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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Barrett's esophagus develops as a complication of chronic gastroesophageal reflux and predisposes patients to the development of dysplasia and adenocarcinoma of the esophagus. Because light microscopy of dysplasia in Barrett's esophagus shows diminished or absent mucus, we used transmission electron microscopy to compare cytoplasmic organelles required for mucus production in dysplastic and nondysplastic esophageal columnar epithelium. These observations of the rough endoplasmic reticulum, Golgi apparatus, and secretory granules were correlated with histologic interpretations and flow cytometric measurements of abnormalities of DNA content. Ultrastructural abnormalities included depletion and alteration of organelles required for mucus biosynthesis. These abnormalities often were accompanied by cells with markedly distended rough endoplasmic reticulum and massive accumulation of cytoplasmic glycogen aggregates. All 9 patients who had Barrett's dysplasia with or without early adenocarcinoma had ultrastructural abnormalities, as did 3 of 8 patients whose biopsy histology was indefinite for dysplasia. Abnormalities measured by flow cytometry correlated well with the presence of these ultrastructural aberrations. All 9 patients with Barrett's dysplasia with or without early adenocarcinoma had abnormalities observed by electron microscopy and aneuploidy or increased G2/tetraploid fractions measured by flow cytometry. Two of the 3 patients whose biopsies were indefinite for dysplasia and who had ultrastructural abnormalities also had aneuploidy or increased G2/tetraploid fractions. Neither ultrastructural nor flow cytometric abnormalities were found in the remaining 5 patients whose biopsies were indefinite for dysplasia, in 19 of 22 patients with Barrett's specialized metaplasia, or in any of the 7 patients with gastroesophageal reflux disease without Barrett's specialized metaplasia. Two of the 22 patients with Barrett's specialized metaplasia had distended rough endoplasmic reticulum in rare cells, and one other had an aneuploid cell population. We conclude that neoplastic progression in Barrett's esophagus is associated with abnormalities of cytoplasmic organelles required for mucus production. With few exceptions, these ultrastructural aberrations correspond to the presence of dysplasia or of aneuploidy or increased G2/tetraploid fractions. Electron microscopy and flow cytometery detect abnormalities associated with the development of dysplasia and cancer in Barrett's esophagus that may be biologically significant.
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PMID:Correlation of ultrastructural aberrations with dysplasia and flow cytometric abnormalities in Barrett's epithelium. 291 Jul 57

Barrett's esophagus is a condition in which metaplastic columnar epithelium replaces squamous esophageal epithelium as a consequence of chronic gastroesophageal reflux. Patients with this condition are at increased risk for the development of adenocarcinoma. To better understand the progression to adenocarcinoma in this disease, we studied abnormalities in DNA content of epithelial cells in Barrett's esophagus. Using flow cytometry, we examined the spatial distribution of abnormal nuclear DNA contents (aneuploidy) in the esophagi of 14 patients with Barrett's adenocarcinoma. Multiple (2 to 14) populations of aneuploid cells were seen in 12 of the 14 cases. Some early carcinomas appeared to be associated with a single aneuploid population of cells. Surrounding dysplastic epithelium often contained multiple, different overlapping aneuploid populations. These data suggest that neoplastic progression in Barret's esophagus is associated with a process of genomic instability which leads to evolution of multiple aneuploid populations, with the ultimate development of a clone of cells capable of malignant invasion. Thus, detection of multiple aneuploid populations of cells in Barrett's esophagus may indicate a high risk of cancer. Barrett's esophagus provides a unique and readily accessible model for the study of neoplastic progression in human epithelial malignancy.
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PMID:Progression to cancer in Barrett's esophagus is associated with genomic instability. 291 Nov 84

