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)

Esophageal carcinoma is one of the most common malignant diseases in China. In order to clarify the pathophysiology of the esophageal motor dysfunction in the disease, a comparative study was done with esophageal manometry and 24 hour pH monitoring in 90 patients with esophageal carcinoma (EC) including 17 cardiac carcinoma (CC) and 56 healthy adult volunteers. The results showed that the resting pressure of the esophagus in patients was lower, particularly during swallowing and Valsalva test, than that of the normal subjects. It indicated that the patients with EC and CC had a hypodynamic esophagus so that a series of abnormal esophageal peristalsis and contractive waves were found. Besides the effect of mechanical obstruction of the tumor itself, it was believed to be a causative factor, at least in part, for the production of the clinical symptoms such as dysphagia and spastic odynophagia occurred during swallowing. Being the lower LESP, the patients with EC and CC presented pathological gastroesophageal reflux which was proved by 24 hour pH monitoring findings.
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PMID:[Motor function of the esophagus in patients with esophageal or gastric cancer]. 822 25

Barrett's esophagus (i.e. columnar epithelial metaplasia in the distal esophagus) is an acquired condition that in most patients results from chronic gastroesophageal reflux. It is a disorder of the white male in the Western world with a prevalence of about 1/400 population. Due to the decreased sensitivity of the columnar epithelium to symptoms, Barrett's esophagus remains undiagnosed in the majority of patients. Gastroesophageal reflux disease in patients with Barrett's esophagus has a more severe character and is more frequently associated with complications as compared with reflux patients without columnar mucosa. This appears to be due to a combination of a mechanically defective lower esophageal sphincter, inefficient esophageal clearance function, and gastric acid hypersecretion. Excessive reflux of alkaline duodenal contents may be responsible for the development of complications (i.e., stricture, ulcer, and dysplasia). Therapy of benign Barrett's esophagus is directed towards treatment of the underlying reflux disease. Barrett's esophagus is associated with a 30- to 125-fold increased risk for adenocarcinoma of the esophagus. The reasons for the dramatic rise in the incidence of esophageal adenocarcinoma, which occurred during the past years, are unknown. High grade dysplasia in a patient with columnar mucosa is an ominous sign for malignant degeneration. Whether an esophagectomy should be performed in patients with high grade dysplasia remains controversial. Complete resection of the tumor and its lymphatic drainage is the procedure of choice in all patients with a resectable carcinoma who are fit for surgery. In patients with tumors located in the distal esophagus, this can be achieved by a transhiatal en-bloc esophagectomy and proximal gastrectomy. Early adenocarcinoma can be cured by this approach. The value of multimodality therapy in patients with advanced tumors needs to be shown in randomized prospective trials.
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PMID:Barrett's esophagus: pathogenesis, epidemiology, functional abnormalities, malignant degeneration, and surgical management. 835 51

History taking is the first step in the evaluation of a patient. An analysis of the information obtained provides the basis for the choice and order of diagnostic tests. In addition, it provides the clinician with the necessary information to determine the relevance of "abnormal tests" to the patient's problem. Dysphagia is a reliable symptom that indicates an abnormality in the swallowing mechanism. The history should contain a detailed description of the symptoms associated with dysphagia from the onset. Especially relevant are questions to determine if dysphagia is experienced every day or intermittently, with solid food or liquids or both, as well as presence and timing of associated symptoms such as, choking, coughing and regurgitation, changes in speech, heartburn and chest pain. It is clinically useful to divide swallowing into three phases: oral, pharyngeal and esophageal. Oral dysphagia is usually due to a neurologic disorder, decreased salivary flow or painful oropharyngeal lesions. Pharyngeal dysphagia is most frequently caused by neuromuscular disorders and less frequently by a Zenker's diverticulum, neoplasm or a mucosal web. Esophageal dysphagia is caused by a structural narrowing, such as produced by a peptic stricture, neoplasm or a Schatzki's ring or by a primary motility abnormality, such as achalasia or diffuse esophageal spasm or by motility abnormalities produced by inflammation caused by gastroesophageal reflux, medication-induced esophageal ulceration or infectious esophagitis.
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PMID:Art and science of history taking in the patient with difficulty swallowing. 846 26

A 66-yr-old white male with a long-standing history of gastroesophageal reflux and Barrett's esophagus developed squamous cell dysplasia proximal to the site of the metaplastic epithelium. Two months later, he presented with progressive dysphagia. Upper endoscopy revealed near obliteration of the lumen from a large friable mass in the distal esophagus. Repeat endoscopic biopsies revealed areas of focal dysplasia but were inconclusive for the presence of malignancy. At surgery, a large inflammatory fibrotic mass was resected that was confirmed histologically to be a verrucous squamous cell carcinoma. Twenty-two months after the resection, there is no evidence of tumor recurrence. The case and relevant literature is discussed.
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PMID:Long-term survival in a patient with verrucous carcinoma of the esophagus. 863 46

The experience of the Digestive Endoscopy Center of the Soavinandriana Hospital in Antananarivo provides insight into not only esogastroduodenal disease in Madagascar but also technical problems involved in performing esophago-gastro-duodenoscopy in tropical areas. From September 1990 to March 1995 a total of 12000 esophago-gastro-duodenoscopy procedures were performed without complication. The main finding was duodenal ulcer which observed in 3580 cases (29.8% of patients) followed by peptic esophagitis due to gastroesophageal reflux in 555 cases and gastric ulcer in 460 cases. Esophageal cancer was detected in 16 cases and malignant gastroduodenal tumor in 82 cases including 63 adenocarcinomas and 5 digestive lymphomas. Overall 4156 procedures (34.6%) were normal and 1130 procedures (9.4%) were performed to investigate digestive tract hemorrhage. These findings document the high incidence of duodenal ulcer in Madagascar where treatment of this condition is difficult due to the high cost. This study underlines the problems encountered in operating an endoscopy department in tropical areas especially with regard to desinfection of equipment and training of endoscopists.
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PMID:[Madagascar: esophagogastroduodenoscopy. Descriptive analysis of 12,000 examinations and problems encountered in the tropics]. 876 1

