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

The results of a questionnaire answered by the European Members of the GEEMO concerning esophagectomy without thoracotomy are reported and discussed. 172 cases of esophagectomy without thoracotomy following benign lesions and 666 cases following various levels of esophageal neoplasia were grouped in the 26 Centers that have answered the questionnaire amounting to a total of 838 cases. The most frequent indications for benign lesions were as follows: decompensated or relapsed megaesophagus (83 cases), acute or stabilized lesions caused by caustic agents (59 cases), stenoses from gastroesophageal reflux (17 cases), scleroderma (7 cases) and spontaneous or iatrogenic perforation (6 cases). Concerning the esophageal site where the technique was employed with esophageal carcinoma, the most frequent was the cervical (201 cases), then the lower (150 cases), the middle (91 cases) and upper thirds of the esophagus (48 cases). Adenocarcinoma of the cardia seems to be an additional indication for many Surgeons to use esophagectomy without thoracotomy (142 cases). In general, the most frequent intra-surgical complications (from benign and malignant lesions) were as follows: pleural lesions (34.4%), lesions of the left recurrent nerve (7.8%), severe endo-mediastinic hemorrhages (8.5%), tracheo-bronchial (1.5%) and thoracic duct (0.5%) lesions. The intra-operative mortality was 0.36%. The post-operative complications were as follows: pleural effusion (17.8%), anastomotic fistulas (15.2%), hemothorax (5%) and post-operative mortality (10.3%). Cancer of the cervical esophagus and adenocarcinoma of the cardia were considered sensitive to this radical treatment whereas in intra-thoracic cancer it can have only a palliative effect.
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PMID:Total esophagectomy without thoracotomy: results of a European questionnaire (GEEMO). 377 Nov 19

Gastroesophageal reflux is well documented in scleroderma, but the complications of Barrett's metaplasia and adenocarcinoma are not well described. The records of 75 patients with scleroderma seen over a four-year period at the Hospital of the University of Pennsylvania were retrospectively reviewed to determine the prevalence of Barrett's metaplasia and adenocarcinoma of the esophagus and to identify clinical, manometric, laboratory, or radiographic criteria that might predict the presence of these lesions. Twenty-four of these patients underwent endoscopy. In this group, the prevalence of Barrett's metaplasia was 37 percent (nine patients) and adenocarcinoma was also present in two of these patients. The patients with and without Barrett's metaplasia were similar in age (range, 22 to 64 compared with 28 to 79, respectively), sex (six of nine compared with 12 of 15 female, respectively), frequency of esophageal motility disorders, presence of proximal skin involvement, digital ulceration, and pulmonary involvement as measured by diffusion capacity. Barrett's metaplasia was diagnosed on the basis of double-contrast esophagographic results in only one of eight patients with Barrett's metaplasia so-studied. Patients with Barrett's metaplasia tended to have longer duration of heartburn (90 +/- 40 months compared with 11 +/- 35 months) and dysphagia (39 +/- 22 months compared with 7 +/- 3 months). Patients with Barrett's metaplasia also tended to have greater impairment of lower esophageal sphincter pressure either at end-expiration (4.0 +/- 2.1 compared with 6.1 +/- 1.8 mm Hg) or mid-respiration (13.0 +/- 3.0 compared with 16.9 +/- 2.5 mm Hg). Using chi-square analysis, however, none of these differences reached statistical significance. Discrimination did occur on the basis of the presence of the CREST (calcinosis, Raynaud's phenomenon, esophageal manifestations of scleroderma, sclerodactyly, and telangiectasis) variant (55 percent compared with 7 percent, p less than 0.01), a duration of dysphagia of more than five months (p less than 0.03), and mid-respiratory lower esophageal sphincter pressure of less than 10 mm Hg (p less than 0.05). It is suggested that: Barrett's metaplasia of the esophagus occurs in one third of patients with scleroderma; clinical, manometric, laboratory, and radiographic features are poor predictors of the presence of Barrett's metaplasia; patients with CREST syndrome, prolonged dysphagia, or a very low lower esophageal sphincter pressure may have an increased risk for the development of metaplasia; patients with scleroderma and Barrett's metaplasia have an increased risk of complications such as stricture or adenocarcinoma.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Barrett's metaplasia and adenocarcinoma of the esophagus in scleroderma. 379 92

