Sample records for esophageal ph testing

  1. Esophageal pH monitoring

    MedlinePLUS

    pH monitoring - esophageal; Esophageal acidity test ... esophagitis You may need to have the following tests if your doctor suspects esophagitis : Barium swallow Esophagogastroduodenoscopy (also called upper GI endoscopy)

  2. Ambulatory 24-hour esophageal pH monitoring

    Microsoft Academic Search

    G. J. Wiener; T. M. Morgan; J. B. Copper; D. O. Castell; J. W. Sinclair; J. E. Richter

    1988-01-01

    If 24-hour esophageal pH monitoring is to be a useful diagnostic tool, it must reliably discriminate gastroesophageal reflux patients despite daily variations in distal esophageal acid exposure. To address this issue, we studied 53 subjects (14 healthy normals, 14 esophagitis patients, and 25 patients with atypical symptoms) with two ambulatory pH tests performed within 10 days of each other. Intrasubject

  3. Generation of Gastroesophageal Reflux Disease Symptoms During Esophageal Acid Infusion With Concomitant Esophageal pH Monitoring in Healthy Adults

    PubMed Central

    Furuta, Kenji; Adachi, Kyoichi; Fukazawa, Kousuke; Aimi, Masahito; Miki, Masaharu; Kinoshita, Yoshikazu

    2013-01-01

    Background/Aims The sensitivity of the upper and lower esophageal mucosa to acid is considered to differ. We investigated the relationship between pH changes in different sites of the esophagus and generation of gastroesophageal reflux symptoms during an acid infusion test. Methods An acid infusion catheter was placed at 5 or 15 cm above the lower esophageal sphincter (LES) in 18 healthy volunteers, while a 2-channel pH sensor catheter was also placed in each with the sensors set at 5 and 15 cm above the LES. Solutions containing water and hydrochloric acid at different concentrations were infused through the infusion catheter. Results Acid infusion in the upper esophagus caused a pH drop in both upper and lower esophageal sites, whereas that in the lower esophagus resulted in a significant pH drop only in the lower without a corresponding pH decline in the upper esophagus. Stronger heartburn, chest pain, and chest oppression symptoms were noted when acid was infused in the upper as compared to the lower esophagus, while increased intra-esophageal acidity strengthened each symptom. Regurgitations caused by upper and lower esophageal acid infusions were similar, and not worsened by a larger drop in intra-esophageal pH. Chest pain was caused only by lowered intra-esophageal pH, while heartburn, chest oppression, and regurgitation were induced by a less acidic solution. Conclusions Higher intra-esophageal acidity caused stronger heartburn, chest pain, and chest oppression symptoms. However, regurgitation was not significantly influenced by intra-esophageal acidity. The upper esophagus showed higher acid sensitivity than the lower esophagus. PMID:24199011

  4. Ambulatory esophageal pH monitoring using a wireless system

    Microsoft Academic Search

    John E Pandolfino; Joel E Richter; Tina Ours; Jason M Guardino; Jennifer Chapman; Peter J Kahrilas

    2003-01-01

    ObjectivesLimitations of catheter-based esophageal pH monitoring are discomfort, inconvenience, and interference with normal activity. An alternative to conventional pH monitoring is the wireless Medtronic Bravo pH System. The aim of this study was to evaluate the safety, performance, and tolerability of this system.

  5. ACG Practice Guidelines: Esophageal Reflux Testing

    Microsoft Academic Search

    Ikuo Hirano; Joel E. Richter

    2007-01-01

    Investigations and technical advances have enhanced our understanding and management of gastroesophageal reflux disease. The recognition of the prevalence and importance of patients with endoscopy-negative reflux disease as well as those refractory to proton pump inhibitor therapy have led to an increasing need for objective tests of esophageal reflux. Guidelines for esophageal reflux testing are developed under the auspices of

  6. Esophageal function testing using multichannel intraluminal impedance.

    PubMed

    Srinivasan, R; Vela, M F; Katz, P O; Tutuian, R; Castell, J A; Castell, D O

    2001-03-01

    Multichannel intraluminal impedance (MII) is a new technique for evaluation of bolus transport. We evaluated esophageal function using bolus transport time (BTT) and contraction wave velocity (CWV) of liquid, semisolid, and solid boluses. Ten healthy subjects underwent MII swallow evaluation with various boluses of sterile water (pH 5), applesauce, three different sized marshmallows, and iced and 130 degrees F water. The effect of bethanechol was also studied. There was no difference in BTT or CWV for all water volumes from 1 to 20 ml. There was significant linear increase of BTT with progressively larger volumes of applesauce, and BTT of applesauce was longer than for water. BTT was significantly longer with large marshmallows vs. small and medium and was longer than for water. BTT for iced water was similar to 130 degrees F water. Applesauce showed a significant linear decrease of CWV with progressively larger volumes and was slower than water. Marshmallow showed significantly slower CWV with the large vs. small, and CWV for ice water was significantly slower than 130 degrees F water. Therefore, BTT of liquid is constant, whereas BTT of semisolid and solid are volume dependent and longer than liquids. CWV of semisolids and solids are slower than liquids. CWV of cold liquids is slower than warm liquids. MII can be used as a discriminating test of esophageal function. PMID:11171628

  7. Eosinophilic Esophagitis

    MedlinePLUS

    ... is to complete a test called an esophageal pH test. In this test, a very thin tube is placed through the nose into the esophagus and stomach, or a temporary sensor is placed in the esophagus via endoscopy. Both allow levels of acid in the esophagus to be monitored ...

  8. A novel optical probe for pH sensing in gastro-esophageal apparatus

    NASA Astrophysics Data System (ADS)

    Baldini, F.; Ghini, G.; Giannetti, A.; Senesi, F.; Trono, C.

    2011-03-01

    Monitoring gastric pH for long periods, usually 24 h, may be essential in analyzing the physiological pattern of acidity, in obtaining information on changes in activity during peptic ulcer disease, and in assessing the effect of antisecretory drugs. Gastro-esophageal reflux, which causes a pH decrease in the esophagus content from pH 7 even down to pH 2, can determine esophagitis with possible strictures and Barrett's esophagus. One of the difficulties of the optical measurement of pH in the gastro-esophageal apparatus lies in the required extended working range from 1 to 8 pH units. The present paper deals with a novel optical pH sensor, using methyl red as optical pH indicator. Contrary to all acidbase indicators characterized by working ranges limited to 2-3 pH units, methyl red, after its covalent immobilization on controlled pore glass (CPG), is characterized by a wide working range which fits with the clinical requirements. The novel probe design here described is suitable for gastro-esophageal applications and allows the optimization of the performances of the CPG with the immobilised indicator. This leads to a very simple configuration characterized by a very fast response time.

  9. Axial force measurement for esophageal function testing

    PubMed Central

    Gravesen, Flemming H; Funch-Jensen, Peter; Gregersen, Hans; Drewes, Asbjørn Mohr

    2009-01-01

    The esophagus serves to transport food and fluid from the pharynx to the stomach. Manometry has been the “golden standard” for the diagnosis of esophageal motility diseases for many decades. Hence, esophageal function is normally evaluated by means of manometry even though it reflects the squeeze force (force in radial direction) whereas the bolus moves along the length of esophagus in a distal direction. Force measurements in the longitudinal (axial) direction provide a more direct measure of esophageal transport function. The technique used to record axial force has developed from external force transducers over in-vivo strain gauges of various sizes to electrical impedance based measurements. The amplitude and duration of the axial force has been shown to be as reliable as manometry. Normal, as well as abnormal, manometric recordings occur with normal bolus transit, which have been documented using imaging modalities such as radiography and scintigraphy. This inconsistency using manometry has also been documented by axial force recordings. This underlines the lack of information when diagnostics are based on manometry alone. Increasing the volume of a bag mounted on a probe with combined axial force and manometry recordings showed that axial force amplitude increased by 130% in contrast to an increase of 30% using manometry. Using axial force in combination with manometry provides a more complete picture of esophageal motility, and the current paper outlines the advantages of using this method. PMID:19132762

  10. Predictive value of esophageal motility test in the proficiency of esophageal speech.

    PubMed

    Sahin, M; Vardar, R; Kirazli, T; Ogut, F; Akyildiz, S; Bor, S

    2015-02-01

    One method of speech rehabilitation following total laryngectomy surgery is esophageal speech therapy (EST). In this method, which has witnessed relatively low success rates at the end of therapy, identification of patients who can benefit from EST beforehand will be important for determining the appropriate method for alaryngeal speech rehabilitation and might be cost-effective, saving time and labor. To this end, this study conducted research on the feasibility of manometric data measured prior to therapy using an esophageal motility test (EMT) in order to determine the candidates most suitable for esophageal speech (ES) beforehand. A total of 51 total laryngectomy male patients who had never been subject to any kind of speech rehabilitation and had always been articulate were included in the study. Data were collected from 44 patients who completed EST, lasting for 6 months in total and consisting of 11 sessions. Manometric measures were obtained through EMT using a water-perfusion system with a Dent sleeve catheter on the patients prior to the therapy. Wepman's scale was used in order to evaluate ES proficiency. Following the therapy, in accordance with this scale, while patients whose scores was 1, 2, or 3 were considered as adequate, those whose scores were 4, 5, 6, or 7 were considered inadequate and were divided into two groups. Manometric correlations were analyzed between 17 patients (group I) who were able to perform ES at an adequate level and 27 patients (group II) who could not. No statistically significant difference between the groups could be observed in terms of average pressure generated within the upper and lower esophageal sphincters obtained through EMT, peak amplitude of esophageal body contraction pressure, contraction duration time, onset velocity, or peak velocity values. EMT conducted prior to application of EST to total laryngectomized patients did not have any value in determining the level of ES that a patient could reach. Our results also suggest that sphincter pressures or esophageal motility patterns do not have any predictive value and should not be performed. PMID:24612437

  11. Friction-assisted magnetic holding of an ingestible capsule for esophageal pH and impedance monitoring.

    PubMed

    Gonzalez, J L; Sadowski, D C; Mintchev, M P

    2006-01-01

    24-hour catheter-based ambulatory pH and impedance monitoring is an essential tool for diagnosing esophageal disorders. However, catheter-based monitoring systems are uncomfortable and interfere with normal activities of the patient. To overcome these disadvantages, different wireless monitoring systems have been proposed. However, efficient ways to position and hold wireless capsules are lacking. Currently there is a need to develop safe and reliable methods to hold an esophageal wireless monitoring system in position for 24 hours. Friction-assisted magnetic holding is proposed as an alternative to conventional holding techniques. Permanent magnet and electromagnet designs with the required characteristics to achieve this task were computer-designed and simulated. The size and power requirements of the magnets were considered. Simulation results were verified using laboratory experiments. Permanent neodymium magnets offered the best performance for the intended application. The obtained results show the feasibility of friction-assisted magnetic holding for esophageal monitoring. Improvements to the thread design, friction enhancing pins, magnetic shielding and encapsulation methods are necessary for in vivo testing. PMID:17945922

  12. Urine pH test

    MedlinePLUS

    A urine pH test measures the level of acid in urine. ... pH - urine ... meat products or cranberries can decrease your urine pH. ... to check for changes in your body's acid levels.It may be done to ... more effective when urine is acidic or non-acidic (alkaline).

  13. Functional esophageal disorders

    PubMed Central

    Clouse, R; Richter, J; Heading, R; Janssens, J; Wilson, J

    1999-01-01

    The functional esophageal disorders include globus, rumination syndrome, and symptoms that typify esophageal diseases (chest pain, heartburn, and dysphagia). Factors responsible for symptom production are poorly understood. The criteria for diagnosis rest not only on compatible symptoms but also on exclusion of structural and metabolic disorders that might mimic the functional disorders. Additionally, a functional diagnosis is precluded by the presence of a pathology-based motor disorder or pathological reflux, defined by evidence of reflux esophagitis or abnormal acid exposure time during ambulatory esophageal pH monitoring. Management is largely empirical, although efficacy of psychopharmacological agents and psychological or behavioral approaches has been established for serveral of the functional esophageal disorders. As gastroesophageal reflux disease overlaps in presentation with most of these disorders and because symptoms are at least partially provoked by acid reflux events in many patients, antireflux therapy also plays an important role both in diagnosis and management. Further understanding of the fundamental mechanisms responsible for symptoms is a priority for future research efforts, as is the consideration of treatment outcome in a broader sense than reduction in esophageal symptoms alone. Likewise, the value of inclusive rather than restrictive diagnostic criteria that encompass other gastrointestinal and non-gastrointestinal symptoms should be examined to improve the accuracy of symptom-based criteria and reduce the dependence on objective testing.???Keywords: globus; rumination; chest pain; esophageal motility disorders; esophageal spasm; gastroesophageal reflux disease; Rome II PMID:10457042

  14. Comparisons of Esophageal Function Tests between Chinese and British Patients with Gastroesophageal Reflux Disease

    PubMed Central

    Gao, Feng; Leach, Samantha; Hao, Jian Yu; Shang, Zhan Min; Hobson, Anthony Robert

    2015-01-01

    Objective. To investigate the esophageal function tests in British and Chinese patients with gastroesophageal reflux disease (GERD). Methods. Patients with GERD were selected from the functional gut clinic, London, and digestive department, Beijing Chao-Yang Hospital, after taking the examinations of High-resolution Manometry and Impedance (HRiM) and 24-hour Multi-Channel Intraluminal Impedance and pH Recording (MII/pH) between 2013 and 2014. Chinese healthy volunteers who undertook HRiM were also selected as control group. Results. Fifty-nine British and 82 Chinese patients with GERD and 62 Chinese healthy volunteers were entered. Values for British patients, Chinese patients, and healthy volunteers were as follows: Lower esophageal sphincter pressure (LESP) 16.0 ± 8.6, 16.5 ± 10.0, and 26.4 ± 10.9?mmHg, peristalsis (normal/small break/large break) 24/12/23, 44/10/28, and 57/1/4, total bolus transit time (TBTT) 7.3 ± 1.3, 7.6 ± 1.2, and 6.9 ± 0.9?s, and complete bolus transit rate (CBTR) 66.7 ± 37.8, 61.7 ± 36.4, and 90.3 ± 14.0%, respectively. Stepwise linear regression analysis showed that age, gender, and ethnicity did not have significant effect on LESP, TBTT, esophageal peristalsis, and CBTR in patients with GERD. Conclusions. British and Chinese patients with GERD presented similar values of LESP, TBTT, and impaired esophageal peristalsis and CBTR. PMID:25784929

  15. Esophageal Multichannel Intraluminal Impedance and pH Monitoring in the Evaluation of Achalasia and Gastroesophageal Reflux Disease in a Child with Down Syndrome: a Case Report.

    PubMed

    Stoicescu, Mihai-Mirel; Mocanu, Mihai; Galos, Felicia; Munteanu, Mihai; Visan, Simina; Ulmeanu, Coriolan; Balgradean, Mihaela

    2014-12-01

    We report the case of a rare association between achalasia and Down syndrome in a child presenting with symptoms that suggest a gastroesophageal reflux. Evaluation of the patient with 24-hour multichannel intraluminal impedance and pH recording and upper endoscopy lead to the diagnosis of achalasia. However, the persistence of the symptoms after the concurrent surgical myomectomy and fundoplication has led to repeat pH-impedance monitoring testing and endoscopy, which identified the presence of gastroesophageal reflux disease. We emphasize in this paper the importance of multichannel intraluminal impedance and pH monitoring in detecting esophageal motility disorders. PMID:25705311

  16. Esophageal Multichannel Intraluminal Impedance and pH Monitoring in the Evaluation of Achalasia and Gastroesophageal Reflux Disease in a Child with Down Syndrome: a Case Report

    PubMed Central

    STOICESCU, Mihai-Mirel; MOCANU, Mihai; GALOS, Felicia; MUNTEANU, Mihai; VISAN, Simina; ULMEANU, Coriolan; BALGRADEAN, Mihaela

    2014-01-01

    We report the case of a rare association between achalasia and Down syndrome in a child presenting with symptoms that suggest a gastroesophageal reflux. Evaluation of the patient with 24-hour multichannel intraluminal impedance and pH recording and upper endoscopy lead to the diagnosis of achalasia. However, the persistence of the symptoms after the concurrent surgical myomectomy and fundoplication has led to repeat pH-impedance monitoring testing and endoscopy, which identified the presence of gastroesophageal reflux disease. We emphasize in this paper the importance of multichannel intraluminal impedance and pH monitoring in detecting esophageal motility disorders. PMID:25705311

  17. Clinical esophageal pH recording: A technical review for practice guideline development

    Microsoft Academic Search

    Peter J Kahrilas; Eamonn M. M Quigley

    1996-01-01

    Our present concept of peptic esophagitis dates back to 1935, when Winkelstein suggested that gastric secretions were the cause of mucosal damage observed in peptic esophagitis.1GASTROENTEROLOGY 1996;110-1982-1996

  18. Esophageal pH and Combined Impedance-pH Monitoring in Children

    PubMed Central

    2014-01-01

    Esophageal pH monitoring is considered the gold standard for the diagnosis of gastroesophageal reflux disease because of the normal ranges across the pediatric age range. However, this method can only detect acid reflux. Multichannel intraluminal impedance-pH (MII-pH) monitoring has recently been used for the detection of bolus reflux in infants and children. This method allows for the detection of liquid, gas or mixed reflux in addition to acid, weakly acidic or weakly alkaline reflux. MII-pH monitoring can record the direction of flow and the height of reflux, which are useful parameters to identify an association between symptoms and reflux. However, the technique is limited by its high cost and the lack of normative data of MII-pH in the pediatric population. Despite certain limitations, MII-pH monitoring will become more common and gradually replace pH monitoring in the future, because pH monitoring is part of MII-pH. PMID:24749083

  19. Dickkopf-1, the Wnt antagonist, is induced by acidic pH and mediates epithelial cellular senescence in human reflux esophagitis

    PubMed Central

    Lyros, Orestis; Rafiee, Parvaneh; Nie, Linghui; Medda, Rituparna; Jovanovic, Nebojsa; Schmidt, Jamie; Mackinnon, Alexander; Venu, Nanda

    2014-01-01

    Squamous esophageal epithelium adapts to acid reflux-mediated injury by proliferation and differentiation via signal transduction pathways. Induction of the Wnt antagonist Dickkopf-1 (Dkk1) is involved in tissue repair during inflammation and cellular injury. In this study, we aimed to identify the biological role of Dkk1 in human reflux esophagitis with respect to cell growth and regulation of Wnt signaling. Esophageal biopsies from reflux-esophagitis patients (n = 15) and healthy individuals (n = 10) were characterized in terms of Dkk1 expression. The role of Dkk1 in response to acid-mediated epithelial injury was analyzed by cellular assays in vitro utilizing squamous esophageal epithelial cell lines (EPC1-hTERT, EPC2-hTERT, and HEEC). Dkk1 was significantly overexpressed in human reflux-esophagitis tissue compared with healthy esophageal mucosa at transcriptional and translational levels. After acute and chronic acid (pH 4) exposure, esophageal squamous epithelial cell lines expressed and secreted high levels of Dkk1 in response to stress-associated DNA injury. High extracellular levels of human recombinant Dkk1 inhibited epithelial cell growth and induced cellular senescence in vitro, as demonstrated by reduced cell proliferation, G0/G1 cell cycle arrest, elevated senescence-associated ?-galactosidase activity, and upregulation of p16. Acid pulsing induced Dkk1-mediated senescence, which was directly linked to the ability of Dkk1 to antagonize the canonical Wnt/?-catenin signaling. In healthy esophageal mucosa, Dkk1 expression was associated with low expression of transcriptionally active ?-catenin, while in reflux-esophagitis tissue, Dkk1 overexpression correlated with increased senescence-associated ?-galactosidase activity and p16 upregulation. The data indicate that, in human reflux esophagitis, Dkk1 functions as a secreted growth inhibitor by suppressing Wnt/?-catenin signaling and promoting cellular senescence. These findings suggest a significant role for Dkk1 and cellular senescence in esophageal tissue homeostasis during reflux esophagitis. PMID:24481601

  20. Dickkopf-1, the Wnt antagonist, is induced by acidic pH and mediates epithelial cellular senescence in human reflux esophagitis.

    PubMed

    Lyros, Orestis; Rafiee, Parvaneh; Nie, Linghui; Medda, Rituparna; Jovanovic, Nebojsa; Schmidt, Jamie; Mackinnon, Alexander; Venu, Nanda; Shaker, Reza

    2014-04-01

    Squamous esophageal epithelium adapts to acid reflux-mediated injury by proliferation and differentiation via signal transduction pathways. Induction of the Wnt antagonist Dickkopf-1 (Dkk1) is involved in tissue repair during inflammation and cellular injury. In this study, we aimed to identify the biological role of Dkk1 in human reflux esophagitis with respect to cell growth and regulation of Wnt signaling. Esophageal biopsies from reflux-esophagitis patients (n = 15) and healthy individuals (n = 10) were characterized in terms of Dkk1 expression. The role of Dkk1 in response to acid-mediated epithelial injury was analyzed by cellular assays in vitro utilizing squamous esophageal epithelial cell lines (EPC1-hTERT, EPC2-hTERT, and HEEC). Dkk1 was significantly overexpressed in human reflux-esophagitis tissue compared with healthy esophageal mucosa at transcriptional and translational levels. After acute and chronic acid (pH 4) exposure, esophageal squamous epithelial cell lines expressed and secreted high levels of Dkk1 in response to stress-associated DNA injury. High extracellular levels of human recombinant Dkk1 inhibited epithelial cell growth and induced cellular senescence in vitro, as demonstrated by reduced cell proliferation, G0/G1 cell cycle arrest, elevated senescence-associated ?-galactosidase activity, and upregulation of p16. Acid pulsing induced Dkk1-mediated senescence, which was directly linked to the ability of Dkk1 to antagonize the canonical Wnt/?-catenin signaling. In healthy esophageal mucosa, Dkk1 expression was associated with low expression of transcriptionally active ?-catenin, while in reflux-esophagitis tissue, Dkk1 overexpression correlated with increased senescence-associated ?-galactosidase activity and p16 upregulation. The data indicate that, in human reflux esophagitis, Dkk1 functions as a secreted growth inhibitor by suppressing Wnt/?-catenin signaling and promoting cellular senescence. These findings suggest a significant role for Dkk1 and cellular senescence in esophageal tissue homeostasis during reflux esophagitis. PMID:24481601

  1. Exploring the physiologic role of human gastroesophageal reflux by analyzing time?series data from 24?h gastric and esophageal pH recordings

    PubMed Central

    Lu, Luo; Mu, John C.; Sloan, Sheldon; Miner, Philip B.; Gardner, Jerry D.

    2014-01-01

    Abstract Our previous finding of a fractal pattern for gastric pH and esophageal pH plus the statistical association of sequential pH values for up to 2 h led to our hypothesis that the fractal pattern encodes information regarding gastric acidity and that depending on the value of gastric acidity, the esophagus can signal the stomach to alter gastric acidity by influencing gastric secretion of acid or bicarbonate. Under our hypothesis values of gastric pH should provide information regarding values of esophageal pH and vice versa. We used vector autoregression, a theory?free set of inter?related linear regressions used to measure relationships that can change over time, to analyze data from 24?h recordings of gastric pH and esophageal pH. We found that in pH records from normal subjects, as well as from subjects with gastroesophageal reflux disease alone and after treatment with a proton pump inhibitor, gastric pH values provided important information regarding subsequent values of esophageal pH and values of esophageal pH provided important information regarding subsequent values of gastric pH. The ability of gastric pH and esophageal pH to provide information regarding subsequent values of each other was reduced in subjects with gastroesophageal reflux disease compared to normal subjects. Our findings are consistent with the hypothesis that depending on the value of gastric acidity, the esophagus can signal the stomach to alter gastric acidity, and that this ability is impaired in subjects with gastroesophageal reflux disease. PMID:25347850

  2. 48-Hour Bravo Esophageal pH Test

    MedlinePLUS

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  3. The use of skin prick tests and patch tests to identify causative foods in eosinophilic esophagitis

    Microsoft Academic Search

    Jonathan M. Spergel; Janet L. Beausoleil; Maria Mascarenhas; Chris A. Liacouras

    2002-01-01

    Background: Eosinophilic esophagitis is a disease entity in which patients have (1) elevated eosinophils on esophageal biopsy and (2) symptoms of gastroesophageal reflux. The symptoms do not improve on aggressive acid blockade but do improve on elimination diet or corticosteroid treatment, which tentatively links food allergies to this disorder. Objective: The purpose of this study was to identify potential food

  4. Role of advanced diagnostics for eosinophilic esophagitis.

    PubMed

    Hirano, Ikuo

    2014-01-01

    In eosinophilic esophagitis (EoE), diagnostic tests aid in the identification of pathophysiologic consequences and accurate detection of the disease. The EoE Endoscopic Reference Score (EREFS) classifies and grades the severity of the five major endoscopically identified esophageal features of EoE (edema, rings, exudates, furrows and strictures). The EREFS may be useful in the evaluation of disease severity and as an objective outcome of response to therapy. pH monitoring identifies the presence of abnormal degrees of acid exposure in the esophagus that characterizes gastroesophageal reflux disease. The presence of acid reflux, however, does not indicate that the reflux is responsible for esophageal eosinophilia. Esophageal manometry has not demonstrated a characteristic abnormality with sufficient sensitivity to make the test of diagnostic value in clinical practice. On the other hand, manometric characteristics of esophageal pressurization and longitudinal muscle dysfunction may help identify important pathophysiologic consequences of EoE. Esophageal impedance testing has demonstrated increased baseline mucosal impedance that correlates with increased epithelial permeability in EoE. Reduced mucosal integrity may provide intraluminal allergens access to antigen-presenting cells, serving as an early event in the pathogenesis of EoE. The functional luminal impedance probe (FLIP) provides quantitative assessment of esophageal mural compliance, a physiologic correlate of remodeling in EoE. Studies using FLIP have associated reductions in esophageal distensibility in EoE with the important outcome of food impaction risk. Finally, confocal endomicroscopy, multiphoton fluorescence microscopy and novel eosinophil-enhancing contrast agents are emerging methods that may allow for in vivo visualization of esophageal eosinophilic inflammation, thereby improving the detection and understanding of this emerging disease. PMID:24603385

  5. Does deep sedation impact the results of 48 hours catheterless pH testing?

    PubMed Central

    Korrapati, Vineet; Babich, Jay P; Balani, Anil; Grendell, James H; Kongara, Kavita R

    2011-01-01

    AIM: To study a cohort of patients undergoing 48 h Bravo pH testing receiving deep sedation with propofol. METHODS: We retrospectively reviewed the charts of 197 patients (81 male, 116 female) who underwent Bravo esophageal pH monitoring from July 2003 to January 2008. All patients underwent Bravo pH probe placement via esophagogastroduodenoscopy (EGD) and received propofol for sedation. Patients on a proton pump inhibitor (89 patients) were excluded. Acid reflux variables measured included the total, upright, and supine fractions of time at pH < 4 and DeMeester score, and were compared between day 1 and day 2. RESULTS: Of the 108 patients that were included in the study, the most common indication for Bravo pH monitoring was heartburn, with chest pain being the second most common. A signed rank test revealed no statistically significant difference between day 1 and day 2 reflux episodes. CONCLUSION: Patients who received propofol for sedation for EGD with Bravo pH capsule placement did not experience any significant difference in reflux episodes from day 1 to day 2. PMID:21455329

  6. Clinical value of hematologic test in predicting tumor response to neoadjuvant chemotherapy with esophageal squamous cell carcinoma

    PubMed Central

    2014-01-01

    Background To investigate the relationship between hematologic test results and the predictive effect of regression of esophageal cancer after neoadjuvant chemotherapy (NACT), we analyzed pre-NACT hematologic data and their relationship to tumor regression. Methods Thirty-eight consecutive patients with locally advanced squamous cell esophageal carcinoma who had undergone two cycles of paclitaxel/carboplatin NACT were enrolled. On the day prior to the first cycle of chemotherapy, hematologic tests, including routine blood test and biochemical examinations, were recorded. All patients were confirmed to have no history of hepatitis. Surgical resection was performed when clinical restaging showed effective regression. Histopathological examination was routinely performed to evaluate the postoperative effects of chemotherapy. Results After two cycles of NACT, tumor imaging evaluation showed that 27 of the 38 patients had CR and PR, including 25 patients who underwent radical esophagectomies. Six patients had stable disease and five patients had progressive disease. According to the hematologic test results before NACT, patients with higher white blood cell counts, lymphocyte percentages, mononuclear cell counts, neutrophilic granulocyte counts, and eosinophilic granulocyte counts and lower alanine aminotransferase (ALT) level had a significantly greater opportunity for an effective response. Conclusion Basal host immunologic function and hepatic function are associated with tumor response to NACT in patients with esophageal cancer. These parameters may have a certain predictive efficacy on NACT for esophageal squamous cell carcinoma. PMID:24568553

  7. Esophageal Cancer

    MedlinePLUS

    ... from your throat to your stomach. Early esophageal cancer usually does not cause symptoms. Later, you may ... You're at greater risk for getting esophageal cancer if you smoke, drink heavily, or have acid ...

  8. Esophageal cancer

    MedlinePLUS

    Cancer - esophagus ... Esophageal cancer is not common in the United States. It occurs most often in men over 50 years old. There are two main types of esophageal cancer: squamous cell carcinoma and adenocarcinoma. These two types ...

  9. Esophageal Cancer Screening

    MedlinePLUS

    ... from the NCI Web site . Tests that may detect (find) esophageal cancer are being studied: Esophagoscopy A ... of the lower part of the esophagus may detect early Barrett esophagus . This procedure may be used ...

  10. Understanding Esophageal Manometry

    MedlinePLUS

    ... Screen4coloncancer.org About Colonoscopy Facts About Common Colon Cancer Screening Tests PATIENTS Understanding Esophageal Manometry The Esophagus The esophagus is a muscular tube that connects your throat to your stomach. With each swallow, the esophagus ...

