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)

There are a wide variety of palliative treatments for esophageal cancer. The aim of most treatments is to maintain oral food intake, which should stabilize or even improve quality of life. Stent placement is currently the most widely used treatment modality for palliation of dysphagia from esophageal cancer. Stent placement offers a rapid relief of dysphagia, however, the rate of complications (late hemorrhage) and recurrent dysphagia (stent migration, tumor overgrowth) is relatively high. The scientific evidence to advocate the use of anti-reflux stents for the prevention of gastro-esophageal reflux is currently too low. Photodynamic therapy is mostly used in North America; however, due to the high costs of the treatment, the long-lasting side effects and the necessity of repeated treatments, it is not an ideal treatment for palliation of malignant dysphagia. Nd:YAG laser is a relatively effective and safe treatment modality, although laser treatment is also expensive, technically difficult and requiring repeated treatment sessions at 4-6 weeks intervals. Single dose brachytherapy compares favorably to stent placement in long-term effectiveness and safety. Effective treatment strategies are probably 12 Gy given in one fraction or 16 Gy given in two fractions. Palliative chemotherapy offers response rates in recent trials (including partial and complete responses) ranging from 35% to 50%. Whether palliative chemotherapy also results in a survival benefit is not established yet. For clinical trials on palliation of esophageal cancer, the measurement of quality of life is an important outcome measure. The cancer-specific EORTC QLQ-C30 and the esophageal cancer-specific EORTC-OES-18 are validated measures for establishing quality of life status. For the future, a multimodality approach with stent placement or brachytherapy in combination with chemotherapy may be indicated.
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PMID:Palliative therapy. 1629 91

Palliation of inoperable esophageal cancer with covered stents aims to relieve progressive dysphagia and improve health-related quality of life (HRQoL). Introducing a stent across the esophagogastric junction in lower third tumors may predispose to unchecked gastro-esophageal reflux (GER). Esophageal stents incorporating an anti-reflux valve have been introduced to address this problem. We prospectively compared an anti-reflux stent with a standard stent in the palliation of inoperable lower third esophageal tumors. Forty-nine consecutive patients with malignant dysphagia were randomized to receive a standard (n = 25, group 1) or an anti-reflux stent (n = 24, group 2). HRQoL was assessed before stenting, at 1 week and at 2 months, utilizing European Organization for Research and Treatment of Cancer questionnaires QLQ-C30, QLQ-OES24 and reflux questionnaires. Esophageal pH testing was performed within 1 week of the stent insertion. Detailed statistical analysis was employed to assess general QoL, symptoms and pH scores in both groups. Both groups reported significantly improved QoL, health and dysphagia scores at 1 week and 2 months after stenting. Group 2 patients reported significantly (P < 0.05) better DeMeester symptom, general reflux scores, and normal pH profile at 1 week. At 2 months DeMeester symptom scores were significantly (P < 0.05) better in group 2 compared with group 1. Standard and anti-reflux stents afford comparable relief from dysphagia and improved quality of life in patients with inoperable lower third esophageal cancer. Anti-reflux stents, however, controlled symptomatic and physiologically relevant reflux and should therefore be considered as optimal palliation in this cohort.
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PMID:Superiority of anti-reflux stent compared with conventional stents in the palliative management of patients with cancer of the lower esophagus and esophago-gastric junction: results of a randomized clinical trial. 1795 20

Esophageal cancer is one of the leading causes of cancer-related mortality and surgery is currently the main treatment modality for resectable esophageal cancer. To assess health-related quality of life (HRQL) of patients with esophageal squamous cell carcinoma (ESCC) following esophagectomy, 62 consecutive patients with middle ESCC were randomly assigned into hand video-assisted thoracoscopic surgery (HVATS) (n=33) and Ivor-Lewis surgery (ILS) (n=29) groups. Quality of life questionnaires (QLQ)-C30 and QLQ-OES18, published by the European Organization for Research and Treatment of Cancer, were used prior to treatment and at regular intervals until 6 months following surgery. The results of QLQ-C30 and QLQ-OES18 demonstrated that i) patients with comorbidities and advanced tumor stage (III-IV) exhibited increased risk of poor HRQL, while their gender, age, body mass index and anastomosis location were not associated with HRQL at 6 months after surgery; ii) all the patients had worse functional, symptom and global scores within 6 months after surgery; iii) patients in the HVATS group had similar baseline functional and symptom scores to those of patients in the ILS group; however, their functional and global scores were higher and their symptom scores were lower compared to those of patients in the ILS group; iv) the HRQL of patients in the HVATS group returned to preoperative levels within a shorter time period compared to patients in the ILS group. There were significant differences in global health, physical functioning, fatigue and pain scales between the two groups. In QLQ-OES18, the dysphagia and gastroesophageal reflux scales were improved in both the HVATS and ILS groups, but no significant differences were observed between the two groups. In addition, the overall survival rate was similar in the two groups. Taken together, our findings indicated that HVATS is a safe procedure, associated with less disturbance to short-term HRQL compared to ILS. Therefore, it appears reasonable to select HVATS for patients with early-stage middle esophageal cancer.
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PMID:Assessment of health-related quality of life of patients with esophageal squamous cell carcinoma following esophagectomy using EORTC quality of life questionnaires. 2546 83