Barrett's esophagus is a precancerous stage as a malign degeneration occurs in about 15%. According to prospective studies the risk of development of cancer is 30 to 42 times higher than in the normal population. Risk factors for malign degeneration, which mostly concerns white males, are abuse of alcohol or nicotine and chronic gastroesophageal reflux. Antireflux surgery is only indicated in Barrett's esophagus in combination with active reflux esophagitis. The uncomplicated Barrett's esophagus should be controlled by endoscopy. The adenocarcinoma in Barrett's esophagus has to be considered as an esophageal carcinoma. Due to its metastatic spread in mostly aboral direction it can be treated by blunt dissection of the esophagus.
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PMID:[Barrett esophagus as a precancerous condition]. 380 23

We performed antireflux surgery on 13 adults with both gastroesophageal reflux (GER) and asthma. The duration of asthma ranged from 7 months to 43 yr. Twelve patients had chronic heartburn, 10 had nocturnal cough and wheezing, eight had chest pain, and one was asymptomatic for GER. GER was determined by a combination of esophagoscopy with biopsy, manometry, and esophageal pH testing. Postoperative follow-up ranged from 13 months to 5 yr. Six patients were completely free of all wheezing episodes, six still had wheezing but the frequency and severity had markedly decreased, and one remained unchanged. Of 11 patients who required chronic bronchodilator therapy, four were able to completely stop and six decreased the dose by more than half; one required the same amount of therapy. Of the seven corticosteroid-dependent patients, two were weaned completely, three were being tapered, one remained unchanged, and one required a smaller dose for nasal polyps although he was free of wheezing and had stopped bronchodilators. Three patients, all of whom dramatically improved after surgery, died during their follow-up course: one died suddenly 8 months postoperatively during a walk after dinner from apparent status asthmaticus; one died 9 months postoperatively of refractory congestive heart failure; and one died 30 months postoperatively of metastatic adenocarcinoma of unknown source. We conclude that surgical correction of GER in selected adults with both asthma and GER may significantly decrease or eliminate pulmonary symptoms and the need for asthmatic medications.
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PMID:Is gastroesophageal reflux a factor in some asthmatics? 381 16

An increased risk of esophageal carcinoma has been reported in systemic sclerosis (scleroderma). Periodic endoscopic or radiologic surveillance, or both, of systemic sclerosis patients with gastroesophageal reflux symptoms has been recommended for early detection of Barrett's mucosa and esophageal adenocarcinoma. A review of 680 closely followed systemic sclerosis patients for esophageal carcinoma of all types, and of a 22-yr experience with esophageal and esophagogastric junction adenocarcinoma and undifferentiated carcinoma, did not reveal a significant increase in the frequency of esophageal carcinoma in systemic sclerosis. Regular surveillance for Barrett's esophagus and esophageal adenocarcinoma would not appear to be cost-effective because of the rarity of carcinoma, increased patient discomfort and expense, and the questionable benefit for long-term survival.
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PMID:Systemic sclerosis (scleroderma) and esophageal adenocarcinoma: Is increased patient screening necessary? 392 90

The pathologic reports of all 1,020 esophageal biopsy specimens obtained between 1975 and 1981 in patients with symptoms of gastroesophageal reflux were reviewed. Barrett's esophagus was identified in 84 patients (8 percent). The 362 patients seen between 1980 and 1981 were reviewed in detail. The symptoms in patients with Barrett's esophagus differed from those of the patients without Barrett's esophagus. Dysphagia was more often present in the former group (34 percent versus 16 percent, p less than 0.05) and epigastric distress was less frequent (11 percent versus 27 percent, p less than 0.05). Objective findings of hiatal hernia, esophageal stricture, and esophageal ulcers occurred more commonly in patients with Barrett's esophagus than in those without Barrett's esophagus (70 percent versus 48 percent, 31 percent versus 4 percent, and 14 percent versus 6 percent, respectively, p less than 0.05). Mid esophageal strictures were associated almost exclusively with Barrett's esophagus (five of six patients). At esophagoscopy, erythema was seen more commonly with Barrett's esophagus. The diagnosis was suspected by the endoscopist in only 34 percent of patients subsequently demonstrated histopathologically to have Barrett's esophagus. There was no significant difference in the prevalence of a positive Bernstein test result or gastroesophageal reflux on upper gastrointestinal series in patients with and without Barrett's esophagus. However, a hypotensive lower esophageal sphincter was found more commonly in patients with Barrett's esophagus (100 percent versus 53 percent, p less than 0.05). Thirteen of the 84 patients with Barrett's esophagus (15 percent) had a coexistent adenocarcinoma arising from Barrett's mucosa. These patients, when compared with the patients with Barrett's esophagus without carcinoma, were more often male (77 percent versus 51 percent, p = 0.1), more often had dysphagia (69 percent versus 34 percent, p less than 0.05), and more frequently had a comparatively short duration of symptoms (67 percent versus 36 percent, p less than 0.05). Our findings suggest that patients with Barrett's esophagus have a high risk of development of carcinoma. Because the entity is often not recognized at endoscopy, routine esophageal biopsy should be performed on all patients undergoing esophagoscopy for symptoms of gastroesophageal reflux. Patients with known Barrett's esophagus should be followed closely with repeated endoscopy and biopsy.
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PMID:Barrett's esophagus: its prevalence and association with adenocarcinoma in patients with symptoms of gastroesophageal reflux. 396 36