  11. Esophageal contribution to chest pain in patients with coronary artery disease.

    PubMed

    Garcia-Pulido, J; Patel, P H; Hunter, W C; Douglas, J E; Thomas, E

    1990-10-01

    We conducted a prospective study to determine the role of the esophagus in causing chest pain in patients with established CAD on optimum therapy. Thirty-two men with documented CAD who complained of frequent and usually daily retrosternal chest pain were evaluated. Following a standard esophageal manometry and acid perfusion test, simultaneous two-channel ambulatory Holter monitor and esophageal pH record tests were performed for 24 hours. Fifty-three episodes of chest pain were documented in 20 patients; 11 patients were free of pain. Of the 20 patients who complained of chest pains, 17 (85 percent) demonstrated at least one episode of PPR, defined as a drop in distal esophageal pH to less than 4 within ten minutes before or after the onset chest pain. Episodes of asymptomatic GER were common. The correlation of PPR with chest pain was 70 percent (37/53 episodes) and of ischemic ECG changes with chest pain 13 percent (7/53); in the remaining, there was no correlation with either. Two patients demonstrated simultaneous PPR and ischemic ECG changes. Seventeen esophageal motility abnormalities were observed in 14 patients (45 percent). It is our conclusion that esophageal disorders contribute to chest pain in patients with documented CAD. In this group, GER plays a greater role than in those with normal coronary arteries. In addition, esophageal motility disorders are common in these patients. Esophageal testing can be undertaken safely in these patients. PMID:2209134

  12. Nutcracker esophagus: demographic, clinical features, and esophageal tests in 115 patients.

    PubMed

    Lufrano, R; Heckman, M G; Diehl, N; DeVault, K R; Achem, S R

    2015-01-01

    Nutcracker esophagus (NE) is a common esophageal motility disorder chacterized by high amplitude peristaltic contractions in the distal esophagus. While previous studies have examined selected aspects of this condition (e.g. pathogenesis and treatment), there is a paucity of data regarding demographic and clinical features in large cohorts of patients. The aim of this study was to describe demographics, clinical features, comorbidities, time to diagnosis, source of patient referral by specialty, and medication use in a large cohort of patients with NE. We retrospectively analyzed consecutive cases of NE diagnosed from 2008-2010. The electronic medical records of these patients were reviewed, and relevant information was extracted. We identified 115 patients with NE. The median age was 62 years (range 25-87 years), and 63% were female. The median time patients experienced symptoms prior to diagnosis was 24 months (0-480 months). Most patients presented to an internal medicine consultant (42%) or to a gastroenterologist (35%). Presenting symptoms were chest pain (31%) and dysphagia (21%). Gastroesophageal reflux disease (GERD) symptoms were common: heartburn occurred in 51% of patients, 77% had a prior history of GERD, and 78% were receiving acid suppressive medications. GERD was confirmed by testing in at least 35%. Psychiatric comorbidity occurred in 24% with half the patients receiving psychotropic medications. Irritable bowel syndrome (IBS) and fibromyalgia co-existed in 15% and 12% of patients, respectively. Surprisingly, opioids were prescribed to 26% of patients. No statistically significant correlation was found between esophageal motility parameters and symptoms. In this study, NE patients were more commonly middle-aged females experiencing a considerable amount of time between symptom onset and diagnosis. Many were initially evaluated by internists for dysphagia or chest pain and had a history of GERD. Medication prescribed prior to diagnoses frequently involved acid suppression, but narcotic and psychotropic prescriptions were also commonly used. Central sensitization syndromes (fibromyalgia and IBS), psychiatric comorbidity, and reflux commonly coexisted. Our study suggests that future investigations should address the role and interaction of GERD and psychiatric disorders in NE. PMID:24251375

  13. Esophageal motor function: technical aspects of manometry.

    PubMed

    Gyawali, C Prakash; Patel, Amit

    2014-10-01

    High-resolution manometry (HRM) has advanced the understanding of esophageal peristaltic mechanisms and has simplified esophageal motor testing. In this article the technical aspects of HRM are addressed, focusing on test protocols, in addition to concerns and pitfalls in performing esophageal motor studies. Specifically, catheter positioning, equipment-related artifacts, basal data acquisition, adequate swallows, and provocative maneuvers are discussed. PMID:25216901

  14. Herpetic esophagitis

    SciTech Connect

    Shortsleeve, M.J.; Gauvin, G.P.; Gardner, R.C.; Greenberg, M.S.

    1981-12-01

    Four patients with herpetic esophagitis were examined. In three of them, the presenting symptom was odynophagia. Early in the course of herpetic esophagitis, shallow round and oval ulcers were seen on barium esophagograms. Later, the ulcers filled with fibrinous exudate, forming nodular plaques that projected into the esophageal lumen. Although these findings are diagnostic of esophagitis, they are not specific for a herpes virus infection. The definitive diagnosis must be established by histologic examination, which demonstrates the cytopathic effect of the herpes virus infection within the squamous epithelium.

  15. Vaginal pH: Home-Use Tests

    MedlinePLUS

    ... provide a more thorough assessment of your vaginal status through your history, physical exam, and other laboratory tests than you can using a single pH test in your home. Useful Links MedlinePlus: ...

  16. Esophageal Rings and Webs

    MedlinePLUS

    ... determine if you have a ring or a web, your doctor may order one of these tests: Barium swallow test. This allows the radiologist to ... contribute to the development of esophageal rings and webs, your doctor probably will order a blood test for iron levels and, if you are deficient, ...

  17. Acid loading test (pH)

    MedlinePLUS

    ... you will need to take a medicine called ammonium chloride for 3 days. Follow instructions exactly on how ... Your provider will tell you to take ammonium chloride capsules by mouth for 3 days before the test.

  18. Association of esophageal reflux and globus symptom: comparison of laryngoscopy and 24-hour pH manometry.

    PubMed

    Woo, P; Noordzij, P; Ross, J A

    1996-12-01

    Thirty-one patients with globus sensation were examined by dual probe pH manometry and videolaryngoscopy to investigate the role of gastroesophageal reflux disease in association with globus. Abnormal laryngeal findings, which included grossly abnormal and subtle changes, were seen in 17 patients. These findings included pharyngeal erythema (12 patients), interarytenoid pachydermia (11), laryngeal edema (11), arytenoid erythema (9), and thick mucus (3). Twenty-one of the 31 pH probe studies showed gastroesophageal reflux disease (14 grossly abnormal, 6 borderline abnormal) with Johnson and DeMeester composite scores for the distal probe. There was no correlation between the upright and supine position, nor was there correlation between positive laryngeal findings and a positive pH probe study. We conclude that globus sensation is often a nonspecific symptom of laryngopharyngeal irritation in which gastroesophageal reflux disease plays a significant role. Combining careful laryngoscopic examination with pH probe studies can help to differentiate between patients with organic pathology caused by gastroesophageal reflux disease and patients with other nonspecific laryngopharyngeal disorders. PMID:8969754

  19. Patients with established gastro-esophageal reflux disease might benefit from Helicobacter pylori eradication

    PubMed Central

    Moschos, John M.; Kouklakis, George; Vradelis, Stergios; Zezos, Petros; Pitiakoudis, Michael; Chatzopoulos, Dimitrios; Zavos, Christos; Kountouras, Jannis

    2014-01-01

    Background The aim of this study was to investigate the effect of Helicobacter pylori (H. pylori) eradication in selected H. pylori-positive patients with a primary diagnosis of gastro-esophageal reflux disease (GERD) by using the 3-h postprandial esophageal pH monitoring. Methods We recruited patients with erosive esophagitis at endoscopy and H. pylori infection at histology, successfully cured following eradication therapy; the selected H. pylori-positive patients had weekly reflux symptoms for at least six months and endoscopically established Grade A or B esophagitis. Twenty-nine eligible patients were initially subjected to esophageal manometry and ambulatory 3-h postprandial esophageal pH monitoring. All patients received H. pylori triple eradication therapy accompanied by successful H. pylori eradication. After successful eradication of H. pylori (confirmed by 13C urea breath test), a second manometry and 3-h postprandial esophageal pH monitoring were introduced to assess the results of eradication therapy, after a 3-month post-treatment period. Results All 29 selected H. pylori-positive patients became negative due to successful H. pylori eradication, evaluated by 13C urea breath test after a 4-week post-treatment period. Post-eradication, 62.1% patients showed similar manometric pattern at baseline; 17.2% showed improvement; 17.2% normalization; and 3.4% deterioration of the manometric patterns. The DeMeester symptom scoring in the 3-h postprandial ambulatory esophageal pH monitoring was improved after eradication of H. pylori (median 47.47 vs. 22.00, Wilcoxon’s singed rank; P=0.016). On comparing the pH monitoring studies for each patient at baseline and post-eradication period, 82.8% patients showed improvement and 17.2% deterioration of the DeMeester score. Conclusion By using 3-h postprandial esophageal pH monitoring, this study showed, for the first time, that H. pylori eradication may positively influence GERD symptoms. Large-scale controlled relative studies are warranted to confirm these findings. PMID:25330805

  20. Skin prick testing does not reflect the presence of IgE against food allergens in adult eosinophilic esophagitis patients: a case study

    Microsoft Academic Search

    Toral A Kamdar; Anne M Ditto; Paul J Bryce

    2010-01-01

    Skin prick testing is widely used to predict the presence of allergen-specific IgE. In eosinophilic esophagitis patients, who frequently exhibit polysensitization and broad reactivity upon skin prick testing, this is commonly used to aid avoidance recommendations in the clinical management of their disease. We present here the predictive value of skin prick testing for the presence of allergen-specific IgE, in

  1. Eosinophilic esophagitis.

    PubMed

    Aceves, Seema S

    2015-02-01

    Eosinophilic esophagitis (EoE) is a clinicopathologic disease of increasing prevalence. Because EoE is a chronic disease, its prevalence will continue to increase. Antigen triggers, including food and aeroallergens, drive eosinophilic and T helper cell type 2 inflammation, resulting in subepithelial fibrosis; this esophageal remodeling is the likely underlying pathogenesis for complications of narrowing, rigidity, and food impactions. Management includes dietary antigen elimination and topical corticosteroids. Long-term therapy and repeated endoscopy are often needed; consideration must be given to maintenance regimens and side effects. This review describes the clinical features, treatment options, epidemiology, and pathogenesis of EoE. PMID:25459582

  2. Challenges of Correlating pH Change with Relief of Clinical Symptoms in Gastro Esophageal Reflux Disease: A Phase III, Randomized Study of Zegerid versus Losec

    PubMed Central

    Walker, Dave; Ng Kwet Shing, Richard; Jones, Deborah; Gruss, Hans-Jurgen; Regu?a, Jaros?aw

    2015-01-01

    Background Zegerid (on demand immediate-release omeprazole and sodium bicarbonate combination therapy) has demonstrated earlier absorption and more rapid pH change compared with Losec (standard enteric coated omeprazole), suggesting more rapid clinical relief of heartburn. This Phase III, multicenter, double-blind, double-dummy, randomized study assessed the clinical superiority of Zegerid versus Losec for rapid relief of heartburn associated with gastro-esophageal reflux disease (GERD). Methods Patients with a history of frequent (2 3 days/week) uncomplicated GERD, were randomized to receive Zegerid (20mg) or Losec (20mg) with corresponding placebo. Study medication was self-administered on the first episode of heartburn, and could be taken for up to 3 days within a 14 day study period. Heartburn severity was self assessed up to 180 minutes post dose (9 point Likert scale). Primary endpoint was median time to sustained response (?3 point reduction in heartburn severity for ?45 minutes). Results Of patients randomized to Zegerid (N=122) or Losec (N=117), 228/239 had recorded ?1 evaluable heartburn episodes and were included in the modified intent-to-treat population. No significant between-group differences were observed for median time to sustained response (60.0 vs. 52.2 minutes, Zegerid [N=117] and Losec [N=111], respectively), sustained partial response (both, 37.5 minutes) and sustained total relief (both, 105 minutes). Significantly more patients treated with Zegerid reached sustained total relief within 0–30 minutes post dose in all analysis sets (p<0.05). Both treatments were well tolerated and did not raise any safety concerns. Conclusions Superiority of Zegerid over Losec for rapid heartburn relief was not demonstrated; both treatments were equally effective however the rapid onset of action of Losec was unexpected. Factors, including aspects of study design may have contributed to this. This study supports previously reported difficulty in correlating intra-gastric pH change with clinical effect in GERD therapy, highlighting the significance of several technical considerations for studies of this type. Trial registration ClinicalTrials.gov NCT01493089 PMID:25706883

  3. Caustic ingestion and esophageal function

    SciTech Connect

    Cadranel, S.; Di Lorenzo, C.; Rodesch, P.; Piepsz, A.; Ham, H.R. (Children University Hospital, Brussels (Belgium))

    1990-02-01

    The aim of the present study was to investigate esophageal motor function by means of krypton-81m esophageal transit scintigraphy and to compare the results with the functional and morphological data obtained by means of triple lumen manometry and endoscopy. In acute and subacute stages of the disease, all clinical, anatomical, and functional parameters were in good agreement, revealing significant impairment. In chronic stages, the severity of the dysphagia was not correlated to the importance of the residual stenosis. Conversely, 81mKr esophageal transit and manometric's findings were in good agreement with the clinical symptoms, during the entire follow-up period ranging between 3 months to 7 years. The 81mKr test is undoubtedly the easiest and probably the most physiological technique currently available for long-term functional evaluation of caustic esophagitis.

  4. Evaluation of Esophageal Motor Function With High-resolution Manometry

    PubMed Central

    2013-01-01

    For several decades esophageal manometry has been the test of choice to evaluate disorders of esophageal motor function. The recent introduction of high-resolution manometry for the study of esophageal motor function simplified performance of esophageal manometry, and revealed previously unidentified patterns of normal and abnormal esophageal motor function. Presentation of pressure data as color contour plots or esophageal pressure topography led to the development of new tools for analyzing and classifying esophageal motor patterns. The current standard and still developing approach to do this is the Chicago classification. While this methodical approach is improving our diagnosis of esophageal motor disorders, it currently does not address all motor abnormalities. We will explore the Chicago classification and disorders that it does not address. PMID:23875094

  5. Test-based exclusion diets in gastro-esophageal reflux disease patients: A randomized controlled pilot trial

    PubMed Central

    Caselli, Michele; Zuliani, Giovanni; Cassol, Francesca; Fusetti, Nadia; Zeni, Elena; Lo Cascio, Natalina; Soavi, Cecilia; Gullini, Sergio

    2014-01-01

    AIM: To investigate the clinical response of gastro-esophageal reflux disease (GERD) symptoms to exclusion diets based on food intolerance tests. METHODS: A double blind, randomized, controlled pilot trial was performed in 38 GERD patients partially or completely non-responders to proton pump inhibitors (PPI) treatment. Fasting blood samples from each patients were obtained; leukocytotoxic test was performed by incubating the blood with a panel of 60 food items to be tested. The reaction of leukocytes (rounding, vacuolization, lack of movement, flattening, fragmentation or disintegration of cell wall) was then evaluated by optical microscopy and rated as follows: level 0 = negative, level 1 = slightly positive, level 2 = moderately positive, and level 3 = highly positive. A “true” diet excluding food items inducing moderate-severe reactions, and a “control” diet including them was developed for each patient. Then, twenty patients received the “true” diet and 18 the “control” diet; after one month (T1) symptoms severity was scored by the GERD impact scale (GIS). Hence, patients in the “control” group were switched to the “true” diet, and symptom severity was re-assessed after three months (T2). RESULTS: At baseline (T0) the mean GIS global score was 6.68 (range: 5-12) with no difference between “true” and control group (6.6 ± 1.19 vs 6.7 ± 1.7). All patients reacted moderately/severely to at least 1 food (range: 5-19), with a significantly greater number of food substances inducing reaction in controls compared with the “true” diet group (11.6 vs 7.0, P < 0.001). Food items more frequently involved were milk, lettuce, brewer’s yeast, pork, coffee, rice, sole asparagus, and tuna, followed by eggs, tomato, grain, shrimps, and chemical yeast. At T1 both groups displayed a reduction of GIS score (“true” group 3.3 ± 1.7, -50%, P = 0.001; control group 4.9 ± 2.8, -26.9%, P = 0.02), although the GIS score was significantly lower in “true” vs “control” group (P = 0.04). At T2, after the diet switch, the “control” group showed a further reduction in GIS score (2.7 ± 1.9, -44.9%, P = 0.01), while the “true” group did not (2.6 ± 1.8, -21.3%, P = 0.19), so that the GIS scores didn’t differ between the two groups. CONCLUSION: Our results suggest that food intolerance may play a role in GERD symptoms development, and leucocytotoxic test-based exclusion diets may be a possible therapeutic approach when PPI are not effective or indicated. PMID:25493035

  6. Pathological esophageal acidification and pneumatic dilitation in achalasic patients. Too much or not enough?

    PubMed

    Benini, L; Sembenini, C; Castellani, G; Bardelli, E; Brentegani, M T; Giorgetti, P; Vantini, I

    1996-02-01

    Endoscopy, esophageal manometry and pH monitoring, gastric emptying test, and heartburn quantification on a visual analog scale were performed in 22 achalasic patients in order to clarify which events are associated with pathological esophageal acidification after successful LES dilatation. Five patients presented pathological acidification. Dilatation reduced LES tone from 38.3 +/- 4.2 to 14.6 +/- 1.1 mm Hg (mean +/- SEM); there was, however, no difference between nonrefluxers and refluxers (14.8 +/- 1.2 vs 13.8 +/- 2.5 mm Hg). The emptying time in achalasic patients was delayed compared to controls (315.9 +/- 20.9 min vs 209 +/- 10.4) due to prolonged lag-phase and reduced slope of the antral section-time curve, but, again, there was no difference between refluxers and nonrefluxers. The acid clearance was delayed in refluxers compared to nonrefluxers (15.9 +/- 4.5 vs 2.5 +/- 1.8 min, P<0.05). Two refluxers presented grade 1 esophagitis; one of them developed an esophageal ulcer. The heartburn score was the same in refluxers and nonrefluxers. Pathological acidification after pneumatic dilatation is associated with persistent problems in esophageal emptying rather than with excessive sphincter divulsion. PMID:8601384

  7. Bacteremia with esophageal dilation

    Microsoft Academic Search

    Douglas B. Nelson; Steven J. Sanderson; Miguel M. Azar

    1998-01-01

    (GUMMI BEARS)Background: Antibiotic prophylaxis has been recommended for selected patients undergoing esophageal stricture dilation because of a reported high rate of bacteremia. The aim of this study was to determine the rate of bacteremia after esophageal dilatation in a large series and the source of the organisms recovered. Methods: Blood cultures and oral temperatures were obtained before esophageal dilation and

  8. Multiple esophageal rings: an association with eosinophilic esophagitis

    Microsoft Academic Search

    Constantinos G. Siafakas; Charlotte K. Ryan; Marilyn R. Brown; Tracie L. Miller

    2000-01-01

    Esophagitis may present endoscopically with erythema, edema, loss of vascular pattern, friability, and ulceration of the esophageal mucosa. Left untreated, chronic esophagitis may result in stricture formation. The presence of multiple concentric rings involving the entire esophagus has been cited as a chronic form of esophagitis. We present a case of an 8-yr-old boy with multiple concentric esophageal rings and

  9. Esophageal motility abnormalities in gastroesophageal reflux disease

    PubMed Central

    Martinucci, Irene; de Bortoli, Nicola; Giacchino, Maria; Bodini, Giorgia; Marabotto, Elisa; Marchi, Santino; Savarino, Vincenzo; Savarino, Edoardo

    2014-01-01

    Esophageal motility abnormalities are among the main factors implicated in the pathogenesis of gastroesophageal reflux disease. The recent introduction in clinical and research practice of novel esophageal testing has markedly improved our understanding of the mechanisms contributing to the development of gastroesophageal reflux disease, allowing a better management of patients with this disorder. In this context, the present article intends to provide an overview of the current literature about esophageal motility dysfunctions in patients with gastroesophageal reflux disease. Esophageal manometry, by recording intraluminal pressure, represents the gold standard to diagnose esophageal motility abnormalities. In particular, using novel techniques, such as high resolution manometry with or without concurrent intraluminal impedance monitoring, transient lower esophageal sphincter (LES) relaxations, hypotensive LES, ineffective esophageal peristalsis and bolus transit abnormalities have been better defined and strongly implicated in gastroesophageal reflux disease development. Overall, recent findings suggest that esophageal motility abnormalities are increasingly prevalent with increasing severity of reflux disease, from non-erosive reflux disease to erosive reflux disease and Barrett’s esophagus. Characterizing esophageal dysmotility among different subgroups of patients with reflux disease may represent a fundamental approach to properly diagnose these patients and, thus, to set up the best therapeutic management. Currently, surgery represents the only reliable way to restore the esophagogastric junction integrity and to reduce transient LES relaxations that are considered to be the predominant mechanism by which gastric contents can enter the esophagus. On that ground, more in depth future studies assessing the pathogenetic role of dysmotility in patients with reflux disease are warranted. PMID:24868489

  10. Treatment Option Overview (Esophageal Cancer)

    MedlinePLUS

    ... may be needed. There are different types of treatment for patients with esophageal cancer. Different types of ... started treatment. Patients have special nutritional needs during treatment for esophageal cancer. Many people with esophageal cancer ...

  11. [Limitations of the traditional manometric test and advantages of computerized manometry in the study of esophageal motility].

    PubMed

    Zaninotto, G; Costantini, M; Polo, R; Rossi, M; Finco, C; Cecolin, G; Sebartoli, G; Ancona, E

    1991-01-01

    The analysis of esophageal motility tracings is laborious, time consuming and subject to reader variability. The motility traces of five patients were analyzed separately by five experienced readers, in order to assess the inter and intra observer variability. Later on, the manual analysis of the motility traces of five healthy volunteers and four patients was compared to the automatic analysis performed by a computerized system. The inter- and intra-observer variability (expressed as coefficient of variation) was high in the manual analysis, especially for the abdominal length of the lower sphincter and the duration of the esophageal body contractions (coefficient of variation ranging from 18 to 43%). On the contrary, automatic readings proved almost identical to the means obtained by manual analysis (Pearson factor 0.988 for amplitude and 0.89 for the duration of contractions). Moreover, the computerized automatic analysis gave a significant time gain in respect to manual readings and eliminated the inter and intra-observer variability. PMID:1873325

  12. Eosinophilic esophagitis in patients with esophageal atresia and chronic dysphagia.

    PubMed

    Kassabian, Sirvart; Baez-Socorro, Virginia; Sferra, Thomas; Garcia, Reinaldo

    2014-12-21

    Esophageal atresia (EA) is defined as a discontinuity of the lumen of the esophagus repaired soon after birth. Dysphagia is a common symptom in these patients, usually related to stricture, dysmotility or peptic esophagitis. We present 4 cases of patients with EA who complained of dysphagia and the diagnosis of Eosinophilic esophagitis (EoE) was made, ages ranging from 9 to 16 years. Although our patients were on acid suppression years after their EA repair, they presented with acute worsening of dysphagia. Esophogastroduodenoscopy and/or barium swallow did not show stricture and biopsies revealed elevated eosinophil counts consistent with EoE. Two of 4 patients improved symptomatically with the topical steroids. It is important to note that all our patients have asthma and 3 out of 4 have tested positive for food allergies. One of our patients developed recurrent anastomotic strictures that improved with the treatment of the EoE. A previous case report linked the recurrence of esophageal strictures in patients with EA repair with EoE. Once the EoE was treated the strictures resolved. On the other hand, based on our observation, EoE could be present in patients without recurrent anastomotic strictures. There appears to be a spectrum in the disease process. We are suggesting that EoE is a frequent concomitant problem in patients with history of congenital esophageal deformities, and for this reason any of these patients with refractory reflux symptoms or dysphagia (with or without anastomotic stricture) may benefit from an endoscopic evaluation with biopsies to rule out EoE. PMID:25548504

  13. Eosinophilic esophagitis in patients with esophageal atresia and chronic dysphagia

    PubMed Central

    Kassabian, Sirvart; Baez-Socorro, Virginia; Sferra, Thomas; Garcia, Reinaldo

    2014-01-01

    Esophageal atresia (EA) is defined as a discontinuity of the lumen of the esophagus repaired soon after birth. Dysphagia is a common symptom in these patients, usually related to stricture, dysmotility or peptic esophagitis. We present 4 cases of patients with EA who complained of dysphagia and the diagnosis of Eosinophilic esophagitis (EoE) was made, ages ranging from 9 to 16 years. Although our patients were on acid suppression years after their EA repair, they presented with acute worsening of dysphagia. Esophogastroduodenoscopy and/or barium swallow did not show stricture and biopsies revealed elevated eosinophil counts consistent with EoE. Two of 4 patients improved symptomatically with the topical steroids. It is important to note that all our patients have asthma and 3 out of 4 have tested positive for food allergies. One of our patients developed recurrent anastomotic strictures that improved with the treatment of the EoE. A previous case report linked the recurrence of esophageal strictures in patients with EA repair with EoE. Once the EoE was treated the strictures resolved. On the other hand, based on our observation, EoE could be present in patients without recurrent anastomotic strictures. There appears to be a spectrum in the disease process. We are suggesting that EoE is a frequent concomitant problem in patients with history of congenital esophageal deformities, and for this reason any of these patients with refractory reflux symptoms or dysphagia (with or without anastomotic stricture) may benefit from an endoscopic evaluation with biopsies to rule out EoE. PMID:25548504

  14. Esophageal lichen planus.

    PubMed

    Chandan, Vishal S; Murray, Joseph A; Abraham, Susan C

    2008-06-01

    Esophageal lichen planus is an underrecognized condition, with fewer than 50 cases reported to date. Unlike cutaneous lichen planus, esophageal lichen planus occurs almost exclusively in middle-aged or older women who also have oral involvement. It commonly involves the proximal esophagus and manifests as progressive dysphagia and odynophagia. Endoscopic findings can include lacy white papules, pinpoint erosions, desquamation, pseudomembranes, and stenosis. Histologic features of esophageal lichen planus have only rarely been illustrated. They differ from those of cutaneous disease in several respects, including the presence of parakeratosis, epithelial atrophy, and lack of hypergranulosis. Correct diagnosis of esophageal lichen planus is difficult but bears important therapeutic implications. It is typically a chronic and relapsing condition that can require systemic or local immunosuppressive therapy and repeated endoscopic dilatations for esophageal strictures. Esophageal lichen planus may have malignant potential, as evidenced by 3 patients who developed squamous carcinoma of the esophagus after longstanding disease. PMID:18517264

  15. Esophageal duplication cyst.

    PubMed

    Bagheri, Reza; Asnaashari, Amir Mohammad Hashem; Afghani, Reza

    2015-03-01

    Esophageal duplication cyst is a rare congenital mediastinal cyst. Most of these cysts become symptomatic in childhood and only rare cases remain asymptomatic until adolescence. They may produce symptoms due to esophageal and respiratory system compression, rupture, and infection. A 25-year-old man presented with pulmonary infection and bronchiectasis that did not improve with medical treatment. A diagnosis of esophageal duplication cyst was made intraoperatively. PMID:24757179

  16. The management of eosinophilic esophagitis.

    PubMed

    Greenhawt, Matthew; Aceves, Seema S; Spergel, Jonathan M; Rothenberg, Marc E

    2013-01-01

    Eosinophilic esophagitis (EoE) is a clinicopathologic, chronic esophageal inflammatory disease resistant to acid suppressive therapy and is associated with variable symptoms indicative of upper gastrointestinal dysfunction. Per current guidelines established by The International Group of Eosinophil Researchers (TIGERS), the diagnosis is made in symptomatic patients after a biopsy that confirms a peak eosinophil level of ?15 eosinophils/high-powered field (HPF). The esophagus is distinguished by pronounced tissue eosinophilia in which dietary antigens are key inciting factors for disease pathogenesis; EoE being reversed by elimination of triggering food allergens suggests that the disease is mediated in part by allergic sensitization to foods. Moreover, experimental EoE in mice can be induced not only via food exposure but also via aeroallergen exposure. Consistent with an allergic etiology rather than an acid-induced esophagitis, swallowed glucocorticoids are effective for the treatment of EoE. Evaluation by an allergist is a recommended part of the diagnostic workup, especially for management of allergic comorbidities. Clinical practice for the evaluation of patients with EoE mainly relies on prick skin tests due to the ease and validation of these tests in the context of immediate hypersensitivity. However, both atopy patch testing and serum IgE testing have been used in EoE. Herein, we reviewed the basic clinical features of EoE with a focus on the approach to diagnosing causative food allergens and to dietary therapy. PMID:24565538

  17. Tech Trek: Testing the pH of soft drinks

    NSDL National Science Digital Library

    Adam J. Holy

    2005-07-01

    Students will ooze with enthusiam as they explore acids and bases in soft drinks. To obtain a numerical value for pH, students can use a probe connected to a graphing calculator or computer as part of a hands-on investigation that they can identify with.

  18. Testing the pH of Soft Drinks

    ERIC Educational Resources Information Center

    Christmann, Edwin P.; Holy, Adam J.

    2005-01-01

    In this article, the authors describe how to use a TI-73/83/84 graphing calculator and Vernier's LabPro/CBL2 probe system to take pH readings. This is not an endorsement of these products, but simply the authors' attempt to give readers an idea of what is involved in using this technology in the classroom. This activity can be accomplished using a…

  19. Stomach-Esophageal Cancer

    Cancer.gov

    Stomach and esophageal cancers are close in anatomical location and have been combined into one project within TCGA. Although they are two separate cancer types, TCGA is collecting samples from various anatomic subsites along the esophageal and gastric tracts for analysis.

