketich, Pittsburgh Patrick M Lynch, HoustonJohn S Macdonald, New YorkWillis C Maddrey, DallasMercedes Susan Mandell, AuroraChristopher Mantyh, DurhamWendy M Mars, PittsburghJohn Marshall, ColumbiaRobert CG Martin, LouisvilleLaura E Matarese, PittsburghCraig J McClain, LouisvilleLynne V McFarland, WashingtonDavid J McGee, ShreveportValentina Medici, SacramentoStephan Menne, New YorkDidier Merlin, AtlantaGeorge Michalopoulos, PittsburghJames M Millis, ChicagoPramod K Mistry, New HavenEmiko Mizoguchi, BostonHuanbiao Mo, DentonRobert C Moesinger, OgdenSmruti R Mohanty, ChicagoJohn Morton, StanfordPeter L Moses, BurlingtonSandeep Mukherjee, OmahaMillion Mulugeta, Los AngelesMichel M Murr, TampaPete Muscarella, ColumbusEce A Mutlu, ChicagoMasaki Nagaya, BostonLaura E Nagy, ClevelandAejaz Nasir, TampaUdayakumar Navaneethan, CincinnatiStephen JD O’Keefe, PittsburghRobert D Odze, BostonGiuseppe Orlando, Winston SalemPal Pacher, RockvilleGeorgios Papachristou, PittsburghJong Park, TampaWilliam R Parker, DurhamMansour A Parsi, ClevelandMarco Giuseppe Patti, ChicagoZhiheng Pei, New York CS Pitchumoni, New Brunswiuc Parviz M Pour, OmahaXiaofa Qin, NewarkFlorencia Georgina Que, RochesterMassimo Raimondo, Jacksonville

Raymund R Razonable, MinnesotaKevin Michael Reavis, OrangeRobert V Rege, DallasDouglas K Rex, IndianapolisVictor E Reyes, Galveston Basil Rigas, New YorkRichard A Rippe, Chapel HillAlexander S Rosemurgy, TampaPhilip Rosenthal, San FranciscoRaul J Rosenthal, WestonJoel H Rubenstein, Ann ArborShawn D Safford, NorfolkRabih M Salloum, RochesterBruce E Sands, BostonTor C Savidge, GalvestonMichael L Schilsky, New HavenBeat Schnüriger, CaliforniaRobert E Schoen, PittsburghMatthew James Schuchert, PittsburghEkihiro Seki, La JollaLe Shen, ChicagoPerry Shen, Winston-SalemStuart Sherman, Indianapolis Mitchell L Shiffman, RichmondShivendra Shukla, ColumbiaBronislaw L Slomiany, NewarkScott Steele, Fort LewisBranko Stefanovic, TallahasseeLygia Stewart, San FranciscoLuca Stocchi, ClevelandDaniel S Straus, RiversideRobert Todd Striker, MadisonJonathan Strosberg, TampaChristina Surawicz, SeattlePatricia Sylla, BostonWing-Kin Syn, DurhamYvette Taché, Los AngelesKazuaki Takabe, RichmondKam-Meng Tchou-Wong, New York Klaus Thaler, ColumbiaCharles Thomas, OregonNatalie J Torok, SacramentoGeorge Triadafilopoulos, Stanford Chung-Jyi Tsai, LexingtonThérèse Tuohy, Salt Lake CityAndrew Ukleja, FloridaSanthi Swaroop Vege, RochesterAaron Vinik, NorfolkDinesh Vyas, WashingtonArnold Wald, WisconsinScott A Waldman, PhiladelphiaJack R Wands, ProvidenceJiping Wang, BostonIrving Waxman, ChicagoWilfred M Weinstein, Los AngelesSteven D Wexner, Weston John W Wiley, Ann ArborJackie Wood, OhioJian Wu, SacramentoWen Xie, PittsburghGuang-Yin Xu, GalvestonFang Yan, NashvilleRadha Krishna Yellapu, New YorkAnthony T Yeung, PhiladelphiaZobair M Younossi, VirginiaLiqing Yu, Winston-SalemRun Yu, Los AngelesRuben Zamora, Pittsburgh Michael E Zenilman, New YorkMark A Zern, SacramentoLin Zhang, PittsburghMartin D Zielinski, RochesterMichael A Zimmerman, Colorado

January 7, 2010VIIWJG|www.wjgnet.com

5907 Reversecholesteroltransportrevisited

van der Velde AE

5908 Reversecholesteroltransport:Fromclassicalviewtonewinsights

van der Velde AE

5916 ScavengerreceptorBI:Amulti-purposeplayerincholesterolandsteroid

metabolism

Hoekstra M, Van Berkel TJC, Van Eck M

5925 Ecto-F1-ATPase:AmoonlightingproteincomplexandanunexpectedapoA-I

receptor

Vantourout P, Radojkovic C, Lichtenstein L, Pons V, Champagne E, Martinez LO

5936 Biliarycholesterolsecretion:MorethanasimpleABC

Dikkers A, Tietge UJF

5946 Anewframeworkforreversecholesteroltransport:Non-biliarycontributions

toreversecholesteroltransport

Temel RE, Brown JM

5953 Frombloodtogut:Directsecretionofcholesterolvia transintestinal

cholesterol efflux

Vrins CLJ

5958 Thyroidhormonesandthyroidhormonereceptors:Effectsofthyromimetics

onreversecholesteroltransport

Pedrelli M, Pramfalk C, Parini P

5965 MultiplexRT-PCR-baseddetectionsofCEA,CK20andEGFRincolorectal

cancerpatients

Tsouma A, Aggeli C, Lembessis P, Zografos GN, Korkolis DP, Pectasides D, Skondra M,

