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

Barrett's esophagus is a metaplastic change in the mucosal lining which represents a peculiar form of healing in response to the chronic injury due to gastroesophageal reflux. It has been recognized that this change is associated with an increased risk of developing esophageal adenocarcinoma. Several factors have been shown to identify the patients who are at particular risk for carcinoma, the most importance of which is the development of dysplasia. As a result, management of patients with Barrett's esophagus must include careful endoscopic surveillance with histological examination of the biopsies by two independent experienced pathologists. Patients with low-grade dysplasia require complete control of reflux and careful endoscopic surveillance. Because the majority of patients with high-grade dysplasia will have co-existent adenocarcinoma, and because of difficulties in differentiating high-grade dysplasia from invasive adenocarcinoma, esophagectomy is the treatment of choice for these individuals. This approach has been shown to result in a significant improvement in survival in patients with esophageal cancer identified under surveillance.
 ...
PMID:Management of Barrett's esophagus with dysplasia. 926 47

Gastro-oesophageal reflux disease (GERD) is primarily due to incompetence of the lower oesophageal sphincter (LOS) and crural diaphragm, with transient LOS relaxation frequently accounting for daytime reflux. In the absence of drugs that adequately correct the motility defects of GERD, treatment is directed towards decreasing gastric acidity. Oesophageal healing is related to control of 24-h intragastric acidity, the degree of acid suppression and duration of treatment. H2-receptor antagonists are generally less effective in GERD than in peptic ulcer disease. While providing symptomatic relief in non-erosive GERD, they are often ineffective in healing erosive oesophagitis. Proton pump inhibitors provide more rapid and complete healing and symptom resolution. They are superior to H2-receptor antagonists in the long-term management of erosive oesophagitis and in reducing recurrence of oesophageal stricture following mechanical dilatation. In Barrett's oesophagus, high-dose proton pump inhibitors in combination with laser/photodynamic ablation therapy can produce metaplastic regression, although this does not preclude future emergence of adenocarcinoma. Surgical morbidity and mortality rates in GERD generally remain higher than those associated with long-term pharmacotherapy. However, direct comparisons between laparascopic anti-reflux surgery and proton pump inhibitor maintenance therapy remain to be performed. Although there is no evidence that H. pylori infection worsens the severity of oesophagitis or that H. pylori is carcinogenic in the metaplastic oesophageal mucosa. It has been suggested that H. pylori-positive patients requiring long-term proton pump inhibitor therapy receive bacterial eradication therapy to reduce the risk of developing atrophic gastritis.
 ...
PMID:Review article: current practice and future perspectives in the management of gastro-oesophageal reflux disease. 930 72

Barrett's esophagus is an acquired condition with columnar metaplasia of the distal esophagus. Gastroesophageal reflux is the main pathophysiological factor, although genetic predisposition may play a role. The significance of Barrett's esophagus is that it is the only recognized risk factor for adenocarcinoma of the esophagus, which is one of the most rapidly rising types of cancer in North America. Cancer develops in Barrett's esophagus through a series of steps including mucosal dysplasia. High grade dysplasia is clearly a premalignant lesion and has been the focus of endoscopic surveillance strategies. Because dysplasia and adenocarcinoma develop predominantly in patients with specialized intestinal columnar epithelium, they make up the group that would be considered for surveillance programs. Endoscopic surveillance for dysplasia is only indicated for patients in whom esophagectomy would be considered if high grade dysplasia or carcinoma was found, at least until other endoscopic ablative techniques are proven to be beneficial. It has been recommended that endoscopy be performed every other year and be increased to yearly if low grade dysplasia is found. High grade dysplasia should be confirmed by another expert pathologist, and the patient should then be considered for esophagectomy. Flow cytometry and genetic markers may improve the ability to select patients for surveillance programs in the near future.
 ...
PMID:Pathophysiology and investigation of Barrett's esophagus. 934 77