  20. Drug-induced esophagitis.

    PubMed

    Zografos, G N; Georgiadou, D; Thomas, D; Kaltsas, G; Digalakis, M

    2009-01-01

    Drug-induced esophagitis is being recognized increasingly in the past few years. Since 1970 more than 650 cases have been reported worldwide caused by 30 or more medications. We have reviewed these cases with a view to classifying this disease based on underlying pathological mechanism. Drug-induced esophageal injury tends to occur at the anatomical site of narrowing, with the middle third behind the left atrium predominating (75.6%). The disease is broadly classified into two groups. The first group being transient and self-limiting as exemplified by the tetracycline group induced injury (65.8%). The second is the persistent esophagitis group, often with stricture, with two distinct entities: (i) patients on nonsteroidal anti-inflammatory agents whose injury is aggravated by gastroesophageal reflux (21.8%) (reflux aggravated); and (ii) patients with potasium chloride and quinidine sulphate induced injury (12.4%) (persistent drug injury). Severe esophageal injury has been reported in some women taking biphosphonates as treatment for postmenopausal osteoporosis. Endoscopic findings in such patients with esophageal injury generally suggested a chemical esophagitis, with erosions or ulcerations and exudative inflammation accompanied by thickening of the esophageal wall. Most cases of medication-induced esophageal injury heal without intervention within a few days. Thus, the most important aspect of therapy is to make the correct diagnosis and then to avoid reinjury with the drug. When possible, potentially caustic oral medications should be discontinued. PMID:19392845

  1. Eosinophilic esophagitis: an autoimmune esophageal disorder.

    PubMed

    Malhotra, Neha; Levine, Jeremiah

    2014-12-01

    Eosinophilic esophagitis (EoE) represents a chronic, immune/antigen-mediated esophageal inflammatory disease associated with esophageal dysfunction resulting from severe inflammation. The incidence and prevalence of EoE have been increasing in the past decade; however, the reason for this increase is unclear. There is a chronic inflammatory infiltrate that is present in EoE which promotes inflammation, symptoms, and dysfunction. In addition to eosinophils, interleukin (IL)-5 expressing T cells, B cells, eotaxin-3, IL-13, and IgE-bearing mast cells are present in EoE and are thought to contribute to the disease process. Eosinophils are pro-inflammatory and modulate multiple aspects of the immune response. Eosinophils produce a wide range of inflammatory cytokines, chemokines, granulocyte-monocyte colony-stimulating factors, and tumor necrosis factors. Once activated, eosinophils release granule components, which are toxic to a variety of tissues. Transforming growth factor ?1 is a pro-fibrotic molecule produced by epithelial and inflammatory cells, is overexpressed in EoE, and plays a role in esophageal remodeling. Fibrous remodeling in EoE could be associated with symptoms of dysphagia and may explain and predict future esophageal strictures and dysmotility. EoE is a complex disease involving multiple activation pathways, a large number of cells, and various inflammatory molecules. It, along with other atopic disease, is becoming increasingly prevalent and has an important genetic load and may represent as an immunological tolerance disorder of the GI tract. PMID:25499460

  2. Esophageal atresia: metaplasia, Barrett.

    PubMed

    Schneider, A; Michaud, L; Gottrand, F

    2013-01-01

    Barrett's esophagus is characterized by the replacement of squamous epithelium by columnar epithelium that is intestinal metaplasia-positive or -negative in the distal esophagus. Gastroesophageal reflux disease, which is frequent and prolonged in esophageal atresia, probably plays a major role in the development of Barrett's esophagus through repeated mucosal damage. Long-term acid exposure contributes to carcinogenesis in Barrett's esophagus of intestinal type, but its effect on gastric metaplasia is less well defined. Recent studies have suggest that metaplasia arises in about 15% of patients with esophageal atresia, with a lag time to developing metaplasia from initial surgical correction of about 10 years. Preliminary data from an ongoing multicenter study including 88 patients with esophageal atresia aged 15-19 years showed gastric metaplasia in 42% of patients (29 fundic and 7 cardial metaplasia), while one patient presented intestinal metaplasia. Esophageal mucosal abnormalities can be observed in esophageal atresia patients at endoscopy despite the absence of symptoms. Whether prolonged, aggressive, acid suppression is beneficial in these situations remains to be determined. Barrett's metaplasia can be removed by endoscopic mucosal resection or destroyed with endoscopic ablative techniques, such as photodynamic therapy, radiofrequency ablation, and cryotherapy. The risk of developing esophageal carcinoma is still a controversial issue as only a few clinical cases have been reported in young adults with esophageal atresia. As late complications of esophageal atresia, particularly esophagitis and Barrett's esophagus, are increasingly being recognized, long-time systematic follow up of the esophageal mucosa including multistage biopsies is therefore required even in asymptomatic patients. PMID:23679037

  3. Influence of pH on the toxicity of nitrophenols to Microtox and Spirotox tests.

    PubMed

    Na?ecz-Jawecki, Grzegorz; Sawicki, Józef

    2003-07-01

    The toxicity of mononitrophenols and dinitrophenols (DNP) to luminescent bacteria Vibrio fischeri (Microtox test) and ciliated protozoan Spirostomum ambiguum (Spirotox test) was evaluated. Spirotox was more sensitive to the tested nitrophenols (NPs) than the Microtox test. 2,5-DNP was the most toxic and 2-NP was the least toxic to the both bioindicators. The toxicity depended greatly on the pH of the medium. The highest changes were observed for DNPs, where the toxicity decreased more than 20-times when the pH increased from 6 to 8. No significant decrease of the toxicity was found for NPs, when the pH increased from 6 to 7. Greater increase of the pH to 8 caused from 1.5 to 4-fold decrease of the toxicity. PMID:12729708

  4. Radiation Therapy, Paclitaxel, and Carboplatin With or Without Trastuzumab in Treating Patients With Esophageal Cancer

    ClinicalTrials.gov

    2015-03-31

    Adenocarcinoma of the Gastroesophageal Junction; Esophageal Adenocarcinoma; Stage IB Esophageal Cancer; Stage IIA Esophageal Cancer; Stage IIB Esophageal Cancer; Stage IIIA Esophageal Cancer; Stage IIIB Esophageal Cancer

  5. Dynamic Tensile Testing of Kevlar 49 Fabrics ; Barzin Mobasher, Ph.D., P.E.2

    E-print Network

    Mobasher, Barzin

    Dynamic Tensile Testing of Kevlar 49 Fabrics Deju Zhu1 ; Barzin Mobasher, Ph.D., P.E.2 of strain. Kevlar-49 fabrics were tested in tension within a strain-rate range of 25 to 170 sÀ1 using a high nature of Kevlar-49 fabric results in large displacements and shape changes during tests. Noncontacting

  6. Epigenetics in esophageal cancers.

    PubMed

    Ahrens, Theresa D; Werner, Martin; Lassmann, Silke

    2014-06-01

    Esophageal cancers are a challenging upper gastrointestinal tract tumor entity for interdisciplinary oncology. For the two main histotypes, namely esophageal squamous cell carcinomas and Barrett's adenocarcinomas, several genetic aberrations have been shown to contribute to carcinogenesis and progression as well as to represent potential novel targets for therapeutic intervention. This is paralleled by growing insight into epigenetic alterations of esophageal cancers. Studies involving the analyses of human tissue specimens predominantly describe altered patterns of miRNA expression, DNA methylation patterns, and histone marks levels. This review provides a critical update on this increasing knowledge of epigenetic alteration in esophageal cancers by specifically focusing on the translational aspects of epigenetic analyses from human tissue specimens. PMID:24816987

  7. Esophageal Cancer Prevention

    MedlinePLUS

    ... risk of esophageal cancer: Tobacco and alcohol use Squamous cell carcinoma of the esophagus is strongly linked with all ... broccoli, and cauliflower) may lower the risk of squamous cell carcinoma of the esophagus. Nonsteroidal anti-inflammatory drugs Some ...

  8. Esophageal Rupture in a Patient With Idiopathic Eosinophilic Esophagitis

    Microsoft Academic Search

    Peter J Riou; Andrew G Nicholson; Ugo Pastorino

    1996-01-01

    Idiopathic eosinophilic esophagitis is an extremely rare condition with fewer than 20 cases described in the literature. We present a case presenting as an emergency with esophageal perforation that eventually required subtotal esophagectomy.

  9. Testing the cost of reproduction with the rotifer Brachionus patulus at different pH levels

    Microsoft Academic Search

    Xu Wang Yin; Cui Juan Niu

    2011-01-01

    In the present work, we tested the hypothesis that the cost of reproduction was evident under stressful conditions with the\\u000a rotifer Brachionus patulus at different pH levels (5–10 at 1 unit intervals). We used sublethal pH levels (pH 5, 9, and 10) to simulate stressful conditions.\\u000a We analyzed the correlations between age-specific fecundity (m\\u000a 1, m\\u000a 2, m\\u000a 3, …)

  10. In Vivo Model to Test Implanted Biosensors for Blood pH

    NASA Technical Reports Server (NTRS)

    Arnaud, Sara B.; Somps, Chris J.; Madou, Marc; Hines, John; Wade, Charles E. (Technical Monitor)

    1997-01-01

    Biosensors for monitoring physiologic data continuously through telemetry are available for heart rate, respiration, and temperature but not for blood pH or ions affected by hydrogen ion concentration. A telemetric biosensor for monitoring blood pH on-line could be used to identify and manage problems in fluid and electrolyte metabolism, cardiac and respiratory function during space flight and the acid-base status of patients without the need for venipuncture in patients on Earth. Critical to the development of biosensors is a method for evaluating their performance after implantation. Mature rats, prepared with jugular, cannulas for repeated blood samples, were exposed to a gas mixture containing high levels of carbon dioxide (7%) in a closed environment to induce mild respiratory acidosis. Serial blood gas and pH measurements in venous blood were compared with electrical responses from sensors implanted in the subcutaneous tissue. Animals became slightly tachypneic after exposure to excess CO2, but remained alert and active. After 5 minutes, basal blood pH decreased from 7.404 +/- 0.013 to 7.289 +/- 0.010 (p less than 0.001)and PC02 increased from 45 +/- 6 to 65 +/- 4 mm. Hg (p les than 0.001). Thereafter pH and blood gas parameters remained stable. Implanted sensors showed a decrease in millivolts (mV) which paralleled the change in pH and averaged 5-6 mV per 0.1 unit pH. Implanted sensors remained sensitive to modest changes in tissue pH for one week. A system for inducing acidosis in rats was developed to test the in vivo performance of pH biosensors. The system provides a method which is sensitive, rapid and reproducible in the same and different animals with full recovery, for testing the performance of sensors implanted in subcutaneous tissues.

  11. Risk Factors for Esophageal Candidiasis

    Microsoft Academic Search

    A. Chocarro Martínez; F. Galindo Tobal; G. Ruiz-Irastorza; A. González López; F. Alvarez Navia; C. Ochoa Sangrador; M. I. Martín Arribas

    2000-01-01

    The role of gastric acid inhibitors as predisposing factors for Candida esophagitis is unknown. A retrospective case-control study of esophageal candidiasis was conducted in human immunodeficiency\\u000a virus (HIV)-negative patients diagnosed from January 1991 to December 1997. The diagnosis of esophageal candidiasis was always\\u000a made on the basis of endoscopic and histological criteria. Fifty-one patients were diagnosed with esophageal candidiasis,\\u000a 15

  12. Eosinophilic Esophagitis: Strictures, Impactions, Dysphagia

    Microsoft Academic Search

    Seema Khan; Susan R. Orenstein; Carlo Di Lorenzo; Samuel A. Kocoshis; Philip E. Putnam; Luther Sigurdsson; Theresa M. Shalaby

    2003-01-01

    Eosinophilic esophagitis, long known to be a feature of acid reflux, has recently been described in patients with food allergies and macroscopically furrowed esophagus. The pathophysiology and optimal management of patients with eosinophilic esophagitis is unclear. We describe our clinical experience related to eosinophilic esophagitis and obstructive symptoms in children and propose etiopathogenesis and management guidelines. Twelve children with obstructive

  13. Surgical Treatment for Esophageal Cancer

    Microsoft Academic Search

    Hiroyuki Kato; Minoru Fukuchi; Tatsuya Miyazaki; Masanobu Nakajima; Naritaka Tanaka; Takanori Inose; Hitoshi Kimura; Ahmad Faried; Kana Saito; Makoto Sohda; Yasuyuki Fukai; Norihiro Masuda; Ryokuhei Manda; Hitoshi Ojima; Katsuhiko Tsukada; Hiroyuki Kuwano

    2007-01-01

    Esophageal cancer is one of the most difficult malignancies to cure. The prognosis remains unsatisfactory despite significant advances in surgical techniques and perioperative management. The optimal treatment strategy for localized esophageal cancer has not yet been established. Surgical resection remains the mainstay of treatment for esophageal cancer, and curative resection is the most important surgery. Extended esophagectomy with three-field lymphadenectomy

  14. Advances in clinical management of eosinophilic esophagitis.

    PubMed

    Dellon, Evan S; Liacouras, Chris A

    2014-12-01

    Eosinophilic esophagitis (EoE) is a chronic immune/antigen-mediated clinicopathologic condition that has become an increasingly important cause of upper gastrointestinal morbidity in adults and children over the past 2 decades. It is diagnosed based on symptoms of esophageal dysfunction, the presence of at least 15 eosinophils/high-power field in esophageal biopsy specimens, and exclusion of competing causes of esophageal eosinophilia, including proton pump inhibitor-responsive esophageal eosinophilia. We review what we have recently learned about the clinical aspects of EoE, discussing the clinical, endoscopic, and histological features of EoE in adults and children. We explain the current diagnostic criteria and challenges to diagnosis, including the role of gastroesophageal reflux disease and proton pump inhibitor-responsive esophageal eosinophilia. It is also important to consider the epidemiology of EoE (with a current incidence of 1 new case per 10,000 per year and prevalence of 0.5 to 1 case per 1000 per year) and disease progression. We review the main treatment approaches and new treatment options; EoE can be treated with topical corticosteroids, such as fluticasone and budesonide, or dietary strategies, such as amino acid-based formulas, allergy test-directed elimination diets, and nondirected empiric elimination diets. Endoscopic dilation has also become an important tool for treatment of fibrostenotic complications of EoE. There are a number of unresolved issues in EoE, including phenotypes, optimal treatment end points, the role of maintenance therapy, and treatment of refractory EoE. The care of patients with EoE and the study of the disease span many disciplines; EoE is ideally managed by a multidisciplinary team of gastroenterologists, allergists, pathologists, and dieticians. PMID:25109885

  15. Gastroesophageal reflux symptoms not responding to proton pump inhibitor: GERD, NERD, NARD, esophageal hypersensitivity or dyspepsia?

    PubMed Central

    Bashashati, Mohammad; Hejazi, Reza A; Andrews, Christopher N; Storr, Martin A

    2014-01-01

    Gastroesophageal reflux (GER) is a common gastrointestinal process that can generate symptoms of heartburn and chest pain. Proton pump inhibitors (PPIs) are the gold standard for the treatment of GER; however, a substantial group of GER patients fail to respond to PPIs. In the past, it was believed that acid reflux into the esophagus causes all, or at least the majority, of symptoms attributed to GER, with both erosive esophagitis and nonerosive outcomes. However, with modern testing techniques it has been shown that, in addition to acid reflux, the reflux of nonacid gastric and duodenal contents into the esophagus may also induce GER symptoms. It remains unknown how weakly acidic or alkaline refluxate with a pH similar to a normal diet induces GER symptoms. Esophageal hypersensitivity or functional dyspepsia with superimposed heartburn may be other mechanisms of symptom generation, often completely unrelated to GER. Detailed studies investigating the pathophysiology of esophageal hypersensitivity are not conclusive, and definitions of the various disease states may overlap and are often confusing. The authors aim to clarify the pathophysiology, definition, diagnostic techniques and medical treatment of patients with heartburn symptoms who fail PPI therapy. PMID:24719900

  16. Epiphrenic esophageal diverticula

    PubMed Central

    Abdollahimohammad, Abdolghani; Masinaeinezhad, Nosratollah; Firouzkouhi, Mohammadreza

    2014-01-01

    Epiphrenic esophageal diverticula (EED) are rare. The estimated incidence is about 1:500,000/year. EED usually result from a combination of esophageal obstruction, functional or mechanical and a point of weakness of the muscularis propria. Most of the symptoms are unspecific, but dysphagia is most common. Chest radiograph, barium esophagogram, endoscopy and manometry are diagnostic tools. The treatment methods are conservative medical therapy, myotomy, diverticulectomy and fundoplication. In addition, endoscopic pneumatic dilation and botulinum toxin injection are a good alternative for symptomatic patients with motility disorders who are unfit for or unwilling to undergo surgery. PMID:25422668

  17. 21 CFR 862.1120 - Blood gases (PCO2, PO2) and blood pH test system.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...PO 2) and blood pH test system is a device intended to measure certain gases in blood, serum, plasma or pH of blood, serum, and plasma. Measurements of blood gases (PCO 2, PO 2) and blood pH are used in the diagnosis and...

  18. 21 CFR 862.1120 - Blood gases (PCO2, PO2) and blood pH test system.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...PO 2) and blood pH test system is a device intended to measure certain gases in blood, serum, plasma or pH of blood, serum, and plasma. Measurements of blood gases (PCO 2, PO 2) and blood pH are used in the diagnosis and...

  19. 21 CFR 862.1120 - Blood gases (PCO2, PO2) and blood pH test system.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 8 2010-04-01 2010-04-01 false Blood gases (PCO2, PO2) and blood pH test system. 862.1120 Section 862.1120...Clinical Chemistry Test Systems § 862.1120 Blood gases (PCO 2, PO 2) and blood pH test...

  20. 21 CFR 862.1120 - Blood gases (PCO2, PO2) and blood pH test system.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 8 2011-04-01 2011-04-01 false Blood gases (PCO2, PO2) and blood pH test system. 862.1120 Section 862.1120...Clinical Chemistry Test Systems § 862.1120 Blood gases (PCO 2, PO 2) and blood pH test...

  1. PILOT TEST OF FATIGUE MANAGEMENT TECHNOLOGIES David F. Dinges, PhD Paper # 05-1234

    E-print Network

    Pennsylvania, University of

    PILOT TEST OF FATIGUE MANAGEMENT TECHNOLOGIES David F. Dinges, PhD Paper # 05-1234 Professor fatigue management technologies (FMT) in trucking operations in Canada and the United States. Technologies bundled into a single intervention came from four domains of fatigue management: 1) one that provided

  2. Two Cases of Esophageal Eosinophilia: Eosinophilic Esophagitis or Gastro-Esophageal Reflux Disease?

    PubMed Central

    Yilmaz, Ozlem; Karagol, Hacer Ilbilge Ertoy; Topal, Erdem; Unlusoy, Aysel Aksu; Egritas, Odul; Gonul, Ipek Isik; Bakirtas, Arzu

    2014-01-01

    Eosinophilic esophagitis (EoE) and gastroesophageal reflux disease are among the major causes of isolated esophageal eosinophilia. Isolated esophageal eosinophilia meeting criteria for EoE may respond to proton pump inhibitor (PPI) treatment. This entity is termed proton pumps inhibitor responsive esophageal eosinophilia (PPI-REE). Gastro-esophageal reflux is thought to comprise a subgroup of patients with PPI-REE. According to the latest guidelines, PPI responsiveness distinguishes people with PPI-REE from patients having EoE (non-responders). In this report, two unusual cases with findings belonging to both EoE and PPI-REE are discussed with known and unknown facts. PMID:24987510

  3. Intraluminal acid activates esophageal nodose C fibers after mast cell activation.

    PubMed

    Zhang, Shizhong; Liu, Zhenyu; Heldsinger, Andrea; Owyang, Chung; Yu, Shaoyong

    2014-02-01

    Acid reflux in the esophagus can induce esophageal painful sensations such as heartburn and noncardiac chest pain. The mechanisms underlying acid-induced esophageal nociception are not clearly understood. In our previous studies, we characterized esophageal vagal nociceptive afferents and defined their responses to noxious mechanical and chemical stimulation. In the present study, we aim to determine their responses to intraluminal acid infusion. Extracellular single-unit recordings were performed in nodose ganglion neurons with intact nerve endings in the esophagus using ex vivo esophageal-vagal preparations. Action potentials evoked by esophageal intraluminal acid perfusion were compared in naive and ovalbumin (OVA)-challenged animals, followed by measurements of transepithelial electrical resistance (TEER) and the expression of tight junction proteins (zona occludens-1 and occludin). In naive guinea pigs, intraluminal infusion with either acid (pH = 2-3) or capsaicin did not evoke an action potential discharge in esophageal nodose C fibers. In OVA-sensitized animals, following esophageal mast cell activation by in vivo OVA inhalation, intraluminal acid infusion for about 20 min started to evoke action potential discharges. This effect is further confirmed by selective mast cell activation using in vitro tissue OVA challenge in esophageal-vagal preparations. OVA inhalation leads to decreased TEER and zona occludens-1 expression, suggesting an impaired esophageal epithelial barrier function after mast cell activation. These data for the first time provide direct evidence of intraluminal acid-induced activation of esophageal nociceptive C fibers and suggest that mast cell activation may make esophageal epithelium more permeable to acid, which subsequently may increase esophageal vagal nociceptive C fiber activation. PMID:24264049

  4. Intraluminal acid activates esophageal nodose C fibers after mast cell activation

    PubMed Central

    Zhang, Shizhong; Liu, Zhenyu; Heldsinger, Andrea; Owyang, Chung

    2013-01-01

    Acid reflux in the esophagus can induce esophageal painful sensations such as heartburn and noncardiac chest pain. The mechanisms underlying acid-induced esophageal nociception are not clearly understood. In our previous studies, we characterized esophageal vagal nociceptive afferents and defined their responses to noxious mechanical and chemical stimulation. In the present study, we aim to determine their responses to intraluminal acid infusion. Extracellular single-unit recordings were performed in nodose ganglion neurons with intact nerve endings in the esophagus using ex vivo esophageal-vagal preparations. Action potentials evoked by esophageal intraluminal acid perfusion were compared in naive and ovalbumin (OVA)-challenged animals, followed by measurements of transepithelial electrical resistance (TEER) and the expression of tight junction proteins (zona occludens-1 and occludin). In naive guinea pigs, intraluminal infusion with either acid (pH = 2–3) or capsaicin did not evoke an action potential discharge in esophageal nodose C fibers. In OVA-sensitized animals, following esophageal mast cell activation by in vivo OVA inhalation, intraluminal acid infusion for about 20 min started to evoke action potential discharges. This effect is further confirmed by selective mast cell activation using in vitro tissue OVA challenge in esophageal-vagal preparations. OVA inhalation leads to decreased TEER and zona occludens-1 expression, suggesting an impaired esophageal epithelial barrier function after mast cell activation. These data for the first time provide direct evidence of intraluminal acid-induced activation of esophageal nociceptive C fibers and suggest that mast cell activation may make esophageal epithelium more permeable to acid, which subsequently may increase esophageal vagal nociceptive C fiber activation. PMID:24264049

  5. Molecular Phenotyping in Predicting Response in Patients With Stage IB-III Esophageal Cancer Receiving Combination Chemotherapy

    ClinicalTrials.gov

    2015-03-13

    Stage IB Esophageal Adenocarcinoma; Stage IIA Esophageal Adenocarcinoma; Stage IIB Esophageal Adenocarcinoma; Stage IIIA Esophageal Adenocarcinoma; Stage IIIB Esophageal Adenocarcinoma; Stage IIIC Esophageal Adenocarcinoma

  6. Epidemiology of esophageal cancer

    PubMed Central

    Zhang, Yuwei

    2013-01-01

    Esophageal cancer (EsC) is one of the least studied and deadliest cancers worldwide because of its extremely aggressive nature and poor survival rate. It ranks sixth among all cancers in mortality. In retrospective studies of EsC, smoking, hot tea drinking, red meat consumption, poor oral health, low intake of fresh fruit and vegetables, and low socioeconomic status have been associated with a higher risk of esophageal squamous cell carcinoma. Barrett’s esophagus is clearly recognized as a risk factor for EsC, and dysplasia remains the only factor useful for identifying patients at increased risk, for the development of esophageal adenocarcinoma in clinical practice. Here, we investigated the epidemiologic patterns and causes of EsC. Using population based cancer data from the Surveillance, Epidemiology and End Results Program of the United States; we generated the most up-to-date stage distribution and 5-year relative survival by stage at diagnosis for 1998-2009. Special note should be given to the fact that esophageal cancer, mainly adenocarcinoma, is one of the very few cancers that is contributing to increasing death rates (20%) among males in the United States. To further explore the mechanism of development of EsC will hopefully decrease the incidence of EsC and improve outcomes. PMID:24039351

  7. Snapshot of Esophageal Cancer

    MedlinePLUS

    ... be found on the NCI Funded Research Portfolio Web site. A genome-wide association study of esophageal adenocarcinoma and Barrett's esophagus identified three new susceptibility loci for their development. Published October 2013. [ PubMed Abstract ] HER2 protein expression ...

  8. Dietary therapies for eosinophilic esophagitis.

    PubMed

    Arias, Angel; Lucendo, Alfredo J

    2014-01-01

    Eosinophilic esophagitis (EoE) represents a prevalent chronic esophageal disorder. Since the condition was first described, its pathophysiology has been known to have an immune-allergic origin, but the high response rate to dietary therapies based on feeding patients exclusively with amino acid-based elemental formulas (with complete elimination of table foods) has clearly established EoE as a particular form of food allergy. Nevertheless, the management of EoE in clinical practice remains widely heterogeneous, with topical steroids being a therapeutic mainstay. However, a growing body of evidence points to dietary therapy as an effective treatment option for both children and adults with EoE, as this approach is capable of achieving a sustained symptomatic and histological response without resorting to drugs. This article reviews the available data on the major types of dietary therapy for EoE, including elemental formula diets, skin allergy testing-directed elimination diets and empirical elimination diets based on common food allergens. PMID:24236700

  9. 21 CFR 868.1910 - Esophageal stethoscope.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 2013-04-01 false Esophageal stethoscope. 868.1910 Section 868.1910...Diagnostic Devices § 868.1910 Esophageal stethoscope. (a) Identification. An esophageal stethoscope is a nonpowered device that is...

  10. 21 CFR 868.1910 - Esophageal stethoscope.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 2011-04-01 false Esophageal stethoscope. 868.1910 Section 868.1910...Diagnostic Devices § 868.1910 Esophageal stethoscope. (a) Identification. An esophageal stethoscope is a nonpowered device that is...

  11. 21 CFR 868.1910 - Esophageal stethoscope.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 2014-04-01 false Esophageal stethoscope. 868.1910 Section 868.1910...Diagnostic Devices § 868.1910 Esophageal stethoscope. (a) Identification. An esophageal stethoscope is a nonpowered device that is...

  12. 21 CFR 868.1910 - Esophageal stethoscope.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 2010-04-01 false Esophageal stethoscope. 868.1910 Section 868.1910...Diagnostic Devices § 868.1910 Esophageal stethoscope. (a) Identification. An esophageal stethoscope is a nonpowered device that is...

  13. 21 CFR 868.1910 - Esophageal stethoscope.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 2012-04-01 false Esophageal stethoscope. 868.1910 Section 868.1910...Diagnostic Devices § 868.1910 Esophageal stethoscope. (a) Identification. An esophageal stethoscope is a nonpowered device that is...

  14. High Intraepithelial Eosinophil Counts in Esophageal Squamous Epithelium Are Not Specific for Eosinophilic Esophagitis in Adults

    Microsoft Academic Search

    Sonali Rodrigo; Gebran Abboud; Daniel Oh; Steven R. DeMeester; Jeffrey Hagen; John Lipham; Tom R. DeMeester; Parakrama Chandrasoma

    2008-01-01

    OBJECTIVESThe histologic criterion of >20 eosinophils per high power field (hpf) is presently believed to establish the diagnosis of idiopathic eosinophilic esophagitis (IEE). This is based on data that the number of intraepithelial eosinophils in gastroesophageal reflux disease (GERD) is less than 20\\/hpf. This study tests this belief.METHODSPathology records were searched for patients who had an eosinophil count >20\\/hpf in

  15. 21 CFR 876.5365 - Esophageal dilator.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5365 Esophageal dilator. (a) Identification. An esophageal...

  16. 21 CFR 876.5365 - Esophageal dilator.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5365 Esophageal dilator. (a) Identification. An esophageal...

  17. 21 CFR 876.5365 - Esophageal dilator.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5365 Esophageal dilator. (a) Identification. An esophageal...

  18. 21 CFR 876.5365 - Esophageal dilator.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5365 Esophageal dilator. (a) Identification. An esophageal...

  19. 21 CFR 876.5365 - Esophageal dilator.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5365 Esophageal dilator. (a) Identification. An esophageal...

  20. Eosinophilic esophagitis in children with esophageal atresia.

    PubMed

    Dhaliwal, J; Tobias, V; Sugo, E; Varjavandi, V; Lemberg, D; Day, A; Bohane, T; Ledder, O; Jiwane, A; Adams, S; Henry, G; Dilley, A; Shi, E; Krishnan, U

    2014-01-01

    Eosinophilic esophagitis (EoE) has only rarely been reported in esophageal atresia (EA) patients. A retrospective case analysis of all EA patients born at our center between January 1999 and April 2012 was performed. A total of 113 of patients were identified; 10 patients were excluded as a result of inadequate data. Eighteen patients (17%) were diagnosed with EoE. The average number of eosinophilis was 30/high-power field (HPF) (19/HPF-80/HPF). The median age for diagnosis of EoE was 1 year and 6 months (8 months-8 years and 7 months). Children with EoE had a significantly greater incidence of reflux symptoms, dysphagia, tracheomalacia, and 'hypoxic spells' (P?esophageal stricture at time of EoE diagnosis. Five were dilated at time of the initial endoscopy, prior to the diagnosis of EoE being available. Two patients had resolution of their strictures on medical treatment of their EoE alone and did not require further dilatation. EoE was seen in 17% of children with EA in this study. EoE should be considered in EA patients with persistent symptoms on standard reflux treatment, increasing dysphagia, and recurrent strictures. PMID:23947919

  1. 21 CFR 862.1120 - Blood gases (PCO2, PO2) and blood pH test system.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...2014-04-01 false Blood gases (PCO2, PO2) and blood pH test... MEDICAL DEVICES CLINICAL CHEMISTRY AND CLINICAL TOXICOLOGY DEVICES Clinical Chemistry Test Systems § 862.1120 Blood gases (PCO 2, PO 2) and...