Adenocarcinoma of the esophagus is a well-known complication of Barrett esophagus, especially in white men. We present three cases of squamous carcinoma of the esophagus in Barrett patients. All three patients were white men. None had a history of symptomatic gastroesophageal reflux or of Barrett esophagus, but all had substantial usage of alcoholic beverages and tobacco. All three tumors were located in squamous-lined mucosa above the Barrett mucosa. Columnar epithelial dysplasia was present in the Barrett mucosa of two of our patients, and the third patient had a squamous carcinoma of the pharynx. Squamous carcinoma represented 2% of Barrett-associated esophageal carcinomas at our institution in 1980 through 1986. Five additional cases were found in the literature, and all were also in white men. This demographic predominance stood in striking contrast to the 26% prevalence of white patients among those with squamous carcinoma of the esophagus at our institution (P less than 0.0002) and to the 50% prevalence of white men among our patients with Barrett esophagus (P less than 0.02). Two of the literature cases also had substantial alcohol and tobacco usage and had synchronous adenocarcinoma arising in Barrett mucosa. Our findings of a strikingly high prevalence of white men and of multifocal neoplastic changes in the upper aerodigestive tract suggest a pathogenetic relationship between squamous carcinoma of the esophagus and Barrett esophagus, possibly due to alcoholic beverage and tobacco usage. Endoscopic surveillance of Barrett patients for early detection of adenocarcinoma has been recommended; contemporaneous evaluation of the squamous-lined esophagus by biopsy and cytopathology may be advisable.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Squamous carcinoma of the esophagus in patients with Barrett esophagus. 292 88

The outcome of Barrett's esophagus was evaluated in 21 patients who prospectively underwent total duodenal diversion and followed from 13 to 86 months. The total duodenal diversion procedure included troncular vagotomy, antrectomy and Roux-en-Y reconstruction incorporating a 70 cm loop. The diagnosis of Barrett's esophagus was made on endoscopy when a circular zone of columnar epithelium more than 3 cm long was found and was always corroborated by biopsies. All patients had esophagitis on endoscopy or acid reflux on pH-monitoring. During follow-up, for all cases, no esophagitis and no bile were detected in the stomach by successive endoscopies; none of the 16 pH-studies showed any aggressive reflux. The length of Barrett's esophagus was measured before and after Roux-en-Y duodenal diversion. In spite of the suppression of gastroesophageal reflux, regression of Barrett's esophagus was observed in one case only beginning 24 months after the diversion. No cases of adenocarcinoma or dysplasia were detected. In conclusion, regression of Barrett's esophagus is exceptional even after duodenal diversion.
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PMID:[Does Barrett esophagus regress after total duodenal diversion?]. 280 10

Barrett esophagus, the columnar-lined distal esophagus acquired as a consequence of chronic gastroesophageal reflux, is associated with the development of columnar epithelial dysplasia and esophageal adenocarcinoma. To determine the efficacy of cytopathology in identifying Barrett esophagus and related neoplasia, observations were compared on 150 esophageal cytology samples with concurrent endoscopic biopsy specimens. Sixty-six specimens that contained benign columnar epithelium in either cytologic or biopsy material were identified. Distinctive-type Barrett mucosa with incomplete intestinalization, considered diagnostic of Barrett esophagus, was found in 34 of 66 cases (52%) and was present only in cytologic material in 11 cases. Twenty-two specimens contained cardiac-type mucosa (present only in cytology in ten cases), a finding of uncertain significance due to lack of localization of the sample with respect to the gastroesophageal junction. Fundic-type mucosa was not observed in any specimen. Two cases of distinctive-type Barrett mucosa with columnar epithelial dysplasia were identified in both biopsy and cytology specimens. Among eight Barrett-associated carcinomas (seven adenocarcinomas and one squamous), cytologic material was diagnostic for malignancy in seven and highly suspicious in one. It was concluded that cytopathologic studies are a useful adjunct to biopsy histopathology in the diagnosis of Barrett esophagus and associated carcinoma. The role of cytopathology in the diagnosis of Barrett-related columnar epithelial dysplasia requires further study, and at present a cautious approach with biopsy confirmation is recommended.
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PMID:Diagnostic value of cytopathology in Barrett esophagus and associated carcinoma. 335 1

The columnar lined (Barrett's) esophagus is an acquired condition resulting from chronic gastroesophageal reflux. The clinical spectrum of 50 consecutive cases of endoscopically consistent, histologically proven Barrett's esophagus was reviewed. The mean age of patients was 65.9 +/- 12.4 (SD) years with only four patients younger than 50 years. The predominant presenting symptoms were dysphagia, heartburn, and regurgitation. At endoscopy, the columnar lined segment extended over 6.5 +/- 3.0 cm of the lower esophagus. Specialised columnar (intestinal) epithelium was the most frequent histological type identified. Radiologic or endoscopic evidence of a hiatal hernia was present in the majority. Complications were present at endoscopy in 38 (76%) patients. Reflux esophagitis (56%) was present at the area of the squamo-columnar junction. Stricture formation (38%) and ulceration (36%) were located either at the squamo-columnar junction or more distally within the columnar epithelium. Two patients (4%) had adenocarcinoma arising in a segment of Barrett's esophagus at presentation. Treatment included physical measures, dilatation, and cimetidine. Bougienage in 20 patients was successful in alleviating dysphagia but multiple treatment sessions were often necessary. Although esophagitis readily resolved with cimetidine therapy, ulceration was generally resistant to medical therapy. Indeed, by two months, healing was achieved in only five of 12 patients. Endoscopic surveillance of 12 patients who received cimetidine (1 g/day) for at least 12 months showed no regression of the metaplastic mucosa.
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PMID:Barrett's esophagus: clinical, endoscopic, and histologic spectrum in fifty patients. 346 72

