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)

This chapter reviews the pathologic aspects of gastroesophageal reflux and reflux esophagitis. High-grade and low-grade changes due to reflux are discussed in the context of peptic complications such as hemorrhage, ulcer, stricture, and acquisition of Barrett mucosa. The limitations of histopathologic criteria in squamous epithelium for the diagnosis of reflux esophagitis, such as elongated vascular papillae and widened basal zone, are described. The pathogenesis of and criteria for diagnosis of Barrett esophagus are addressed. The neoplastic complication of adenocarcinoma arising in Barrett esophagus is discussed. Finally, the implications of columnar epithelial dysplasia and potential markers in Barrett mucosa for surveillance of Barrett patients are reviewed.
 ...
PMID:Reflux esophagitis and Barrett esophagus. 240 72

To evaluate the consequences of dysplasia in Barrett's esophagus, six patients with esophageal mucosal biopsies showing dysplastic Barrett's mucosa in the absence of clinically evident esophageal carcinoma were identified and their clinicopathologic features reviewed. The patients, four men and two women, averaged 60 years and had long histories of gastroesophageal reflux. Four patients had high-grade dysplasia; two had low-grade. Dysplastic Barrett's mucosa appeared to arise most commonly from specialized-type Barrett's mucosa. After a mean follow-up of 29 months, four patients, all with high-grade dysplasia, had esophageal resections. Three of the four were found to have invasive adenocarcinoma, which extended through the esophageal wall in two patients. The fourth patient had a noninvasive adenomatous polyp ("Barrett's adenoma"), an infrequently described form of dysplasia in Barrett's esophagus. The two patients with low-grade dysplasia had developed no clinical indications of carcinoma. The results confirm that dysplastic Barrett's mucosa, particularly the high grade, is a morphologic marker for adenocarcinoma. Biopsy surveillance of patients with Barrett's esophagus is histologically feasible, but prospective studies are required to prove its effectiveness.
 ...
PMID:Dysplasia in Barrett's esophagus. A clinicopathologic study of six patients. 241 26

Barrett's esophagus is a disease that is common in patients with gastroesophageal reflux of acid but may also occur in association with bile reflux and rarely with other factors. It cannot be reliably distinguished from patients with reflux alone on the basis of demographic factors, clinical characteristics, or manometry. Radiology only serves to make Barrett's epithelium less likely in the presence of a completely normal study. The gold standard for diagnosing Barrett's esophagus is still multiple biopsies taken at the time of endoscopy. By performing multiple biopsies at various levels, the gastroenterologist will be effective not only in diagnosis but in selecting and screening that subset of patients with dysplasia that may predict coexisting or future adenocarcinoma. Treatment of high-grade dysplasia or carcinoma is resection, whereas medical treatment or fundoplication is still directed at the severity and complications of gastroesophageal reflux rather than at Barrett's characteristics alone. A decision tree given in Figure 5 summarizes these recommendations.
 ...
PMID:Barrett's esophagus: detection and management. 266 73

The Ruvalcaba syndrome is a rare malformation syndrome characterized by skeletal dysplasia, facial anomalies, and mental retardation. We report on a 22-year-old woman with severe growth and mental retardation and numerous manifestations characteristic of the Ruvalcaba syndrome. In addition, she has several anomalies not previously described in the Ruvalcaba syndrome, including upslanting palpebral fissures, torus palatinus, hiatal hernia with gastroesophageal reflux, recurrent respiratory infections, pectus excavatum, equinovarous deformity, hypotonia, unilateral renal hypoplasia, an accessory ovary, and atretic fallopian tube. Review of published reports of Ruvalcaba syndrome confirms variability of the clinical and radiographic changes. Findings present in at least 50% of reported patients include mental retardation, short stature, pubertal delay, an abnormal nose (usually beaked) with hypoplastic nasal alae, microstomia with narrow maxilla, thin upper lip vermilion, broad hips, small hands, joint limitation, short fingers and toes, and vertebral abnormalities. Because 5 of the reported patients had renal abnormalities, a renal ultrasound or contrast study is indicated in the evaluation of these patients. Additional reports, particular from multiplex families, will be important to better characterize this syndrome.
 ...
PMID:Apparent Ruvalcaba syndrome with genitourinary abnormalities. 267 89