  2. Suitability of the isolated chicken eye test for classification of extreme pH detergents and cleaning products.

    PubMed

    Cazelle, Elodie; Eskes, Chantra; Hermann, Martina; Jones, Penny; McNamee, Pauline; Prinsen, Menk; Taylor, Hannah; Wijnands, Marcel V W

    2015-04-01

    A.I.S.E. investigated the suitability of the regulatory adopted ICE in vitro test method (OECD TG 438) with or without histopathology to identify detergent and cleaning formulations having extreme pH that require classification as EU CLP/UN GHS Category 1. To this aim, 18 extreme pH detergent and cleaning formulations were tested covering both alkaline and acidic extreme pHs. The ICE standard test method following OECD Test Guideline 438 showed good concordance with in vivo classification (83%) and good and balanced specificity and sensitivity values (83%) which are in line with the performances of currently adopted in vitro test guidelines, confirming its suitability to identify Category 1 extreme pH detergent and cleaning products. In contrast to previous findings obtained with non-extreme pH formulations, the use of histopathology did not improve the sensitivity of the assay whilst it strongly decreased its specificity for the extreme pH formulations. Furthermore, use of non-testing prediction rules for classification showed poor concordance values (33% for the extreme pH rule and 61% for the EU CLP additivity approach) with high rates of over-prediction (100% for the extreme pH rule and 50% for the additivity approach), indicating that these non-testing prediction rules are not suitable to predict Category 1 hazards of extreme pH detergent and cleaning formulations. PMID:25614451

  3. An Overview of Eosinophilic Esophagitis

    PubMed Central

    Park, Hyojin

    2014-01-01

    Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated esophageal disease affecting both children and adults. The condition is characterized by an eosinophilic infiltration of the esophageal epithelium. Symptoms of esophageal dysfunction include dysphagia, food impaction and symptoms mimicking gastroesophageal reflux disease. Endoscopic examination typically reveals mucosal fragility, ring or corrugated mucosa, longitudinal furrows, whitish plaques or a small caliber esophagus. Histologic findings of >15 eosinophils per high-power field is the diagnostic hallmark of EoE. An elimination diet, topical corticosteroids or endoscopic dilation for fibrostenotic disease serve as effective therapeutic option. PMID:25368745

  4. Mean esophageal radiation dose is predictive of the grade of acute esophagitis in lung cancer patients treated with concurrent radiotherapy and chemotherapy

    PubMed Central

    Ozgen, Aytul; Hayran, Mutlu; Kahraman, Fatih

    2012-01-01

    The intention of this research was to define the predictive factors for acute esophagitis (AE) in lung cancer patients treated with concurrent chemotherapy and three-dimensional conformal radiotherapy. The data for 72 lung cancer patients treated with concurrent chemoradiotherapy between 2008 and 2010 were prospectively evaluated. Mean lung dose, mean dose of esophagus, volume of esophagus irradiated and percentage of esophagus volume treated were analysed according to esophagitis grades. The mean esophageal dose was associated with an increased risk of esophageal toxicity (Kruskal-Wallis test, P < 0.001). However, the mean lung dose and the volume of esophagus irradiated were not associated with an increased risk of esophageal toxicity (Kruskal-Wallis test, P = 0.50 and P = 0.41, respectively). The mean radiation dose received by the esophagus was found to be highly correlated with the duration of Grade 2 esophagitis (Spearman test, r = 0.82, P < 0.001). The mean dose of esophagus ?28 Gy showed statistical significance with respect to AE Grade 2 or worse (receiver operating characteristic curve analysis, 95% CI, 0.929–1.014). In conclusion, the mean esophageal dose was significantly associated with a risk of esophageal toxicity in patients with lung cancer treated with concurrent radiotherapy and chemotherapy. PMID:22915782

  5. Radiochemotherapy of esophageal cancer.

    PubMed

    Liao, Zhongxing; Cox, James D; Komaki, Ritsuko

    2007-06-01

    Cancer of the esophagus continues to be a threat to public health. The common practice is esophagectomy for surgically resectable tumors and radiochemotherapy for locally advanced, unresectable tumors. However, local regional tumor control and overall survival of esophageal cancer patients after the standard therapies remain poor, approximately 30% of patients treated with surgery only will develop local recurrence, and 50% to 60% patients treated with radiochemotherapy only fail local regionally due to persistent disease or local recurrence. Esophagectomy after radiochemotherapy or preoperative radiochemotherapy has increased the complete surgical resection rate and local regional control without a significant survival benefit. Induction chemotherapy followed by preoperative radiochemotherapy has produced encouraging results. In addition to patient-, tumor-, and treatment-related factors, involvement of celiac axis nodes, number of positive lymph nodes after preoperative radiochemotherapy, incomplete pathologic response, high metabolic activity on positron emission tomography scan after radiochemotherapy, and incomplete surgical resection are factors associated with a poor outcome. Radiochemotherapy followed by surgery is associated with significant adverse effects, including treatment-related pneumonitis, postoperative pulmonary complications, esophagitis and pericarditis. The incidence and severity of the adverse effects are associated with chemotherapy and radiotherapy dosimetric factors. Innovative treatment strategies including physically and biologically molecular targeted therapy is needed to improve the treatment outcome of patients with esophageal cancer. PMID:17545853

  6. Effect of bolus composition on esophageal transit: concise communication

    SciTech Connect

    Fisher, R.S.; Malmud, L.S.; Applegate, G.; Rock, E.; Lorber, S.H.

    1982-10-01

    The technique of esophageal scintigraphy was developed as a sensitive, quantitative, noninvasive test of esophageal transit. Esophageal scintigraphy was performed in 40 asymptomatic normal volunteers in order to determine the effect on esophageal transit of the following: body posture (sitting vs. supine), liquid vs. solid, the solid being either a standard number4 gelatin capsule of the size used for antibiotic capsules, or a cube of solid food such as cooked chicken liver. The results showed that liquids emptied completely from the esophagus after one swallow, whether supine or sitting. Capsules or liver cubes, when ingested without water, frequently remained in the esophagus for up to two hours without the subject's having any sensation that the solid had not left the esophagus. Both capsules and liver cubes cleared the esophagus better in the upright than in the supine position. When gelatin capsules were swallowed with as little as 15 ml of water, but after a preliminary sip of water, there was complete transit in each case. The study suggests that the practice of assisting patients into a sitting position and instructing them to take a sip of water before attempting to swallow a capsule will assure better transit of the capsule even when swallowed with as little as 15 ml of water. This may reduce the incidence of esophagitis following oral antibiotics, and of esophageal erosions from aspirin-containing medications.

  7. Effect of bolus composition on esophageal transit: concise communication

    SciTech Connect

    Fisher, R.S.; Malmud, L.S.; Appelgate, G.; Rock, E.; Lorber, S.H.

    1982-10-01

    The technique of esophageal scintigraphy was developed as a sensitive, quantitative, noninvasive test of esophageal transit. Esophageal scintigraphy was performed in 40 asymptomatic normal volunteers in order to determine the effect on esophageal transit of the following: body posture (sitting vs. supine), liquid vs. solid, the solid being either a standard gelatin capsule of the size used for antibiotic capsules, or a cube of solid food such as cooked chicken liver. The results showed that liquids emptied completely from the esophagus after one swallow whether supine or sitting. Capsules or liver cubes, when ingested without water, frequently remained in the esophagus for up to two hours without the subject's having any sensation that the solid had not left the esophagus. Both capsules and liver cubes cleared the esophagus better in the upright than in the supine position. When gelatin capsules were swallowed with as little as 15 ml of water, but after a preliminary sip of water, there was complete transit in each case. The study suggests that the practice of assisting patients into a sitting position and instructing them to take a sip of water before attempting to swallow a capsule will assure better transit of the capsule even when swallowed with as little as 15 ml of water. This may reduce the incidence of esophagitis following oral antibiotics, and of esophageal erosions from aspirin-containing medications.

  8. 21 CFR 868.1920 - Esophageal stethoscope with electrical conductors.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...2014-04-01 false Esophageal stethoscope with electrical conductors. ...Devices § 868.1920 Esophageal stethoscope with electrical conductors. (a) Identification. An esophageal stethoscope with electrical...

  9. 21 CFR 868.1920 - Esophageal stethoscope with electrical conductors.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...2012-04-01 false Esophageal stethoscope with electrical conductors. ...Devices § 868.1920 Esophageal stethoscope with electrical conductors. (a) Identification. An esophageal stethoscope with electrical...

  10. 21 CFR 868.1920 - Esophageal stethoscope with electrical conductors.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...2013-04-01 false Esophageal stethoscope with electrical conductors. ...Devices § 868.1920 Esophageal stethoscope with electrical conductors. (a) Identification. An esophageal stethoscope with electrical...

  11. 21 CFR 868.1920 - Esophageal stethoscope with electrical conductors.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...2011-04-01 false Esophageal stethoscope with electrical conductors. ...Devices § 868.1920 Esophageal stethoscope with electrical conductors. (a) Identification. An esophageal stethoscope with electrical...

  12. 21 CFR 868.1920 - Esophageal stethoscope with electrical conductors.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...2010-04-01 false Esophageal stethoscope with electrical conductors. ...Devices § 868.1920 Esophageal stethoscope with electrical conductors. (a) Identification. An esophageal stethoscope with electrical...

  13. Caustic ingestion and esophageal function

    Microsoft Academic Search

    S. Cadranel; C. Di Lorenzo; P. Rodesch; A. Piepsz; H. R. Ham

    1990-01-01

    The aim of the present study was to investigate esophageal motor function by means of krypton-81m esophageal transit scintigraphy and to compare the results with the functional and morphological data obtained by means of triple lumen manometry and endoscopy. In acute and subacute stages of the disease, all clinical, anatomical, and functional parameters were in good agreement, revealing significant impairment.

  14. Polymorphisms in DNA repair genes in the molecular pathogenesis of esophageal (Barrett) adenocarcinoma

    Microsoft Academic Search

    Alan G. Casson; Zuoyu Zheng; Susan C. Evans; Paul J. Veugelers; Geoffrey A. Porter; Duane L. Guernsey

    To test the hypothesis that aberrations of DNA repair contribute to susceptibility for the progression of gastro- esophageal reflux disease (GERD) into Barrett esophagus (BE) and esophageal adenocarcinoma (EADC), we studied the frequency of polymorphisms of selected DNA repair genes in patients with GERD (n ¼ 126), BE (n ¼ 125) and EADC (n ¼ 56) enrolled in a 2-year

  15. Effect of variables on pH measurement in acid-rain-like solutions as determined by Ruggedness Tests

    Microsoft Academic Search

    G. Marinenko; R. C. Paule; W. F. Koch; M. Knoerdel

    1986-01-01

    Ruggedness Test (RT) experiments were performed to assess the significance of the various main factors which affect pH measurements in low ionic strength aqueous solutions, as well as to establish the presence of interactions between the main factors. Stirring has an adverse effect on the measurement of pH, since it not only increases the random noise but also biases the

  16. Nuclear medicine and esophageal surgery

    SciTech Connect

    Taillefer, R.; Beauchamp, G.; Duranceau, A.C.; Lafontaine, E.

    1986-06-01

    The principal radionuclide procedures involved in the evaluation of esophageal disorders that are amenable to surgery are illustrated and briefly described. The role of the radionuclide esophagogram (RE) in the diagnosis and management of achalasia, oculopharyngeal muscular dystrophy and its complications, tracheoesophageal fistulae, pharyngeal and esophageal diverticulae, gastric transposition, and fundoplication is discussed. Detection of columnar-lined esophagus by Tc-99m pertechnetate imaging and of esophageal carcinoma by Ga-67 citrate and Tc-99m glucoheptonate studies also is presented. 37 references.

  17. White specks in the esophageal mucosa: an endoscopic manifestation of non-reflux eosinophilic esophagitis in children

    Microsoft Academic Search

    Joel R Lim; Sandeep K Gupta; Joseph M Croffie; Marian D Pfefferkorn; Jean P Molleston; Mark R Corkins; Mary M Davis; Philip P Faught; Steven J Steiner; Joseph F Fitzgerald

    2004-01-01

    BackgroundWhite specks in the esophageal mucosa have been observed in children with eosinophilic esophagitis. The aim of this study was to determine the relationship between white specks in the esophageal mucosa and allergic (non-reflux) eosinophilic esophagitis.

  18. Esophageal motor disorders in subjects with incidentally discovered Chagas disease: a study using high-resolution manometry and the Chicago classification.

    PubMed

    Remes-Troche, J M; Torres-Aguilera, M; Antonio-Cruz, K A; Vazquez-Jimenez, G; De-La-Cruz-Patiño, E

    2014-08-01

    In patients with chronic indeterminate Chagas disease, conventional manometry has shown that 25-48% had esophageal motor disorders. Recently, esophageal high-resolution manometry (HRM) has revolutionized the assessment of esophageal motor function. In this study, we performed esophageal HRM in a group of subjects with incidentally positive serological findings for Trypanosoma cruzi. In this prospective observational study, we evaluated subjects who had positive serological tests for Chagas disease detected during a screening evaluation for blood donation. All subjects underwent symptomatic evaluation and esophageal HRM with a 36 solid-state catheter. Esophageal abnormalities were classified using the Chicago classification. Forty-two healthy subjects (38 males) aged 18-61 years (mean age, 40.7 years) were included. When specific symptoms questionnaire was applied, 14 (33%) subjects had esophageal symptoms. Esophageal high-resolution manometry revealed that 28 (66%) of the subjects had an esophageal motility disorder according to the Chicago classification. Most common findings were hypocontractile disorders in 18 subjects (43%) and esophagogastric junction (EGJ) outflow obstruction in 6 (15%). Esophageal high-resolution manometry reveals that up to two thirds of the subjects with an incidental diagnosis of Chagas disease have esophageal abnormalities. This technology increases the detection and allows a more complete assessment of esophageal motor function in subjects infected with T.?cruzi even in the early stages of the disease. PMID:23088758

  19. Esophageal Atresia and Tracheoesophageal Fistula

    MedlinePLUS

    ... baby is just a few days old. How long will my baby be sick? In uncomplicated cases, ... future? Babies born with esophageal atresia sometimes have long-term problems, the most common of which is ...

  20. Environmental Causes of Esophageal Cancer

    PubMed Central

    Kamangar, Farin; Chow, Wong-Ho; Abnet, Christian; Dawsey, Sanford

    2009-01-01

    Synopsis This articles reviews the environmental risk factors and predisposing conditions for the two main histological types of esophageal cancer, esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EA). Tobacco smoking, excessive alcohol consumption, drinking maté, low intake of fresh fruits and vegetables, achalasia, and low socioeconomic status increase the risk of ESCC. Results of investigations on several other potential risk factors, including opium consumption, intake of hot drinks, eating pickled vegetables, poor oral health, and exposure to human papillomavirus, polycyclic aromatic hydrocarbons, N-nitroso compounds, acetaldehyde, and fumonisins are also discussed. Gastroesophageal reflux, obesity, tobacco smoking, hiatal hernia, achalasia, and probably absence of H. pylori in the stomach increase the risk of EA. Results of studies investigating other factors, including low intake of fresh fruits and vegetables, consumption of carbonated soft drink, use of H2 blockers, non-steroidal anti-inflammatory drugs, and drugs that relax the lower esophageal sphincter are also discussed. PMID:19327566

  1. Drugs Approved for Esophageal Cancer

    Cancer.gov

    This page lists cancer drugs approved by the Food and Drug Administration (FDA) for esophageal cancer. The list includes generic names and brand names. The drug names link to NCI's Cancer Drug Information summaries.

  2. Imaging of uncommon esophageal malignancies.

    PubMed

    Tirumani, H; Rosenthal, M H; Tirumani, S H; Shinagare, A B; Krajewski, K M; Ramaiya, N H

    2014-03-17

    Malignant esophageal neoplasms other than squamous cell carcinoma and adenocarcinoma are uncommon and include endocrine tumors, lymphoid malignancies, melanoma, malignant stromal tumors, and secondary tumors (metastases). Imaging, though not diagnostic in many cases, helps in selecting the appropriate treatment strategy by determining the anatomic extent of the tumor and locoregional and distant spread. In this article, we provide a comprehensive review of the imaging features of these uncommon esophageal malignancies. PMID:24635682

  3. Flow Curve Analysis of 17-4 PH Stainless Steel under Hot Compression Test

    NASA Astrophysics Data System (ADS)

    Mirzadeh, Hamed; Najafizadeh, Abbas; Moazeny, Mohammad

    2009-12-01

    The hot compression behavior of a 17-4 PH stainless steel (AISI 630) has been investigated at temperatures of 950 °C to 1150 °C and strain rates of 10-3 to 10 s-1. Glass powder in the Rastegaev reservoirs of the specimen was used as a lubricant material. A step-by-step procedure for data analysis in the hot compression test was given. The work hardening rate analysis was performed to reveal if dynamic recrystallization (DRX) occurred. Many samples exhibited typical DRX stress-strain curves with a single peak stress followed by a gradual fall toward the steady-state stress. At low Zener-Hollomon ( Z) parameter, this material showed a new DRX flow behavior, which was called multiple transient steady state (MTSS). At high Z, as a result of adiabatic deformation heating, a drop in flow stress was observed. The general constitutive equations were used to determine the hot working constants of this material. Moreover, after a critical discussion, the deformation activation energy of 17-4 PH stainless steel was determined as 337 kJ/mol.

  4. [Management of caustic esophagitis in children].

    PubMed

    Mas, E; Breton, A; Lachaux, A

    2012-12-01

    In children, caustic ingestion is due to accidents at home and inadequate storage of caustic agents. In emergency, it is useful to remove the soiled clothes, rinse the affected area, and prevent vomiting and feeding. Caustic ingestion (pH<2 or>12) induces burns of the upper gastrointestinal tract requiring esophagogastro-duodenoscopy between H12 and H24. Strong alkalis cause necrosis with liquefaction of the esophagus, penetrating deeply with a high-risk of perforation. Management of these children requires a specialized care center with an intensive care unit, endoscopic equipment, and a surgical team. Esophageal stricture is the main complication; no prophylactic treatment (steroids) is effective. Strictures occur after the 3rd week, and barium swallow should be performed by the end of the 1st month. Stricture are often multiple, long, and tortuous; endoscopic dilatation is difficult with a high-rate of perforation and a low-rate of success. In situ application of mitomycin C or injection of triamcinolone could reduce the recurrence rate of stricture. In recalcitrant or recurrent strictures, it is recommended to perform an esophageal replacement using a colonic interposition or a gastric tube. Endoscopy should also be performed 15-20years after caustic ingestion to screen for early neoplastic lesions. Prevention is very important for avoiding caustic ingestions. Information and education should be given specifically to the parents of toddlers; caustic products should be stored out of reach of children and they should not be kept with food. PMID:23141564

  5. Gastroesophageal reflux disease and non-esophageal cancer

    PubMed Central

    Herbella, Fernando AM; Neto, Sebastião Pannocchia; Santoro, Ilka Lopes; Figueiredo, Licia Caldas

    2015-01-01

    The association of gastroesophageal reflux disease (GERD) and esophageal cancer is well known. The carcinogenic properties of the gastroduodenal contents may also lead to cancer in target organs for GERD especially considering that they do not have intrinsic protective mechanisms as found in the esophagus. This review focuses on the putative relation between GERD and non-esophageal cancer. Most of the papers reviewed are far from ideal to prove the relationship of extra-esophageal cancer and GERD since a small number of patients is presented, most do not control cases based on tobacco usage and obesity, and the diagnosis of GERD is variable, not always from an objective measurement such as pH monitoring but relying on symptoms in most reports. Nevertheless, head and neck and lung cancer have a growing incidence parallel to GERD and a shift towards non-smoking, female gender and adenocarcinoma (compared to squamous cell carcinoma) is arising, similar to the example of esophageal cancer with the exception of the female gender. PMID:25624714

  6. Gastroesophageal reflux disease and non-esophageal cancer.

    PubMed

    Herbella, Fernando A M; Neto, Sebastião Pannocchia; Santoro, Ilka Lopes; Figueiredo, Licia Caldas

    2015-01-21

    The association of gastroesophageal reflux disease (GERD) and esophageal cancer is well known. The carcinogenic properties of the gastroduodenal contents may also lead to cancer in target organs for GERD especially considering that they do not have intrinsic protective mechanisms as found in the esophagus. This review focuses on the putative relation between GERD and non-esophageal cancer. Most of the papers reviewed are far from ideal to prove the relationship of extra-esophageal cancer and GERD since a small number of patients is presented, most do not control cases based on tobacco usage and obesity, and the diagnosis of GERD is variable, not always from an objective measurement such as pH monitoring but relying on symptoms in most reports. Nevertheless, head and neck and lung cancer have a growing incidence parallel to GERD and a shift towards non-smoking, female gender and adenocarcinoma (compared to squamous cell carcinoma) is arising, similar to the example of esophageal cancer with the exception of the female gender. PMID:25624714

  7. Epidemiology of eosinophilic esophagitis.

    PubMed

    Hruz, Petr

    2014-01-01

    Eosinophilic esophagitis (EoE) is an allergy-associated disease defined clinically by esophagus-related symptoms in combination with a dense esophageal eosinophilia, both of which are unresponsive to prolonged acid suppression with proton pump inhibitors. Over the last two decades EoE has increasingly been recognized in various geographical areas (mostly industrialized countries) with high socioeconomic development. The prevalence rate is increasing and reaches up to 50 patients per 100,000 inhabitants in some indicator regions. Whether this increased prevalence is due to a real increase in incidence, a result of increased awareness by health care providers or because of the nonfatal nature of EoE adding more and more cases to the patient pool is still a matter of controversy. Several studies have consistently demonstrated a male predominance in EoE, with a male-to-female risk ratio of 3:1. The average age at diagnosis ranges between 30 and 50 years and suggests that EoE is a disease of the middle-aged man. It can affect patients of every race, but the disease is more common among Caucasians. In both children and adults, EoE has been clearly associated with allergies to food and aeroallergens, and most EoE patients present with a personal allergic background (e.g. asthma, rhinoconjunctivitis or oral allergy syndrome). In conclusion, knowledge of epidemiologic parameters of EoE is crucial for identifying risk factors as well as pathogenic mechanisms, planning preventive measures and determining optimal treatment strategies. PMID:24603379

  8. Effect of variables on pH measurement in acid-rain-like solutions as determined by ruggedness tests

    Microsoft Academic Search

    G. Marinenko; R. C. Paule; W. F. Koch

    1985-01-01

    Ruggedness Test (RT) experiments were performed to assess the significance of the various main factors that affect pH measurements in low-ionic-strength aqueous solutions, as well as to establish the presence of interactions between the main factors. Stirring has an adverse effect on the measurement of pH, since it not only increases the random noise but also biases the measured value.

  9. Vero cell assay validation of an alternative to the Ph. Eur. diphtheria potency tests.

    PubMed

    Gommer, A M

    1996-01-01

    In the framework of the Biological Standardisation Programme of the European Pharmacopoeia Commission, in 1993 a collaborative study was organised for the validation of an alternative to the diphtheria in vivo challenge tests required by the Ph.Eur. monograph V.2.2.7. The alternative assay is based on the detection of neutralising antibodies in the sera from mice immunised with the vaccines to be tested (Vero cell assay). In the study this assay method was validated against intradermal and lethal challenge in guinea-pigs, performed in conformity with Ph.Eur. Therefore the potency currently on the European market, was assayed in parallel by the different assay methods. Seventeen laboratories, from eleven different countries, participated in the study. Three laboratories performed the intradermal challenge assay, while three other laboratories performed the lethal challenge assay. All seventeen laboratories performed the Vero cell assay. The results of the study suggest that the potency of the diphtheria component of both monovalent diphtheria vaccines and combined diphtheria-tetanus vaccines can be estimated adequately by means of the Vero cell assay. It does not yet seem possible for all combined diphtheria-tetanus-pertussis vaccines to replace a potency assay based on the protective capacity of a vaccine in guinea-pigs by the Vero cell assay. This may be due to an adjuvant effect of the pertussis component of the vaccine, in combination with the adsorbent used, which may be more pronounced in mice than in guinea-pigs and may also differ between different strains of mice. PMID:8785952

  10. Eosinophilic esophagitis in adults: An emerging problem with unique esophageal features

    Microsoft Academic Search

    Jon W Potter; Kia Saeian; Benson T Massey; Richard A Komorowski; Reza Shaker; Walter J Hogan

    2004-01-01

    BackgroundEosinophilic esophagitis is an inflammatory condition in which there is dense eosinophilic infiltration of the surface lining of the esophagus. Reports of eosinophilic esophagitis pertain almost exclusively to pediatric populations. However, eosinophilic esophagitis is emerging as a clinical affliction of adults. This report describes the clinical and endoscopic findings of eosinophilic esophagitis in the largest cohort of adult patients reported

  11. An uncommon cause of corrosive esophageal injury

    E-print Network

    Fabio Pace; Salvatore Greco; Stefano Pallotta; Daniela Bossi; Emilio Trabucchi; Gabrielle Bianchi Porro; Fabio Pace; Salvatore Greco; Stefano Pallotta; Clinical Science; Daniela Bossi; Emilio Trabucchi; Clinical Science Department

    2007-01-01

    We present an unusual case of corrosive esophageal injury following liquid glue ingestion. The endoscopic findings were tissue sloughing and blackened appearance of the esophagogastric junction, due to caustic esophageal injuries following ingestion of glue containing toluene.

  12. Eosinophilic Esophagitis in Pediatric and Adolescent Patients

    MedlinePLUS

    Eosinophilic Esophagitis in Pediatric and Adolescent Patients Basics Overview Eosinophilic esophagitis also known as (EoE) is a chronic disease that occurs in both children and adults resulting in inflammation ...

  13. 21 CFR 878.3610 - Esophageal prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3610 Esophageal prosthesis. (a) Identification. An esophageal prosthesis is a rigid,...

  14. 21 CFR 878.3610 - Esophageal prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3610 Esophageal prosthesis. (a) Identification. An esophageal...

  15. 21 CFR 878.3610 - Esophageal prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3610 Esophageal prosthesis. (a) Identification. An esophageal...

  16. 21 CFR 878.3610 - Esophageal prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3610 Esophageal prosthesis. (a) Identification. An esophageal...

  17. 21 CFR 878.3610 - Esophageal prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3610 Esophageal prosthesis. (a) Identification. An esophageal...

  18. Esophageal Helicobacter pylori colonization aggravates esophageal injury caused by reflux

    PubMed Central

    Chu, Yun-Xiang; Wang, Wei-Hong; Dai, Yun; Teng, Gui-Gen; Wang, Shu-Jun

    2014-01-01

    AIM: To investigate esophageal Helicobacter pylori (H. pylori) colonization on esophageal injury caused by reflux and the related mechanisms. METHODS: An esophagitis model, with acid and bile reflux, was surgically produced in male rats. The rats were randomly divided into either: (1) an esophagogastroduodenal anastomosis (EGDA) group; (2) an EGDA with H. pylori infection group; (3) a pseudo-operation with H. pylori infection group; or (4) a pseudo-operation group. All rats were kept for 36 wk. Based on the location of H. pylori colonization, the EGDA rats with H. pylori infection were subdivided into those with concomitant esophageal H. pylori colonization or those with only gastric H. pylori colonization. The esophageal injuries were evaluated grossly and microscopically. The expressions of CDX2 and MUC2 were determined by real-time polymerase chain reaction (RT-PCR) and immunohistochemistry. Ki-67 antigen expression was determined by immunohistochemistry. The mRNA levels of cyclin D1, c-Myc, Bax and Bcl-2 were determined by RT-PCR. Cell apoptosis was evaluated using the TdT-mediated dUTP nick-end labeling method. RESULTS: Esophagitis, Barrett’s esophagus (BE), and esophageal adenocarcinoma (EAC) developed in rats that underwent EGDA. When comparing rats with EGDA and concomitant esophageal H. pylori colonization to EGDA-only rats, the severity of injury (87.9 ± 5.2 vs 77.2 ± 8.6, macroscopically, 92.5 ± 8.0 vs 83.8 ± 5.5, microscopically, both P < 0.05) and the incidences of BE (80.0% vs 33.3%, P = 0.055) and EAC (60.0% vs 11.1%, P < 0.05) were increased. These increases were associated with upregulation of CDX2 and MUC2 mRNA (10.1 ± 5.4 vs 3.0 ± 2.9, 8.4 ± 4.6 vs 2.0 ± 3.2, respectively, Ps < 0.01) and protein (8.1 ± 2.3 vs 3.3 ± 3.1, 7.3 ± 4.0 vs 1.8 ± 2.7, respectively, all P < 0.05). The expression of Ki-67 (8.9 ± 0.7 vs 6.0 ± 1.7, P < 0.01) and the presence of apoptotic cells (8.3 ± 1.1 vs 5.3 ± 1.7, P < 0.01) were also increased significantly in rats with EGDA and concomitant esophageal H. pylori colonization compared with rats with EGDA only. The mRNA levels of cyclin D1 (5.8 ± 1.9 vs 3.4 ± 1.3, P < 0.01), c-Myc (6.4 ± 1.7 vs 3.7 ± 1.2, P < 0.01), and Bax (8.6 ± 1.6 vs 5.1 ± 1.3, P < 0.01) were significantly increased, whereas the mRNA level of Bcl-2 (0.6 ± 0.3 vs 0.8 ± 0.3, P < 0.01) was significantly reduced in rats with EGDA and concomitant esophageal H. pylori colonization compared with rats with EGDA only. CONCLUSION: Esophageal H. pylori colonization increases esophagitis severity, and facilitates the development of BE and EAC with the augmentation of cell proliferation and apoptosis in esophageal mucosa. PMID:25400455

  19. Pediatric Erosive Esophagitis Maintenance: Finally, Some Level 1 Evidence!

    Microsoft Academic Search

    Susan R. Orenstein

    2007-01-01

    In children, as in adults, gastroesophageal reflux disease (GERD), particularly erosive esophagitis, is now believed to be a chronic disease, probably requiring lifelong maintenance therapy. However, this assumption has not received adequate clinical testing, and the provocative article by Boccia et al. in this issue of the Journal challenges it. The strengths of this exceptional pediatric study lie in its

  20. Esophageal rupture complicated by acute pericarditis.

    PubMed

    Duman, Hakan; Bak?rc?, Eftal Murat; Karada?, Zakir; U?urlu, Yavuz

    2014-10-01

    Esophageal perforation is a serious condition with a high mortality rate. Delayed detection of esophageal perforation may result in devastating complications such as mediastinitis and pericarditis. Esophageal perforation is rarely due to aspiration of foreign bodies. Here we report the case of a 59-year-old male patient with complicated esophageal perforation due to ingestion of a chicken bone, whose first signs are considered to be acute non-specific pericarditis. PMID:25490302

  1. Esophageal pathology: a brief guide and atlas.

    PubMed

    Chokhavatia, Sita; Alli-Akintade, Latifat; Harpaz, Noam; Stern, Richard

    2013-12-01

    This article contains a brief atlas for esophageal dysphagia, with an emphasis on endoscopic evaluation. Dysphagia refers to an abnormality with food propulsion, and it may be caused by oropharyngeal or esophageal disorders. Radiological modalities, endoscopy, and manometry play an important role in both the diagnosis and management of esophageal disorders. PMID:24262958

  2. Effect of variables on pH measurement in acid-rain-like solutions as determined by ruggedness tests

    SciTech Connect

    Marinenko, G.; Paule, R.C.; Koch, W.F.

    1985-11-04

    Ruggedness Test (RT) experiments were performed to assess the significance of the various main factors that affect pH measurements in low-ionic-strength aqueous solutions, as well as to establish the presence of interactions between the main factors. Stirring has an adverse effect on the measurement of pH, since it not only increases the random noise but also biases the measured value. Temperature control to the nearest 0.5 C is sufficient for maintaining measurements accurate to 0.01 pH. Addition of NaNO/sub 3/ or KC1 can not be tolerated in accurate pH measurements. Three small two-factor interactions were also revealed.

  3. [Esophageal diseases: GERD, Barrett, achalasia and eosinophilic esophagitis].

    PubMed

    Calvet, Xavier; Villoria, Albert

    2014-09-01

    At Digestive Disease Week (DDW) 2014, developments in esophageal disease were presented. Highlights include: the usefulness of impedancemetry to diagnose reflux disease, or the effectiveness of PPIs for treating non-cardiac chest pain. Concerning Barrett's esophagus, its prevalence is identical in patients with and without reflux symptoms, Barrett segments less than 1cm probably do not require follow-up, and in older patients with long-segment Barrett, initial endoscopies overlooked up to 2% of significant lesions. Regarding achalasia, surgical myotomy is no more effective than endoscopic dilation and may even be less effective than peroral endoscopic myotomy (POEM). In terms of eosinophilic esophagitis, it is important to systematically take biopsies in patients with dysphagia so that cases of eosinophilic esophagitis are not overlooked. In addition, for this condition, routine endoscopic dilations not only do not seem useful in improving the course of the disease, but could also worsen the response to medical treatment. PMID:25294266

  4. Esophageal fistula associated with intracavitary irradiation for esophageal carcinoma

    SciTech Connect

    Hishikawa, Y.; Tanaka, S.; Miura, T.