Pissimissis N, Tzonou A, Koutsilieris M

Contents

EDITORIAL

Weekly Volume 16 Number 47 December 21, 2010

ORIGINAL ARTICLE

TOPIC HIGHLIGHT

� December 21, 2010|Volume 16|�ssue 47|WJG|www.wjgnet.com

S

ContentsWorld Journal of Gastroenterology

Volume 16 Number 47 December 21, 2010

5975 RelationshipbetweenCOX-2andcellcycle-regulatoryproteinsinpatientswith

esophagealsquamouscellcarcinoma

Huang JX, Xiao W, Chen WC, Lin MS, Song ZX, Chen P, Zhang YL, Li FY, Qian RY,

Salminen E

5982 Benefit of combination β-blockerandendoscopictreatmenttoprevent

varicealrebleeding:Ameta-analysis

Funakoshi N, Ségalas-Largey F, Duny Y, Oberti F, Valats JC, Bismuth M, Daurès JP,

Blanc P

5993 Hepatocellularcarcinomatreatedwithtransarterialchemoembolization:

Dynamicperfusion-CTintheassessmentofresidualtumor

Ippolito D, Bonaffini PA, Ratti L, Antolini L, Corso R, Fazio F, Sironi S

6001 Immunephenotypeinchildrenwiththerapy-naïveremittedandrelapsed

Crohn’sdisease

Cseh A, Vasarhelyi B, Molnar K, Szalay B, Svec P, Treszl A, Dezsofi A, Lakatos PL, Arato A,

Tulassay T, Veres G

6010 Gastroesophageal flap valve status distinguishes clinical phenotypes of large

hiatalhernia

Kaneyama H, Kaise M, Arakawa H, Arai Y, Kanazawa K, Tajiri H

6016 Diagnosisandsurgicaltreatmentofprimaryhepaticlymphoma

Yang XW, Tan WF, Yu WL, Shi S, Wang Y, Zhang YL, Zhang YJ, Wu MC

6020 Meta-analysisofADH1BandALDH2polymorphismsandesophagealcancer

riskinChina

Zhang GH, Mai RQ, Huang B

6026 Prognosticvaluesofchromosome18qmicrosatellitealterationsinstageⅡ

coloniccarcinoma

Wang W, Wang GQ, Sun XW, Chen G, Li YF, Zhang LY, Qiu HB, Huang CY, Zhan YQ,

Zhou ZW

BRIEF ARTICLE

�� December 21, 2010|Volume 16|�ssue 47|WJG|www.wjgnet.com

ContentsWorld Journal of Gastroenterology

Volume 16 Number 47 December 21, 2010

FLYLEAF

APPENDIX

EDITORS FOR THIS ISSUE

Responsible Assistant Editor: Xiao-Fang Liu Responsible Science Editor: Lin TianResponsible Electronic Editor: Xiao-Mei Zheng Proofing Editorial Office Director: Jian-Xia ChengProofing Editor-in-Chief: Lian-Sheng Ma

NAMEOFJOURNALWorld Journal of Gastroenterology

LAUNCHDATEOctober 1, 1995

RESPONSIBLEINSTITUTIONDepartment of Science and Technology of Shanxi Province

SPONSORTaiyuan Research and Treatment Center for Digestive Diseases, 77 Shuangta Xijie, Taiyuan 030001, Shanxi Province, China

EDITINGEditorial Board of World Journal of Gastroenterology, Room 903, Building D, Ocean International Center, No. 62 Dongsihuan Zhonglu, Chaoyang District, Beijing 100025, ChinaTelephone: +86-10-5908-0039Fax: +86-10-8538-1893E-mail: wjg@wjgnet.comhttp://www.wjgnet.com

PUBLISHINGBaishideng Publishing Group Co., Limited,Room 1701, 17/F, Henan Building, No.90 Jaffe Road, Wanchai, Hong Kong, ChinaFax: +852-3115-8812Telephone: +852-5804-2046E-mail: baishideng@wjgnet.comhttp://www.wjgnet.com

SUBSCRIPTIONBeijing Baishideng BioMed Scientific Co., Ltd., Room 903, Building D, Ocean International Center, No. 62 Dongsihuan Zhonglu, Chaoyang District, Beijing 100025, ChinaTelephone: +86-10-8538-1892Fax: +86-10-8538-1893E-mail: baishideng@wjgnet.comhttp://www.wjgnet.com

PRINTSUBSCRIPTIONRMB 245 Yuan for each issue, RMB 11760 Yuan for one year.

