Background and study aim: Although narrow-band imaging (NBI) in endoscopy can improve detection of early-stage esophageal malignancies in patients with head and neck cancers, false-positive results may be obtained in areas with nonspecific inflammatory changes. This study evaluated the feasibility of primary screening with NBI and magnification for the presence of esophageal malignancies in these cancer patients. Patients and methods: Sixty-nine patients with documented head and neck cancers were enrolled from April 2008 to January 2009. All patients underwent a meticulous endoscopic examination of the esophagus using a conventional white-light system followed by re-examination using the NBI system and final confirmation with NBI plus magnification. Results: Twenty-one patients (30.4 %) were confirmed to have esophageal neoplasia. Among these 21, 16 (76.2 %) had synchronous lesions, 9 (42.9 %) were asymptomatic, and 10 (47.6 %) had early-stage neoplasia. The incidence of multiple esophageal neoplasia was 57.1 %. NBI was more effective than conventional endoscopy in detecting neoplastic lesions (35 lesions in 21 patients vs. 22 lesions in 18 patients) and was particularly effective in patients with dysplasia (13 lesions in 9 patients vs. 3 lesions in 3 patients). The sensitivity and accuracy of detection were 62.9 % and 64.4 % for conventional endoscopy, 100 % and 86.7 % for NBI alone, and 100 % and 95.6 % for NBI with high magnification, respectively. Conclusions: Compared with current approaches, NBI followed by high magnification significantly increases the accuracy of detection of esophageal neoplasia in patients with head and neck cancers. The result warrants conducting prospective randomized controlled study to confirm its efficacy.

Background: Nonalcoholic fatty liver disease ( NAFLD ) is independently associated with QT prolongation among patients with diabetes. It has not yet been determined whether this association remains valid in the general population. We designed an observational study to explore this association. Methods and Results: We conducted a cross‐sectional analysis of 31 116 consecutive participants in our health management program. Heart rate–corrected QT ( QT c) interval was derived from 12‐lead electrocardiography and by Bazett's formula. NAFLD was diagnosed by abdominal ultrasonography and classified as none, mild, moderate , or severe , according to the ultrasonographic criteria. A multivariable linear regression model was fitted for the association between QT c interval and potential predictors (including demographic, anthropometric, biochemical factors, and comorbidities). Multivariable logistic regression analyses were fitted to assess the association between the severity of NAFLD and QT c prolongation, with the adjustment of significant predictors derived from multivariable linear regression. The mean QT c interval was 421.3 ms ( SD 45.4 ms). In the multivariable linear regression analyses, mild, moderate, and severe NAFLD were associated with increases of 2.55, 6.59, and 12.13 ms, respectively, in QT c interval compared with no NAFLD (all P <0.001). In the multivariable logistic regression analyses, mild, moderate, and severe NAFLD were associated with an increased risk for QT c prolongation, with odds ratios of 1.11 (95% CI: 1.01 to 1.21, P <0.05), 1.61 (95% CI: 1.36 to 1.9, P <0.001), and 1.31 (95% CI: 1.16 to 2.24, P <0.01), respectively, in women, and 1.11 (95% CI: 1.01 to 1.21, P <0.05), 1.39 (95% CI: 1.22 to 1.59, P <0.001), and 1.87 (95% CI: 1.16 to 2.24, P <0.001), respectively, in men, after adjusting for predictors known to be associated with the QT c interval. The association remained significant among subgroups with or without diabetes. Conclusions: The severity of NAFLD was associated with a higher risk for QT c prolongation in the general population with and without diabetes.

Background and objective: Whether there is distinct pathogenesis in subgroups of functional dyspepsia (FD), the postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS) remains controversial. We aimed to identify the risk factors of FD and its subgroups in the Chinese population. Methods: Patients with dyspepsia and healthy subjects who underwent gastric cancer screening were enrolled in this multicentre study from 2010 to 2012. All patients were evaluated by questionnaire, oesophagoduodenoscopy, histological examination and Helicobacter pylori tests. Subgroups of FD were classified according to the Rome III criteria. Psychiatric stress was assessed by the short form Brief Symptom Rating Scale. CagA and VacA genotypes were determined by PCR. Results: Of 2378 patients screened for eligibility, 771 and 491 fulfilled the diagnostic criteria of uninvestigated dyspepsia and FD, respectively. 298 (60.7%) and 353 (71.9%) individuals were diagnosed with EPS and PDS, respectively, whereas 169 (34.4%) had the overlap syndrome. As compared with 1031 healthy controls, PDS and EPS shared some common risk factors, including younger age (OR 0.95; 99.5% CI 0.93 to 0.98), non-steroidal anti-inflammatory drugs (OR 6.60; 99.5% CI 3.13 to 13.90), anxiety (OR 3.41; 99.5% CI 2.01 to 5.77) and concomitant IBS (OR 6.89; 99.5% CI 3.41 to 13.94). By contrast, H. pylori (OR 1.86; 99.5% CI 1.01 to 3.45), unmarried status (OR 4.22; 99.5% CI 2.02 to 8.81), sleep disturbance (OR 2.56; 99.5% CI 1.29 to 5.07) and depression (OR 2.34; 99.5% CI 1.04 to 5.36) were associated with PDS. Moderate to severe antral atrophy and CagA positive strains were also more prevalent in PDS. Conclusions: Different risk factors exist among FD subgroups based on the Rome III criteria, indicating distinct aetiopathogenesis of the subdivisions that may necessitate different therapeutic strategies.

The efficacy of sequential therapy and the applicability of genotypic resistance to guide the selection of antibiotics in the third-line treatment of Helicobacter pylori have not been reported. We aimed to assess the efficacy of genotypic resistance-guided sequential therapy in third-line treatment. Genotypic and phenotypic resistances were determined in patients who failed at least two eradication therapies by PCR with direct sequencing and agar dilution test, respectively. The patients were retreated with sequential therapy containing esomeprazole and amoxicillin for the first 7 days, followed by esomeprazole and metronidazole plus clarithromycin, levofloxacin or tetracycline for another 7 days (all twice daily), according to genotypic resistance determined using gastric biopsy specimens. Eradication status was determined by the ¹³C-urea breath test. Trial registered at clinicaltrials.gov (identifier: NCT01032655). The overall eradication rate was 80.7% (109/135, 95% CI 73.3%–86.5%) in the intention-to-treat analysis. The presence of amoxicillin resistance (OR 6.83, 95% CI 1.62–28.86, P = 0.009) and prior sequential therapy (OR 4.77, 95% CI 1.315–17.3, P = 0.017), but not tetracycline resistance (tetracycline group), were associated with treatment failure. The eradication rates in patients who received clarithromycin-, levofloxacin- and tetracycline-based sequential therapies were 78.9% (15/19), 92.2% (47/51) and 71.4% (25/35) in strains susceptible to clarithromycin, levofloxacin and tetracycline, respectively. A simple molecular method guiding sequential therapy can achieve a high eradication rate in the third-line treatment of refractory H. pylori infection.