    1986-05-01

    Fifty-three patients with esophageal carcinoma were treated with high-dose-rate intracavitary irradiation following external irradiation. Ten patients developed esophageal fistula. Perforations were found in the bronchus (four), major vessels (four), pericardium (one), and mediastinum (one). The frequency of fistula occurrence in these patients was not remarkably different from that in 30 other patients treated only with greater than or equal to 50 Gy external irradiation. From the time of the development of esophageal fistula, intracavitary irradiation did not seem to accelerate the development of fistula. The fistulas in our ten patients proved to be associated with tumor, deep ulcer (created before intracavitary irradiation), chemotherapy, infection, and trauma rather than the direct effect of intracavitary irradiation.

  5. The Pathophysiology of Eosinophilic Esophagitis

    PubMed Central

    Raheem, Mayumi; Leach, Steven T.; Day, Andrew S.; Lemberg, Daniel A.

    2014-01-01

    Eosinophilic esophagitis (EoE) is an emerging disease characterized by esophageal eosinophilia (>15eos/hpf), lack of responsiveness to acid-suppressive medication and is managed by allergen elimination and anti-allergy therapy. Although the pathophysiology of EoE is currently unsubstantiated, evidence implicates food and aeroallergen hypersensitivity in genetically predisposed individuals as contributory factors. Genome-wide expression analyses have isolated a remarkably conserved gene-expression profile irrespective of age and gender, suggesting a genetic contribution. EoE has characteristics of mainly TH2 type immune responses but also some TH1 cytokines, which appear to strongly contribute to tissue fibrosis, with esophageal epithelial cells providing a hospitable environment for this inflammatory process. Eosinophil-degranulation products appear to play a central role in tissue remodeling in EoE. This remodeling and dysregulation predisposes to fibrosis. Mast-cell-derived molecules such as histamine may have an effect on enteric nerves and may also act in concert with transforming growth factor-? to interfere with esophageal musculature. Additionally, the esophageal epithelium may facilitate the inflammatory process under pathogenic contexts such as in EoE. This article aims to discuss the contributory factors in the pathophysiology of EoE. PMID:24910846

  6. Risk factors for esophageal cancer in a low-incidence area of Brazil.

    PubMed

    Mota, Orlando Milhomem; Curado, Maria Paula; Oliveira, José Carlos; Martins, Edesio; Cardoso, Daniela Medeiros Milhomem

    2013-01-01

    CONTEXT AND OBJECTIVES Esophageal cancer is the eighth commonest type of cancer worldwide, occupying sixth place in terms of mortality. Smoking and alcohol use are known risk factors for this type of cancer. The aim here was to evaluate the risk factors for esophageal cancer in a low-incidence area. DESIGN AND SETTING Case-control study in Goiânia, with 99 cases of esophageal cancer and 223 controls. METHODS The variables were sociodemographic, dietary, occupational and lifestyle data. The sample was analyzed using the chi-square test, Mann-Whitney test and Mantel-Haenszel approach for multivariate analysis. Odds ratios (OR) were calculated with 5% significance and 95% confidence intervals. RESULTS The risk of esophageal cancer was higher in patients ? 55 years (OR = 1.95; P < 0.001). Patients from rural areas were at greater risk of esophageal cancer (OR = 4.9; P < 0.001). Smoking was a risk factor among the cases (OR = 3.8; P < 0.001), as was exposure to woodstoves (OR = 4.42; P < 0.001). The practice of oral sex was not a risk factor (OR = 0.45; P = 0.04). Consumption of apples, pears, vegetables, cruciferous vegetables and fruit juices were protective against esophageal cancer. CONCLUSION In a region in which the incidence of esophageal cancer is low, the most significant risk factors were exposure to woodstoves, smoking and living in rural areas. PMID:23538592

  7. Esophageal tissue engineering: A new approach for esophageal replacement

    PubMed Central

    Totonelli, Giorgia; Maghsoudlou, Panagiotis; Fishman, Jonathan M; Orlando, Giuseppe; Ansari, Tahera; Sibbons, Paul; Birchall, Martin A; Pierro, Agostino; Eaton, Simon; De Coppi, Paolo

    2012-01-01

    A number of congenital and acquired disorders require esophageal tissue replacement. Various surgical techniques, such as gastric and colonic interposition, are standards of treatment, but frequently complicated by stenosis and other problems. Regenerative medicine approaches facilitate the use of biological constructs to replace or regenerate normal tissue function. We review the literature of esophageal tissue engineering, discuss its implications, compare the methodologies that have been employed and suggest possible directions for the future. Medline, Embase, the Cochrane Library, National Research Register and ClinicalTrials.gov databases were searched with the following search terms: stem cell and esophagus, esophageal replacement, esophageal tissue engineering, esophageal substitution. Reference lists of papers identified were also examined and experts in this field contacted for further information. All full-text articles in English of all potentially relevant abstracts were reviewed. Tissue engineering has involved acellular scaffolds that were either transplanted with the aim of being repopulated by host cells or seeded prior to transplantation. When acellular scaffolds were used to replace patch and short tubular defects they allowed epithelial and partial muscular migration whereas when employed for long tubular defects the results were poor leading to an increased rate of stenosis and mortality. Stenting has been shown as an effective means to reduce stenotic changes and promote cell migration, whilst omental wrapping to induce vascularization of the construct has an uncertain benefit. Decellularized matrices have been recently suggested as the optimal choice for scaffolds, but smart polymers that will incorporate signalling to promote cell-scaffold interaction may provide a more reproducible and available solution. Results in animal models that have used seeded scaffolds strongly sug- gest that seeding of both muscle and epithelial cells on scaffolds prior to implantation is a prerequisite for complete esophageal replacement. Novel approaches need to be designed to allow for peristalsis and vascularization in the engineered esophagus. Although esophageal tissue engineering potentially offers a real alternative to conventional treatments for severe esophageal disease, important barriers remain that need to be addressed. PMID:23322987

  8. Approaches to Test AutomationApproaches to Test Automation Cem Kaner, J.D., Ph.D.Cem Kaner, J.D., Ph.D.

    E-print Network

    on Software Testing (LAWST) and the Austin Workshop on Test Automation (AWTA). · LAWST 5 focused on oracles, Jane Stepak, Melora Svoboda, Jeremy White, and Rodney Wilson. · AWTA also reviewed and discussed

  9. Sloughing Esophagitis: A Not So Common Entity

    PubMed Central

    Akhondi, Hossein

    2014-01-01

    BACKGROUND: Sloughing esophagitis, also known as esophagitis dissecans superficialis, is a very rare and underdiagnosed entity with unknown incidence rate. It can be associated with bullous dermatoses and medications such as central nervous system depressants and those causing esophageal injury. CASE REPORT: A 55-years-old woman was recovering from renal failure due to rhabdomyolysis when she developed dysphagia and odynophagia. Esophagogastroduodenoscopy with biopsy was performed for suspected bullous pemphigus and confirmed sloughing esophagitis. She improved with intravenous steroids. CONCLUSIONS: Sloughing Esophagitis should enter our differential diagnosis more frequently. It is mostly a benign, self-limiting process but when associated with bullous dermatoses will require steroid treatment. PMID:25598761

  10. Photodynamic therapy for esophageal cancer

    PubMed Central

    Hatogai, Ken; Morimoto, Hiroyuki; Yoda, Yusuke; Kaneko, Kazuhiro

    2014-01-01

    Photodynamic therapy (PDT) is a treatment that uses a photosensitizing drug that is administered to the patient, localized to a tumor, and then activated with a laser to induce a photochemical reaction to destroy the cell. PDT using porfimer sodium followed by excimer dye laser irradiation is approved as a curative treatment for superficial esophageal cancer in Japan. While endoscopic submucosal dissection (ESD) is currently more popular for esophageal cancer, there is evidence to support PDT as an alternative treatment and as a salvage treatment for local failure after chemoradiotherapy (CRT). A photosensitizing agent has also been developed that requires a shorter sun shade period after administration, and studies are currently underway to establish an esophageal cancer indication for this next-generation PDT in Japan. PMID:25333005

  11. Evaluation of a broth microdilution antifungal susceptibility test with a pH indicator: comparison with the broth macrodilution procedures.

    PubMed

    Fournier, C; Gaspar, A; Boillot, F; Villard, J

    1995-03-01

    A broth microdilution antifungal susceptibility test with a pH indicator (bromocresol purple) in a synthetic medium was evaluated. This method measures cellular activity instead of simply a change in biomass. The variations of pH caused by fungal activity were measured by changes in optical densities at 450 nm. The MICs50 obtained were compared with the MICs found by the classical broth macrodilution procedure. In most cases broth micro- and macrodilution MICs were in agreement for amphotericin B, fluconazole, flucytosine and nystatin. PMID:7782253

  12. Effect of esophageal emptying and saliva on clearance of acid from the esophagus

    SciTech Connect

    Helm, J.F.; Dodds, W.J.; Pelc, L.R.; Palmer, D.W.; Hogan, W.J.; Teeter, B.C.

    1984-02-02

    The clearance of acid from the esophagus and esophageal emptying in normal subjects was studied. A 15-ml bolus of 0.1 N hydrochloric acid (pH 1.2) radiolabeled with (/sup 99m/Tc)sulfur colloid was injected into the esophagus, and the subject swallowed every 30 seconds. Concurrent manometry and radionuclide imaging showed nearly complete emptying of acid from the esophagus by an immediate secondary peristaltic sequence, although esophageal pH did not rise until the first swallow 30 seconds later. Esophageal pH then returned to normal by a series of step increases, each associated with a swallow-induced peristaltic sequence. Saliva stimulation by an oral lozenge shortened the time required for acid clearance, whereas aspiration of saliva from the mouth abolished acid clearance. Saliva stimulation or aspiration did not affect the virtually complete emptying of acid volume by the initial peristaltic sequence. It was concluded that esophageal acid clearance normally occurs as a two-step process: (1) Virtually all acid volume is emptied from the esophagus by one or two peristaltic sequences, leaving a minimal residual amount that sustains a low pH, and (2) residual acid is neutralized by swallowed saliva.

  13. Effect of esophageal emptying and saliva on clearance of acid from the esophagus

    SciTech Connect

    Helm, J.F.; Dodds, W.J.; Pelc, L.R.; Palmer, D.W.; Hogan, W.J.; Teeter, B.C.

    1984-02-02

    The clearance of acid from the esophagus and esophageal emptying in normal subjects was studied. A 15-ml bolus of 0.1 N hydrochloric acid (pH 1.2) radiolabeled with (/sup -99m/Tc)sulfur colloid was injected into the esophagus, and the subject swallowed every 30 seconds. Concurrent manometry and radionuclide imaging showed nearly complete emptying of acid from the esophagus by an immediate secondary peristaltic sequence, although esophageal pH did not rise until the first swallow 30 seconds later. Esophageal pH then returned to normal by a series of step increases, each associated with a swallow-induced peristaltic sequence. Saliva stimulation by an oral lozenge shortened the time required for acid clearance, whereas aspiration of saliva from the mouth abolished acid clearance. Saliva stimulation or aspiration did not affect the virtually complete emptying of acid volume by the initial peristaltic sequence. It was concluded that esophageal acid clearance normally occurs as a two-step process: (1) virtually all acid volume is emptied from the esophagus by one or two peristaltic sequences, leaving a minimal residual amount that sustains a low pH, and (2) residual acid is neutralized by swallowed saliva. 13 references, 3 figures.

  14. Efficacy of Intensity Modulated Radiation Therapy After Surgery in Early Stage of Esophageal Carcinoma;

    ClinicalTrials.gov

    2012-12-28

    Esophageal Neoplasm; Esophageal Cancer TNM Staging Primary Tumor (T) T2; Esophageal Cancer TNM Staging Primary Tumor (T) T3; Esophageal Cancer TNM Staging Regional Lymph Nodes (N) N0; Esophageal Cancer TNM Staging Distal Metastasis (M) M0

  15. Esophageal dilations in eosinophilic esophagitis: A single center experience

    PubMed Central

    Ukleja, Andrew; Shiroky, Jennifer; Agarwal, Amitesh; Allende, Daniela

    2014-01-01

    AIM: To diagnose the clinical and histologic features that may be associated with or predictive of the need for dilation and dilation related complications; examine the safety of dilation in patients with eosinophilic esophagitis (EoE). METHODS: The medical records of all patients diagnosed with EoE between January 2002 and July 2010 were retrospectively reviewed. Esophageal biopsies were reexamined by an experienced pathologist to confirm the diagnosis (? 15 eos/hpf per current guidelines). Patients were divided into 2 groups: patients who did not receive dilation therapy and those who did. Demographics, clinical history, the use of pharmacologic therapy, endoscopic and pathology findings, and the number of biopsies and dilations carried out, if any, and their locations were recorded for each patient. The dilation group was further examined based on the interval between diagnosis and dilation, and whether or not a complication occurred. RESULTS: Sixty-one patients were identified with EoE and 22 (36%) of them underwent esophageal dilations for stricture/narrowing. The peak eos/hpf was significantly higher in patients who received a dilation (P = 0.04). Four (18% of pts.) minor complications occurred: deep mucosal tear 1, and small mucosal tears 3. There were no cases of esophageal perforations. Higher peak eos/hpf counts were not associated with increased risk of complications. CONCLUSION: Esophageal dilation appears to be a safe procedure in EoE patients, carrying a low complication rate. No correlation was found between the peak of eosinophil count and complication rate. Complications can occur independently of the histologic features. The long-term outcome of EoE treatment, with or without dilation, needs to be determined. PMID:25071351

  16. Testing Native Grasses For Survival and Growth in Low pH Mine Overburden1

    Microsoft Academic Search

    David R. Dreesen; John T. Harrington; Anne M. Wagner; Leigh Murray; Peixin Sun

    Overburden piles at the Molycorp molybdenum mine in North-Central New Mexico contain neutral rock types as well as mixed volcanic rocks, which are highly weathered materials with low pH and high salinity from pyrite oxidation. The mixing of rock types during overburden pile construction has resulted in heterogeneous substrates with a range of pH and soluble salt levels. An experiment

  17. The Diagnosis of Esophageal Eosinophilia is Not Increased in the Summer Months.

    PubMed

    Elias, Martha K; Kopacova, Jana; Arora, Amindra S; Dierkhising, Ross A; Enders, Felicity T; Katzka, David A; Kryzer, Lori A; Halland, Magnus; Smyrk, Thomas C; Talley, Nicholas J; Alexander, Jeffrey A

    2015-02-01

    Smaller studies have suggested seasonal variation of the diagnosis of eosinophilic esophagitis with more patients being diagnosed in the aeroallergen season. We evaluated a large group of adult patients for a seasonal variation of the diagnosis of symptomatic eosinophilic esophageal infiltration. We performed a retrospective review of adult patients from a large Eosinophilic esophagitis database at the Mayo Clinic Rochester. We only included patients from three states in the upper Midwest, who had 15 or more eosinophils per high-power field on esophageal biopsy, symptomatic dysphagia, and were seen, in our Gastroenterology Clinic between 2000 and 2008. Clinical data were abstracted and the month of diagnosis was determined. The Rayleigh circular test and the Chi-square goodness-of-fit test were used to detect seasonality of symptomatic esophageal eosinophilia diagnosis and seasonality corrected for esophagogastroduodenoscopy monthly volume. The diagnosis of symptomatic eosinophilic esophageal infiltration was made in 372 patients. The mean number of eosinophils was 39.6 per high-power field. The December/January and May/June periods seem to have an increased presentation rate (p = 0.014). Of those tested, reactions to any aeroallergen was present in 69 % (48/70), reactions to >4 aeroallergens in 47 % (33/70) and reactions to any food allergen in 63 % (50/80) of patients. There was no evidence of monthly concentration of symptomatic esophageal eosinophilia diagnosis in the subgroups of patients with any positive aeroallergen, >4 positive aeroallergens, or history of atopy. The diagnosis of symptomatic esophageal eosinophilia is not made more frequently in the summer months. PMID:25288197

  18. The Changing Face of Esophageal Cancer

    PubMed Central

    Melhado, Rachel E.; Alderson, Derek; Tucker, Olga

    2010-01-01

    The two main histological esophageal cancer types, adenocarcinoma and squamous cell carcinoma, differ in incidence, geographic distribution, ethnic pattern and etiology. This article focuses on epidemiology with particular reference to geographic and temporal variations in incidence, along with a review of the evidence supporting environmental and genetic factors involved in esophageal carcinogenesis. Squamous cell carcinoma of the esophagus remains predominantly a disease of the developing world. In contrast, esophageal adenocarcinoma is mainly a disease of western developed societies, associated with obesity and gastro-esophageal reflux disease. There has been a dramatic increase in the incidence of adenocarcinoma in developed countries in parallel with migration of both esophageal and gastric adenocarcinomas towards the gastro-esophageal junction. PMID:24281163

  19. Endoscopic restoration of esophageal continuity in caustic burn

    Microsoft Academic Search

    Anies Mahomed; Anver Mahomed; George Youngson

    1997-01-01

    Total obliteration of the esophageal lumen after caustic ingestion is an uncommon event. Esophageal continuity was reestablished using endoscopic resection of scar tissue followed by serial dilatations.

  20. Fragility of the esophageal mucosa: A pathognomonic endoscopic sign of primary eosinophilic esophagitis?

    Microsoft Academic Search

    Alex Straumann; Livio Rossi; Hans-Uwe Simon; Pius Heer; Hans-Peter Spichtin; Christoph Beglinger

    2003-01-01

    Background: Primary eosinophilic esophagitis, a chronic inflammatory disorder of the esophagus, evokes recurrent dysphagia. Endoscopy is often unremarkable, and no consensus exists regarding management of resultant dysphagia. The response of a series of patients with primary eosinophilic esophagitis to dilation is reported together with a description of a possibly pathognomonic sign: fragile esophageal mucosa, for which the term “crêpe-paper” mucosa

  1. A case of esophageal stricture after corrosive esophagitis successfully treated by frequent endoscopic balloon dilation

    Microsoft Academic Search

    Tomokazu Matsuyama; Satoshi Aiko; Yutaka Yoshizumi; Yoshiaki Sugiura; Tadaaki Maehara

    2004-01-01

    A 14-year-old girl was admitted to our hospital for treatment of abdominal pain after an attempt to commit suicide by swallowing a caustic soda solution. Severe esophageal stricture following corrosive esophagitis occurred 2 weeks after admission. First, we tried to dilate the stenotic esophagus by using an esophageal bougie, but it was not effective and was also painful, and the

  2. Experimental esophagitis induced by acid and pepsin in rabbits mimicking human reflux esophagitis

    Microsoft Academic Search

    Angel Lanas; Yolanda Royo; Javier Ortego; M. Molina; R. Sáinz

    1999-01-01

    Background & Aims: The lack of appropriate animal models might explain the paucity of information on the mechanisms of mucosal damage and defense in reflux esophagitis. The aim of this study was to develop a model of esophagitis in rabbits mimicking human reflux esophagitis. Methods: New Zealand white rabbits underwent surgery for placement of a plastic tube into the cervical

  3. Effect of Monotherapy and Combination Therapy of Pantoprazole and Aprepitant in Gastric Esophageal Reflux Disease in Albino Rats

    PubMed Central

    Shukla, Kamleshwar; Raj, Prince; Kumar, Arun; Kumar, Mukesh; Kaithwas, Gaurav

    2014-01-01

    The present study was undertaken to elucidate the effect of pantoprazole and aprepitant on experimental esophagitis in albino rats. Groups of rats, fasted overnight, received normal saline (3?mL/kg, sham control) or toxic control (3?mL/kg) or pantoprazole (30?mg/kg) or aprepitant (10?mg/kg), or their combinations and were subjected to pylorus and forestomach ligation. Animals were sacrificed after 8?h and evaluated for the gastric pH, volume of gastric juices, total acidity, esophagitis index, and free acidity. Esophageal tissues were further subjected to estimations of TBARS, GSH, catalase, and SOD. Treatment with pantoprazole and aprepitant significantly inhibited the gastric secretion, total acidity, and esophagitis index. The treatment also helped to restore the altered levels oxidative stress parameters to normal. PMID:24790551

  4. Intestinal interposition for benign esophageal disease

    Microsoft Academic Search

    Racquel Smith Bueno; Carlos Galvani; Santiago Horgan

    2008-01-01

    Opinion statement  Various options exist for intestinal interposition for benign, but debilitating, end-stage esophageal disorders. Principally,\\u000a the stomach, colon, or jejunum is used for esophageal replacement. Much debate exists regarding the ideal esophageal replacement\\u000a option. The conduit choice must be tailored to the individual patient. Unlike malignant processes, the conduit choice for\\u000a benign disorders must be sufficiently durable and functional. Colonic

  5. Surgical treatment of superficial esophageal cancer

    Microsoft Academic Search

    Mitsuo Tachibana; Shoichi Kinugasa; Muneaki Shibakita; Yasuhito Tonomoto; Shinji Hattori; Ryoji Hyakudomi; Hiroshi Yoshimura; Dipok Kumar Dhar; Naofumi Nagasue

    2006-01-01

    Objective  The worldwide incidence of superficial esophageal cancer (SEC) is increasing. The aim of this study is to review the systematic surgical outcomes of esophagectomy for SEC.Data sources  Only manuscripts written in English and written between 1980 and 2003 were selected from MEDLINE. The keywords consisting of superficial esophageal cancer, early esophageal cancer, and early stage or superficial stage or stage I

  6. Critical evaluation and further development of methods for testing ecotoxicity at multiple pH using Daphnia magna and Pseudokirchneriella subcapitata.

    PubMed

    Rendal, Cecilie; Trapp, Stefan; Kusk, Kresten Ole

    2012-08-01

    To meet the requirements of risk assessment legislature regarding the ecotoxicity of ionizing compounds, the present study attempts to establish easy, robust methods for testing ecotoxicity at various pH levels. An overview is given of the buffering methods found in the literature. This is supplemented by a series of experiments where toxicity and ability to stabilize pH of seven common buffering compounds was tested on Daphnia magna and Pseudokirchneriella subcapitata. We consider a buffer applicable at a given concentration if the pH drift is below 0.2 pH units, and if there are no toxic effects. Twenty-four- and 48-h acute toxicity tests with D. magna were carried on a series of organic buffers with pH monitoring. Based on the experimental results it is possible to give recommendations for buffer concentrations for use in toxicity testing with D. magna at pH levels in the range of pH 6.0-7.8 for 48 h exposure, and pH 6.0-9.5 for 24 h exposure. Forty-eight- and 72-h growth inhibition tests with P. subcapitata were carried out, and recommendations for buffer concentrations at pH 7.5 and 8.0 are made for both 48 and 72 h of exposure. PMID:22585467

  7. Corrosive esophagitis caused by ingestion of picosulfate.

    PubMed

    Seo, Jae Yong; Kang, Ki Joo; Kang, Ho Suk; Kim, Seong Eun; Park, Ji Won; Moon, Sung Hoon; Kim, Jong Hyeok; Park, Choong Kee

    2015-01-01

    Corrosive esophagitis is characterized by caustic injury due to the ingestion of chemical agents, mainly alkaline substances such as detergents. Esophageal bleeding, perforation, or stricture can be worsened by high-degree corrosive esophagitis. Picosulfate is a commonly used laxative frequently administered for bowel preparation before colonoscopy or colon surgery. Picosulfate powder should be completely dissolved in water before ingestion because the powder itself may cause chemical burning of the esophagus and stomach. Here, we report a case of corrosive esophagitis due to the ingestion of picosulfate powder that was not completely dissolved in water. PMID:25674529

  8. Corrosive Esophagitis Caused by Ingestion of Picosulfate

    PubMed Central

    Seo, Jae Yong; Kang, Ho Suk; Kim, Seong Eun; Park, Ji Won; Moon, Sung Hoon; Kim, Jong Hyeok; Park, Choong Kee

    2015-01-01

    Corrosive esophagitis is characterized by caustic injury due to the ingestion of chemical agents, mainly alkaline substances such as detergents. Esophageal bleeding, perforation, or stricture can be worsened by high-degree corrosive esophagitis. Picosulfate is a commonly used laxative frequently administered for bowel preparation before colonoscopy or colon surgery. Picosulfate powder should be completely dissolved in water before ingestion because the powder itself may cause chemical burning of the esophagus and stomach. Here, we report a case of corrosive esophagitis due to the ingestion of picosulfate powder that was not completely dissolved in water. PMID:25674529

  9. Esophageal Stenosis Associated With Tumor Regression in Radiotherapy for Esophageal Cancer: Frequency and Prediction

    SciTech Connect

    Atsumi, Kazushige [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Shioyama, Yoshiyuki, E-mail: shioyama@radiol.med.kyushu-u.ac.jp [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Arimura, Hidetaka [Department of Health Sciences, Kyushu University, Fukuoka (Japan); Terashima, Kotaro [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Matsuki, Takaomi [Department of Health Sciences, Kyushu University, Fukuoka (Japan); Ohga, Saiji; Yoshitake, Tadamasa; Nonoshita, Takeshi; Tsurumaru, Daisuke; Ohnishi, Kayoko; Asai, Kaori; Matsumoto, Keiji [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Nakamura, Katsumasa [Department of Radiology, Kyushu University Hospital at Beppu, Oita (Japan); Honda, Hiroshi [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan)

    2012-04-01

    Purpose: To determine clinical factors for predicting the frequency and severity of esophageal stenosis associated with tumor regression in radiotherapy for esophageal cancer. Methods and Materials: The study group consisted of 109 patients with esophageal cancer of T1-4 and Stage I-III who were treated with definitive radiotherapy and achieved a complete response of their primary lesion at Kyushu University Hospital between January 1998 and December 2007. Esophageal stenosis was evaluated using esophagographic images within 3 months after completion of radiotherapy. We investigated the correlation between esophageal stenosis after radiotherapy and each of the clinical factors with regard to tumors and therapy. For validation of the correlative factors for esophageal stenosis, an artificial neural network was used to predict the esophageal stenotic ratio. Results: Esophageal stenosis tended to be more severe and more frequent in T3-4 cases than in T1-2 cases. Esophageal stenosis in cases with full circumference involvement tended to be more severe and more frequent than that in cases without full circumference involvement. Increases in wall thickness tended to be associated with increases in esophageal stenosis severity and frequency. In the multivariate analysis, T stage, extent of involved circumference, and wall thickness of the tumor region were significantly correlated to esophageal stenosis (p = 0.031, p < 0.0001, and p = 0.0011, respectively). The esophageal stenotic ratio predicted by the artificial neural network, which learned these three factors, was significantly correlated to the actual observed stenotic ratio, with a correlation coefficient of 0.864 (p < 0.001). Conclusion: Our study suggested that T stage, extent of involved circumference, and esophageal wall thickness of the tumor region were useful to predict the frequency and severity of esophageal stenosis associated with tumor regression in radiotherapy for esophageal cancer.

  10. CHARACTERIZATION AND PH/EH-BASED LEACHING TESTS OF MINING WASTES CONTAINING MERCURY

    EPA Science Inventory

    This study was undertaken as a part of developing treatment alternatives for waste materials, primarily waste rock and roaster tailings, from sites contaminated with Mercury (Hg) mining wastes. Leaching profiles of waste rock over a range of different pH and oxidation-reduction ...

  11. CHARACTERIZATION AND PH/EH-BASED LEACHING TESTS OF MINING WASTES CONTAINING MERCURY

    EPA Science Inventory

    This study was undertaken as a part of developing treatment alternatives for waste materials, primarily waste rock and roaster tailings, from sites contaminated with mercury (Hg) mining wastes. Leaching profiles of waste rock over a range of different pH and oxidation-reduction (...

  12. PENTACHLOROPHENOL TOXICITY TO AMPHIPODS AND FATHEAD MINNOWS AT DIFFERENT TEST PH VALUES

    EPA Science Inventory

    Juvenile amphipods (Gammarus pseudolimnaeus and Crangonyx pseudogracilis) and fathead minnows (Pimephales promelas) were exposed to pentachlorophenol (PCP) at pH values of 6.5, 7.5, 8.0 and 8.5 for 96 h, and early life stages of fathead minnows were exposed for 32 d at the same p...