ONLINESUBSCRIPTIONOne-Year Price 864.00 USD

PUBLICATIONDATEDecember 21, 2010

CSSNISSN 1007-9327 (print)ISSN 2219-2840 (online)

HONORARYEDITORS-IN-CHIEFJames L Boyer, New HavenKe-Ji Chen, BeijingMartin H Floch, New Haven Geng-Tao Liu, BeijingEmmet B Keeffe, Palo AltoLein-Ray Mo, TainanEamonn M Quigley, CorkRafiq A Sheikh, SacramentoNicholas J Talley, RochesterMing-Lung Yu, Kaohsiung

PRESIDENTANDEDITOR-IN-CHIEFLian-Sheng Ma, Beijing

ACADEMICEDITOR-IN-CHIEFTauseef Ali, OklahomaMauro Bortolotti, BolognaTarkan Karakan, AnkaraWeekitt Kittisupamongkol, BangkokAnastasios Koulaouzidis, EdinburghGerd A Kullak-Ublick, ZürichBo-Rong Pan, Xi’anSylvia LF Pender, Southampton Max S Petrov, AucklandGeorge Y Wu, Farmington

STRATEGYASSOCIATEEDITORS-IN-CHIEFPeter Draganov, FloridaHugh J Freeman, VancouverMaria Concepción Gutiérrez-Ruiz, MéxicoKazuhiro Hanazaki, Kochi

Akio Inui, KagoshimaKalpesh Jani, BarodaJavier S Martin, Punta del EsteNatalia A Osna, OmahaWei Tang, TokyoAlan BR Thomson, EdmontonHarry HX Xia, Hanover

ASSOCIATEEDITORS-IN-CHIEFYou-Yong Lu, BeijingJohn M Luk, PokfulamHiroshi Shimada, Yokohama

EDITORIALOFFICEJian-Xia Cheng, DirectorWorld Journal of GastroenterologyRoom 903, Building D, Ocean International Center, No. 62 Dongsihuan Zhonglu, Chaoyang District, Beijing 100025, ChinaTelephone: +86-10-5908-0039Fax: +86-10-8538-1893E-mail: wjg@wjgnet.comhttp://www.wjgnet.com

COPYRIGHT© 2010 Baishideng. All rights reserved; no part of this publication may be reproduced, stored in a re-trieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, record-ing, or otherwise without the prior permission of Baishideng. Authors are required to grant World Journal of Gastroenterology an exclusive license to publish.

SPECIALSTATEMENTAll articles published in this journal represent the viewpoints of the authors except where indicated otherwise.

INSTRUCTIONSTOAUTHORSFull instructions are available online at http://www.wjgnet.com/1007-9327/g_info_20100315215714.htm. If you do not have web access please contact the editorial office.

ONLINESUBMISSIONhttp://www.wjgnet.com/1007-9327office

AIM AND SCOPE

ACKNOWLEDGMENTS I AcknowledgmentstoreviewersofWorldJournalofGastroenterology

I Meetings

I-VI Instructionstoauthors

World Journal of Gastroenterology (World J Gastroenterol, WJG, print ISSN 1007-9327, DOI:

10.3748) is a weekly, open-access, peer-reviewed journal supported by an editorial board

of 1144 experts in gastroenterology and hepatology from 60 countries.

The major task of WJG is to report rapidly the most recent results in basic and

clinical research on esophageal, gastrointestinal, liver, pancreas and biliary tract diseases,

Helicobacter pylori, endoscopy and gastrointestinal surgery, including: gastroesophageal

reflux disease, gastrointestinal bleeding, infection and tumors; gastric and duodenal

disorders; intestinal inflammation, microflora and immunity; celiac disease, dyspepsia

and nutrition; viral hepatitis, portal hypertension, liver fibrosis, liver cirrhosis, liver

transplantation, and metabolic liver disease; molecular and cell biology; geriatric and

pediatric gastroenterology; diagnosis and screening, imaging and advanced technology.

I-VII EditorialBoard

��� December 21, 2010|Volume 16|�ssue 47|WJG|www.wjgnet.com

Gastroesophageal flap valve status distinguishes clinical phenotypes of large hiatal hernia

Haruka Kaneyama, Mitsuru Kaise, Hiroshi Arakawa, Yoshinori Arai, Keisuke Kanazawa, Hisao Tajiri

