Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 56-year-old man presented with dysphagia, and was found to have a type 3 advanced gastric cancer with bilateral multiple lung metastases. This patient was treated with low-dose 5-FU plus CDDP chemotherapy. In the first course, CDDP (6 mg/m2/day) plus 5-FU (300 mg/m2/day) were infused for 5 successive days a week, but a tumor response was not achieved. Therefore, in the second course, CDDP (6 mg/m2/day) plus 5-FU (600 mg/m2/day) were infused every other day (3 days a week). In response to the treatment, both the gastric tumor and the lung metastases almost completely disappeared (reduction rate 95%), and PR was achieved. The CEA level markedly decreased, from 260.3 to 1.4 ng/ml and the patient's symptoms disappeared. Following this treatment, low-dose CDDP plus UFT therapy was performed and the PR was maintained for 12 months. This report shows a case of advanced gastric cancer that responded to low-dose 5-FU plus CDDP.
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PMID:[A case of advanced gastric cancer responding to combination chemotherapy with low-dose 5-FU plus CDDP]. 1235 50

Gastric cancer continues to be the second cause of cancer-related mortality in the world. Surgery is the only potentially curative therapy, although the adverse effects of surgery are considerable and include digestive symptoms, loss of appetite and malnutrition. Our study included 45 patients subjected to gastrectomy who were under treatment at our unit during 2000. The data given here refer to their first visit following surgery. The most frequent complications were diarrhoea (31%), pain (29%) and early dumping (24%). Other complications found were late dumping, nausea/vomiting and dysphagia. Anorexia appeared in 49% and 29% presented a negative attitude towards food. These complications give rise to insufficient food intake, leading to malnutrition, mainly marasmic in nature. Only 7% of the patients were normonourished, with 86% presenting slight or moderate malnutrition and 7% severe malnutrition. The mean Body Mass Index (BMI) of these patients was 20 +/- 3 kg/m2. The most frequent analytical alterations were anaemia with ferropenia and b12 deficit, and a reduction in the levels of zinc and retinol transporting protein. Many patients had impaired quality of life; 43% did not leave home and only 13% were able to work. Three groups were established depending on the time that had passed since the gastrectomy was performed before the first nutritional assessment (less than 3 months, from three months to a year, and over one year), without significant differences being found in any of the parameters studied. In this article we include recommendations for the nutritional handling and treatment of patients following gastrectomy.
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PMID:[Nutritional evaluation in patients with total gastrectomy]. 1242 99

Esophageal and gastric tumors are often considered as a single group: they share similar symptoms - upper GI endoscopy with a flexible video-endoscope is the gold standard procedure of detection - similar techniques of endotherapy for cure or palliation are offered for both types of tumors. When the endoscopic procedure is performed for a superficial cancer or its precursors, with a curative intent, endoscopic mucosal resection (EMR) is generally preferred to mucosal ablation with a thermal (Nd:YAG) or non-thermal (photodynamic therapy) procedure. In addition to esophageal squamous cell cancer and gastric cancer, new indications of EMR arise in the Barrett esophagus. Guidelines for safe indications concern diameter, polypoid or non polypoid morphology with the subtypes elevated, flat and depressed, and depth of invasion. A superficial invasion in the sub-mucosa is a relative contra-indication in the esophagus, but not in the stomach. The technique of EMR is now codified with an injection into the submucosa for lifting the lesion and either suction with a cap, grasping with a forceps if a 2 channel instrument is used, or tissue incision with a needle knife. En bloc, gives better results than piecemeal resection. The most frequent complication is bleeding. When legitimate indications are respected, the results of EMR are equivalent to those of surgical resection and have reached the consensus level. The major indication in palliation is the relief of dysphagia from malignant esophageal obstruction. Increased indications are proposed for malignant pyloric obstruction. Multiple models of metal expandable and coated stents with appropriate balance between rigidity and flexibility (nitinol alloy) and enough expansive radial force are now offered. After stenting the survival period is short and there is a toll of complications.
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PMID:Treatment of esophagogastric tumors. 1256 Oct 5