The bulk of available evidence supports the view that Barrett's oesophagus is an acquired condition due to chronic gastro-oesophageal reflux. It is possible that a few cases are congenital. Barrett's oesophagus gives rise to severe stricture and ulceration and has a significant malignant potential. Treatment is designed to prevent reflux and, if possible, to reverse the metaplastic change. Dysplasia is of ominous significance and requires frequent careful surveillance.
 ...
PMID:Barrett's oesophagus. 285 4

Barrett's esophagus develops as a complication of chronic gastroesophageal reflux and predisposes patients to the development of dysplasia and adenocarcinoma of the esophagus. Because light microscopy of dysplasia in Barrett's esophagus shows diminished or absent mucus, we used transmission electron microscopy to compare cytoplasmic organelles required for mucus production in dysplastic and nondysplastic esophageal columnar epithelium. These observations of the rough endoplasmic reticulum, Golgi apparatus, and secretory granules were correlated with histologic interpretations and flow cytometric measurements of abnormalities of DNA content. Ultrastructural abnormalities included depletion and alteration of organelles required for mucus biosynthesis. These abnormalities often were accompanied by cells with markedly distended rough endoplasmic reticulum and massive accumulation of cytoplasmic glycogen aggregates. All 9 patients who had Barrett's dysplasia with or without early adenocarcinoma had ultrastructural abnormalities, as did 3 of 8 patients whose biopsy histology was indefinite for dysplasia. Abnormalities measured by flow cytometry correlated well with the presence of these ultrastructural aberrations. All 9 patients with Barrett's dysplasia with or without early adenocarcinoma had abnormalities observed by electron microscopy and aneuploidy or increased G2/tetraploid fractions measured by flow cytometry. Two of the 3 patients whose biopsies were indefinite for dysplasia and who had ultrastructural abnormalities also had aneuploidy or increased G2/tetraploid fractions. Neither ultrastructural nor flow cytometric abnormalities were found in the remaining 5 patients whose biopsies were indefinite for dysplasia, in 19 of 22 patients with Barrett's specialized metaplasia, or in any of the 7 patients with gastroesophageal reflux disease without Barrett's specialized metaplasia. Two of the 22 patients with Barrett's specialized metaplasia had distended rough endoplasmic reticulum in rare cells, and one other had an aneuploid cell population. We conclude that neoplastic progression in Barrett's esophagus is associated with abnormalities of cytoplasmic organelles required for mucus production. With few exceptions, these ultrastructural aberrations correspond to the presence of dysplasia or of aneuploidy or increased G2/tetraploid fractions. Electron microscopy and flow cytometery detect abnormalities associated with the development of dysplasia and cancer in Barrett's esophagus that may be biologically significant.
 ...
PMID:Correlation of ultrastructural aberrations with dysplasia and flow cytometric abnormalities in Barrett's epithelium. 291 Jul 57

Adenocarcinoma of the esophagus is a well-known complication of Barrett esophagus, especially in white men. We present three cases of squamous carcinoma of the esophagus in Barrett patients. All three patients were white men. None had a history of symptomatic gastroesophageal reflux or of Barrett esophagus, but all had substantial usage of alcoholic beverages and tobacco. All three tumors were located in squamous-lined mucosa above the Barrett mucosa. Columnar epithelial dysplasia was present in the Barrett mucosa of two of our patients, and the third patient had a squamous carcinoma of the pharynx. Squamous carcinoma represented 2% of Barrett-associated esophageal carcinomas at our institution in 1980 through 1986. Five additional cases were found in the literature, and all were also in white men. This demographic predominance stood in striking contrast to the 26% prevalence of white patients among those with squamous carcinoma of the esophagus at our institution (P less than 0.0002) and to the 50% prevalence of white men among our patients with Barrett esophagus (P less than 0.02). Two of the literature cases also had substantial alcohol and tobacco usage and had synchronous adenocarcinoma arising in Barrett mucosa. Our findings of a strikingly high prevalence of white men and of multifocal neoplastic changes in the upper aerodigestive tract suggest a pathogenetic relationship between squamous carcinoma of the esophagus and Barrett esophagus, possibly due to alcoholic beverage and tobacco usage. Endoscopic surveillance of Barrett patients for early detection of adenocarcinoma has been recommended; contemporaneous evaluation of the squamous-lined esophagus by biopsy and cytopathology may be advisable.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Squamous carcinoma of the esophagus in patients with Barrett esophagus. 292 88