Barrett's esophagus represents the most serious consequence of chronic gastroesophageal reflux disease (GERD), primarily because of its association with an increased incidence of esophageal adenocarcinoma. Specific therapy for Barrett's esophagus should lead to the complete regression of the metaplastic epithelium with adequate squamous reepithelialization. Ideally, this regression should be permanent and be associated with a reduction in the incidence of adenocarcinoma. Several reports in the literature have assessed the effects of H2-blocker treatment of Barrett's epithelium, but none has clearly documented a significant and consistent regression of the metaplastic epithelium. Proton pump inhibitors have been shown to be superior to H2 blockers in the treatment of patients with severe esophagitis. Despite initial enthusiasm, it does not appear that a significant regression of Barrett's epithelium can be achieved, even with high doses of proton pump inhibitors given for a prolonged period of time. Various groups have assessed the effects of antireflux surgery on the regression of columnar epithelium and dysplasia and its potential protective effect on the subsequent development of carcinoma. Overall, it appears from these reports that antireflux surgery, despite adequate symptomatic results, does not significantly and consistently lead to a reduction in length or disappearance of the Barrett's mucosa, and does not prevent the development of dysplasia and its progression to carcinoma. More recently, numerous authors have documented the regression of Barrett's mucosa by using various endoscopic thermal modalities. Technological advances including laser and photodynamic therapy have allowed for endoscopic mucosal ablation. Long term results are more encouraging when this mucosal ablation is associated with aggressive antireflux therapy (medical or surgical). Further studies are required before these exciting new therapies can be recommended. Currently, none of these approaches can obviate the need for continued endoscopic surveillance.
 ...
PMID:Treatment of Barrett's esophagus. 934 88

The columnar replacement of squamous epithelium in the lower esophagus is the result of gastroesophageal reflux. Whether the squamous cells are replaced or undergo metaplasia is still conjectural. This neoepithelium is unstable in the presence of continued reflux and prone to complications of stricture, ulceration, and adenocarcinoma. Considerable evidence supports the hypothesis that duodenal contents play a role in the development of Barrett's esophagus and its complications. The increasing incidence of adenocarcinoma in Barrett's esophagus is of concern in the Western World. Surveillance programs in some centers have been successful in early diagnosis, and excellent survival periods have been reported following resection in these cases. Both medical and surgical antireflux treatment is successful in symptom relief, but even in the absence of symptoms, reflux may continue. Surgery offers better overall results than proton pump inhibition of gastric acid and has been more popular since less aggressive (minimally invasive) techniques have been popularized. Mucosal ablation and antireflux measures by medicine or surgery are still in the experimental stages but hold considerable promise for the future.
 ...
PMID:Barrett's esophagus. 934 34

An estimated 700,000 persons in the United States currently have this disease, which is often preceded by gastroesophageal reflux and may progress to adenocarcinoma. Questions posed in management include: Which patients merit endoscopic surveillance? And in which is medical therapy or surgery appropriate?
 ...
PMID:Barrett's esophagus: the changing management. 938 18

Gastroesophageal reflux disease (GERD) is a common, typically chronic recurring disorder. The majority of patients with heartburn and regurgitation have intermittent symptoms for which they do not consult their physicians. The main long-term risk of esophagitis is adenocarcinoma arising from Barrett's metaplasia. There are two principle therapeutic strategies in the treatment of GERD. The use of prokinetic drugs aims at treating the primary motility disorder leading to reflux, whereas acid-suppressive therapy targets at the reduction of gastric acid production to prevent symptoms and complication of GERD. The cornerstone in the treatment of GERD are proton pump inhibitors (PPI). Patients with mild symptoms and rarely relapsing disease may be best treated intermittently. Longterm maintenance acid-suppressive therapy with PPIs is necessary in GERD patients with immediate and severe relapse. At present, eradication of Helicobacter pylori in GERD patients is not recommended. Antireflux surgery is an effective treatment to control gastroesophageal reflux. However, surgery is associated with a low, but still substantial morbidity, a low mortality of up to 0.5% and is only indicated in patients with pharmacological refractory reflux disease.
 ...
PMID:[Gastroesophageal reflux]. 945 61