  13. Neoadjuvant therapy for esophageal cancer.

    PubMed

    Shah, Rachit D; Cassano, Anthony D; Neifeld, James P

    2014-10-15

    Esophageal cancer is increasing in incidence more than any other visceral malignancy in North America. Adenocarcinoma has become the most common cell type. Surgery remains the primary treatment modality for locoregional disease. Overall survival with surgery alone has been dismal, with metastatic disease the primary mode of treatment failure after an R0 surgical resection. Cure rates with chemotherapy or radiation therapy alone have been disappointing as well. For these reasons, over the last decade multi-modality treatment has gained increasing acceptance as the standard of care. This review examines the present data and role of neoadjuvant treatment using chemotherapy and radiation therapy followed by surgery for the treatment of esophageal cancer. PMID:25320656

  14. Management of esophageal stricture after complete circular endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma

    Microsoft Academic Search

    Hajime Isomoto; Naoyuki Yamaguchi; Toshiyuki Nakayama; Tomayoshi Hayashi; Hitoshi Nishiyama; Ken Ohnita; Fuminao Takeshima; Saburo Shikuwa; Shigeru Kohno; Kazuhiko Nakao

    2011-01-01

    Background  Endoscopic submucosal dissection (ESD) permits removal of esophageal epithelial neoplasms en bloc, but is associated with esophageal stenosis, particularly when ESD involves the entire circumference of the esophageal lumen.\\u000a We examined the effectiveness of systemic steroid administration for control of postprocedural esophageal stricture after\\u000a complete circular ESD.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Seven patients who underwent wholly circumferential ESD for superficially extended esophageal squamous cell

  15. Esophageal mucosal injury with low-dose aspirin and its prevention by rabeprazole.

    PubMed

    Sugimoto, Mitsushige; Nishino, Masafumi; Kodaira, Chise; Yamade, Mihoko; Ikuma, Mutsuhiro; Tanaka, Tatsuo; Sugimura, Haruhiko; Hishida, Akira; Furuta, Takahisa

    2010-03-01

    Aspirin is used widely as an antithrombotic drug for the prevention of cardiovascular and cerebrovascular events. Although aspirin increases the risk for gastrointestinal mucosal injury, the effect on esophageal mucosa is unclear. This study investigates whether aspirin induces esophageal mucosal injury and whether a proton-pump inhibitor can prevent such injury in relation to CYP2C19 genotypes. Fifteen healthy Japanese volunteers are dosed for 7 days in a 5-way randomly crossover trial: placebo, aspirin 100 mg, rabeprazole 10 mg, and aspirin 100 mg plus rabeprazole 10 mg either once daily or 4 times per day. All subjects undergo endoscopy and 24-hour intragastric pH monitoring on day 7. With the aspirin regimen, esophageal mucosal disorders occur in 7 patients (46.7%) (5, grade M; 2, grade A). The median 24-hour pH differs significantly among subjects who develop grade M or A gastroesophageal reflux disease and those who do not develop gastroesophageal reflux disease; the median pH in grade A gastroesophageal reflux disease is significantly lower (1.5 [range, 1.1-1.9]) than that in patients without gastroesophageal reflux disease (5.6 [range, 0.8-8.4], P = .04). Rabeprazole significantly inhibits acid secretion irrespective of CYP2C19 genotypes and decreases the incidence of aspirin-related esophageal injury and symptoms according to increasing pH value. Aspirin induces esophageal mucosal injury in an acid-dependent manner. Concomitant proton-pump inhibitor therapy may prevent advanced effects of low-dose aspirin. PMID:19940233

  16. Esophageal inflammatory pseudotumor mimicking malignancy.

    PubMed

    Kurihara, K; Mizuseki, K; Ichikawa, M; Okada, K; Miyata, Y

    2001-01-01

    A 54-year-old man with a complaint of dysphagia was found to have a prominent stricture in the proximal esophagus. A biopsy of the stenotic area indicated sarcoma, leading to subtotal esophagectomy. The surgically removed esophagus demonstrated a well-defined intramural mass, consisting of a mixture of fibroblastic cells with bland cytological appearances and inflammatory cells. Reflux esophagitis which was present distal to the stricture seemed to play a role in the development of this inflammatory pseudotumor. PMID:11201363

  17. Thallium cardiac stressing by esophageal pacing

    SciTech Connect

    Allen, M.L.; Vacek, J.L.; Preston, D.F.; Robinson, R.G.; Feldkamp, M.J. (Univ. of Kansas Medical Center, Kansas City (USA))

    1989-09-01

    Forty-three patients were examined with the transesophageal pacing method of cardiac stressing and thallium imaging. Transesophageal cardiac pacing, using a pill electrode or a permanent pacemaker lead, is a safe alternative for patients who are physically unable to exercise. Prior studies suggest that transvenous right atrial pacing with thallium injection is equivalent to physical exercise thallium studies in the detection of coronary artery disease. The esophageal pacing bipolar electrode similarly increases heart rate without the necessity of transvenous pacing or fluoroscopy and without the adverse side effects often seen when using pharmacologic stressing agents (i.e., dipyridamole). The results compare well with cardiac catheterization, echocardiographic, and electrocardiographic results. Cardiac paced stress testing requires no sedation, is performed on an out-patient basis, and causes little if any discomfort for the patient.

  18. Esophageal capnometry during hemorrhagic shock and after resuscitation in rats

    Microsoft Academic Search

    Balagangadhar R Totapally; Harun Fakioglu; Dan Torbati; Jack Wolfsdorf

    2003-01-01

    BACKGROUND: Splanchnic perfusion following hypovolemic shock is an important marker of adequate resuscitation. We tested whether the gap between esophageal partial carbon dioxide tension (PeCO2) and arterial partial carbon dioxide tension (PaCO2) is increased during graded hemorrhagic hypotension and reversed after blood reinfusion, using a fiberoptic carbon dioxide sensor. MATERIALS AND METHOD: Ten Sprague–Dawley rats were anesthetized, tracheotomized, and cannulated

  19. Effect of Perilla frutescens Fixed Oil on Experimental Esophagitis in Albino Wistar Rats

    PubMed Central

    Arya, Ekta; Saha, Sudipta; Saraf, Shubhini A.; Kaithwas, Gaurav

    2013-01-01

    The present study was undertaken to elucidate the effect of Perilla frutescens fixed oil on experimental esophagitis in albino rats. A group of rats (n = 6), treated with control vehicle (0.9% NaCl in double distilled water, 3?mL/kg, i.p.) and Perilla frutescens fixed oil (100%) (1, 2, and 3?mL/kg, i.p.), or pantoprazole (30?mg/kg, i.p.), were subjected to pylorus and forestomach ligation. Animals were sacrificed after 6?h and evaluated for the gastric pH, volume of gastric juices, total acidity, esophagitis index and free acidity. Esophageal tissues were further subjected to estimations of TBARS, GSH, catalase, and SOD. Treatment with fixed oil significantly inhibited the gastric secretion, total acidity, and esophagitis index. The oil also helped to restore the altered levels of oxidative stress parameters to normal. The present study also makes evident the in vitro antihistaminic and anticholinergic activity of alpha linolenic acid (ALA) (18?:?3, n ? 3) on isolated rat ileum preparation. The lipoxygenase inhibitory, histamine antagonistic, antisecretory (anticholinergic), and antioxidant activity of the oil was attributed for its efficacy in reflux esophagitis. PMID:24027769

  20. Endoscopic assessment of children with esophageal atresia: Lack of relationship of esophagitis and esophageal metaplasia to symptomatology

    PubMed Central

    Castilloux, Julie; Soglio, Dorothée Bouron-Dal; Faure, Christophe

    2010-01-01

    BACKGROUND: Late complications of esophageal atresia (EA), particularly esophagitis and Barrett’s esophagus, are increasingly being recognized. With the exception of patients with dysphagia associated with esophageal stricture, it is unknown whether patient symptomatology can predict endoscopic findings. METHODS: Data regarding the digestive symptoms of patients who were referred to the EA multidisciplinary clinic from October 2005 to October 2008, and underwent upper gastrointestinal endoscopic evaluation, were systematically collected. Macroscopic and histological findings were analyzed. Endoscopy was considered normal if no esophagitis, intestinal metaplasia or gastric metaplasia (GM) was discerned. RESULTS: Sixty-three patients underwent endoscopy. Eighteen had dysphagia related to an esophageal stricture needing dilation and were subsequently excluded from the analysis. Forty-five patients (26 girls) with a median age of 7.3 years (range 0.4 to 17.9 years) were evaluated. Twenty-six patients (58%) were normal at endoscopy, 14 patients (31%) had esophagitis and 16 patients (36%) had GM. No intestinal metaplasia or adenocarcinoma was detected. Six patients with abnormal endoscopy results were asymptomatic. No correlation between digestive symptoms and endoscopy results was found. CONCLUSION: The present cross-sectional study showed that symptomatology was not predictive of abnormal endoscopy in EA patients. Esophagitis or GM may be discovered, even in the absence of symptoms, suggesting that physicians cannot rely solely on symptomatology to accurately evaluate the extent of these esophageal complications in this population. PMID:20485706

  1. pH

    NSDL National Science Digital Library

    This lab activity is designed to teach students how to test for pH and understand its relationship to them and their environment. They will learn what pH is, draw and label a pH scale, measure the pH of various items, and explain why it's important to understand pH, for example, the danger presented by substances having very high or low pH.

  2. Scintigraphic Methods to Evaluate Alterations of Gastric and Esophageal Functions in Female Obesity

    PubMed Central

    Ömür, Özgür; Erdo?an, Mehmet; Özk?l?ç, Hayal; Y?lmaz, Cande?er

    2014-01-01

    Objective: Altered gastrointestinal function has frequently been observed in obese patients. The aim of this study was to investigate the frequency of gastro-esophageal reflux (GER) and to determine the alterations of gastric emptying and esophageal transit by scintigraphic methods in obese patients. Methods: Scintigraphic studies of 50 obese female non-diabetic patients who had not received any treatment for weight control were retrospectively reviewed. Mean Body Mass Index (BMI) was 34.96±3.04 kg/m2 (range:32-39 kg/m2). All subjects were submitted to scintigraphic evaluation of esophageal transit, gastro-esophageal reflux, gastric emptying and presence of Helicobacter pylori infection. The data of obese patients were compared with those of sex-age matched 30 non-obese cases who were selected from our clinical archive. Results: In obese group, seventeen (34%) patients were found to be GER positive scintigraphically; mean gastric emptying time (t½) was 59.18±30.8 min and the mean esophageal transit time was 8.9±7.2 s. Frequency of positive GER scintigraphy and the mean value of esophageal transit time were significantly higher in obese patients than non-obese control subjects. Gastric emptying time and esophageal transit time values were significantly longer in GER positive obese patients than GER negative ones. There was no statistically significant difference in the frequency of positive C14 urea breath test between obese and non-obese subjects and there were also no statistically significant correlations between BMI, GER, esophageal transit time and gastric emptying time. Conclusion: In our study, 42 of the 50 obese patients had esophago-gastric motility alterations. The significance of these alterations in obesity is not fully understood, but it is believed that these changes could be because of potential contributing factors in the development or maintenance of obesity or changes in eating habits. Conflict of interest:None declared. PMID:24653928

  3. Erlotinib Hydrochloride in Treating Patients With Advanced Esophageal Cancer or Stomach Cancer

    ClinicalTrials.gov

    2013-06-03

    Adenocarcinoma of the Esophagus; Adenocarcinoma of the Gastroesophageal Junction; Recurrent Esophageal Cancer; Squamous Cell Carcinoma of the Esophagus; Stage III Esophageal Cancer; Stage IV Esophageal Cancer

  4. Laparoscopic approach to benign esophageal disorders

    Microsoft Academic Search

    K. P. Balsara; C. R. Shah; N. H. Patell; H. Shah; B. Jamaiwar; P. Gupta

    Background: The technique of laparoscopic surgery (LS) has taken rapid strides over the past decade. Though the biliary tract has been the main focus of LS, the surgical treatment of benign esophageal disease is an area of growing interest. In this article we outline our experience using LS in the treatment of benign esophageal diseases. Material and Methods: From March

  5. Cololaryngostomy procedure in caustic esophageal burns

    Microsoft Academic Search

    Hayrettin Cebeci; Melih Paksoy; As?m Kaytaz; Ethem Unal

    2002-01-01

    The study presented herein was undertaken to report an original case of cololaryngostomy operation in caustic esophageal burns. Cololaryngostomy application to a chronic caustic esophageal burn case is reported with a detailed literature review of the topic. For the first time in the world, the larynx was used for the integrity of the gastrointestinal system by applying a cololaryngostomy procedure

  6. Cololaryngostomy procedure in caustic esophageal burns

    Microsoft Academic Search

    Hayrettin Cebeci; Melih Paksoy; Asim Kaytaz; Ethem Unal

    The study presented herein was undertaken to report an original case of cololaryngostomy operation in caustic esophageal burns. Cololaryngostomy application to a chronic caustic esophageal burn case is reported with a detailed literature review of the topic. For the first time in the world, the larynx was used for the integrity of the gastrointestinal system by applying a cololaryngostomy procedure

  7. Retained esophageal foreign bodies in children

    Microsoft Academic Search

    B. Ravi Shankar; S. K. Yachha; B. C. Sharma; B. Singh; T. S. Mahant; V. K. Kapoor

    1996-01-01

    Foreign-body (FB) ingestion is common in children. Retained FBs in the esophagus can produce serious complications. We report five children with retained esophageal FBs: one presented with massive hematemesis due to an esophago-carotid fistula and the others had FB impaction above esophageal strictures. The hazards of impaction of small FBs above the strictures and delayed referral are highlighted.

  8. Immune signaling and regulation in esophageal cancer.

    PubMed

    Calpe, Silvia; Compare, Debora; Mari, Luigi; Nardone, Gerardo; Parikh, Kaushal

    2014-09-01

    The following, from the 12th OESO World Conference: Cancers of the Esophagus, includes commentaries on signaling pathways that can be targeted with immunotherapy; the role of micro-RNAs in the immune response to esophageal cancer; and the association between obesity, the immune system, and esophageal adenocarcinoma. PMID:25266011

  9. High-resolution EUS in children with eosinophilic “allergic” esophagitis

    Microsoft Academic Search

    Victor L. Fox; Samuel Nurko; Jonathan E. Teitelbaum; Kamran Badizadegan; Glenn T. Furuta

    2003-01-01

    Background: The pathophysiology of dysphagia associated with eosinophilic esophagitis is unknown. This study investigated possible anatomic alterations in children with eosinophilic esophagitis in comparison with healthy children by using high-resolution EUS to precisely measure individual tissue layers of the esophagus. Methods: Children with eosinophilic esophagitis (n = 11) and control children (n = 8) without esophagitis were prospectively evaluated by

  10. Unusual Presentation of a Metastatic Esophageal Carcinoma

    PubMed Central

    Orlicka, Katarzyna; Maynard, Stéphanie; Bouin, Mickael

    2012-01-01

    Esophageal cancer most commonly presents with upper digestive symptoms such as dysphagia. Lymph nodes are among the most common metastatic sites of this type of cancer. We report the case of a 53-year-old man presenting with unusual sole presenting features of esophageal cancer. The patient sought medical attention for abdominal pain without dysphagia, which was first investigated with an abdominal computed tomography scan. A large abdominal mass was discovered on imaging. Biopsies of this mass were in keeping with esophageal squamous cell cancer. With this finding, gastroscopy was performed, confirming the presence of primary esophageal cancer. This is a rare presentation of esophageal cancer without upper gastrointestinal symptoms. This case reinforces the value of biopsy for any neoplastic mass, especially in a context of unusual symptoms. PMID:22679417

  11. Esophageal lung resection and prosthesis placement in a preterm neonate.

    PubMed

    Parida, Lalit; Pal, Kamalesh; Buainain, Hussah A; Al-Umran, Khalid U

    2015-01-01

    This report describes a successful outcome in a preterm baby with an esophageal atresia and tracheo-esophageal fistula, who initially underwent a primary esophageal repair; but a persistent nonexpanding lung on the side of surgery led to further investigations. A further diagnosis of an esophageal lung resulted in pneumonectomy and prophylactic placement of an intra-thoracic prosthesis to prevent post-pneumonectomy syndrome. To the best of our knowledge, this is the first report of a prophylactic placement of an intra-thoracic prosthesis in a neonate with the condition of esophageal atresia and tracheo-esophageal fistula and associated esophageal lung. PMID:25829674

  12. [Marshmallow for investigating functional disturbances of the esophageal body].

    PubMed

    Keren, S; Argaman, E

    1992-09-01

    Manometric studies using water boluses do not always demonstrate disturbances in esophageal motility. We tested the use of a marshmallow bolus to induce abnormal manometric patterns in patients with dysphagia in whom manometric studies using water boluses were normal or nearly so. The study group included 12 normal volunteers and 22 patients with dysphagia and nearly normal manometric studies. Pressure was recorded along the esophageal body using 10 "wet" swallows followed by 10 "solid" swallows of marshmallow. In normal subjects there were fewer abnormal contractions after solid swallows than after wet swallows. In 15 patients solid swallows induced abnormal motility patterns which were not observed after wet swallows. The probability of inducing abnormal contractions in patients after solid swallows is significantly greater than after wet swallows (p < 0.0001). Solid swallowing is therefore useful in evaluating functional disturbances of the esophagus in patients with dysphagia. PMID:1427473

  13. Food allergy and eosinophilic esophagitis: what do we do?

    PubMed

    Chehade, Mirna; Aceves, Seema S; Furuta, Glenn T; Fleischer, David M

    2015-01-01

    Eosinophilic esophagitis (EoE) is an inflammatory disease of the esophagus triggered by foods and possibly environmental allergens. Common conditions that mimic EoE include gastroesophageal reflux disease and proton pump inhibitor-responsive esophageal eosinophilia. These need to be excluded before confirming the diagnosis of EoE. Identification of food triggers for EoE using standard allergy tests remains challenging. Dietary therapy for EoE so far consists of test-directed elimination of foods, empiric elimination of common food allergens, or exclusive feeding of amino acid-based formulas, with variable success. No FDA-approved medications yet exist for EoE. Topical corticosteroids to the esophagus are being used. EoE is a chronic disease; therefore, long-term therapy seems to be necessary to avoid potential long-term complications such as esophageal remodeling and strictures. Optimal long-term therapies and follow-ups are still not established; therefore, discussion with patients and families regarding the choice of therapy is important to ensure the best possible outcomes from a medical and social standpoint. In this article, we discuss all the above issues in detail by using a hypothetical case; highlighting in a stepwise manner what is known with respect to diagnosis, work-up, and management of EoE; and discussing gaps in knowledge that need to be addressed in the future. PMID:25577614

  14. [Non-neoplastic esophageal stenosis: not always so benign].

    PubMed

    Lorenz, Julie; Vollenweider, Peter; Vuilleumier, Henri; Schwab, Marcos

    2013-10-01

    Esophageal intramural pseudodiverticulosis is a rare pathology whose etiology is unknown, but which is frequently associated with three highly prevalent entities: esophageal reflux disease, esophageal candidosis and alcoholic esophagitis. With conservative treatment the course of these pathologies is usually benign. However, some severe cases are resistant to conservative treatment and may require more aggressive management. We here present the case of patient suffering from a severe esophagitis complicated by chronic mediastinitis with life-threatening repercussions, requiring esophagectomy as treatment. PMID:24088236

  15. Counselor Trainees in M.S. versus Ph.D. Programs: Testing Two Models of Supervision.

    ERIC Educational Resources Information Center

    Ellis, Michael V.

    A study was conducted which continued the investigation of the underlying structure of supervision by empirically testing Bernard's (1979) two-dimensional model and Littrell et al.'s (1979) unidimensional developmental model of supervision. To test the models, 25 counselor trainees from two master's counselor programs were compared to 23 counselor…

  16. Helicobacter pylori Protection Against Reflux Esophagitis

    PubMed Central

    Entezari, Omid; Nouraie, Mehdi; Dowlati, Ehsan; Frederick, Wayne; Woods, Alfreda; Lee, Edward; Brim, Hassan; Smoot, Duane T.; Ghadyari, Firoozeh; Kamangar, Farin; Razjouyan, Hadie

    2013-01-01

    Background and Aim Negative association has been reported between presence of Helicobacter pylori and developing gastroesophageal reflux disease (GERD) and its complications. The aim of this study was to determine whether H. pylori (HP) can be protective against GERD in an African American (AA) population. Methods From 2004 to 2007, we studied 2,020 cases; esophagitis (58), gastritis (1,558), both esophagitis and gastritis (363) and a normal control group (41). We collected their pathology and endoscopy unit reports. HP status was determined based on staining of gastric biopsy. Results HP data was available for 79 % (1,611) of the cases. The frequency of HP positivity in gastritis patients was 40 % (506), in esophagitis patients 4 % and in normal controls 34 % (11), while HP was positive in 34 % of the patients with both esophagitis and gastritis. After adjusting for effects of age and sex, odds ratio of HP was 0.06 (95 % CI 0.01–0.59; P value = 0.01) for the esophagitis group versus the normal group. Conclusions Our results show H. pylori has a significant negative association with esophagitis in AAs which may point to a protective role of H. pylori in the pathogenesis of esophagitis. In addition, H. pylori may be the reason for the low GERD complications in AAs. PMID:23010740

  17. Efficacy and histopathological esophageal wall damage of biodegradable esophageal stents for treatment of severe refractory esophageal anastomotic stricture in a child with long gap esophageal atresia.

    PubMed

    Okata, Yuichi; Hisamatsu, Chieko; Bitoh, Yuko; Yokoi, Akiko; Nishijima, Eiji; Maeda, Kosaku; Yoshida, Makiko; Ishida, Tsukasa; Azuma, Takeshi; Kutsumi, Hiromu

    2014-12-01

    A case in which a self-expandable biodegradable (BD) esophageal stent was used for a refractory esophageal anastomotic stricture (EAS) in a 5-year-old female is presented. The patient underwent closure of a tracheoesophageal fistula and gastrostomy in the neonatal period. Esophagoesophagostomy was performed at 18 months of age after a multistaged extrathoracic esophageal elongation procedure. The patient developed refractory EAS and required repeated esophageal balloon dilation. Four sessions of esophageal BD stenting were performed from the age of 5-8 years. Each BD stenting allowed her to eat chopped food, but the anastomotic stricture recurred 4-7 months after the procedure. No major complications were observed, though transient chest pain and dysphagia were observed after each stenting. Finally, at 8 years of age, EAS resection and esophagoesophageal anastomosis were performed. The resected specimens showed thickened scar formation at the EAS lesion, while the degree of esophageal wall damage, both at the proximal and distal ends of the stricture, was slight. To the best of our knowledge, this is the first case report of this kind of treatment and assessment of damage to the esophageal wall microscopically. The advantages and problems of the use of BD stents in children are discussed. PMID:25399341

  18. Dilated Intercellular Spaces of Esophageal Epithelium in Nonerosive Reflux Disease Patients with Physiological Esophageal Acid Exposure

    Microsoft Academic Search

    Renato Caviglia; Mentore Ribolsi; Nicola Maggiano; Armando M Gabbrielli; Sara Emerenziani; Michele Pier Luca Guarino; Simone Carotti; Fortunéé Irene Habib; Carla Rabitti; Michele Cicala

    2005-01-01

    OBJECTIVES:It has been demonstrated that dilation of intercellular spaces of esophageal epithelium is a marker of tissue injury in GERD patients with a pathological esophageal acid exposure time. To evaluate the relationship among ultrastructural changes, acid esophageal exposure, and GERD symptoms, intercellular space diameters have been assessed in nonerosive reflux disease (NERD) patients with\\/without abnormal acid exposure time.METHODS:Following a pharmacological

  19. High Resolution Microendoscopy for Quantitative Diagnosis of Esophageal Neoplasia

    NASA Astrophysics Data System (ADS)

    Shin, Dongsuk

    Esophageal cancer is the eighth most common cancer in the world. Cancers of the esophagus account for 3.8% of all cases of cancers, with approximately 482,300 new cases reported in 2008 worldwide. In the United States alone, it is estimated that approximately 18,000 new cases will be diagnosed in 2013, and 15,210 deaths are expected. Despite advances in surgery and chemoradiation therapy, these advances have not led to a significant increase in survival rates, primarily because diagnosis often at an advanced and incurable stage when treatment is more difficult and less successful. Accurate, objective methods for early detection of esophageal neoplasia are needed. Here, quantitative classification algorithms for high resolution miscroendoscopic images were developed to distinguish between esophageal neoplastic and non-neoplastic tissue. A clinical study in 177 patients with esophageal squamous cell carcinoma (ESCC) was performed to evaluate the diagnostic performance of the classification algorithm in collaboration with the Mount Sinai Medical Center in the United States, the First Hospital of Jilin University in China, and the Cancer Institute and Hospital, the Chinese Academy of Medical Science in China. The study reported a sensitivity and specificity of 93% and 92%, respectively, in the training set, 87% and 97%, respectively, in the test set, and 84% and 95%, respectively, in an independent validation set. Another clinical study in 31 patients with Barrett's esophagus resulted in a sensitivity of 84% and a specificity of 85%. Finally, a compact, portable version of the high resolution microendoscopy (HRME) device using a consumer-grade camera was developed and a series of biomedical experimental studies were carried out to assess the capability of the device.

  20. Prevalence of human papillomavirus in esophageal carcinoma in Tangshan, China

    PubMed Central

    Mehryar, Mohammadreza Mohammadzad; Li, Shu-Ying; Liu, Hong-Wei; Li, Fan; Zhang, Fang; Zhou, Yu-Bai; Zeng, Yi; Li, Jin-Tao

    2015-01-01

    AIM: To study the prevalence of human papillomavirus (HPV) in esophageal carcinoma in Tangshan, China, a high-incidence area. METHODS: Formalin-fixed, paraffin-embedded tissue specimens from 198 patients who were pathologically diagnosed with esophageal squamous cell carcinoma from 2011 to 2013 were obtained from a pathology department in Tangshan. DNA was extracted from all 198 specimens to detect HPV by polymerase chain reaction (PCR). ?-globin PCR was performed to check the quality of the DNA extraction procedure. PCR was performed to detect a wide range of HPV types, and type-specific PCR was performed to detect HPV types 16 and 18. Negative and positive controls were used for HPV 16 and 18 detection. RESULTS: The DNA extraction method in this study appeared to be more effective than other previously reported methods. After DNA extraction, more than 98% of the tissue specimens had an acceptable result in the DNA qualification test (?-globin PCR). The overall prevalence of HPV in tumor tissues by GP6+/GP5+ PCR was 79.79%, and the prevalence of HPV types 16 and 18 was 40.40% and 47.47%, respectively. PCR demonstrated the presence of HPV, and direct sequencing confirmed the HPV genotypes. All HPV-positive PCR products were checked by DNA sequence analysis using DNAman and compared with the known HPV sequences listed in the Basic Local Alignment Search Tool database to evaluate the HPV types. This analysis confirmed the presence of HPV types 16 and 18. CONCLUSION: DNA of high-risk HPV types 16 and 18 is present in esophageal tumors, implicating HPV as a possible etiologic factor for esophageal squamous cell carcinoma. PMID:25780287

  1. Esophageal melanocytosis in oral opium consumption.

    PubMed

    Geramizadeh, Bita; Asadian, Fatemeh; Taghavi, Alireza

    2014-01-01

    Esophageal melanocytosis is a rare and benign condition, characterized by melanocytic proliferation of the esophageal squamous epithelium with heavy melanin deposition. The etiology and pathogenesis has not been exactly known but it seems to be a chronic stimulus such as gastroesophageal reflux. This condition is very rare and about 35 cases have been reported so far, most of which have been from India and Japan. Herein, we present a case of esophageal melanocytosis in a patient with long history of oral opium consumption. To the best of our knowledge, such a history has not been reported. PMID:24719715

  2. [Palliative endoscopic therapy of esophageal carcinoma].

    PubMed

    Lux, G; Riemann, J F; Groitl, H

    1984-03-22

    Endoscopic insertion of esophageal bridging tubes provides palliative therapy in patients with inoperable esophageal carcinoma. Indications are tumor stenoses and esophago-bronchial fistulae. In 138 patients endoscopical application of bridging tubes was performed: 51 esophageal, 42 cardiac and 24 gastric carcinoma, six tumor stenoses caused by bronchial carcinoma and 15 esophago-bronchial fistulae. Letality rate was 8,5%, which is significantly less compared to operative methods. Average survival time of 120 days after implantation seems not to be prolonged despite marked improvement of symptoms, especially of dysphagia. PMID:6201422

  3. Current management of esophageal cancer

    PubMed Central

    Thomas, Pascal Alexandre

    2014-01-01

    Management of esophageal cancer has evolved since the two last decades. Esophagectomy remains the primary treatment for early stage esophageal cancer although its specific role in superficial cancers is still under debate since the development of endoscopic mucosal treatment. To date, there is strong evidence to consider that locally advanced cancers should be recommended for a multimodal treatment with a neoadjuvant chemotherapy or a combined chemoradiotherapy (CRT) followed by surgery. For locally advanced squamous cell carcinoma or for a part of adenocarcinoma, some centers have proposed treating with definitive CRT to avoid related-mortality of surgery. In case of persistent or recurrent disease, a salvage esophagectomy remains a possible option but this procedure is associated with higher levels of perioperative morbidity and mortality. Despite the debate over what constitutes the best surgical approach (transthoracic versus transhiatal), the current question is if a minimally procedure could reduce the periopertive morbidity and mortality without jeopardizing the oncological results of surgery. Since the last decade, minimally invasive esophagectomy (MIE) or hybrid operations are being done in up to 30% of procedures internationally. There are some consistent data that MIE could decrease the incidence of the respiratory complications and decrease the length of hospital-stay. Nowadays, oncologic outcomes appear equivalent between open and minimally invasive procedures but numerous phase III trials are ongoing. PMID:24868443

  4. Temporal evolution in caveolin 1 methylation levels during human esophageal carcinogenesis

    PubMed Central

    2014-01-01

    Background Esophageal cancer ranks eighth among frequent cancers worldwide. Our aim was to investigate whether and at which neoplastic stage promoter hypermethylation of CAV1 is involved in human esophageal carcinogenesis. Methods Using real-time quantitative methylation-specific PCR (qMSP), we examined CAV1 promoter hypermethylation in 260 human esophageal tissue specimens. Real-time RT-PCR and qMSP were also performed on OE33 esophageal cancer cells before and after treatment with the demethylating agent, 5-aza-2’-deoxycytidine (5-Aza-dC). Results CAV1 hypermethylation showed highly discriminative ROC curve profiles, clearly distinguishing esophageal adenocarcinomas (EAC) and esophageal squamous cell carcinomas (ESCC) from normal esophagus (NE) (EAC vs. NE, AUROC?=?0.839 and p?test). Treatment of OE33 EAC cells with 5-Aza-dC reduced CAV1 methylation and increased CAV1 mRNA expression. Conclusions CAV1 promoter hypermethylation is a frequent event in human esophageal carcinomas and is associated with early neoplastic progression in Barrett’s esophagus. PMID:24885118

  5. Effect of esophageal emptying and saliva on clearance of acid from the esophagus

    Microsoft Academic Search

    James F. Helm; Wylie J. Dodds; Lorie R. Pelc; David W. Palmer; Walter J. Hogan; Bruce C. Teeter

    1984-01-01

    The clearance of acid from the esophagus and esophageal emptying in normal subjects was studied. A 15-ml bolus of 0.1 N hydrochloric acid (pH 1.2) radiolabeled with (\\/sup -99m\\/Tc)sulfur colloid was injected into the esophagus, and the subject swallowed every 30 seconds. Concurrent manometry and radionuclide imaging showed nearly complete emptying of acid from the esophagus by an immediate secondary

  6. A disintegrin and metalloproteinase 17 mRNA and protein expression in esophageal squamous cell carcinoma, as well as its clinicopathological factors and prognosis.