Esophageal squamous papilloma is an uncommon benign squamous epithelial polypoid tumor and is usually identified as a solitary lesion in the lower esophagus. Chronic mucosal irritation and infection with human papilloma virus (HPV) are two proposed etiologies. However, the natural history of esophageal squamous papilloma is unknown, and whether it can develop to esophageal cancer is also controversial. The authors report a case of esophageal papillomatous polyposis in which the presence of high-risk HPV DNA was proven by type-specific polymerase chain reaction (PCR). The patient was an 83-year-old man referred to our hospital with complaints of nausea and dysphagia. Esophago-gastroduodenoscopy (EGD) was carried out, and diffuse polyposis of the entire length of the esophagus and stenosis in the antrum of the stomach were revealed. Histological examination of the tissue confirmed the diagnosis of squamous papilloma of the esophagus and poorly differentiated adenocarcinoma of the stomach. Furthermore, HPV type-specific PCR was carried out in the biopsied specimens, and HPV type-16 and type-33 were detected. One month after total gastrectomy performed for the treatment of gastric cancer, follow-up EGD was carried out, and complete regression of the esophageal polyps was noted. This case is rare and supports the evidence that esophageal squamous papilloma is caused by infection with HPV. Furthermore, this case also reflects a unique aspect of the natural history of esophageal papillomatous polyposis.
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PMID:Regression of esophageal papillomatous polyposis caused by high-risk type human papilloma virus. 1285 74

While self-expandable metallic stents (EMS) have been reported to be useful for palliation of unresectable esophagogastric malignancies, complications accompanying such stenting also have been pointed out. Both advantages and disadvantages of EMS stenting are discussed on the basis of 25 cases of esophageal cancer and 5 cases of gastric cancer treated in our institute. Although dysphagia improved in 26 of the 30 patients with stenosis, only 14 of the patients who had been able to ingest more than 1,200 kcal of food could be discharged to their homes. Complications were noted in 12 (48%) of the esophageal cancer patients and 4 (80%) of the gastric cancer patients, including incomplete sealing of esophagorespiratory fistula in 6, tumor ingrown in 3, mucosal hyperplasia in 2, stent migration in 2 and reflux of digestive juice in 1. The patients with complications took food for shorter periods than those who had no complications. Successful patient outcomes can be achieved by the prevention of complications accompanying stenting and mastering the techniques to overcome those complications described above.
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PMID:[Self-expandable metallic stent for palliation of unresectable esophagogastric malignancies]. 1461 70

Due to its prevalence, impact on quality-of-life and the associated significant health resource utilization, dyspepsia is a major healthcare concern. The available management strategies for uninvestigated dyspepsia include prompt endoscopy, the 'test-and-treat' strategy for Helicobacter pylori, and empiric antisecretory therapy. There is consensus that endoscopy should be reserved for patients with alarm features (e.g. symptom onset after 45 years of age, recurrent vomiting, weight loss, dysphagia, evidence of bleeding, anaemia), H. pylori-positive individuals who fail test-and-treat, and those with an inadequate response to empiric antisecretory therapy. Factors influencing the decision between test-and-treat and empiric antisecretory therapy in uninvestigated dyspepsia include the local prevalence of H. pylori and peptic ulcer disease and the proportion of ulcers attributable to H. pylori. For uninvestigated dyspepsia in patients without alarm features, test-and-treat is the preferred initial management method in Europe based on the relatively high prevalence of H. pylori/peptic ulcer disease whereas empiric antisecretory therapy is preferred in many parts of the United States, where the prevalence of H. pylori/peptic ulcer disease is relatively low. In patients with non-ulcer dyspepsia, H. pylori eradication and empiric antisecretory therapy result in comparable and small, but statistically significant, improvements in dyspepsia. Empiric antisecretory therapy is the preferred initial method of managing non-ulcer dyspepsia in Europe and the US. The test-and-treat approach would receive increased enthusiasm if H. pylori cure is shown to prevent development of gastric cancer in non-ulcer dyspepsia patients in a large Western trial.
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PMID:Review article: uninvestigated dyspepsia and non-ulcer dyspepsia-the use of endoscopy and the roles of Helicobacter pylori eradication and antisecretory therapy. 1472 72