Haruka Kaneyama, Mitsuru Kaise, Hiroshi Arakawa, Yo-shinori Arai, Keisuke Kanazawa, Hisao Tajiri, Department of Endoscopy, The Jikei University School of Medicine, Tokyo, 105-8471, JapanHisao Tajiri, Department of Gastroenterology and Hepatology, The Jikei University School of Medicine, Tokyo, 105-8471, JapanAuthor contributions: Kaise M designed the research; Kaneya-ma H, Kaise M, Arai Y and Kanazawa K performed the research; Kaneyama H, Kaise M and Arakawa H analyzed the data; Kaneyama H and Kaise M wrote the paper; Tajiri H organized the department.Correspondence to: Haruka Kaneyama, MD, Department of Endoscopy, The Jikei University School of Medicine, 3-25-8, Ni-shi Shinbashi, Minato-ku, Tokyo, 103-8461, Japan. haruka@jikei.ac.jpTelephone: +81-3-34331111-3181 Fax: +81-3-54388380Received: April 28, 2010 Revised: June 10, 2010Accepted: June 17, 2010Published online: December 21, 2010

AbstractAIM: To investigate two distinct clinical phenotypes of reflux esophagitis and intra-hernial ulcer (Cameron le-sions) in patients with large hiatal hernias.

METHODS: A case series study was performed with 16 831 patients who underwent diagnostic esophago-gastroduodenoscopy for 2 years at an academic refer-ral center. A hiatus diameter ≥ 4 cm was defined as a large hernia. A sharp fold that surrounded the cardia was designated as an intact gastroesophageal flap valve (GEFV), and a loose fold or disappearance of the fold was classified as an impaired GEFV. We studied the as-sociations between large hiatal hernias and the distinct clinical phenotypes (reflux esophagitis and Cameron le-sions), and analyzed factors that distinguished the clini-cal phenotypes.

RESULTS: Large hiatal hernias were found in 49 (0.3%) of 16 831 patients. Cameron lesions and reflux esopha-

gitis were observed in 10% and 47% of these patients, and 0% and 8% of the patients without large hiatal hernias, which indicated significant associations be-tween large hiatal hernias and these diseases. However, there was no coincidence of the two distinct disorders. Univariate analysis demonstrated significant associations between Cameron lesions and the clinico-endoscopic factors such as nonsteroidal anti-inflammatory drug (NSAID) intake (80% in Cameron lesion cases vs 18% in non-Cameron lesion cases, P = 0.015) and intact GEFV (100% in Cameron lesion cases vs 18% in non-Cameron lesion cases, P = 0.0007). In contrast, reflux esophagitis was linked with impaired GEFV (44% in reflux esophagitis cases vs 8% in non-reflux esophagitis cases, P = 0.01). Multivariate regression analysis con-firmed these significant associations.

CONCLUSION: GEFV status and NSAID intake distin-guish clinical phenotypes of large hiatal hernias. Cam-eron lesions are associated with intact GEFV and NSAID intake.

© 2010 Baishideng. All rights reserved.

Key words: Large hiatal hernia; Reflux esophagitis; Cam-eron lesion; Gastroesophageal flap valve; Nonsteroidal anti-inflammatory drug

Peer reviewers: Dr. Andrzej Dabrowski, MD, PhD, Professor, Department of Gastroenterology and Internal Medicine, Medical University of Bialystok, ul. M. Sklodowska-Curie 24A, 15-276 Bialystok, Poland; Wojciech Blonski, MD, PhD, University of Pennsylvania, GI Research-Ground Centrex, 3400 Spruce St, Philadelphia, PA 19104, United States

Kaneyama H, Kaise M, Arakawa H, Arai Y, Kanazawa K, Tajiri H. Gastroesophageal flap valve status distinguishes clinical phenotypes of large hiatal hernia. World J Gastroenterol 2010; 16(47): 6010-6015 Available from: URL: http://www.wjgnet.com/1007-9327/full/v16/i47/6010.htm DOI: http://dx.doi.org/10.3748/wjg.v16.i47.6010

BRIEF ARTICLE

World J Gastroenterol 2010 December 21; 16(47): 6010-6015ISSN 1007-9327 (print) ISSN 2219-2840 (online)

© 2010 Baishideng. All rights reserved.

Online Submissions: http://www.wjgnet.com/1007-9327officewjg@wjgnet.comdoi:10.3748/wjg.v16.i47.6010

6010 December 21, 2010|Volume 16|Issue 47|WJG|www.wjgnet.com

Kaneyama H et al . Cameron lesions and reflux esophagitis

INTRODUCTIONHiatal hernia promotes gastric acid access to the esopha-gus and impairs its clearance. The overall consequence of increased esophageal acid exposure is reflux esopha-gitis. Larger hiatal hernias impair the normal anti-reflux mechanisms to a greater extent than do smaller hernias. Esophagitis severity and esophageal acid exposure in-crease significantly for hernias > 3 cm in length, as mea-sured endoscopically[1]. The size of a hiatal hernia and the degree of lower sphincter hypotension are the most sig-nificant independent predictors of esophagitis presence and severity[2].

Gastric erosions or ulcers located on or near the neck of a large hiatal hernia sac, collectively referred to as Cameron lesions, cause gastrointestinal bleeding and ane-mia[3]. The prevalence of Cameron lesions is known to be dependent upon hiatal hernia size, with higher prevalence corresponding to larger hiatal hernia size[4].