    PubMed

    Liu, Hong-Bin; Yang, Qi-Chang; Shen, Yi; Zhu, Yan; Zhang, Xiao-Juan; Chen, Hao

    2015-02-01

    The aim of the present study was to explore a disintegrin and metalloproteinase 17 (ADAM17) mRNA and protein expression in esophageal squamous cell carcinoma and its association with clinicopathological factors and prognosis. Through semi?quantitative reverse transcription polymerase chain reaction, the ADAM17 mRNA expression in 50 cases of esophageal squamous cell carcinoma and corresponding normal esophageal mucosa were detected. Using streptavidin peroxidase conjugated immunohistochemistry, ADAM17 protein levels were detected in 80 cases of esophageal squamous cell carcinoma and corresponding normal esophageal mucosa. A log rank test and the Cox proportional hazards model were used for the esophageal cancer survival analysis. ADAM17 mRNA expression levels in esophageal squamous cell carcinoma and corresponding normal esophageal mucosa were 0.937±0.241 and 0.225±0.077, respectively (P<0.01). ADAM17 mRNA expression in esophageal squamous cell carcinoma was correlated with lymph node metastasis (P<0.01) and tumor, node and metastasis (TNM) staging (P<0.05), however, it was not correlated with gender, age or histological grade (P>0.05). ADAM17 protein expression rates in esophageal squamous cell carcinoma and corresponding normal esophageal mucosa were 66.25 and 6.25% respectively, a difference that was statistically significant (P<0.01). In addition, ADAM17 protein expression in esophageal squamous cells was correlated with lymph node metastasis and TNM stage (P<0.05), while it was not correlated with gender, age or histological grade (P>0.05). ADAM17 protein expression and epidermal growth factor receptor (EGFR) protein expression were positively correlated (P<0.01). Lymph node metastasis, TNM stage, ADAM17 and EGFR protein expression may be used as independent prognostic indicators of esophageal squamous cell carcinoma (all P<0.05). ADAM17 mRNA and protein were highly expressed in esophageal squamous cell carcinoma; they have important roles in invasion and metastasis and a certain value in judging the prognosis of patients with esophageal squamous cell carcinoma. PMID:25351873

  7. A disintegrin and metalloproteinase 17 mRNA and protein expression in esophageal squamous cell carcinoma, as well as its clinicopathological factors and prognosis

    PubMed Central

    LIU, HONG-BIN; YANG, QI-CHANG; SHEN, YI; ZHU, YAN; ZHANG, XIAO-JUAN; CHEN, HAO

    2015-01-01

    The aim of the present study was to explore a disintegrin and metalloproteinase 17 (ADAM17) mRNA and protein expression in esophageal squamous cell carcinoma and its association with clinicopathological factors and prognosis. Through semi-quantitative reverse transcription polymerase chain reaction, the ADAM17 mRNA expression in 50 cases of esophageal squamous cell carcinoma and corresponding normal esophageal mucosa were detected. Using streptavidin peroxidase conjugated immunohistochemistry, ADAM17 protein levels were detected in 80 cases of esophageal squamous cell carcinoma and corresponding normal esophageal mucosa. A log rank test and the Cox proportional hazards model were used for the esophageal cancer survival analysis. ADAM17 mRNA expression levels in esophageal squamous cell carcinoma and corresponding normal esophageal mucosa were 0.937±0.241 and 0.225±0.077, respectively (P<0.01). ADAM17 mRNA expression in esophageal squamous cell carcinoma was correlated with lymph node metastasis (P<0.01) and tumor, node and metastasis (TNM) staging (P<0.05), however, it was not correlated with gender, age or histological grade (P>0.05). ADAM17 protein expression rates in esophageal squamous cell carcinoma and corresponding normal esophageal mucosa were 66.25 and 6.25% respectively, a difference that was statistically significant (P<0.01). In addition, ADAM17 protein expression in esophageal squamous cells was correlated with lymph node metastasis and TNM stage (P<0.05), while it was not correlated with gender, age or histological grade (P>0.05). ADAM17 protein expression and epidermal growth factor receptor (EGFR) protein expression were positively correlated (P<0.01). Lymph node metastasis, TNM stage, ADAM17 and EGFR protein expression may be used as independent prognostic indicators of esophageal squamous cell carcinoma (all P<0.05). ADAM17 mRNA and protein were highly expressed in esophageal squamous cell carcinoma; they have important roles in invasion and metastasis and a certain value in judging the prognosis of patients with esophageal squamous cell carcinoma. PMID:25351873

  8. Esophageal ulceration induced by intracavitary irradiation for esophageal carcinoma

    SciTech Connect

    Hishikawa, Y.; Tanaka, S.; Miura, T.

    1984-08-01

    Twenty-two patients with esophageal carcinoma had no local recurrence after external and intracavitary radiation treatment, but all developed ulcers in the field of intracavitary irradiation. Ten were linear ulcers that appeared 3-12 months after radiation treatment (mean, 5.3 months); the other 12 were the long circumferential type and appeared 1-8 months after irradiation (mean, 3.7 months). Esophagobronchial fistulae developed in two cases in which deep ulcer had been found between the completion of external irradiation and the beginning of intracavitary irradiation. In these cases with deep ulcer, intracavitary irradiation should not be done. For patients receiving intracavitary radiation, the total dosage should be less than 20 Gy.

  9. Esophageal papilloma: Flexible endoscopic ablation by radiofrequency

    PubMed Central

    del Genio, Gianmattia; del Genio, Federica; Schettino, Pietro; Limongelli, Paolo; Tolone, Salvatore; Brusciano, Luigi; Avellino, Manuela; Vitiello, Chiara; Docimo, Giovanni; Pezzullo, Angelo; Docimo, Ludovico

    2015-01-01

    Squamous papilloma of the esophagus is a rare benign lesion of the esophagus. Radiofrequency ablation is an established endoscopic technique for the eradication of Barrett esophagus. No cases of endoscopic ablation of esophageal papilloma by radiofrequency ablation (RFA) have been reported. We report a case of esophageal papilloma successfully treated with a single session of radiofrequency ablation. Endoscopic ablation of the lesion was achieved by radiofrequency using a new catheter inserted through the working channel of endoscope. The esophageal ablated tissue was removed by a specifically designed cup. Complete ablation was confirmed at 3 mo by endoscopy with biopsies. This case supports feasibility and safety of as a new potential indication for BarrxTM RFA in patients with esophageal papilloma. PMID:25789102

  10. No evidence of HPV DNA in esophageal squamous cell carcinoma in a population of Southern Brazil

    PubMed Central

    Antunes, Luís Carlos Moreira; Prolla, João Carlos; de Barros Lopes, Antonio; da Rocha, Marta Pires; Fagundes, Renato Borges

    2013-01-01

    AIM: To investigate the association between human papillomavirus (HPV) and esophageal squamous cell carcinoma (ESCC) in southern Brazil. METHODS: We studied 189 esophageal samples from 125 patients from three different groups: (1) 102 biopsies from 51 patients with ESCC, with one sample from the tumor and another from normal esophageal mucosa distant from the tumor; (2) 50 esophageal biopsies from 37 patients with a previous diagnosis of head and neck squamous cell carcinoma (HNSCC); and (3) 37 biopsies from esophageal mucosa with normal appearance from 37 dyspeptic patients, not exposed to smoking or alcohol consumption. Nested-polymerase chain reaction (PCR) with the MY09/11 and GP5/6 L1 primers was used to detect HPV L1 in samples fixed in formalin and stored in paraffin blocks. All PCR reactions were performed with a positive control (cervicovaginal samples), with a negative control (Human Genomic DNA) and with a blank reaction containing all reagents except DNA. We took extreme care to prevent DNA contamination in sample collection, processing, and testing. RESULTS: The histological biopsies confirmed the diagnosis of ESCC in 52 samples (51 from ESCC group and 1 from the HNSCC group) and classified as well differentiated (12/52, 23.1%), moderately differentiated (27/52, 51.9%) or poorly differentiated (7/52, 13.5%). One hundred twenty-eight esophageal biopsies were considered normal (51 from the ESCC group, 42 from the HNSCC group and 35 from dyspeptic patients). Nine had esophagitis (7 from the HNSCC and 2 from dyspeptic patients). Of a total of 189 samples, only 6 samples had insufficient material for PCR analysis: 1 from mucosa distant from the tumor in a patient with ESCC, 3 from patients with HNSCC and 2 from patients without cancer. In 183 samples (96.8%) GAPDH, G3PDH and/or ?-globin were amplified, thus indicating the adequacy of the DNA in those samples. HPV DNA was negative in all the 183 samples tested: 52 with ESCC, 9 with esophagitis and 122 with normal esophageal mucosa. CONCLUSION: There was no evidence of HPV infection in different ESCC from southern Brazil. PMID:24151387

  11. The cryogenic wind tunnel for high Reynolds number testing. Ph.D. Thesis

    NASA Technical Reports Server (NTRS)

    Kilgore, R. A.

    1974-01-01

    Experiments performed at the NASA Langley Research Center in a cryogenic low-speed continuous-flow tunnel and in a cryogenic transonic continuous-flow pressure tunnel have demonstrated the predicted changes in Reynolds number, drive power, and fan speed with temperature, while operating with nitrogen as the test gas. The experiments have also demonstrated that cooling to cryogenic temperatures by spraying liquid nitrogen directly into the tunnel circuit is practical and that tunnel temperature can be controlled within very close limits. Whereas most types of wind tunnel could operate with advantage at cryogenic temperatures, the continuous-flow fan-driven tunnel is particularly well suited to take full advantage of operating at these temperatures. A continuous-flow fan-driven cryogenic tunnel to satisfy current requirements for test Reynolds number can be constructed and operated using existing techniques. Both capital and operating costs appear acceptable.

  12. Columbia study reveals origins of esophageal cancer:

    Cancer.gov

    Researchers at Columbia University Medical Center have identified the critical early cellular and molecular events that give rise to a type of esophageal cancer called esophageal adenocarcinoma, the fastest-rising solid tumor in the United States. The findings, published online today in Cancer Cell, challenge conventional wisdom regarding the origin and development of this deadly cancer and its precursor lesion, Barrett’s esophagus, and highlight possible targets for new clinical therapies.

  13. Surgical treatment of primary esophageal adenocarcinoma

    Microsoft Academic Search

    Yong-gang Wang; Da-wei Zhang; Liang-jun Wang; Ru-gang Zhang; De-chao Zhang; Gui-yu Cheng; Ke-lin Sun; Ping-jun Meng

    1999-01-01

    Objective: To study the biocharacteristics of primary esophageal adenocarcinoma (PEAC) and factors influencing patients’ prognosis\\u000a and to find rational surgical indications and combined therapy. Methods: To analyze the clinical material of 106 patients\\u000a with PEAC and compared with that of patients with esophageal squamous-cell carcinoma (ESCC). Results: The overall resectability,\\u000a morbidity and 30-day mortality rates of PEAC were 92.5%, 23.5%

  14. Nitric oxide: Mediator of nonadrenergic noncholinergic nerve-induced responses of opossum esophageal muscle

    SciTech Connect

    Murray, J.; Du, C.; Conklin, J.L.; Ledlow, A.; Bates, J.N. (Univ. of Iowa, Iowa City (United States))

    1991-03-15

    Nonadrenergic noncholinergic (NANC) nerves of the opossum esophagus mediate relaxation of circular muscle from the lower esophageal sphincter (LES) and the off contraction of circular esophageal muscle. The latencies between the end of the stimulus and the off contraction describe a gradient such that the latency is longest in muscle from the caudad esophagus. N{sup G}-nitro-L-arginine (L-NNA), an inhibitor of nitric oxide synthase, and nitric oxide were used to test the hypothesis that NO is a mediator of these nerve-induced responses. Both electrical field stimulation (EFS) of intrinsic esophageal nerves and exogenous NO relaxed LES muscle. Only EFS-induced relaxation was inhibited by L-NNA. L-arginine, the substrate for NO synthase, antagonized the inhibitory effect of L-NNA. Exogenous NO neither relaxed nor contracted circular esophageal muscle. Both the amplitude and the latency of the off contraction were diminished by L-NNA. L-arginine antagonized the action of L-NNA. N{sup G}-nitro-L-arginine also attenuated the gradient in the latency of the off response by shortening latencies in muscle form the caudad esophagus. It had no effect on cholinergic nerve-induced contraction of longitudinal esophageal muscle. These data support the hypothesis that NO or an NO-containing compound mediates NANC nerve-induced responses of the esophagus and LES.

  15. Do large hiatal hernias affect esophageal peristalsis?

    PubMed Central

    Roman, Sabine; Kahrilas, Peter J; Kia, Leila; Luger, Daniel; Soper, Nathaniel; Pandolfino, John E

    2013-01-01

    Background & Aim Large hiatal hernias can be associated with a shortened or tortuous esophagus. We hypothesized that these anatomic changes may alter esophageal pressure topography (EPT) measurements made during high-resolution manometry (HRM). Our aim was to compare EPT measures of esophageal motility in patients with large hiatal hernias to those of patients without hernia. Methods Among 2000 consecutive clinical EPT, we identified 90 patients with large (>5 cm) hiatal hernias on endoscopy and at least 7 evaluable swallows on EPT. Within the same database a control group without hernia was selected. EPT was analyzed for lower esophageal sphincter (LES) pressure, Distal Contractile Integral (DCI), contraction amplitude, Contractile Front Velocity (CFV) and Distal Latency time (DL). Esophageal length was measured on EPT from the distal border of upper esophageal sphincter to the proximal border of the LES. EPT diagnosis was based on the Chicago Classification. Results The manometry catheter was coiled in the hernia and did not traverse the crural diaphragm in 44 patients (49%) with large hernia. Patients with large hernias had lower average LES pressures, lower DCI, slower CFV and shorter DL than patients without hernia. They also exhibited a shorter mean esophageal length. However, the distribution of peristaltic abnormalities was not different in patients with and without large hernia. Conclusions Patients with large hernias had an alteration of EPT measurements as a consequence of the associated shortened esophagus. However, the distribution of peristaltic disorders was unaffected by the presence of hernia. PMID:22508779

  16. Management of refractory Eosinophilic Esophagitis

    PubMed Central

    Mukkada, Vincent A.; Furuta, Glenn T.

    2014-01-01

    Background/Aims Whereas most children and adults respond to traditional EoE treatments, such as exclusion of dietary allergens or the use of topical steroids, a small fraction may not. Methods Based on clinical experiences and review of the literature, the aim of this work is to provide practical advice to care for ‘refractory’ patients with EoE. Results The approach to this type of patient continues to evolve and decision-making should consider a number of issues including the patient's age, lack of complete understanding of the natural history of this disease, risks of monitoring and side effects of treatments. Next, one needs to define the term refractory, in that this can refer either to persistent symptoms, or to continued inflammation in the face of presumably effective drug or diet therapy. Before considering alternative treatments, it is important to rule out any other cause of persistent symptoms. For instance, could they be related to an occult esophageal narrowing not identified at the time of endoscopy? Esophagrams may be necessary to identify localized or longitudinal narrowing that could be amenable to dilation. If symptoms and inflammation are persistent and no narrowing is appreciated, an elemental diet can be considered but the long term use of this in older children and adults may be difficult. Prednisone or systemic steroids may be indicated to induce remission but side effects and complications associated with chronic use are limiting. Finally, the use of immunosuppression or biological agents has been reported in case reports and studies; use of these may be limited by side effects or the need to utilize compassionate use protocols. Conclusions As the scope of esophageal eosinophilia continues to evolve, the clinical and molecular characterization of new clinical phenotypes will be important so that new therapeutic targets can be identified. PMID:24603397

  17. Microsatellite instability in esophageal adenocarcinoma.

    PubMed

    Evans, Susan C; Gillis, Amy; Geldenhuys, Laurette; Vaninetti, Nadine M; Malatjalian, Dickran A; Porter, Geoffrey A; Guernsey, Duane L; Casson, Alan G

    2004-08-30

    The frequency of microsatellite instability (MSI), a result of defective mismatch repair during DNA replication, has been reported inconsistently in primary esophageal adenocarcinoma (EADC). Using a panel of 15 markers, the primary aim of this study was to analyze the frequency of MSI in a well-characterized series of 27 primary EADCs, defined according to strict clinicopathologic criteria. Polymerase chain reaction was used to amplify the following microsatellite repeat loci: D2S123, D10S197, D2S119, D11S904, D2S147, D3S1764, D7S1830, D7S1805, D2S434, D9S299, BAT25, BAT26, D5S346, D17S250, and TGF-beta-RII. Tumors were classified as microsatellite-stable (MSS) when no alterations were seen in tumor DNA compared to matched normal tissues, low-level MSI (MSI-L) when 1-5 of 15 markers were altered, and high-level MSI (MSI-H) when more than five markers were altered. Using these stringent criteria, 9/27 (33%) tumors were MSS, 18/27 (67%) tumors were MSI-L, and no tumor was MSI-H. Immunohistochemistry demonstrated cell nuclear expression of DNA mismatch repair proteins (both hMLH1 and hMSH2) in 78% (21/27) of tumors. No associations were seen between MSI and immunohistochemical expression of hMLH1, hMSH2, alterations in p53 or MBD4, tumor grade, pathologic stage, or patient survival. In conclusion, the finding of low levels of MSI in most tumors suggests an inherent baseline genomic instability, and potentially increased susceptibility to mutations during the progression of esophageal adenocarcinoma. PMID:15279904

  18. R and D, fabrication and testing of pH and CO/sub 2/ sensors for geothermal brines

    SciTech Connect

    Baxter, R.D.; Clack, P.J.; Phelan, D.M.; Taylor, R.M.

    1987-03-01

    Reduction or elimination of scaling is a mandatory requirement for the operation of geothermal power plants. The use of downhole sampling and subsequent analysis for solution chemistry has many disadvantages. These disadvantages include composition change with cooling, risk of sample contamination, and non real-time indication. The use of in-line sensing of solution chemistry avoids these drawbacks but requires sensors which can survive the extremely harsh environment of brine at high temperatures and elevated pressures. Leeds and Northrup had previously undertaken a contract to develop sensors for pH and pCO/sub 2/ which would withstand these harsh environments. A number of sensors were tested at a field site under actual operating conditions. Field test results indicated that certain facets of the design were inadequate to give accurate long term measurement. The primary areas addressed here are replacement of polymeric seals with anodic bonding where possible, improved methods of lead attachment, improved sealing of the pCO/sub 2/ reference feed-through, H/sub 2/S getter optimization and improved passivation of the sensing head. Each of these areas is addressed in detail in the report along with laboratory test results pertaining to the particular phase.

  19. Silica-dispersed glucose oxidase for glucose sensing: in vitro testing in serum and blood and the effect of condensation pH

    PubMed Central

    Harris, James M.; Lopez, Gabriel P.; Reichert, William M.

    2012-01-01

    The objectives of this study were to examine the feasibility of using glucose oxidase (GOx) dispersed in a silica matrix for glucose monitoring in whole blood, and then to assess whether the flexibility of silica sol-gel chemistry could be exploited to enhance glucose sensor performance and stability. Silica-dispersed GOx was deployed on platinized platinum (Pt) wire to form a Clark-type amperometric glucose sensor. Sensors were calibrated using buffered glucose standard solutions, and then tested against glucose spiked human serum and whole blood. All serum and whole blood measurements met the minimum FDA requirement of falling within the “A+B region” of a Clark Error Grid. To our knowledge this is the first report of using silica-dispersed GOx to measure glucose in whole blood. The effect of condensation pH on sensor performance was assessed by dispersing GOx in silica condensed at pH 3, 7 and 12, and then testing the sensor response against glucose calibration standards. The pH 12 silica sensors had statistically faster response time, and higher sensor sensitivity compared to pH 7, pH 3 silica and glutaraldehyde crosslinked sensors. Membranes of the pH 12 silica had statistically higher glucose diffusion coefficient than did the pH 7 and 3 sensors. GOx dispersed in pH 12 silica also had the longest half life. We hypothesize that the gel-like pH 12 silica gels provided reduced barriers to glucose diffusion, and the more aqueous microenvironment provided greater stability for the enzyme. PMID:23024461

  20. Broken Esophageal Stent Successfully Treated by Interventional Radiology Technique

    SciTech Connect

    Zelenak, Kamil, E-mail: zelenak@mfn.s [University Hospital, Department of Radiology (Slovakia); Mistuna, Dusan; Lucan, Jaroslav [University Hospital, Department of Surgery (Slovakia); Polacek, Hubert [University Hospital, Department of Radiology (Slovakia)

    2010-06-15

    Esophageal stent fractures occur quite rarely. A 61-year-old male patient was previously treated for rupture of benign stenosis, occurring after dilatation, by implanting an esophageal stent. However, a year after implantation, the patient suffered from dysphagia caused by the broken esophageal stent. He was treated with the interventional radiology technique, whereby a second implantation of the esophageal stent was carried out quite successfully.

  1. Intraoperative temperature monitoring sites in infants and children and the effect of inspired gas warming on esophageal temperature.

    PubMed

    Bissonnette, B; Sessler, D I; LaFlamme, P

    1989-08-01

    This study tested the hypotheses that 1) temperatures of "central" sites are similar in infants and children undergoing noncardiac surgery and 2) airway heating and humidification increases distal esophageal temperature. Twenty children were randomly assigned to receive 1) active airway humidification using an airway heater and humidifier set at 37 degrees C (N = 8), 2) passive airway humidification using a heat and moisture exchanger (N = 6), or 3) no airway humidification and/or heating (control, N = 6). There were no statistically significant differences between tympanic membrane, esophageal, rectal, and axillary temperatures. The temperatures of the peripheral skin surface (forearm and fingertip) were significantly lower than tympanic membrane temperature and significantly different from each other. Although esophageal and tympanic membrane temperatures in the entire group were similar, esophageal temperatures in patients receiving active and passive airway humidification were about 0.35 degrees C above tympanic temperatures after induction of anesthesia. In contrast, esophageal temperatures in patients without airway humidification were 0.25 degrees C below tympanic temperatures after induction of anesthesia. Esophageal-tympanic membrane temperature differences in the patients given active and passive humidification differed significantly from the corresponding sum in the control group at all times, but not from each other. PMID:2764288

  2. Ultrasonographic prediction of esophageal varices in patients with liver cirrhosis

    Microsoft Academic Search

    Xiao-Hong Zhang; Yu-Feng Zhang; Fang-Qin Ning; Shao-Ji Yang

    AIM: To study the value of ultrasonographic prediction of the esophageal varices in patients with liver cirrhosis. METHODS: All 207 cases were examined by ultrasonography and endoscopy, and classified according to the Child-Pugh score. The valuable ultrasonographic variables were selected to form regression formulae to predict the esophageal varices degrees in patients with liver cirrhosis. RESULTS: The esophageal varices degree

  3. Caustic esophageal strictures in children: 30 years’ experience

    Microsoft Academic Search

    Alaa F Hamza; Sameh Abdelhay; Hatem Sherif; Tarek Hasan; Hisham Soliman; Ashraf Kabesh; Ibraheem Bassiouny; Ahmed F Bahnassy

    2003-01-01

    Many children in developing countries continue to sustain caustic esophageal injures. The first line of treatment is dilatation, unless contraindicated, where 60% to 80% success rate is expected. In cases of failure, esophageal replacement is the only hope for achieving normal swallowing. Over the last 30 years, more than 850 cases of esophageal replacement were done in the Pediatric Surgery

  4. Molecular and cellular features of esophageal cancer cells

    Microsoft Academic Search

    Tetsuro Nishihira; Yu Hashimoto; Masafumi Katayama; Shozo Mori; Toshio Kuroki

    1993-01-01

    More than 70 cell lines were established from esophageal cancer, including 15 TE-series cell lines established by the authors. This article reviews molecular and cellular features of esophageal cancer cells from studies using these cell lines as well as primary tumors. The subjects reviewed include primary cultures of normal epithelium of the esophagus and of esophageal tumors, their growth and

  5. Chronic esophageal foreign bodies in pediatric patients: a retrospective review

    Microsoft Academic Search

    Robert Sean Miller; J. Paul Willging; Michael J. Rutter; Korpong Rookkapan

    2004-01-01

    Objective: Chronic esophageal foreign bodies (CEFB) are associated with a high incidence of morbidity and mortality in adults. However, the presentation, management and outcome of chronic esophageal foreign bodies in children are not well described. Methods: We performed a retrospective chart review of children with chronic esophageal foreign bodies admitted to the Children’s Hospital Medical Center, Cincinnati, OH, between May

  6. Improving Appropriate Use of Antifungal Medications: The Role of an Over-the-Counter Vaginal pH Self-Test Device

    PubMed Central

    Caillouette, James C.; Faden, Joel S.; Roy, Tapon; Ramos, Diana E.

    2003-01-01

    Objectives: To determine whether patients can understand and use the vaginal pH device in the diagnosis of vaginitis. To compare whether vaginal pH readings determined by patients and healthcare providers are similar. To determine whether vaginalpHcan reduce inappropriate over-the-counter (OTC) antifungal medication use and improve the correct diagnosis of vaginitis. Methods: One hundred and fifty-one women indicated their belief about the cause of their vaginal infection, read the instructions of the vaginal pH device package insert, used the device and interpreted the findings. The patient interpretations were compared with results obtained by healthcare providers, blinded to patient findings. Results: Over 96% of patients stated that they could easily read the instructions, use the vaginal pH device and interpret the readings. They obtained the same readings as healthcare professionals (Kappa = 0.9). Restricting the use of OTC antifungal medications to those individuals with vaginitis symptoms and vaginal pH ? 4.5 significantly reduced inappropriate use by approximately 50%, Fisher's exact test,p-value = 0.018. Conversely, seeking healthcare provider assessment with vaginal pH > 4.5, leads to correct diagnosis of vaginitis. Conclusions: The vaginal pH device can be used as an OTC diagnostic tool by consumers when a vaginal infection is suspected. Vaginal pH readings would direct patients whether to purchase an antifungal medication or seek professional diagnosis from a healthcare provider. Understanding and use of this vaginal pH device could reduce inappropriate use of OTC antifungal medications by approximately 50% and improve the correct diagnosis of vaginitis. PMID:15108867

  7. Use of glucagon in relieving esophageal food bolus impaction in the era of eosinophilic esophageal infiltration.

    PubMed

    Thimmapuram, Jayaram; Oosterveen, Scott; Grim, Rodney

    2013-06-01

    Esophageal food bolus impaction may require an urgent endoscopy. Glucagon is often administered to promote spontaneous passage of the food bolus. Eosinophilic esophagitis is increasingly recognized as a cause of dysphagia, and food impaction is often the presenting symptom. Our study was aimed at determining the effectiveness of glucagon in relieving esophageal foreign body obstruction in general and in the setting of esophageal eosinophilic infiltration (EEI). A retrospective chart review was performed using the ICD codes and the emergency department database of adult patients presenting with symptoms of esophageal food bolus impaction from July 2004 to October 2010. Response to glucagon was defined as symptomatic relief of obstruction prior to endoscopic intervention. A total of 213 episodes of esophageal food bolus obstruction in 192 patients were identified during the study period. Glucagon was given in 125 cases of which 41 had a response (32.8 %). A total of 170 episodes had an Esophagogastroduodenoscopy performed either during the impaction event or at a later date. Of the 60 patients' biopsies, 45 had received glucagon (17 with EEI, 28 without EEI). None of the 17 episodes with EEI as compared to 8 of the 28 without EEI responded to glucagon (0 % vs. 28.5 %, p = 0.017). Glucagon is effective in about one third of patients with esophageal food bolus impaction, which is consistent with historical data. Patients with EEI appear less likely to respond to glucagon. PMID:23203568

  8. A novel laparoscopic approach for severe esophageal stenosis due to reflux esophagitis: how to do it.

    PubMed

    Tsuboi, Kazuto; Omura, Nobuo; Yano, Fumiaki; Hoshino, Masato; Yamamoto, Se Ryung; Akimoto, Shunsuke; Kashiwagi, Hideyuki; Yanaga, Katsuhiko

    2015-02-01

    We herein report our technique for laparoscopic esophageal myotomy combined with Collis gastroplasty and Nissen fundoplication for severe esophageal stenosis. Our patient had experienced vomiting since childhood, and his dysphagia had gradually worsened. He was referred to our department for surgery because of resistance to pneumatic dilation. He was diagnosed with a short esophagus based on the findings of a preoperative upper gastrointestinal series and GI endoscopy. After exposing the abdominal esophagus, esophageal myotomy around the esophago-gastric junction (EGJ) was undertaken to introduce an esophageal bougie into the stomach. Then, stapled wedge gastroplasty was performed, and a short and loose Nissen fundoplication was performed. In addition, the bulging mucosa after myotomy was patched using the Dor method. The patient's postoperative course was uneventful. Most patients with esophageal stricture require subtotal esophagectomy. Laparoscopic surgery for patients with benign esophageal stricture refractory to repeated pneumatic dilation is challenging. However, our current procedure might abrogate the need for invasive esophagectomy for the surgical management of severe esophageal stenosis. PMID:24647633

  9. Esophageal perception and noncardiac chest pain.

    PubMed

    Orlando, Roy C

    2004-03-01

    Symptoms arising from the esophagus are produced generally in one of two ways: through stimulation of chemosensitive-nociceptors (eg, through excess esophageal exposure to refluxed gastric acid or the resulting inflammation arising in acid-damaged tissue) or through stimulation of mechanosensitive nociceptors (eg, through repeated deformation or distension of the esophageal wall resulting from peristaltic or lower esophageal sphincter dysfunction). These symptoms are usually attributed in most patients to such well recognized conditions as reflux esophagitis, achalasia,etc. that subsequently result in the delivery of specific and effective treatment.However, a subset of patients exists in which the etiology of "similar-sounding symptoms" remains obscure and their responses to standard specific treatments poor. Now recognized as among this group of patients are those with visceral hypersensitivity. Visceral hypersensitivity is not itself a disease but a definable aberrant sensory response (allodynia or hyper-algesia) to end-organ stimulation. Such an aberrant sensory response is neither specific for nor limited to the esophagus, and the etiopathogenesis for its development within this organ is unknown. Nonetheless, esophageal symptoms as a manifestation of visceral hypersensitivity are increasingly recognized and worthy of attention because they identify a disorder that responds to treatment aimed at the end organ's nociceptors or their neuroanatomic pathways within the CNS. PMID:15062434

  10. Pharmacological Management of Esophageal Food Bolus Impaction

    PubMed Central

    Khayyat, Yasir Mohammed

    2013-01-01

    Background. Soft esophageal bolus impaction is an emergency that requires skilled endoscopic removal if persistent obstructive symptoms do not resolve spontaneously after careful observation. Expedited care of these patients is crucial to avoid respiratory and mechanical complications. Other possible options for management include medical agents used to manage it prior to performing endoscopy if access to endoscopy was not available or declined by the patient. Aim. To review the available pharmacological and other nonmedicinal options and their mechanism of relief for soft esophageal impaction. Method. Pubmed, Medline and Ovid were used for search of MESH terms pertinent including “foreign body, esophageal, esophageal bolus and medical” for pharmacological and non medicinial agents used for management of esophageal soft bolus impaction as well as manual review of the cross-references. Results. Several agents were identified including Buscopan, Glucagon, nitrates, calcium channel blockers, and papaveretum. Non medicinal agents are water, effervescent agents, and papain. No evidence was found to suggest preference or effectiveness of use of a certain pharmacological agent compared to others. Buscopan, Glucagon, benzodiazepines, and nitrates were studied extensively and may be used in selected patients with caution. Use of papain is obsolete in management of soft bolus impaction. PMID:23738071