We report a case of synchronous esophageal and gastric cancer in a patient with severe liver dysfunction who was treated successfully using TS-1/CDDP therapy combined with irradiation therapy. A 56-year-old man with a chief complaint of dysphagia was diagnosed with thoracic esophageal cancer by endoscopy, and was referred to our hospital. Synchronous esophageal and gastric cancer were diagnosed by endoscopy and barium swallow. The preoperative diagnosis was T3N0M0, Stage II esophageal cancer and T1N0M0, Stage I A gastric cancer, both of which were diagnosed to be resectable. However, surgery was contraindicated because of severe liver dysfunction, due to an ICG15 of 35%. TS-1 (80 mg/day) and CDDP (3 mg/day) therapy was combined with irradiation, 60 Gy given in a T-pattern to the mediastinum. The patient did not suffer any side-effects, and endoscopy performed 44 days after the start of treatment showed that the esophageal lesion was now only a scar. Only a slight elevation of the esophagus was seen by endoscopy 219 days after the start of the therapy. The patient is currently undergoing only TS-1 treatment as an outpatient and is under observation. No metastasis to the liver or any other organ has been detected. TS-1 and CDDP therapy combined with radiotherapy appears to be effective in treating thoracic esophageal cancer.
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PMID:[A case of synchronous esophageal and gastric cancer successfully treated by combination TS-1/CDDP therapy with irradiation]. 1499 62

We report a case of advanced gastric cancer with bulky N2 lymph node metastases resected after successful treatment with novel oral anticancer drug TS-1 as a neoadjuvant chemotherapy (NAC). A 62-year-old man was admitted to our hospital complaining of epigastralgia and dysphagia. Endoscopic examination revealed type 3 advanced gastric cancer in the upper gastric body. Computed tomography (CT) showed bulky N2 lymph node metastases. He was treated with a daily dose of 120 mg of TS-1 for 4 consecutive weeks, followed by 2 weeks of rest. No serious adverse reaction was observed. After 1 course of treatment, the primary tumor and metastatic lymph nodes were reduced. Therefore, a total gastrectomy combined with splenectomy and D2 lymph node dissection was performed. Histopathologically, a few viable cancer cells remained in the resected stomach and metastatic lymph nodes were found. The histological effect of NAC was judged to be grade 2. The patient's postoperative course was uneventful, and he has been well for 11 months following surgery. TS-1 as NAC is considered to be effective for advanced gastric cancer.
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PMID:[A case of advanced gastric cancer with bulky N2 lymph node metastases resected after successful treatment with TS-1]. 1522 16

There are several different approaches available for the palliation of esophago-gastric cancer. The decision on which type of therapy is used should be made individually based on an interdisciplinary consensus.In case of inoperable esophageal carcinoma, it becomes the primary objective of the therapy to maintain oral nutrition. This can be achieved through the insertion of self expanding metal stents as a minimally invasive procedure which results in an immediate elimination of dysphagia. As alternative and/or complementary therapy, radiological techniques (external beam radiation, brachytherapy) can be applied. Other locally endoscopic techniques (laser, APC-beamer) are often used for treating local complications of esophageal and inoperable stomach carcinomas. For these carcinomas palliative chemotherapy with cisplatin has been established as a standard regimen.
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PMID:[Palliative treatment options for esophageal and gastric cancer]. 1524 5

When no organic cause for dyspepsia is found, the condition generally is considered to be functional, or idiopathic. Nonulcer dyspepsia can cause a variety of symptoms, including abdominal pain, bloating, nausea, and vomiting. Many patients with nonulcer dyspepsia have multiple somatic complaints, as well as symptoms of anxiety and depression. Extensive diagnostic testing is not recommended, except in patients with serious risk factors such as dysphagia, protracted vomiting, anorexia, melena, anemia, or a palpable mass. In these patients, endoscopy should be considered to exclude gastroesophageal reflux disease, peptic or duodenal ulcer, and gastric cancer. In patients without risk factors, consideration should be given to empiric therapy with a prokinetic agent (e.g., metoclopramide), an acid suppressant (histamine-H2 receptor antagonist), or an antimicrobial agent with activity against Helicobacter pylori. Treatment of patients with H. pylori infection and nonulcer dyspepsia (rather than peptic ulcer) is controversial and should be undertaken only when the pathogen has been identified. Psychotropic agents should be used in patients with comorbid anxiety or depression. Treatment of nonulcer dyspepsia can be challenging because of the need to balance medical management strategies with treatments for psychologic or functional disease.
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PMID:Evaluation and management of nonulcer dyspepsia. 1525 26


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