Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Three cases of patients with esophageal involvement by scleroderma, chronic reflux esophagitis, and adenocarcinoma of the distal esophagus are presented. An underlying columnar metaplasia (Barrett esophagus) was identified in two patients and postulated in the third. It is believed that scleroderma patients with symptomatic chronic gastroesophageal reflux should be investigated for Barrett epithelium. If it is present, these patients should be followed and considered as having an increased risk for development of adenocarcinoma of the esophagus.
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PMID:Adenocarcinoma of the esophagus in patients with scleroderma. 660 35

Using strict criteria for diagnosis, 23 patients having benign Barrett's esophagus, and 20 patients with adenocarcinoma arising in this epithelium have been analyzed. Evidence supports severe gastroesophageal reflux as a cause of Barrett's esophagus. Successful antireflux surgery leads to stabilization and possibly regression of the dysplasia in Barrett's epithelium, and can be followed by squamous epithelial regeneration in some. Antireflux surgery is advocated in all patients with Barrett's esophagus demonstrated to have abnormal reflux regardless of symptoms. The malignant potential of the columnar epithelium is higher in men who smoke, in patients with intestinal-type metaplasia who continue to have severe reflux, and in patients who develop dysplasia. In those with high grade dysplasia, the probability of carcinoma is high and esophagectomy should be seriously considered in the hopes that the pathological stage of the neoplasm is still favorable.
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PMID:Barrett's esophagus. Comparison of benign and malignant cases. 662 23

A 56-yr-old man with severe reflux esophagitis, Barrett's esophagus, and a peptic lower esophageal stricture underwent subtotal resection of the Barrett's esophagus with colonic interposition. After the interposition procedure, gastroesophageal reflux was eliminated, as evidenced by absence of clinical and radiographic findings and by the results of a later continuous pH probe recording. Despite the absence of reflux, 8 yr after the colonic interposition the patient was found to have adenocarcinoma in the remnant of the Barrett's esophagus. This case indicates that elimination of gastroesophageal reflux does not necessarily lead to regression of Barrett's mucosa, nor does it prevent development of adenocarcinoma. As a result, patients with Barrett's esophagus should remain under long-term surveillance for dysplasia and adenocarcinoma, even after successful antireflux therapy. If esophagectomy is performed, every attempt should be made to resect all of the esophagus lined by Barrett's mucosa.
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PMID:Adenocarcinoma in Barrett's esophagus after elimination of gastroesophageal reflux. 669 Mar 63

In a 28-year-old man with a long history of esophageal reflux, two polypoid lesions in a columnar-lined (Barrett) esophagus proved to be adenopapillary cancer. Despite extensive preoperative endoscopic evaluation, no other malignant foci were found until after complete postoperative dissection of the esophageal specimen, when two more small flat lesions were diagnosed as adenocarcinoma. Dysplastic changes of specialized columnar epithelium and junctional epithelium were mild, except around the tumors. In the preoperative assessment of patients with a columnar-lined esophagus, physicians should be aware of the possibility of multifocal development of tumors either exophytic or superficial spreading, and multiple biopsies should be taken from normal-looking areas.
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PMID:Quadruple cancer in a columnar-lined (Barrett) esophagus. 684 52

Barrett's esophagus denotes the presence of columnar epithelium in the esophagus instead of the usual stratified squamous epithelium. Barrett's esophagus had been thought to represent a mediastinal extension of the stomach in patients with a congenital short esophagus. Subsequent clinical and experimental data have established the abnormality as an acquired condition resulting from chronic gastroesophageal reflux. Although roentgenographic studies may show a mild-esophageal stricture or an esophageal ulcer, definitive diagnosis requires endoscopy with directed biopsy of erythematous mucosa in the esophagus, or manometrically guided biopsies for showing the presence of columnar epithelium above the lower esophageal sphincter. Although the origin of the cells causing this epithelium is still unclear, three distinct epithelial types have been found: atrophic gastric-fundic, junctional, and specialized columnar. Esophageal strictures and esophageal ulcers are complications associated with Barrett's esophagus, but its major significance is the association with the development of adenocarcinoma of the esophagus. Treatment of Barrett's esophagus is aimed at preventing gastroesophageal reflux with the additional need for close endoscopic surveillance for the development of dysplasia or early adenocarcinoma. Whether the diagnosis of Barrett's esophagus mandates anti-reflux surgery (fundoplication) remains controversial.
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PMID:Barrett's esophagus. 704 50