Barrett's oesophagus is the eponym applied to the columnar epithelium-lined lower oesophagus which is acquired as a complication of chronic gastro-oesophageal reflux (GER). Various complications seen in the Barrett's oesophagus, such as peptic ulcer, stricture, adenocarcinoma are named as Barrett's ulcer, Barrett's stricture-and Barrett's carcinoma, respectively. It is now generally accepted that Barrett's oesophagus is an acquired condition resulting from chronic repetitive GER. The frequency of Barrett's oesophagus seems to be higher in Caucasian than in Oriental or Negro populations. There is a tendency towards increasing prevalence rates all over the world, including Taiwan, due to the Westernization of diet, rapid growth in the elderly population, obesity etc. Almost 6% of the patients who manifest heartburn in GI clinics in Taiwan now suffer from GER, which is almost similar to the 7% reported by Nabel, (USA) in 1976. During the last 30 years, the incidence of esophageal adenocarcinoma has increased rapidly. Patients with Barrett's oesophagus have an increased risk of developing oesophageal adenocarcinoma and should be kept under surveillance. Regular follow-up, at least twice a year or preferably, every 2-3 months, for those patients with SCE using endoscopic surveillance and biopsy for those with severe dysphasia (oesophageal columnar intraepithelial neoplasia) in the surrounding area to detect Barrett's oesophagus cancer, is very important.
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PMID:Review: Barrett's oesophagus in Taiwan. 919 7

There are a variety of diagnostically challenging lesions in the head and neck region. Contact ulcer usually occurs within specific clinical parameters (vocal abuse, post-intubation and gastro-esophageal reflux), which should be documented in correlation with the granulation tissue-like response affecting the posterior vocal cords. Spindle squamous cell carcinoma (carcinosarcoma) presents a variably cellular spindle cell proliferation, often with surface epithelial ulceration. The clinical presentation of a firm, polypoid mass in the larynx, combined with the histomorphologic features of a spindle cell tumor, can be confirmed to be of epithelial origin when a portion of the overlying epithelium is seen to blend with the spindle cell component, or when ancillary studies authenticate the epithelial origin of the tumor. The diagnosis of a verrucous squamous cell carcinoma can only be made accurately with an accurate clinical history. The very well differentiated histologic appearance, a broad pushing border of infiltration, a bland epithelial proliferation with scant mitotic activity and "church-spire"-type keratosis coupled with the clinical presentation of a large, locally destructive lesion, can confirm the diagnosis of verrucous carcinoma. A wide variety of disorders can result in midline destructive disease clinically, but a specific etiology must be sought to provide appropriate clinical management. Angiocentric T/NK-cell lymphoma of the sinonasal tract is one such disease. The atypical lymphoid cells are usually angiocentric and angiodestructive in their growth pattern. Identification of the atypical cells in the early stages of disease may be difficult, often requiring multiple biopsies over time with the application of immunohistochemical stains or molecular studies to accurately identify the nature of the infiltrate. Cystic squamous cell carcinoma in the neck is almost always a manifestation of metastatic tumor and not a brachiogenic carcinoma. When specific histomorphologic features are noted (a large, unfilled cyst lined by a ribbon-like or endophytic growth of a "transitional"-appearing squamous epithelium with a limited degree of anaplasia), most of these tumors demonstrate primaries in Waldeyer's ring, often of a very small size. Adequate clinical work-up (pan-endoscopy, extensive radiographic imaging and random biopsies or prophylactic tonsillectomy) is mandatory in order to limit the radiation-therapy ports and to document the location of the primary, yielding an excellent long-term prognosis.
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PMID:Diagnostically challenging lesions in head and neck pathology. 933 90

The GER human pancreatic carcinoma cell line possesses receptors for 1,25-dihydroxyvitamin D3. We report that the vitamin D analogue EB 1089 inhibits the growth of these cells in vitro and when grown as tumour xenografts in immunodeficient mice. Tumour-bearing mice were given EB 1089 at a dose of 5 microg kg(-1) body weight i.p. thrice weekly for 4-6 weeks. Tumour growth was significantly inhibited in treated animals compared with controls in the absence of hypercalcaemia. These findings may have therapeutic implications in pancreatic cancer.
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PMID:Vitamin D receptors and anti-proliferative effects of vitamin D derivatives in human pancreatic carcinoma cells in vivo and in vitro. 937 60

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.
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PMID:[Esophageal cancer]. 948 May 21

Gastroesophageal reflux (GER) is often associated with respiratory disorders. We report an unusual case of GER presented with haemoptysis. On fibreoptic bronchoscopy (FFB) a focal erythematous lesion of the mucosa of the main carina was found. Repeated FFB and biopsy excluded in situ neoplasm. Pharmacological treatment of GER with sisapride and ranitidine resulted in complete remission of the bronchial lesions. To the best of our knowledge haemoptysis with bronchoscopic lesions due to the gastroesophageal reflux has not been described previously.
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PMID:Gastroesophageal reflux presented with haemoptysis and carinal erythematous lesion resembling in situ carcinoma. 992 57


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