There is convincing evidence that large hiatal hernias involve each of the two distinct disorders reflux esopha-gitis and Cameron lesions. However, the relationships between large hiatal hernias and these two disorders have not been clarified. We aimed to elucidate these relation-ships and to clarify the key factors that differentiate the clinical phenotypes of large hiatal hernias into reflux esophagitis and/or Cameron lesions.

MATERIALS AND METHODSPatients and methodsFrom January 2005 to January 2007, 16 831 patients were referred for diagnostic esophagogastroduodenoscopy (EGD) to the Department of Endoscopy at Jikei Univer-sity Hospital. Patients with the diagnosis of hiatal hernia were identified using databases of endoscopic and medi-cal records. Endoscopic images of these patients were retrieved from the endoscopic filing system (Olympus Medical Systems, Tokyo, Japan), to confirm the presence of Cameron lesions and/or reflux esophagitis, as well as the presence and size of the hiatal hernia.

Cameron lesions were defined as gastric erosions or ulcers located on or near the neck of the hiatal hernia sac. Although Cameron lesions were originally described as linear erosions[3], various lesion shapes, namely, linear, oblong or round, have been reported[4]. Therefore, the shapes of the erosions or ulcers were not taken into ac-count as long as the lesions were located on or near the neck of the hiatal hernia sac. Long linear erosions that extended from the neck to the lower or middle gastric body were excluded from this definition.

The standard endoscopic recording of diagnostic EGD comprised 40 still images, including two images of the gastric cardia from the retroflex views of the so-called U-turn and J-turn, and two images of the esopha-gogastric junction from the esophageal antegrade view. Additional still images were obtained with no limitation as to image numbers when abnormal findings, such as esophagitis and ulceration, were noted. Hiatal hernia size

was defined as the diameter of the neck of the hernia sac in the still images of the retroflex views of the gas-tric cardia. For example, if the diameter of the neck was three times that of the endoscope shaft (the diameters of the endoscopes used ranged from 8.9 mm to 10.4 mm; GIF-Q260, GIF-XQ260, GIF-H260, GIF-Q240, GIF-XQ240; Olympus Medical Systems), the size of the hiatal hernia was recorded as 3 cm (Figure 1). The measure-ments were made at 0.5 cm intervals. A large hiatal hernia was tentatively defined as having a diameter ≥ 4 cm.

A fold or ridge that surrounded the gastric cardia was designated as a gastroesophageal flap valve (GEFV). GEFV status was assessed using the still images of the retroflex views of the gastric cardia. A GEFV com-posed of a sharp fold that firmly surrounded the cardia was defined as an intact GEFV, which corresponded to grade Ⅰ in Hill’s classification[5,6]. A loose and dull fold or disappearance of the fold was classified as an impaired GEFV, which corresponded to grade Ⅱ-Ⅵ (Figure 2).

Reflux esophagitis was evaluated using the Los An-geles classification[7]. Patients with mucosal breaks were defined as having reflux esophagitis (grade A-D). The status of gastric mucosal atrophy was assessed using the Kimura-Takemoto classification[8]. The closed and open types were defined according to the presence of gastric mucosal atrophy.

GEFV status, hernia size, and the existence of reflux esophagitis and Cameron lesions were evaluated separate-ly by three endoscopists, who were blinded to the clinical information. When there was a lack of consensus among the three endoscopists regarding the results obtained for the endoscopic factors, the matching results (if available) from two of the three endoscopists were adopted. If there were no matched results between the three endos-copists, they re-examined together the endoscopic still images and reached a consensus.

Statistical analysisThe parameters of age, sex, hiatus diameter, GEFV status, long-term nonsteroidal anti-inflammatory drug (NSAID) intake, gastric atrophy, and hemoglobin level were exam-ined for associations with Cameron lesions and reflux esophagitis. Long-term NSAID intake was defined as the

6011 December 21, 2010|Volume 16|Issue 47|WJG|www.wjgnet.com

Hiatal neck

Cameron lesion

Diameter of the hiatal neck

Figure 1 Representative image of the retroflex view of the gastric cardia in a patient with a large hiatal hernia and Cameron lesions.

use of any NSAID, including low-dose aspirin, for at least 3 d a week in the previous month. The associations were evaluated by univariate and multivariate logistic regression analyses. When the P-value was less than 0.05, the dif-ference was considered to be statistically significant. All analyses were performed using the STATA 8.0 software (STATA Inc., College Station, TX, USA).

RESULTSAssociations between large hiatal hernias and the two clinical phenotypesOf the 16 831 patients who underwent EGD, 4658 (27.7%) were identified as having hiatal hernias, and 49 (0.3%; 24 male and 25 female) met the criteria for large hiatal her-nias. The mean age of the patients with large hiatal her-nias was 69.8 years (range: 41-90 years). The indications for EGD for the 49 patients were as follows: epigastralgia (n = 12), heartburn (n = 11), anemia (n = 6), melena or hematemesis (n = 4), dysphagia (n = 2), vomiting (n = 2), and others (n = 12).