The outcome of Barrett's esophagus was evaluated in 21 patients who prospectively underwent total duodenal diversion and followed from 13 to 86 months. The total duodenal diversion procedure included troncular vagotomy, antrectomy and Roux-en-Y reconstruction incorporating a 70 cm loop. The diagnosis of Barrett's esophagus was made on endoscopy when a circular zone of columnar epithelium more than 3 cm long was found and was always corroborated by biopsies. All patients had esophagitis on endoscopy or acid reflux on pH-monitoring. During follow-up, for all cases, no esophagitis and no bile were detected in the stomach by successive endoscopies; none of the 16 pH-studies showed any aggressive reflux. The length of Barrett's esophagus was measured before and after Roux-en-Y duodenal diversion. In spite of the suppression of gastroesophageal reflux, regression of Barrett's esophagus was observed in one case only beginning 24 months after the diversion. No cases of adenocarcinoma or dysplasia were detected. In conclusion, regression of Barrett's esophagus is exceptional even after duodenal diversion.
 ...
PMID:[Does Barrett esophagus regress after total duodenal diversion?]. 280 10

The cases of 50 consecutive patients requiring operative treatment for esophageal strictures were reviewed to evaluate results and develop principles of management. Forty-eight had gastroesophageal reflux disease and 2 had chronic lye strictures. Of the patients with gastroesophageal reflux disease, 21 had a Barrett's esophagus. Esophageal dilations had been performed in 29 patients, 12 of whom also had undergone previous surgical procedures. Preoperative dilations by our group were used to determine further intervention. Patients with dilatable strictures were randomized to either a Nissen or a Belsey operation. In this group, there were no operative deaths, and excellent or good clinical results were obtained in 28 of 34 (82%) patients, with no significant differences noted in the outcomes between the two operations. Patients with undilatable strictures, Barrett's ulcer, or mucosal dysplasia underwent resection plus colon interposition (N = 12) or resection plus gastric interposition (N = 4). Two of the patients in the Nissen operation group later required resection and colon interposition, bringing that total to 14. Resection plus colon interposition resulted in excellent or good results in 71% of patients, with a 7% operative mortality. These results suggest that a standard transthoracic antireflux procedure can be performed with a low risk when strictures are dilatable. Excellent or good results were obtained in 82% of patients, which is equivalent to results for more complex operations. There was no significant difference in the outcome for the transthoracic Nissen procedure compared with the Belsey procedure. In addition, when required, resection plus colon interposition provided excellent or good results in 71% of the patients.
 ...
PMID:Surgical management of esophageal strictures. 334 21

Barrett esophagus, the columnar-lined distal esophagus acquired as a consequence of chronic gastroesophageal reflux, is associated with the development of columnar epithelial dysplasia and esophageal adenocarcinoma. To determine the efficacy of cytopathology in identifying Barrett esophagus and related neoplasia, observations were compared on 150 esophageal cytology samples with concurrent endoscopic biopsy specimens. Sixty-six specimens that contained benign columnar epithelium in either cytologic or biopsy material were identified. Distinctive-type Barrett mucosa with incomplete intestinalization, considered diagnostic of Barrett esophagus, was found in 34 of 66 cases (52%) and was present only in cytologic material in 11 cases. Twenty-two specimens contained cardiac-type mucosa (present only in cytology in ten cases), a finding of uncertain significance due to lack of localization of the sample with respect to the gastroesophageal junction. Fundic-type mucosa was not observed in any specimen. Two cases of distinctive-type Barrett mucosa with columnar epithelial dysplasia were identified in both biopsy and cytology specimens. Among eight Barrett-associated carcinomas (seven adenocarcinomas and one squamous), cytologic material was diagnostic for malignancy in seven and highly suspicious in one. It was concluded that cytopathologic studies are a useful adjunct to biopsy histopathology in the diagnosis of Barrett esophagus and associated carcinoma. The role of cytopathology in the diagnosis of Barrett-related columnar epithelial dysplasia requires further study, and at present a cautious approach with biopsy confirmation is recommended.
 ...
PMID:Diagnostic value of cytopathology in Barrett esophagus and associated carcinoma. 335 1


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