Between 1951 and 1983, 32 patients who had adenocarcinoma develop in Barrett's esophagus were identified at our institution. Twenty-nine patients were male (91 per cent) and 29 were white. Amongst the 23 patients in whom the relevant data were available, 78 per cent admitted to regular alcohol intake and 78 per cent smoked. Only one of these patients did not smoke or drink alcohol. Surprisingly, only 61 per cent of the patients had symptoms suggestive of gastroesophageal reflux and reflux was demonstrated roentgenographically in only 41 per cent. Twenty-one of the patients underwent esophagogastrectomy. Life table analysis revealed a survival rate of 34 per cent at two years and 14.8 per cent at five years.
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PMID:Carcinoma arising in Barrett's esophagus. 407 70

Tc-99m pertechnetate scintigraphy was performed in a patient with Barrett's esophagus and a history of previous lye ingestion. Radionuclide uptake was present in the distal two-thirds of the esophagus and persisted after the drinking of water. This technique is simple and accurate and may be of significant benefit in determining the presence and extent of Barrett's esophagus, which carries an increased incidence of adenocarcinoma development. Examination of patients with chronic gastroesophageal reflux, using this technique, is advocated.
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PMID:Barrett's esophagus complicating lye ingestion. Demonstration by pertechnetate scintigraphy. 631 61

Barrett's esophagus may be defined as a columnar epithelium-lined distal esophagus. As a frequently recognized complication of gastroesophageal reflux, Barrett's esophagus has become a diagnosis of general clinical concern. Factors governing the development of this complication in patients with gastroesophageal reflux are unknown but may be congenitally determined in part. When symptoms are present, they are due to the complications of reflux, such as esophagitis, stricture, ulcer, or bleeding. Barrett's esophagus may be suspected on the basis of results of a barium meal test, endoscopy, or isotope scanning. Iodine staining at endoscopy or manometrically guided biopsy helps to localize the abnormal mucosal segment. The diagnosis is proved by biopsy. The columnar epithelium of Barrett's esophagus has a malignant predisposition, and, once the diagnosis is made, periodic endoscopy, with biopsy and cytologic study, is indicated. The treatment of Barrett's esophagus is directed toward objective cessation of gastroesophageal reflux. In refractory cases, antireflux surgery improves symptoms and complications from reflux, but the columnar epithelium generally persists along with its malignant potential. It is not known whether effective antireflux treatment will lower the incidence of adenocarcinoma.
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PMID:Barrett's esophagus: a review. 633 89

The clinical and pathologic features of carcinoma arising in Barrett's esophagus were studied in resection specimens from 26 patients. White males predominated (73%). A history of symptomatic gastroesophageal reflux was frequently absent, being elicited in only eight of 14 patients (57%) with a carefully obtained history at the time of presentation with carcinoma. Survival was relatively short with a median survival of 23 +/- 5 months, and only three patients had a disease-free survival longer than 2 years. A pathologic spectrum of carcinoma was found: differentiation ranged from well to poorly differentiated in the 20 patients with a single adenocarcinoma; two separate carcinomas were found in four patients; and a spectrum of differentiation in a single tumor was found in the other two cases, one an adenocarcinoid tumor and the other an adenosquamous carcinoma. The tumors were generally far advanced, with extension through the esophageal wall in 23 of 26 cases (88%) and metastases to lymph nodes in 17 of 24 cases (71%). Epithelial dysplasia, including carcinoma in situ in some cases, was found in Barrett's mucosa adjacent to the tumor in all 26 patients. Our findings suggest that a surveillance program for dysplasia in patients known to have Barrett's esophagus is warranted in an attempt to improve the outcome. However, the impact of surveillance on the incidence of Barrett's carcinoma may be lessened by its frequent occurrence in patients with asymptomatic gastroesophageal reflux.
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PMID:The spectrum of carcinoma arising in Barrett's esophagus. A clinicopathologic study of 26 patients. 646 17


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