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)

Squamous cell carcinoma is the most common malignant tumor of the esophagus and it is one of the most common fatal cancers worldwide. There is great geographic variation in occurrence of these tumors. Especially high-risk areas have been identified in Northern Iran, Central Asian Republics, Northern China and South Africa. In some of these areas annual mortality rates reach 133/100,000 and over 20% of the population dies of esophageal cancer. The mortality in the US is considerably lower (3 to 8 per 100,000). In common with squamous dysplasias elsewhere eg the cervix, squamous dysplasia of the esophagus also appears to be a precancerous lesion. We have found that squamous dysplasia and early cancer are characterized by a number of distinctive endoscopic changes, namely, mucosal friability, erosions, plaques and nodules. Another finding of interest is the failure on our part to confirm the frequency of esophagitis in high risk areas. Barrett's esophagus is an epithelial metaplasia which replaces esophageal squamous epithelium for variable lengths from the lower esophageal sphincter region cephalad. It is a complication that occurs in approximately 12% of patients with prolonged gastroesophageal reflux. The importance of this disorder is that it is associated with an increased risk of adenocarcinoma of the esophagus. In assessing biopsies from patients with Barrett's esophagus, the main role of the pathologist is to be on the alert for histologic features of dysplasia and adenocarcinoma. Since dysplasia in Barrett's is endoscopically invisible, multiple biopsies are necessary if surveillance is to be successful in detecting dysplastic lesions and early carcinoma.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Malignant and premalignant lesions of the esophagus. 143 13

According to the experience of the authors on a non-selected case report, pharmacologic progresses in the therapy of various aspects of peptic disease permit an ease management also of gastro-esophageal reflux disease. Moreover, endoscopy is the very modern pivot of conservative treatment of more severe complications as strictures are, through repetitive and progressive instrumental dilatations. The surgical treatment of the most severe and intractable eveniences must be chosen for only a low percentage number of patients, after a careful functional analysis of the single case. Very important is the endoscopic and histologic control of Barrett esophagus and severe dysplasia.
 ...
PMID:[Complications of gastroesophageal reflux: considerations on a non-selected case series]. 146 57

Barrett's oesophagus or columnar lined epithelium of the oesophagus (CLO) is a metaplastic condition associated with excessive gastro-oesophageal reflux. It is found in 15% of patients with reflux oesophagitis. In a detailed study of 115 CLO patients dysplasia was found in 46%; 13.9% were moderate or severe dysplasia, usually found in intestinal type CLO. Fifty patients were endoscoped annually to determine the natural history of the disease. The incidence of adenocarcinoma was 1 in 52 patient-years, a 125-fold excess risk. A dysplasia-carcinoma sequence was seen in the five who developed carcinoma. Patients with early carcinoma were treated surgically with 12% postoperative mortality and 100% survival for 24-70 months.
 ...
PMID:Barrett's oesophagus. 146 82

Current concepts regarding the nature and the treatment of Barrett's esophagus and its complications are reviewed. The columnar-lined lower esophagus is being increasingly recognized as an acquired condition caused by gastroesophageal reflux. Many patients are asymptomatic. Barrett's esophagus occurs in about 10% to 15% of patients with reflux esophagitis. The diagnosis depends on endoscopy and biopsy. Complications are common and include ulceration, stricture, dysplasia, and adenocarcinoma. Esophagitis, ulceration, and stricture can usually be treated medically. Surgical approaches are discussed for patients whose condition is refractory to medical therapy. The premalignant nature of Barrett's epithelium is well recognized, and strategies for surveillance and resection are discussed. Survival after resection of adenocarcinoma in Barrett's esophagus is not appreciably different from that of other carcinomas. Surveillance with endoscopy offers the best chance for early detection and cure.
 ...
PMID:Current concepts concerning the nature and treatment of Barrett's esophagus and its complications. 846 28

The diagnosis of gastroesophageal reflux disease (GERD) entails the identification of patients with esophagitis and its complications as well as patients who have symptoms but no mucosal disease. Endoscopy is mandatory to establish a diagnosis of reflux esophagitis, to exclude other esophageal disease and to permit directed biopsy if columnar metaplasia, dysplasia or carcinoma is suspected. The lesions of reflux esophagitis--erosions, ulceration, stricturing and metaplasia--should be identified and graded independently, using a classification system such as the recently described "MUSE" (Metaplasia, Ulcer, Stricture, Erosions) system. Fluoroscopy can identify associated structural changes such as stricturing or esophageal shortening. Measures of esophageal acid exposure time may be used to quantify reflux before and after treatment; however, if the patient has typical symptoms but no esophagitis, a temporal association between symptoms and episodes of esophageal acidification should be sought. Ambulatory 24-hour esophageal pH-monitoring with accurate event-marking provides recordings suitable for an objective statistical analysis, which was evaluated prospectively in 14 patients. Computerized analysis of 24-hour esophageal pH recordings diagnosed 5 patients as having acid-related symptoms although only 3 of 5 patients fulfilling the criteria for pathological reflux had pH-related chest pain. This finding was confirmed by 5 experts who analyzed all recordings visually, unaware of the result of the computer analysis. The Bernstein test should be reserved for patients whose symptoms are too infrequent to permit an objective assessment of symptom occurrence during pH monitoring. In conclusion, i) endoscopy is the test of choice for the diagnosis of esophagitis but it should be supplemented by a standardized and reliable scoring system for disease severity; ii) ambulatory esophageal pH recording with accurate event-marking is the test of choice for the diagnosis of GER-related symptoms, but it should be supplemented by an objective assessment of the temporal relationship between symptoms and esophageal pH; and iii) esophageal manometry is the test of choice for evaluating esophageal peristalsis and LES (lower esophageal sphincter) function but, in the context of GERD, its main indication is the assessment of GERD patients who are being considered for surgery. The widespread use of other tests for clinical purposes must await a better understanding of the pathophysiological mechanisms which can lead to the development of GERD.
 ...
PMID:Diagnostic assessment of gastroesophageal reflux disease: what is possible vs. what is practical? 157 93