Twenty-seven patients from an institution for the developmentally disabled underwent endoscopy for evaluation of vomiting, regurgitation, rumination, or upper gastrointestinal bleeding. The presence of gastroesophageal reflux and Barrett's esophagus was determined retrospectively. Twenty-three patients had an IQ less than 20, 19 were nonambulatory, and 14 were taking at least one neuroleptic drug daily. Seven patients (26%) had histologically documented Barrett's esophagus of the specialized-columnar type. Two patients with Barrett's esophagus had benign esophageal strictures, but no cases of adenocarcinoma were found. There were no significant differences (p greater than 0.05) between patients with or without Barrett's esophagus in regard to symptoms, age, sex, IQ, medications, or ambulatory status. The present data suggest that Barrett's esophagus may frequently occur in developmentally disabled patients with symptoms and signs of gastroesophageal reflux.
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PMID:Gastroesophageal reflux and Barrett's esophagus in developmentally disabled patients. 348 46

This paper reports a series of 52 patients with Barrett's (or columnar-lined) oesophagus from one medical unit diagnosed over a six-year period. The commonest associated symptoms were heartburn, regurgitation and dysphagia but 10 patients had no oesophageal symptoms and two had no symptoms at all. Gastrointestinal bleeding (overt or occult) was observed in almost one-third of patients. At diagnosis, 26 patients had oesophagitis, 23 had oesophageal ulceration and 10 had benign oesophageal strictures. An association between oesophageal ulceration and non-steroidal anti-inflammatory drug ingestion was suggested by the data and patients with oesophageal ulceration were significantly older than patients with uncomplicated Barrett's oesophagus. No patient had adenocarcinoma of the oesophagus at diagnosis and neither carcinoma nor dysplasia were seen during a mean period of 16.4 months. However, 17 per cent of patients in the series had malignancies in other sites. Most patients did well on medical treatment and only two were referred for anti-reflux surgery (both for non-healing oesophageal ulcers). Barrett's oesophagus was seen in 10 per cent of patients with gastro-oesophageal reflux at endoscopy. Oesophageal ulceration in patients with Barrett's oesophagus made up 21 per cent of oesophageal ulcers seen and benign oesophageal stricture in patients with Barrett's oesophagus constituted 13 per cent of all benign strictures seen. Barrett's oesophagus is common in our population and despite complications, it can be managed successfully, at least in the short term, by conservative means.
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PMID:Barrett's oesophagus: a clinical study of 52 patients. 349 62

Barrett's esophagus represents an epithelial metaplasia in which a columnar lining replaces normal squamous epithelium of the esophagus. It occurs in at least 10% of patients with chronic gastroesophageal reflux and is associated with an increased risk of adenocarcinoma of the esophagus. This review focuses on the criteria for the diagnosis of Barrett's esophagus, discusses its association with adenocarcinoma, and provides guidelines for surveillance for carcinoma.
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PMID:Barrett's esophagus and adenocarcinoma. 355 8

A 40-year-old woman with chronic symptoms of gastroesophageal reflux had a 1.5-cm filling defect in the distal esophagus on esophagogram. Endoscopy revealed distal esophagitis and, immediately above a hiatal hernia, a pedunculated polyp on a short stalk, which was removed by snare cautery. The polyp was an adenoma composed of tubular glands and covered by intestinal-type epithelium. Serial distal esophageal biopsies confirmed Barrett's metaplasia with areas of specialized columnar epithelium with goblet cells. These findings suggest that the full expression of neoplasia in Barrett's esophagus includes the development of adenomatous polyps as well as dysplasia and adenocarcinoma.
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PMID:Adenomatous polyp arising in Barrett's esophagus. 373 58


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