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

Gastroesophageal reflux disease (GERD) is a chronic condition that ranges from mild, intermittent symptoms to more severe cases of esophageal strictures and possibly adenocarcinoma of the esophagus. The etiology of GERD is multifactorial, although transient lower esophageal sphincter relaxations are thought to play an important role in addition to poor esophageal clearance and weak lower esophageal sphincter pressures. Lifestyle modifications and over-the-counter medications may be used to treat GERD. After these methods are tried, therapy with histamine receptor type 2 antagonists is the best treatment, although increasingly, proton pump inhibitors are being used. Long-term therapy needs to be maintained in patients with GERD, in contrast to those patients with peptic ulcer disease. The role of lifestyle modifications is described, and the costs of the various regimens are compared.
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PMID:Medical therapy for gastroesophageal reflux disease. 1115 1

A population-based, case-control study to investigate the possible association between gastroesophageal reflux (GER) and adenocarcinoma of the esophagus and gastric cardia was performed. It demonstrated an odds ratio of 7.7 for esophageal adenocarcinoma in patients with GER symptoms. The frequency, severity, and duration of symptoms correlated with an increased risk of esophageal adenocarcinoma. A weaker association was noted for GER and adenocarcinoma of the gastric cardia. No association surfaced between GER and squamous cell carcinoma of the esophagus.
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PMID:Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. 1125 59

Oesophageal adenocarcinoma is one of the most deadly human malignancies. Gastro-oesophageal reflux disease (GERD) has been established as a strong risk factor for oesophageal adenocarcinoma, and more than 40% of adult Americans experience regular GERD symptoms. GERD can be complicated by oesophagitis, and by replacement of oesophageal squamous mucosa with metaplastic, intestinal-type epithelium (Barrett's oesophagus) that is predisposed to malignancy. Cancers in Barrett's oesophagus arise through a sequence of genetic alterations which endow unlimited proliferative capacity upon the cells by affecting components of the cell cycle clock apparatus-the pivotal molecular machinery in the cell nucleus that controls whether a cell will proliferate, differentiate, become quiescent or die. This report describes how the genetic abnormalities that have been recognized in Barrett's oesophagus might promote carcinogenesis through effects on the cell cycle clock machinery. The goal of this review is to provide the clinician with a useful conceptual basis for evaluating studies on the molecular mechanisms underlying the progression from metaplasia to carcinoma in Barrett's oesophagus.
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PMID:Review article: a conceptual approach to understanding the molecular mechanisms of cancer development in Barrett's oesophagus. 1147 11

Gastroesophageal reflux (GER) is the strongest known risk factor for esophageal adenocarcinoma. For long-term sufferers with severe symptoms, the excess risk may exceed 40-fold. GER has also been shown to increase the risk of cancers of the gastric cardia more than fourfold. Several foods, including dietary fat, chocolate, mints, coffee, onions, citrus fruit, and tomatoes, have been associated with temporary symptoms of reflux, most likely through a relaxation of the lower esophageal sphincter (LES). Our aim was to determine whether these foods are associated with risk of adenocarcinoma of the esophagus or gastric cardia. We studied intakes of LES-relaxing foods and other dietary habits potentially associated with reflux in a nationwide population-based case-control study in Sweden, with 185 and 258 cases of esophageal adenocarcinoma and gastric cardia adenocarcinoma, respectively, and 815 controls. We found no association between LES-relaxing foods and symptoms of chronic reflux, although this might be due to avoidance of these foods among sufferers. In addition, we found no association between dietary factors known to cause LES relaxation and the risk of adenocarcinoma of the esophagus or gastric cardia. Our findings indicate that dietary factors associated with LES relaxation and transient GER (but perhaps not severe chronic reflux) are not associated with any important risk of esophageal malignancy.
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PMID:Reflux-inducing dietary factors and risk of adenocarcinoma of the esophagus and gastric cardia. 1152 96

The incidence of adenocarcinoma of the esophagus and gastric cardia is increasing. Many factors are presumed to be associated: symptoms of gastroesophageal reflux disease, tobacco use, alcohol consumption, dietary factors, and obesity. A recent large population-based case-control study evaluated the association between dietary fiber intake and cancers of the gastric cardia and esophagus. This interesting study indicated that high intake of cereal fiber may significantly decrease the risk of gastric cardia cancer. More research is needed on this topic in the hope that dietary intake may decrease the incidence of these cancers.
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PMID:Preventive role of dietary fiber in gastric cardia cancers. 1172 Mar 43

The prevalence of esophageal adenocarcinoma has increased substantially in the United States. Studies demonstrate that certain preexisting conditions place persons at an increased risk for developing adenocarcinoma of the esophagus and of the head and neck. Such conditions include gastroesophageal reflux disease (GERD) and Barrett's esophagus (BE). The degree to which these conditions increase the risk is variable. This article critically evaluates data on the relationships between GERD and esophageal adenocarcinoma, between BE and esophageal adenocarcinoma, and between GERD and cancers of the head and neck.
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PMID:The relation between gastroesophageal reflux disease and esophageal and head and neck cancers: a critical appraisal of epidemiologic literature. 1174 37