Barrett's esophagus is a condition in which the normal stratified squamous epithelium is replaced by a specialized metaplastic columnar epithelium. It develops as a consequence of chronic gastroesophageal reflux and predisposes to the development of esophageal adenocarcinoma. Adenocarcinoma develops in Barrett's esophagus by a multistep process in which specialized metaplasia progresses to dysplasia, then to early adenocarcinoma, and eventually to deeply invasive and metastatic disease. This neoplastic progression is associated with a process of genomic instability that generates abnormal clones of cells, some of which have aneuploid or increased G2/tetraploid DNA content. A systematic protocol of endoscopic biopsy can detect Barrett's adenocarcinomas at an early stage, when they may be curable.
 ...
PMID:Barrett's esophagus and esophageal adenocarcinoma. 178 15

Barrett's esophagus, a condition in which the distal esophagus is lined by columnar epithelium, is almost always caused by gastroesophageal reflux and often occurs in conjunction with a sliding hiatal hernia. Patients are typically white men in their 50s who smoke and drink, and they present with complaints of regurgitation, heartburn, and/or dysphagia. Endoscopic biopsies are required to confirm the diagnosis. Complications, such as stricture, ulcer, dysplasia, and malignant degeneration, occur in many cases. Adenocarcinoma is the most serious complication. Medical treatment, including life-style changes as well as pharmacologic therapy, usually relieves symptoms and heals esophagitis, but when it fails, antireflux surgery is indicated. Patients without evidence of dysplasia should undergo endoscopy yearly; those with mild dysplasia require more frequent surveillance. If biopsies disclose severe dysplasia, esophagogastrectomy should be performed.
 ...
PMID:Barrett's esophagus. A continuing conundrum. 206 52

The authors review the literature about the assessment of risks of adenocarcinoma occurring over the natural history of Barrett's oesophagus with an incidence much higher than in the general population. The best marker is histological analysis of the cylindric epithelium for signs of dysplasia or early carcinoma. Although there is much controversy about the practical benefit of regular surveillance, the authors recommend a yearly endoscopy with multiple site biopsies. With the new potent drugs aimed at controlling gastro-oesophageal reflux, regression of metaplasia might occur, as the authors have observed in 3 patients treated by 60 mg omeprazole. However, prospective studies are needed to confirm this finding and its possible effect on reducing the risk of adenocarcinoma.
 ...
PMID:[Barrett's esophagus. Characterization and monitoring policy]. 213 May 86

Regression of Barrett's epithelium after antireflux operations remains a controversial topic. We evaluated the effect of antireflux procedures in patients with Barrett's esophagus on the regression of columnar epithelium and dysplasia and its potential protective effect on the subsequent development of carcinoma. Of the 241 patients with Barrett's esophagus treated at the Lahey Clinic from 1973 to 1989, 37 patients underwent an antireflux operation. Regression was defined as histological evidence of regenerating squamous mucosa that completely or partially replaced the columnar epithelium. Improvement in lower esophageal sphincter pressure to 12 mm Hg or greater occurred in 19 of 26 patients (73%) who had perioperative manometry. Symptomatic relief of esophagitis occurred in 34 of 37 patients (92%). Four patients had partial regression with regenerating squamous mucosa juxtaposed with areas of columnar epithelium. Carcinoma developed in 3 of 37 patients (8.1%). One patient had recurrence of severe symptoms of reflux esophagitis before development of carcinoma. Patients with Barrett's esophagus who have undergone a successful antireflux operation with symptomatic relief and evidence of improvement in lower esophageal sphincter pressures rarely show regression of Barrett's mucosa and may still be at risk for development of carcinoma. Therefore, the indications for antireflux operation in Barrett's esophagus should remain the same as for other patients with gastroesophageal reflux, but yearly endoscopic and histological surveillance should be continued postoperatively.
 ...
PMID:Effect of antireflux operation on Barrett's mucosa. 232 44

To clarify the possible association between gastrectomy and the subsequent development of esophageal cancer, we studied the incidence of subjective gastroesophageal reflux in 287 patients and analyzed the nutritional status and results of endoscopic examination of the esophagus in 62 patients who had survived for a long period after gastrectomy for nonmalignant diseases. The incidence of postoperative reflux was 22.6%. None of the patients had severe deterioration of blood parameters or nutritional status. Endoscopic observation revealed esophagitis in 24.2% of patients, mainly in the lower esophagus. Histologically, there was a high incidence of infiltration of neutrophils and lymphocytes, enlarged papillae, and basal cell hyperplasia. Epithelial dysplasia was detected in 41.9% of patients, and of these there were more patients in whom the degree of dysplasia was more severe in the lower esophagus than in other areas. These data suggest that postgastrectomy gastroesophageal reflux is more likely than postgastrectomy changes in nutritional status to be a possible contributory factor to the development of subsequent esophageal cancer.
 ...
PMID:Possible association between gastrectomy and subsequent development of esophageal cancer. 234 71


1 2 3 4 5 6 7 8 9 10 Next >>