Esophageal cancer is a pathology with a remarkable geographical variety, considered to be a disease of the poor. The common incidence reported in western countries of 3 per 100,000 per year, contrasts with 140 per 100,000 reported in Central Asia in an area that is known as the "esophageal cancer belt". Among a wide spectrum of potential etiologic agents, the use of alcohol and tobacco remain the most frequently reported. The most common pathologic type is squamous cell carcinoma, although is important to consider that in the past decades, a shift to adenocarcinoma has been consistently observed. This phenomenon might have an explanation in the inclusion of tumors of the cardia and the importance of metaplasic Barret's epithelium and gastroesophageal reflux. As it happens in the majority of gastrointestinal tumors, diagnosis is often done late in esophageal cancer. The most common presenting symptoms of esophageal cancer are dysphagia and weight loss. Others are, odynophagia, upper GI bleeding, hoarseness and respiratory symptoms. In patients with advanced disease, diagnostic studies are confirmatory in nature. The combined use of contrast esophagogram and endoscopy yield to a diagnostic accuracy above 95%. These studies have to be complimentary. Computed tomography is the best modality for staging tumors of the esophagus. Although its accuracy varies from one study to another, demonstration of disease beyond the esophagus precludes surgical treatment. Endoluminal ultrasound has assumed an important role as part of the staging studies, considered by some authors superior to CT scanning. Its use is not considered rutinary because of the difficulty on passing the instrument through an obstructive lesion, and to the fact that this technology is not widely available. In the majority of patients, surgical treatment is considered to be palliative, due to the presence of advanced disease at the time of diagnosis. From the multiple surgical options available, transhiatal esophagectomy without thoracotomy is one of the more widely accepted techniques. Controversy persists regarding the optimal surgical approach to the disease. It is well accepted that prognosis depends more in the biology of the tumor and the stage of the disease rather than the surgical procedure. Overall five year survival after esophageal resection is 20%, regardless of the surgical option. Other alternatives are standard transthoracic esophagectomy, the thoraco-abdominal approach and the triple approach with extensive lymphadenectomy of cervical, mediastinal and abdominal areas. These latter procedures carry more morbidity and mortality rates. It is probably the multimodality approach with pre or postoperative chemotherapy and radiotherapy what can impact in further improvement of the poor survival rates for this disease. This combined approach is currently being investigated under control prospective randomized trials.
 ...
PMID:[Esophageal cancer]. 948 May 21

Barrett's esophagus, or specialized intestinal metaplasia, is a common condition associated with gastroesophageal reflux and an increased risk for adenocarcinoma of the esophagus and gastric cardia. Currently, clinical surveillance for early detection of adenocarcinoma relies on the histopathological assessment of dysplasia. In this review we present data from the published literature, and combine this with results from our own research, to address what is currently known about the environmental factors and the molecular changes thought to be important in the pathogenesis of Barrett's esophagus. The most important and well-characterized molecular changes, preceding the development of dysplasia, are alterations in the p53 and erbB-2 genes and aneuploidy. These molecular changes, as well as environmental influences, such as the quality and quantity of gastroduodenal refluxate, may result in abnormal cell proliferation which in turn promotes further genetic abnormalities and deregulation of cell growth. The identification of molecular changes, in the context of predisposing environmental factors, will enhance our understanding of the malignant progression of Barrett's esophagus leading to more effective surveillance and treatment.
 ...
PMID:Recent developments in the molecular characterization of Barrett's esophagus. 957 72

In Barrett's esophagus, the squamous lining of the lower esophagus is replaced by columnar epithelium. Barrett's esophagus is associated with gastroesophageal reflux and an increased risk of the development of esophageal cancer. Endoscopy shows red columnar epithelium in the lower esophagus. Biopsy is needed to confirm intestinal metaplasia. Some cases progress from dysplasia to invasive adenocarcinoma. Medical or surgical antireflux treatment controls symptoms and esophagitis, but Barrett's esophagus remains. Patients are usually followed up by endoscopy for detection of dysplasia or early cancer. For patients with low-grade dysplasia, follow-up is adequate; however, for those with high-grade dysplasia, esophagectomy or experimental endoscopic mucosal ablation is advised.
 ...
PMID:Management of Barrett's esophagus. 958 88


<< Previous 1 2 3 4 5 6 7 8 9 10