Peptic stenosis of the esophagus is no longer considered as an irreversible lesion. It may stabilize or even regress if gastro-esophageal reflux is suppressed. The treatment of these stenoses during the last decade has been progressively oriented towards conservative techniques, the only ones capable of conferring the necessary low degree of complexity on this type of surgery. The authors report their experience between 1965 and 1980 on 151 operations. Resection was performed in 1/3 of the cases and the remainder were treated conservatively, by either thoracic or abdominal routes. The route of choice is abdominal. Peroperative dilatation of the stenosis is done with a finger or a bougie. The anti-reflux configuration is a Nissen type fundoplicatio when the cardia can be lowered in the abdomen. If the cardia cannot be lowered because of a shortening of the esophagus, the authors utilize a complete wrapping of the gastric cone since 1969. This technique has been used 45 times, often in old and weak patients who would have tolerated no other procedure. Mortality was zero. Long-term results are satisfactory and longlasting in 75% of the cases. Secondary dilatations are sometimes (18%) necessary, especially during the first postoperative year. In case of failure, it remains possible to perform another conservative operation through the thoracic route. No late-arising adenocarcinoma has been observed in the stenotic zone.
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PMID:[Treatment of peptic stenosis of the esophagus. Conservative techniques (author's transl)]. 711 62

Endoscopy constitutes an important investigation in the presence of a gastro-oesophageal reflux. The primary intention is to exclude the possibility of an organic pathology, for example cancer, which has not been demonstrated by other investigative procedures. Accordingly it must provide a detailed exploration of the whole superior digestive tract, from the mouth to the duodenum. Secondly, endoscopy must establish the consequence of the reflux on the mucosa of the lower oesophagus both by a macroscopic and a detailed microscopic description. Peptic lesions are classified according to 4 degrees of severity. The difficulty in evaluating the very early lesions (1st degree) and the advanced stages (4th degree) necessitates systematic biopsies of the lesions. The erythroplasic type of carcinoma in situ can present the same endoscopic changes as a 1st degree peptic lesion, whereas the exclusion of an adenocarcinoma constitutes the major preoccupation at the time of endoscopy of a 4th degree oesophagitis.
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PMID:[Gastroesophageal reflux: importance of endoscopy in surgical indications and postoperative control]. 722 20

In order to assess the outlook for patients with peptic oesophageal strictures treated by Eder Puestow dilatation at fibreoptic endoscopy, 50 patients were followed up for periods ranging from nine months to four years. Twenty patients (40%) required only a single dilatation, and the remaining 30 (60%) required multiple dilatations. The frequency of dilatation tended to decrease with time. There was one death attributable to the procedure. Two patients developed an adenocarcinoma at the site of the stricture. We conclude that conservative management of peptic oesophageal stricture combining the use of dilatation at fibreoptic endoscopy with medical measures to control gastro-oesophageal reflux offers a relatively safe means of providing symptomatic relief, maintaining nutrition, and allowing the patient an acceptable quality of life.
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PMID:Outlook with conservative treatment of peptic oesophageal stricture. 736 14

The athymic nude rat rnu/rnu has been established as an in vivo model for the acceptance of human digestive-tumour xenografts. We report the successful xenografting of 7/12 (58%) primary explants from patients with digestive cancer. Successful xenografting also occurred in 21/25 (84%) pancreatic tumours derived from a pancreatic exocrine adenocarcinoma (GER) maintained in cell culture; 2 of those have been successfully passaged in nude rats. The simultaneous implantation of these tumours into nude mice led to an almost identical take rate. Passage of one colonic and one pancreatic xenograft from nude rats into nude mice, and transplantation back into nude rats, increased the take rates. The critical period for the establishment of primary tumour growth was usually 28-42 days. The xenografts maintained histological and cytological characteristics of the primary explants or of the original tumour from which the cell line derived. The karyotype of the cell line was also maintained in the solid tumour. Three murine tumours were successfully grown as xenografts. Despite their immunoincompetence, the rats in this study showed no increased morbidity or mortality when kept in conventional conditions, compared with animals housed in isolators. The athymic nude rat will become a valuable complementary tool to the nude mouse for the establishment and maintenance of human digestive tumours and for surgical and serial serological studies.
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PMID:Growth of human digestive-tumour xenografts in athymic nude rats. 745 38

Barrett's esophagus is a complication of gastroesophageal reflux disease that is diagnosed with increasing frequency in connection with the increased utilization of upper endoscopy. It remains unclear why some patients with gastroesophageal reflux disease develop Barrett's esophagus while others do not. The association of Barrett's esophagus and adenocarcinoma is well established; if not for this fact, Barrett's esophagus would be of little clinical importance. Endoscopic surveillance with a rigorous biopsy protocol for the detection of dysplasia or early adenocarcinoma is indicated in any patient with Barrett's esophagus who is a candidate for surgery. New therapeutic strategies, including profound acid suppression with proton pump inhibitors, laser ablation of Barrett's epithelium, and photodynamic therapy, are currently under evaluation for the treatment of Barrett's esophagus.
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PMID:Barrett's esophagus. 781 46


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