Cameron lesions and reflux esophagitis were found in five (10%) and 24 (49%) of the patients with large hiatal hernias, respectively. In contrast, Cameron lesions and re-flux esophagitis were found in 0 (0%) and 1253 (8.4%) of the patients without large hiatal hernias, which indicated significant associations between large hiatal hernias and these two disorders. However, Cameron lesions concomi-tant with reflux esophagitis were not detected in any of the patients with large hiatal hernias.

Univariate and multivariate regression analyses of the associations between Cameron lesions and clinico-endoscopic factors The results are shown in Table 1. Univariate analysis dem-onstrated significant associations between Cameron lesions and the clinico-endoscopic factors of NSAID intake, in-tact GEFV, and hemoglobin level in the 49 patients with large hiatal hernias. Although reflux esophagitis was found in 54.5% of the patients without Cameron lesions, it was not found in any of the patients with such lesions. Multi-variate regression analysis showed a significant association

between the presence of Cameron lesions and NSAID in-take. As all of the patients with Cameron lesions showed intact GEFV, the association between Cameron lesions and GEFV status could not be evaluated adequately in the multivariate regression analysis.

Univariate and multivariate regression analyses of the associations between reflux esophagitis and clinico-endoscopic factors The results are shown in Table 2. Univariate analysis dem-onstrated significant associations between reflux esopha-gitis and the clinico-endoscopic factors of sex and intact GEFV. Reflux esophagitis was frequently observed in male patients and in patients without intact GEFV. Mul-tivariate regression analysis showed a significant reverse association between reflux esophagitis and intact GEFV.

Endoscopic features of Cameron lesions The results are shown in Figure 3. Five patients with large hiatal hernias presented with Cameron lesions. Two of

6012 December 21, 2010|Volume 16|Issue 47|WJG|www.wjgnet.com

Table 1 Univariate regression analysis and multivariate logistic regression analysis on the linkage between Cameron lesion and clinico-endoscopic factors

Univariate regression Multivariate logistic regression

Cameron Non-Cameron

Odds ratio 95% CI

No. of patients 5 44 - -Age (mean ± SD, yr) 68-84

(77.2 ± 6.4)41-90

(77.0 ± 11.9)- -

Gender (male:female) 0:5 24:20 - -Gastric atrophy (%) 0.4 0.5 - -Erosive esophagitis (%)

0 0.545 - -

Intact GEFV (%) 100 18.1b Can not be evaluated

-

NSAID intake (%) 80 18.2a 12.0a 1.07-134.1a

Hemoglobin level (g/dL)

7.2 ± 2.2a 12.7 ± 1.8a - -

aP < 0.05, bP < 0.01 vs Cameron lesion. GEFV: Gastroesophageal flap valve; NSAID: Nonsteroidal anti-inflammatory drug.

Kaneyama H et al . Cameron lesions and reflux esophagitis

Figure 2 Representative endoscopic images of an intact gastroesophageal flap valve (A) and an impaired gastroesophageal flap valve (B, C). A loose and dull fold was classified as an impaired gastroesophageal flap valve (arrow in B).

CBA

these patients (#3 and #4) showed multiple linear ero-sions or ulcers that resembled the lesions described by Cameron et al[3]. In contrast, three of the patients showed solitary, non-linear lesions. In three patients (#1-#3) the lesions were localized to the crossing of the hiatal neck and the extension of the GEFV fold on the anterior gastric wall. In patient #4, there was no open ulcer at the crossing of the hiatal neck and the extension of the GEFV fold, although an ulceration scar was noted at the point at which the GEFV fold diverged from the anterior stomach wall (arrows in Figure 3).

DISCUSSIONLarge hiatal hernias were identified in 0.3% of the pa-tients referred to an academic referral center for diag-nostic EGD. For this population, we found significant associations between the presence of large hiatal hernias and Cameron lesions or reflux esophagitis. These two disorders, which individually are linked with large hiatal hernias, were not detected concomitantly in any patient. GEFV status clearly differentiated the clinical phenotypes of large hiatal hernias into Cameron lesions or reflux esophagitis. Although the Cameron lesions were found exclusively in patients with intact GEFV, reflux esophagi-tis was frequently found in those with impaired GEFV.

GEFV contributes to the barrier functions against gastroesophageal reflux. The sling fibers of the stomach, which are located below the lower esophageal sphincter, are associated with a valve mechanism through which the pressure in the gastric fundus creates a flap that presses against the lower end of the esophagus[9]. GEFV status has been proposed as a useful predictor of gastroesopha-geal reflux disease[5,10,11]. In the present study, we have demonstrated that the anti-reflux mechanism of GEFV functions effectively, even in patients with large hiatal hernias, who are generally considered to have impaired barrier functions against gastroesophageal reflux.