Gastroesophageal reflux disease (GERD) and columnar-lined esophagus with intestinal metaplasia (Barrett's esophagus) are the major recognized risk factors for adenocarcinoma of the esophagus. The American College of Gastroenterology recommends that patients with long-standing GERD symptoms (particularly those 50 years of age or older) undergo endoscopic screening to identify Barrett's esophagus and that those patients who have Barrett's esophagus undergo regular endoscopic surveillance. These recommendations are made with the expectation that screening and surveillance will decrease mortality from esophageal cancer, although this association is unclear. Nonetheless, retrospective studies have shown that endoscopic surveillance can detect some early, curable neoplasms in patients with Barrett's esophagus. Dysplasia in Barrett's esophagus is widely regarded as the precursor of invasive malignancy. Although grading dysplastic changes is largely subjective, dysplasia remains the most appropriate biomarker for clinical evaluation of Barrett's esophagus. Flow-cytometric and p53 abnormalities may be earlier and more specific markers for cancer development, but application of these abnormalities is not yet recommended for clinical practice. Endoscopic surveillance also is adversely affected by biopsy sampling error. Techniques that may minimize biopsy sampling error include chromoendoscopy, endosonography, optical coherence tomography, and fluorescence detection techniques. Further studies are needed to clearly define the role of these techniques in surveillance, and none is practical for routine clinical use at this time. Although not specifically recommended, experimental ablative therapies, such as photodynamic therapy, can be considered by physicians for their patients with high-grade dysplasia in Barrett's esophagus, if they are provided as part of an established, approved research protocol.
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PMID:Screening and surveillance for complications related to gastroesophageal reflux disease. 1174 38

The treatment of patients with Barrett's esophagus is similar to that of any patient with underlying gastroesophageal reflux disease (GERD). The treatment of reflux includes medical and surgical therapy. A key component of medical therapy is the use of a proton pump inhibitor to treat the underlying GERD. The major controversy is whether the end point of therapy should be the control of reflux symptoms or the control of esophageal pH. When controlling reflux symptoms with proton pump inhibitor therapy, it is important to eliminate all of the symptoms of reflux. An alternative to medical therapy is surgical fundoplication, which is currently performed laparoscopically. Fundoplication may be indicated when a patient has persistent regurgitation even while on proton pump inhibitor therapy. An individual patient also may choose fundoplication, preferring surgical intervention to taking medication long term on a daily basis. Patients with Barrett's esophagus also have the risk of the developing of adenocarcinoma of the esophagus. Therefore, there is an additional goal in the therapy for individuals with Barrett's to prevent progression to adenocarcinoma. The standard approach to the issue of the premalignant nature of Barrett's esophagus is surveillance endoscopy with biopsy in order to detect dysplasia, a cytologic and architectural histologic change. Dysplasia is the first step in the neoplastic process, an early stage offering the opportunity of intervention and longer-term survival.
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PMID:Barrett's Esophagus, a Complication of GERD. 1179 37

Over the last 25 years, the incidence of adenocarcinoma of the esophagus has increased 350%, faster than any other malignancy in the western world. This increase is largely due to gastroesophageal reflux disease and Barrett's esophagus. While the current incidence of esophageal cancer is relatively low in comparison to other cancers in the United States, this may rapidly change. A cost-effective screening technique is needed for populations at risk for adenocarcinoma of the esophagus. Using unsedated esophagoscopy, gastroenterology nurses may be in the best position to coordinate and perform esophageal cancer screening for the U.S. population. This article provides an overview of esophageal cancer, including types, etiology, symptoms, and diagnosis. In addition to an overview of esophageal cancer, this article provides a look at non-physician, unsedated esophagoscopy as a future direction for esophageal cancer screening.
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PMID:Esophageal cancer. Facts, figures, and screening. 1183 11

Gastroesophageal reflux disease (GERD), a condition commonly encountered in the primary care setting, is a risk factor for adenocarcinoma of the esophagus. Despite the ubiquity of the complaint, considerable uncertainty exists with respect to several basic questions, including when to perform endoscopy in patients with chronic reflux symptoms and how to address the cancer risk associated with GERD. These clinical vignettes illustrate common clinical questions encountered in caring for patients with GERD, especially as they relate to the issue of cancer risk. Applying data reviewed in the companion article, we propose practical answers to common clinical situations regarding care of patients with reflux. We also present an algorithm for treatment of patients with chronic GERD symptoms.
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PMID:Gastroesophageal reflux, Barrett esophagus, and esophageal cancer: clinical applications. 1196 May 41


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