Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0033377 (prolapse)
 11,717 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Patients who present with uncontrolled esophageal acid reflux symptoms require endoscopy to determine the presence or absence of ulcers and stenoses, acid reflux testing to determine if acid reflux is present, and manometry to evaluate esophageal peristalsis and spastic states. These studies are usually done in stages, at separate times. Esophageal manometry catheters currently in use have an incorporated infusion channel. This allows instillation of a dilute acid meal after esophageal manometry has been completed. Standard acid reflux testing can then be done using dynamic positioning and physiologic maneuvers. When combined with an esophagogastroduodenas copy (EGD), these three studies provide all information necessary within 2-3 h to determine further treatment of these patients. A total of 210 patients underwent these studies. A hiatus hernia was present in 84%. An ineffective lower esophageal sphincter was found in 64%. Esophageal hypocontractility was present in 18%, hypercontractility in 14%, and dysmotility in 36%. Upper esophageal sphincter was weak in 42%, hypercontractile in 42%, and dysmotile in 32%. Acid reflux disease was found in the hiatus hernia in 14% and acid reflux to the level of the lower esophagus in 16%, middle esophagus in 13%, and upper esophagus in 40%. Distal esophagitis was present in 47%, esophageal ulceration in 29%, gastric prolapse in 11%, gastritis in 52%, bile reflux disease in 10%, and Barrett's epithelium in 5%. In conclusion, an extremely high number of patients with esophageal acid reflux disease show dysmotility patterns. Standard acid reflux testing using dynamic positioning will identify most patients with significant acid reflux disease. When combined with an EGD, complete testing for acid reflux disease can be performed at one setting. Further study is needed comparing dynamic acid reflux testing to 24-h pH testing.
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PMID:Standard acid reflux testing revisited. 1131 39

Bleeding complications arise in 1/4 of patients with hiatal hernia and GERD, and are the cause in 10% of all acute and 1/3 of chronic foregut bleedings. Most common bleeding disorders directly related to hiatal hernia and GERD are: hiatal hernia ulcers, erosive esophagitis, esophageal ulcers, peptic strictures and Barrett esophagus. The aim of this review article is to point out a significance of proper diagnosis and treatment for conditions bonded with hiatal hernia and GERD which can lead to severe esophageal bleedings. Detailed etiology, incidence, diagnostic algorithm and treatment of Cameron lesions, prolapse gastropathy, erosive esophagitis, peptic esophageal ulcers and postoperative complications related to hiatal hernia and GERD are presented in this article.
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PMID:[Hiatal hernia of the esophagus and GERD as a cause of hemorrhage]. 1763 74

Endoscopic mucosal resection (EMR) is increasingly used for management of Barrett esophagus (BE)-related neoplasia. Duplication of the muscularis mucosae (MM) has been described in BE esophagectomy specimens, where it can pose difficulties with accurate staging of carcinoma. The frequency, morphologic characteristics, and effect of MM duplication in adenocarcinoma staging in EMRs have not yet been evaluated. We studied 122 EMR specimens from 100 patients from 1999 to 2006. The following histologic features were scored: depth of EMR, presence of MM duplication and its extent, prolapse changes (extension of smooth muscle into lamina propria), gland entrapment, and diagnosis (original and study/final). Carcinomas reaching the level of submucosa were classified as invasive adenocarcinoma (INV); those confined to lamina propria or MM were classified as intramucosal adenocarcinoma (IMAC). Of 122 EMRs, 11 (9%) reached mucosa only, 109 (89%) extended to submucosa, and 2 (2%) extended into muscularis propria. MM duplication was present in 67% (75 of 111 specimens that reached at least submucosa). Prolapse changes were noted in 65 (54%) cases and gland entrapment in 67 (56%). Final pathologic diagnoses were 9 (7%) no specialized Barrett mucosa, 4 (3%) BE without dysplasia, 13 (11%) low-grade dysplasia, 51 (42%) high-grade dysplasia, 33 (27%) IMAC, and 12 (10%) INV. EMRs without BE were less likely to show MM duplication (P = 0.01) and there was a trend toward less frequent prolapse change (P = 0.08) and less gland entrapment (P = 0.08) as compared with EMRs with BE. However, there were no significant differences with respect to MM duplication, prolapse change, or gland entrapment between BE with or without dysplasia, IMAC, or INV. Among 33 cases of IMAC, tumor invaded lamina propria in 10 (30%), inner or single MM in 14 (42%), space between duplicated MM in 5 (15%), and outer MM layer in 4(12%). Lymphatic invasion was seen in 2 (10%) cases in which tumor reached the space between MM layers. Overstaging of carcinomas occurred in the original reports in 8 (7%) cases due to misinterpretation of the muscular anatomy, including one case in which the deep MM was interpreted as muscularis propria. These results show that MM duplication is commonly seen in EMR specimens. It is closely associated with the presence of BE but is not affected by neoplastic progression in the Barrett epithelium. Pathologists need to be aware of this distinctive anatomy of BE for accurate staging of adenocarcinomas, particularly to avoid mistaking a thickened outer MM as muscularis propria. Level of IMAC may be a critical feature because of potential access to lymphatic spaces between duplicated MM layers, and we therefore recommend including an explicit statement about the depth of adenocarcinoma invasion rather than using only broad terms such as IMAC or INV in the diagnostic report.
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PMID:Muscularis mucosae duplication and the musculo-fibrous anomaly in endoscopic mucosal resections for barrett esophagus: implications for staging of adenocarcinoma. 1830 Jul 96