All of the patients with Cameron lesions had intact GEFV, and 80% of the lesions were located at the point where the intact and sharp fold of the GEFV diverged from the stomach wall, especially on the anterior wall. As shown in Figure 1, the fold of the GEFV is speculated to be stretched excessively at the points where the fold

6013 December 21, 2010|Volume 16|Issue 47|WJG|www.wjgnet.com

Figure 3 Representative endoscopic images of five patients with Cameron lesions. A: Case #1 (no nonsteroidal anti-inflammatory drug, Hb5.4); B: Case #2 (loxoprofen + low dose aspirin, Hb5.3); C: Case #3 (diclofenac, Hb6.3); D, E: Case #4 (low dose aspirin, Hb8.0); F, G: Case #5 (low dose aspirin, Hb10.3). An ulcer-ation scar was noted at the point at which the gastroesophageal flap valve fold diverged from the anterior stomach wall (arrows in E and F).

D

CBA

E F G

Kaneyama H et al . Cameron lesions and reflux esophagitis

Table 2 Univariate regression analysis and multivariate logistic regression analysis on the linkage between reflux esophagitis and clinico-endoscopic factors

Univariate regression Multivariate logistic regression

Reflux esophagitis

No esophagitis

Odds ratio 95% CI

No. of patients 24 25 - -Age (mean ± SD, yr) 41-87

(67.3 ± 14.1)52-90

(72.2 ± 8.4)- -

Gender (male:female) 17:7 7:18a 2.66 (male) 0.73-9.7Gastric atrophy (%) 34.6 64 - -Erosive esophagitis (%)

8.3 44a 0.17a 0.03-0.95a

Intact GEFV (%) 0 20 - -NSAID intake (%) 12.5 36 - -Hemoglobin level (g/dL)

12.5 ± 1.9 11.6 ± 2.9 - -

aP < 0.05 vs reflux esophagitis. GEFV: Gastroesophageal flap valve; NSAID: Nonsteroidal anti-inflammatory drug.

diverges from the stomach wall. Although the mecha-nisms that underlie the onset of Cameron lesions remain unclear, mucosal ischemia might result from the accu-mulation of excessive loads at a point on the hiatus neck and/or the extension of the GEFV. Mucosal injury might be exacerbated by the combination of mechanical loading and NSAID intake, which has been significantly linked with Cameron lesions.

Although Helicobacter pylori (H. pylori) is one of the main causes of gastric ulcer, the status was not examined systemically in this case series. We tested H. pylori status in four of five patients with Cameron lesions. Three and one of these four patients were negative and positive for H. pylori, respectively. Since the H. pylori-positive rate of the tested patients with Cameron lesions is lower than the rate (60%-80%) in elderly Japanese patients, H. pylori infection might not be the major ulcerogenic factor in Cameron lesions. One of the limitations in the present study is that we could not obtain the information on anti-secretory drug intake in all patients. Therefore, it is dif-ficult to evaluate the association between anti-secretory drug intake and the clinical phenotypes seen in large hia-tal hernia.

Cameron et al[3] have described multiple linear erosions on the gastric folds of the hiatus neck as a distinct entity. However, lesions of various shapes (i.e. linear, oblong or round) have been reported[4]. For three of the cases in the present study, the lesions were solitary and non-linear, and appeared to be different from the lesions demon-strated in the original article. Gastric erosions or ulcers located on the hiatus neck might have different etiologies. For example, multiple linear erosions or red streaks are often observed in other disorders, such as alkaline reflux gastritis, or in the antrum of the H. pylori-negative stom-ach[12]. Further studies with larger populations of patients with Cameron lesions might increase our understanding of the various etiologies of this disorder.

Endoscopic diagnosis of a hiatal hernia is not easy, and accurate measurement of hernial size is difficult[11,13]. Most investigators define hernial size as the distance be-tween the Z-line and diaphragmatic crus using the length markings on the endoscope (most of the markings are at 5-cm intervals). This application of endoscopy has been shown to be unreliable owing to the large inter-observer variability[14]. It is also difficult to ensure that the tip of the endoscope is located precisely at the Z-line or diaphragmatic crus, as the circumferential distance from these landmarks to the incisors can vary. In cases of para-esophageal hernias without sliding hernias (type Ⅱ hiatus hernias)[15], measurements of this distance are not valid for assessing the size of an esophageal hernia. In the present study, which included type Ⅱ hiatus hernias, her-nial size was defined as the diameter of the neck of the hernia sac in images taken of the retroflex views of the gastric cardia. The measurement of hiatus diameter by comparison with the endoscope shaft is relatively objec-tive, and hiatus diameter might be valid for assessing the size of a type Ⅱ hiatus hernia. However, the hiatus diam-

eter does not necessarily reflect the distance between the Z-line and diaphragmatic crus, even if these two param-eters show strong correlation. Therefore, our definition of large hiatal hernias as having hiatus diameter ≥ 4 cm is tentative, and confirmation of the results obtained in the present study in prospective studies using both types of measurement is required.

In conclusion, GEFV status and NSAID intake dif-ferentiate the clinical phenotypes of patients with large hiatal hernias. Cameron lesions are found exclusively in patients with intact GEFV, and reflux esophagitis is fre-quently found in patients with impaired GEFV. NSAID intake and mechanical loading could contribute to the onset of Cameron lesions.

ACKNOWLEDGMENTSThe authors thank Dr. Urashima for his assistance.

COMMENTSBackgroundGastric erosions or ulcers, located on or near the neck of a large hiatal hernia sac, are designated as Cameron lesions. Large hiatal hernias are involved in reflux esophagitis and Cameron lesions.Research frontiersCameron lesions and reflux esophagitis are mutually exclusive lesions that can be distinguished by the status of gastroesophageal flap valve (GEFV). Nonsteroidal anti-inflammatory drug (NSAID) intake is linked to the presence of Cameron lesions.Innovations and breakthroughsThe authors have demonstrated that the anti-reflux mechanism of GEFV func-tions effectively even in a large hiatal hernia. Further investigations with ma-nometer and pH monitoring might confirm the barrier function of GEFV and the etiology of Cameron lesions. ApplicationsIt is known that Cameron lesions recur frequently and cause chronic anemia. Conservative treatment such as anti-secretory drug and iron drug intake are ef-fective for Cameron lesions. Sometimes blood transfusion might be necessary for treatment.Peer reviewThis is an interesting paper about the association between hiatal hernia and pathological changes in esophageal and gastric mucosa represented by esoph-agitis and Cameron lesions. The authors also evaluated the effect of treatment with NSAID on the development of these mucosal changes. In addition, they have presented an alternative method for estimation of hiatal hernia size.

REFERENCES1 Patti MG, Goldberg HI, Arcerito M, Bortolasi L, Tong J, Way

LW. Hiatal hernia size affects lower esophageal sphincter function, esophageal acid exposure, and the degree of muco-sal injury. Am J Surg 1996; 171: 182-186

2 Jones MP, Sloan SS, Rabine JC, Ebert CC, Huang CF, Kah-rilas PJ. Hiatal hernia size is the dominant determinant of esophagitis presence and severity in gastroesophageal reflux disease. Am J Gastroenterol 2001; 96: 1711-1717

3 Cameron AJ, Higgins JA. Linear gastric erosion. A lesion as-sociated with large diaphragmatic hernia and chronic blood loss anemia. Gastroenterology 1986; 91: 338-342

4 Weston AP. Hiatal hernia with cameron ulcers and erosions. Gastrointest Endosc Clin N Am 1996; 6: 671-679

5 Hill LD, Kozarek RA, Kraemer SJ, Aye RW, Mercer CD,

6014 December 21, 2010|Volume 16|Issue 47|WJG|www.wjgnet.com

COMMENTS

Kaneyama H et al . Cameron lesions and reflux esophagitis

Low DE, Pope CE 2nd. The gastroesophageal flap valve: in vitro and in vivo observations. Gastrointest Endosc 1996; 44: 541-547

6 Hill LD, Kozarek RA. The gastroesophageal flap valve. J Clin Gastroenterol 1999; 28: 194-197

7 Armstrong D, Bennett JR, Blum AL, Dent J, De Dombal FT, Galmiche JP, Lundell L, Margulies M, Richter JE, Spechler SJ, Tytgat GN, Wallin L. The endoscopic assessment of esopha-gitis: a progress report on observer agreement. Gastroenterol-ogy 1996; 111: 85-92

8 Kimura K, Takemoto T. An endoscopic recognition of the atrophic border and its significance in chronic gastritis. En-doscopy 1969; 1: 87-97

9 Thor KB, Hill LD, Mercer DD, Kozarek RD. Reappraisal of the flap valve mechanism in the gastroesophageal junction. A study of a new valvuloplasty procedure in cadavers. Acta Chir Scand 1987; 153: 25-28

10 Contractor QQ, Akhtar SS, Contractor TQ. Endoscopic esoph-

agitis and gastroesophageal flap valve. J Clin Gastroenterol 1999; 28: 233-237

11 Kinoshita Y, Adachi K. Hiatal hernia and gastroesophageal flap valve as diagnostic indicators in patients with gastro-esophageal reflux disease. J Gastroenterol 2006; 41: 720-721

12 Gordon C, Kang JY, Neild PJ, Maxwell JD. The role of the hiatus hernia in gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2004; 20: 719-732

13 Kawabe T, Maeda S, Ogura K, Yamaji Y, Okamoto M, Yo-shida H, Shiratori Y, Omata M. Antral red streaking is a negative endoscopic sign for Helicobacter pylori infection. Dig Endosc 2002; 14: 87-92

14 Guda NM, Partington S, Vakil N. Inter- and intra-observer variability in the measurement of length at endoscopy: Im-plications for the measurement of Barrett's esophagus. Gas-trointest Endosc 2004; 59: 655-658

15 Mittal RK. Hiatal hernia: myth or reality? Am J Med 1997; 103: 33S-39S

S- Editor Wang YR L- Editor Kerr C E- Editor Zheng XM

6015 December 21, 2010|Volume 16|Issue 47|WJG|www.wjgnet.com

Kaneyama H et al . Cameron lesions and reflux esophagitis