  11. Design of pH-responsive alginate raft formulation of risedronate for reduced esophageal irritation.

    PubMed

    Jang, Sun Woo; Lee, Jung Woo; Ryu, Dong Sung; Son, Miwon; Kang, Myung Joo

    2014-09-01

    Risedronate sodium (RA), a pyridinyl bisphosphonate, is widely used in the treatment of osteoporosis. However, the free acid form of the bisphosphonate below pH 3.5 has the potential to produce severe impatience of the upper gastrointestinal tract, particularly esophagitis. A pH-responsive raft-forming tablet (PRR-T) was designed to prevent the esophageal irritation, mainly consisting of low-molecular-weight alginate (LFR 5/60, 300 mg) as raft-forming polymer, sodium bicarbonate (1000 mg) as gas-generating agent and citrate and sodium citrate (600 and 200 mg, respectively) as buffer system. A PRR-T was rapidly liquefied in water within 80 s with a low viscosity 8.0 mPa s, offering ease of swallowing in patients. A formulation profoundly neutralized simulated gastric fluid over pH 5.5, leading to an ionization of the bisphosphonate, without raft formation. On the other hand, the raft was rapidly formed on the top layer preventing the reflux of RA, if the contact with acidic medium is much higher than 0.5 N of hydrochloric acid. Nevertheless, the release rate of the drug was equivalent, providing over 95% release within 5 min. Our study demonstrated the potential usefulness of alginate-based PRR-T for an oral therapy with bisphosphonates for reduced esophageal adverse experiences. PMID:24995633

  12. Fluorescent Nanoparticle Imaging Allows Noninvasive Evaluation of Immune Cell Modulation in Esophageal Dysplasia

    PubMed Central

    Habibollahi, Peiman; Waldron, Todd; Heidari, Pedram; Cho, Hoon Sung; Alcantara, David; Josephson, Lee; Wang, Timothy C.; Rustgi, Anil K.; Mahmood, Umar

    2014-01-01

    Esophageal tumors provide unique challenges and opportunities for developing and testing surveillance imaging technology for different tumor microenvironment components, including assessment of immune cell modulation, with the ultimate goal of promoting early detection and response evaluation. In this context, accessibility through the lumen using a minimally invasive approach provides a means for repetitive evaluation longitudinally by combining fluorescent endoscopic imaging technology with novel fluorescent nanoparticles that are phagocytized by immune cells in the microenvironment. The agent we developed for imaging is synthesized from Feraheme (ferumoxytol), a Food and Drug Administration–approved monocrystaline dextran-coated iron oxide nanoparticle, which we conjugated to a near-infrared fluorochrome, CyAL5.5. We demonstrate a high level of uptake of the fluorescent nanoparticles by myeloid-derived suppressor cells (MDSCs) in the esophagus and spleen of L2Cre;p120ctnflox/flox mice. These mice develop esophageal dysplasia leading to squamous cell carcinoma; we have previously demonstrated that dysplastic and neoplastic esophageal lesions in these mice have an immune cell infiltration that is dominated by MDSCs. In the L2Cre;p120ctnflox/flox mice, evaluation of the spleen reveals that nearly 80% of CD45+ leukocytes that phagocytized the nanoparticle were CD11b+Gr1+ MDSCs. After dexamethasone treatment, we observed concordant decreased fluorescent signal from esophageal lesions during fluorescent endoscopy and decreased CyAL5.5-fluorescent–positive immune cell infiltration in esophageal dysplastic lesions by fluorescence-activated cell sorting analysis. Our observations suggest that this translatable technology may be used for the early detection of dysplastic changes and the serial assessment of immunomodulatory therapy and to visualize changes in MDSCs in the esophageal tumor microenvironment. PMID:24824854

  13. Palliation of malignant esophageal obstruction and fistulas with self expandable metallic stents

    PubMed Central

    Dobrucali, Ahmet; Caglar, Erkan

    2010-01-01

    AIM: To evaluate the efficacy of self expandable metallic stents (SEMS) in patients with malignant esophageal obstruction and fistulas. METHODS: SEMS were implanted in the presence of fluoroscopic guidance in patients suffering from advanced and non-resectable esophageal, cardiac and invasive lung cancer between 2002 and 2009. All procedures were performed under conscious sedation. All patients had esophagus obstruction and/or fistula. In all patients who required reintervention, recurrence of dysphagia, hemorrhage, and fistula formation were indications for further endoscopy. Patients’ files were scanned retrospectively and the obtained data were analyzed using SPSS 13.0 for Windows. The ?2 test was used for categorical data and was analysis of variance for non-categorical data. Patients’ long-term survival was assessed using the Kaplan-Meier method. RESULTS: Stents were successfully implanted in 90 patients using fluoroscopic guidance. Reasons for stent implantation in these patients were esophageal stricture (77/90, 85.5%), external pressure (8/90, 8.8%) and tracheo-esophageal fistula (5/90, 5.5%). Dysphagia scores (mean ± SD) were 3.37 ± 0.52 before and 0.90 ± 0.43 after stent implantation (P = 0.002). Intermittent, non-massive hemorrhage due to the erosion caused by the distal end of the stent in the stomach occurred in only one patient who received implementation at cardio-esophageal junction. Mean survival following stenting was 134.14 d (95% confidence interval: 94.06-174.21). CONCLUSION: SEMS placement is safe and effective in the palliation of dysphagia in selected patients with malignant esophageal strictures. PMID:21128325

  14. Fluorescent nanoparticle imaging allows noninvasive evaluation of immune cell modulation in esophageal dysplasia.

    PubMed

    Habibollahi, Peiman; Waldron, Todd; Heidari, Pedram; Cho, Hoon Sung; Alcantara, David; Josephson, Lee; Wang, Timothy C; Rustgi, Anil K; Mahmood, Umar

    2014-05-01

    Esophageal tumors provide unique challenges and opportunities for developing and testing surveillance imaging technology for different tumor microenvironment components, including assessment of immune cell modulation, with the ultimate goal of promoting early detection and response evaluation. In this context, accessibility through the lumen using a minimally invasive approach provides a means for repetitive evaluation longitudinally by combining fluorescent endoscopic imaging technology with novel fluorescent nanoparticles that are phagocytized by immune cells in the microenvironment. The agent we developed for imaging is synthesized from Feraheme (ferumoxytol), a Food and Drug Administration-approved monocrystaline dextran-coated iron oxide nanoparticle, which we conjugated to a near-infrared fluorochrome, CyAL5.5. We demonstrate a high level of uptake of the fluorescent nanoparticles by myeloid-derived suppressor cells (MDSCs) in the esophagus and spleen of L2Cre;p120ctnflox/flox mice. These mice develop esophageal dysplasia leading to squamous cell carcinoma; we have previously demonstrated that dysplastic and neoplastic esophageal lesions in these mice have an immune cell infiltration that is dominated by MDSCs. In the L2Cre;p120ctnflox/flox mice, evaluation of the spleen reveals that nearly 80% of CD45+ leukocytes that phagocytized the nanoparticle were CD11b+Gr1+ MDSCs. After dexamethasone treatment, we observed concordant decreased fluorescent signal from esophageal lesions during fluorescent endoscopy and decreased CyAL5.5-fluorescent-positive immune cell infiltration in esophageal dysplastic lesions by fluorescence-activated cell sorting analysis. Our observations suggest that this translatable technology may be used for the early detection of dysplastic changes and the serial assessment of immunomodulatory therapy and to visualize changes in MDSCs in the esophageal tumor microenvironment. PMID:24824854

  15. Critical role for the receptor tyrosine kinase EPHB4 in esophageal cancers.

    PubMed

    Hasina, Rifat; Mollberg, Nathan; Kawada, Ichiro; Mutreja, Karun; Kanade, Geetanjali; Yala, Soheil; Surati, Mosmi; Liu, Ren; Li, Xiuqing; Zhou, Yue; Ferguson, Benjamin D; Nallasura, Vidya; Cohen, Kenneth S; Hyjek, Elizabeth; Mueller, Jeffery; Kanteti, Rajani; El Hashani, Essam; Kane, Dorothy; Shimada, Yutaka; Lingen, Mark W; Husain, Aliya N; Posner, Mitchell C; Waxman, Irving; Villaflor, Victoria M; Ferguson, Mark K; Varticovski, Lyuba; Vokes, Everett E; Gill, Parkash; Salgia, Ravi

    2013-01-01

    Esophageal cancer incidence is increasing and has few treatment options. In studying receptor tyrosine kinases associated with esophageal cancers, we have identified EPHB4 to be robustly overexpressed in cell lines and primary tumor tissues. In total, 94 squamous cell carcinoma, 82 adenocarcinoma, 25 dysplasia, 13 Barrett esophagus, and 25 adjacent or unrelated normal esophageal tissues were evaluated by immunohistochemistry. EPHB4 expression was significantly higher in all the different histologic categories than in adjacent normal tissues. In 13 esophageal cancer cell lines, 3 of the 9 SCC cell lines and 2 of the 4 adenocarcinomas expressed very high levels of EPHB4. An increased gene copy number ranging from 4 to 20 copies was identified in a subset of the overexpressing patient samples and cell lines. We have developed a novel 4-nitroquinoline 1-oxide (4-NQO)-induced mouse model of esophageal cancer that recapitulates the EPHB4 expression in humans. A specific small-molecule inhibitor of EPHB4 decreased cell viability in a time- and dose-dependent manner in 3 of the 4 cell lines tested. The small-molecule inhibitor and an EPHB4 siRNA also decreased cell migration (12%-40% closure in treated vs. 60%-80% in untreated), with decreased phosphorylation of various tyrosyl-containing proteins, EphB4, and its downstream target p125FAK. Finally, in a xenograft tumor model, an EPHB4 inhibitor abrogated tumor growth by approximately 60% compared with untreated control. EphB4 is robustly expressed and potentially serves as a novel biomarker for targeted therapy in esophageal cancers. PMID:23100466

  16. Eosinophilic esophagitis: a clinicopathological review.

    PubMed

    Philpott, Hamish; Nandurkar, Sanjay; Thien, Francis; Gibson, Peter R; Royce, Simon G

    2015-02-01

    Eosinophilic esophagitis (EoE) is considered to be a chronic antigen-driven disease whereby food and/or aeroallergens induce a chronic inflammatory infiltrate in the esophagus, resulting in pathological hyperplasia of the epithelia and muscular layers, and fibrosis of the lamina propria (referred to collectively as remodelling) and the symptoms of dysphagia and food impaction. EoE shares features with other atopic conditions of asthma and atopic dermatitis, such as a TH2 cytokine milieu and a mixed inflammatory infiltrate of eosinophils, mast cells and lymphocytes. Relatively distinct features include the strong male predominance amongst adult patients, and the expression of the eosinophil chemokine eotaxin 3. Current first line treatments such as strict dietary modification and corticosteroids fail many patients. Looking forward, clarification of distinct genotype/phenotype associations, determining the reversibility of remodelling following treatment, and the development of new pharmacotherapies that target fibrotic pathways (as opposed to eosinophilic inflammation per se) or specifically improve barrier integrity appear relevant. PMID:25200122

  17. Recent developments in esophageal adenocarcinoma.

    PubMed

    Lagergren, Jesper; Lagergren, Pernilla

    2013-01-01

    Answer questions and earn CME/CNE Esophageal adenocarcinoma (EAC) is characterized by 6 striking features: increasing incidence, male predominance, lack of preventive measures, opportunities for early detection, demanding surgical therapy and care, and poor prognosis. Reasons for its rapidly increasing incidence include the rising prevalence of gastroesophageal reflux and obesity, combined with the decreasing prevalence of Helicobacter pylori infection. The strong male predominance remains unexplained, but hormonal influence might play an important role. Future prevention might include the treatment of reflux or obesity or chemoprevention with nonsteroidal antiinflammatory drugs or statins, but no evidence-based preventive measures are currently available. Likely future developments include endoscopic screening of better defined high-risk groups for EAC. Individuals with Barrett esophagus might benefit from surveillance, at least those with dysplasia, but screening and surveillance strategies need careful evaluation to be feasible and cost-effective. The surgery for EAC is more extensive than virtually any other standard procedure, and postoperative survival, health-related quality of life, and nutrition need to be improved (eg, by improved treatment, better decision-making, and more individually tailored follow-up). Promising clinical developments include increased survival after preoperative chemoradiotherapy, the potentially reduced impact on health-related quality of life after minimally invasive surgery, and the new endoscopic therapies for dysplastic Barrett esophagus or early EAC. The overall survival rates are improving slightly, but poor prognosis remains a challenge. PMID:23818335

  18. Proton Beam Therapy and Concurrent Chemotherapy for Esophageal Cancer

    SciTech Connect

    Lin, Steven H., E-mail: shlin@mdanderson.org [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Komaki, Ritsuko; Liao Zhongxing [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Wei, Caimiao [Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Myles, Bevan [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Guo Xiaomao [Department of Radiation Oncology, Fudan University Cancer Hospital, Shanghai (China); Palmer, Matthew [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Mohan, Radhe [Department of Physics, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Swisher, Stephen G.; Hofstetter, Wayne L. [Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Ajani, Jaffer A. [Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Cox, James D. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2012-07-01

    Purpose: Proton beam therapy (PBT) is a promising modality for the management of thoracic malignancies. We report our preliminary experience of treating esophageal cancer patients with concurrent chemotherapy (CChT) and PBT (CChT/PBT) at MD Anderson Cancer Center. Methods and Materials: This is an analysis of 62 esophageal cancer patients enrolled on a prospective study evaluating normal tissue toxicity from CChT/PBT from 2006 to 2010. Patients were treated with passive scattering PBT with two- or three-field beam arrangement using 180 to 250 MV protons. We used the Kaplan-Meier method to assess time-to-event outcomes and compared the distributions between groups using the log-rank test. Results: The median follow-up time was 20.1 months for survivors. The median age was 68 years (range, 38-86). Most patients were males (82%) who had adenocarcinomas (76%) and Stage II-III disease (84%). The median radiation dose was 50.4 Gy (RBE [relative biologic equivalence]) (range, 36-57.6). The most common grade 2 to 3 acute toxicities from CChT/PBT were esophagitis (46.8%), fatigue (43.6%), nausea (33.9%), anorexia (30.1%), and radiation dermatitis (16.1%). There were two cases of grade 2 and 3 radiation pneumonitis and two cases of grade 5 toxicities. A total of 29 patients (46.8%) received preoperative CChT/PBT, with one postoperative death. The pathologic complete response (pCR) rate for the surgical cohort was 28%, and the pCR and near CR rates (0%-1% residual cells) were 50%. While there were significantly fewer local-regional recurrences in the preoperative group (3/29) than in the definitive CChT/PBT group (16/33) (log-rank test, p = 0.005), there were no differences in distant metastatic (DM)-free interval or overall survival (OS) between the two groups. Conclusions: This is the first report of patients treated with PBT/CChT for esophageal cancer. Our data suggest that this modality is associated with a few severe toxicities, but the pathologic response and clinical outcomes are encouraging. Prospective comparison with more traditional approach is warranted.

  19. Endoscopic ultrasonography in the management of esophageal cancer

    NASA Astrophysics Data System (ADS)

    Trowers, Eugene A.

    2000-05-01

    Precise tumor-staging is critical in the management of early esophageal caner. Endoscopic ultrasound (EUS) allows the endoscopist a view beyond the esophageal wall which opens the door to a variety of new gastroenterologic techniques. Endoscopic mucosal resection, laser photoablation and photodynamic therapy may be successfully employed in early esophageal cancer management. Combination radiation therapy and chemotherapy have shown better responses in advanced cancer. Expandable metallic stents may also provide palliation with inoperable esophageal cancer. The efficacy of EUS in the management of esophageal cancer is critically reviewed.

  20. Congenital esophageal stenosis owing to tracheobronchial remnants

    PubMed Central

    Rebelo, Priscila Guyt; Ormonde, João Victor C.; Ormonde, João Baptista C.

    2013-01-01

    OBJECTIVE To emphasize the need of an accurate diagnosis of congenital esophageal stenosis due to tracheobronchial remnants, since its treatment differs from other types of congenital narrowing. CASE DESCRIPTION Four cases of lower congenital esophageal stenosis due to tracheobronchial remnants, whose definitive diagnosis was made by histopathology. Except for the last case, in which a concomitant anti-reflux surgery was not performed, all had a favorable outcome after resection and anastomosis of the esophagus. COMMENTS The congenital esophageal stenosis is an intrinsic narrowing of the organâ€(tm)s wall associated with its structural malformation. The condition can be caused by tracheobronchial remnants, fibromuscular stenosis or membranous diaphragm and the first symptom is dysphagia after the introduction of solid food in the diet. The first-choice treatment to tracheobronchial remnants cases is the surgical resection and end-to-end anastomosis of the esophagus. PMID:24142326

  1. Endoscopic options for early stage esophageal cancer

    PubMed Central

    Shah, Pari M.

    2015-01-01

    Surgery has traditionally been the preferred treatment for early stage esophageal cancer. Recent advances in endoscopic treatments have been shown to be effective and safe. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) allow endoscopists to remove small, superficial lesions, providing tumor specimen that can be examined for accurate pathologic tumor staging and assessment of adequacy of resection. Endoscopic ablation procedures, including photodynamic therapy (PDT) and radio frequency ablation (RFA), have also been shown to safely and effectively treat esophageal dysplasia and early stage neoplasia, with excellent long-term disease control. Both approaches are becoming more widely available around the world, and provide an alternative, safe, low risk strategy for treating early stage disease, making combined endoscopic therapy the recommended treatment of choice for early stage esophageal cancers. PMID:25642334

  2. Early esophageal carcinoma treated with intracavitary irradiation

    SciTech Connect

    Hishikawa, Y.; Tanaka, S.; Miura, T.

    1985-08-01

    Five patients with early esophageal carcinoma were treated by 6-12 Gy of intracavitary irradiation following 50-60 Gy of external irradiation as a boost therapy. Surgery was not performed in these cases. None of the patients had local recurrence after radiation therapy, as demonstrated by esophagography and endoscopy. Three patients have been alive for 1-3 years 10 months. Esophageal ulceration induced by intracavitary irradiation has occurred in three of the five patients; however, intracavitary irradiation is still a beneficial treatment because of its efficacy in controlling local lesions and because radiation ulceration can eventually be cured. Intracavitary irradiation is recommended to follow external irradiation as a boost therapy for the treatment of early esophageal carcinoma.

  3. Endocytoscopic observation of esophageal squamous cell carcinoma.

    PubMed

    Kumagai, Youichi; Kawada, Kenro; Yamazaki, Shigeru; Iida, Michio; Ochiai, Takanori; Momma, Kumiko; Odajima, Hajime; Kawachi, Hiroshi; Nemoto, Tetsuo; Kawano, Tatsuyuki; Takubo, Kaiyo

    2010-01-01

    The endocytoscopy system (ECS), adapted for clinical use in 2003, is an ultra-high-power magnifying endoscope that allows observations at the cell level. ECS is based on the technology of light-contact microscopy. The most evident use of ECS is for real-time, high-resolution diagnosis of nuclear abnormalities, mainly in patients with esophageal cancer. Up to now, three different types of ECS have been available. This diagnostic tool makes it possible to omit histological examination of biopsy samples in approximately 84% of esophageal squamous cell carcinoma, as evidence for both an increase of cell density and nuclear abnormalities is considered to be convincing proof that a lesion is malignant. Here we describe the features of ECS and the background that led to its development, and review the published literature pertaining to the observation of esophageal neoplasms using ECS. PMID:20078658

  4. Immunoserologic Pepsin Detection in The Saliva as a Non-Invasive Rapid Diagnostic Test for Laryngopharyngeal Reflux

    PubMed Central

    Ocak, Emre; Kubat, Gözde; Yorulmaz, ?rfan

    2015-01-01

    Background: The most common tool for the diagnosis of laryngopharyngeal reflux (LPR) is still 24-hours esophageal pH monitoring; there is lack of non-invasive, less expensive and accurate diagnostic tools for this frequent disease. Aims: To evaluate the accuracy of immunoserologic pepsin detection in the saliva for the diagnosis of LPR. Study Design: Cross-sectional study. Methods: A two channeled 24-hour esophageal pH monitoring catheter was placed in patients with a suspicion of LPR. During the 24-hour period, each patient gave one sample of sputum for the immunoserologic pepsin detection test. Pathologic gastroesophageal reflux (GER) findings, LPR findings, pH score in the proximal and distal probes when the sputum sample was given were recorded. The sensitivity, specificity, positive and negative predictive values of the pepsin detection test were analyzed and compared to pH monitoring scores. Results: The study group consisted of 20 patients who met the criteria. A positive pepsin detection test was elicited from 6 patients. The sensitivity and specificity of the pepsin detection test was 33% and 100%, respectively. A positive predictive value of 100% was recorded. When the pH results of the pepsin positive patients (PPP) and the rest of the study group in the proximal probe at the sample time were compared, the PPP had an apparent acidic pH value compared to the pepsin negative patients (pH: 3.26 for the PPP, pH: 6.81 for the pepsin negative patients). Conclusion: Pepsin detection in the saliva is a recent method and becoming increasingly popular. Because of the benefits and ease of application, a positive salivary pepsin test in a patient suspected of having LPR can be a cost effective, accurate and alternative diagnostic method. Increasing the daily number of sputum samples may increase the sensitivity of the test.

  5. Etiology, diagnosis and treatment of infectious esophagitis

    PubMed Central

    Kierzkiewicz, Maciej

    2013-01-01

    Infectious esophagitis may be caused by fungal, viral, bacterial or even parasitic agents. Risk factors include antibiotics and steroids use, chemotherapy and/or radiation therapy, malignancies and immunodeficiency syndromes including acquired immunodeficiency syndrome. Acute onset of symptoms such as dysphagia and odynophagia is typical. It can coexist with heartburn, retrosternal discomfort, nausea and vomiting. Abdominal pain, anorexia, weight loss and even cough are present sometimes. Infectious esophagitis is predominantly caused by Candida species. Other important causes include cytomegalovirus and herpes simplex virus infection. PMID:24868280

  6. Eosinophilic esophagitis in adults: distinguishing features from gastroesophageal reflux disease: a study of 41 patients

    Microsoft Academic Search

    Jeremy R Parfitt; James C Gregor; Neville G Suskin; Hani A Jawa; David K Driman

    2006-01-01

    Eosinophilic esophagitis in adults is a recently described entity occurring in young males with dysphagia, in whom esophageal biopsies show eosinophilic infiltration. This study defines the clinical and histological features of patients with eosinophilic esophagitis, distinguishing it from gastroesophageal reflux disease. Esophageal biopsies from patients with dysphagia or esophagitis were reviewed blindly, and assessed for: epithelial eosinophil counts, presence of

  7. Curative Resection for Esophageal Adenocarcinoma

    PubMed Central

    Hagen, Jeffrey A.; DeMeester, Steven R.; Peters, Jeffrey H.; Chandrasoma, Para; DeMeester, Tom R.

    2001-01-01

    Objective To document what can be accomplished with surgical resection done according to the classical principles of surgical oncology. Methods One hundred consecutive patients underwent en bloc esophagectomy for esophageal adenocarcinoma. No patient received pre- or postoperative chemotherapy or radiation therapy. Tumor depth and number and location of involved lymph nodes were recorded. A lymph node ratio was calculated by dividing the number of involved nodes by the total number removed. Follow-up was complete in all patients. The median follow-up of surviving patients was 40 months, with 23 patients surviving 5 years or more. Results The overall actuarial survival rate at 5 years was 52%. Survival rates by American Joint Commission on Cancer (AJCC) stage were stage 1 (n = 26), 94%; stage 2a (n = 11), 65%; stage 2b (n = 13), 65%; stage 3 (n = 32), 23%; and stage 4 (n = 18), 27%. Sixteen tumors were confined to the mucosa, 16 to the submucosa, and 13 to the muscularis propria, and 55 were transmural. Tumor depth and the number and ratio of involved nodes were predictors of survival. Metastases to celiac (n = 16) or other distant node sites (n = 26) were not associated with decreased survival. Local recurrence was seen in only one patient. Latent nodal recurrence outside the surgical field occurred in 9 patients and systemic metastases in 31. Tumor depth, the number of involved nodes, and the lymph node ratio were important predictors of systemic recurrence. The surgical death rate was 6%. Conclusion Long-term survival from adenocarcinoma of the esophagus can be achieved in more than half the patients who undergo en bloc resection. One third of patients with lymph node involvement survived 5 years. Local control is excellent after en bloc resection. The extent of disease associated with tumors confined to the mucosa and submucosa provides justification for more limited and less morbid resections. PMID:11573045

  8. Proton pump inhibitor-responsive esophageal eosinophilia: a historical perspective on a novel and evolving entity.

    PubMed

    Molina-Infante, Javier; Katzka, David A; Dellon, Evan S

    2015-01-01

    Eosinophilic esophagitis (EoE) is an emerging chronic esophageal disease, first described in 1993, with a steadily increasing incidence and prevalence in western countries. Over the 80's and early 90's, dense esophageal eosinophilia was mostly associated gastroesophageal reflux disease (GERD). For the next 15 years, EoE and GERD were rigidly considered separate entities: Esophageal eosinophilia with pathological acid exposure on pH monitoring or response to proton pump inhibitor (PPI) therapy was GERD, whereas normal pH monitoring or absence of response to PPIs was EoE. Updated guidelines in 2011 described a novel phenotype, proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE), referring to patients who appear to have EoE clinically, but who achieve complete remission after PPI therapy. Currently, PPI-REE must be formally excluded before diagnosing EoE, since 30-40% of patients with suspected EoE are eventually diagnosed with PPI-REE.Interestingly, PPI-REE and EoE remain undistinguishable based on clinical, endoscopic, and histological findings, pH monitoring, and measurement of tissue markers and cytokines related to eosinophilic inflammation.This review article aims to revisit the relatively novel concept of PPI-REE from a historical perspective, given the strong belief that only GERD, as an acid peptic disorder, could respond to the acid suppressing ability of PPI therapy, is becoming outdated. Evolving evidence suggests that PPI-REE is genetically and phenotypically undistinguishable from EoE and PPI therapy alone can almost completely reverse allergic inflammation. As such, PPI-REE might constitute a subphenotype of EoE and PPI therapy may be the first therapeutic step and diet/ steroids may represent step up therapy. Possibly, the term PPI-REE will be soon replaced by PPI-responsive EoE. The mechanism as to why some patients respond to PPI therapy (PPI-REE) while others do not (EoE), remains to be elucidated. PMID:25603329

  9. Eosinophilic esophagitis: asthma of the esophagus?

    Microsoft Academic Search

    AMINDRA S. ARORA; Kiyoshi Yamazaki

    2004-01-01

    Eosinophilic esophagitis (EE) is rapidly emerging as a distinct disease entity in both pediatric and adult gastroenterology. The typical clinical presentation includes solid food dysphagia in young men who have an atopic predisposition. Food impaction necessitating endoscopic intervention is common. EE should be suspected, in particular, in patients with unexplained dysphagia or those with no response to antacid or anti-acid

  10. Perception of Syllable Stress in Esophageal Speech.

    ERIC Educational Resources Information Center

    Walker, Christopher Niles; Morris, Hughlett L.

    1988-01-01

    Ten esophageal speakers and ten normal speakers produced repetitions of the disyllable /mama/ using five different conditions of syllable stress. Nine normal listeners judged both relative and absolute syllable stress. Reliable judgments were made of the syllable stress, and speakers were able to effect systematic changes in listener perceptions…

  11. Postoperative Intensive Care Treatment after Esophageal Resection

    Microsoft Academic Search

    Dirk L. Stippel; K. Tobias E. Beckurts

    2004-01-01

    The aim of this article is to give a short review of problems associated with the intensive care treatment of patients after esophageal resection. Pulmonary dysfunction, supraventricular tachyarrhythmia, anastomotic leakage and mental disorders are the topics covered. Systemic inflammatory reaction and sepsis is the linking topic between these specific complications. Pulmonary dysfunction having an incidence of up to 40% is

  12. A safe treatment option for esophageal bezoars

    PubMed Central

    Yaqub, Sheraz; Shafique, Muhammad; Kjæstad, Erik; Thorsen, Yngve; Lie, Erik S.; Dahl, Vegard; Bakka, Njål; Røkke, Ola

    2012-01-01

    INTRODUCTION Bezoar in the esophagus is a rare condition and associated with structural or functional abnormalities of the esophagus. Endoscopy is the main tool for diagnosis and treatment for bezoar in the esophagus. PRESENTATION OF CASE Here we present a case where an endoscopic evacuation of an esophageal bezoar was unsuccessful. We treated the bezoar through a nasogastric tube using a cocktail composed of pancreatic enzymes dissolved in Coca-Cola. DISCUSSION Endoscopy is regarded as the mainstay for the diagnosis and treatment of esophageal bezoars. However, when this approach fails, other treatment options include dissolution therapy, and surgical exploration and removal of the bezoar. Surgical removal of an esophageal bezoar is associated with a high risk of morbidity and mortality. We advocate that dissolving therapy should be the first choice of treatment when endoscopic evacuation is not possible. CONCLUSION This is the first report describing a successful treatment of an esophageal bezoar with a cocktail of Coca-Cola and pancreatic enzymes. It is an effective, inexpensive, and worldwide available treatment and should be considered when endoscopic evacuation fails. PMID:22609703

  13. Barrett’s and Esophageal Adenocarcinoma Consortium

    Cancer.gov

    An international consortium with epidemiologic studies of Barrett's Esophagus and esophageal adenocarcinoma. Analyses so far have included alcohol consumption, anthropometry, cigarette smoking, excess risk models, gastroesophageal reflux disease, non-steroidal anti-inflammatory drugs, reproductive factors, and genome-wide studies to identify susceptibility loci associated with Barrett’s esophagus and/or adenocarcinomas of the esophagus.

  14. Benign esophageal lesions: Endoscopic and pathologic features

    PubMed Central

    Tsai, Shu-Jung; Lin, Ching-Chung; Chang, Chen-Wang; Hung, Chien-Yuan; Shieh, Tze-Yu; Wang, Horng-Yuan; Shih, Shou-Chuan; Chen, Ming-Jen

    2015-01-01

    Benign esophageal lesions have a wide spectrum of clinical and pathologic features. Understanding the endoscopic and pathologic features of esophageal lesions is essential for their detection, differential diagnosis, and management. The purpose of this review is to provide updated features that may help physicians to appropriately manage these esophageal lesions. The endoscopic features of 2997 patients are reviewed. In epithelial lesions, the frequency of occurrence was in the following order: glycogenic acanthosis, heterotopic gastric mucosa, squamous papilloma, hyperplastic polyp, ectopic sebaceous gland and xanthoma. In subepithelial lesions, the order was as follows: hemangioma, leiomyoma, dysphagia aortica and granular cell tumor. Most benign esophageal lesions can be diagnosed according to their endoscopic appearance and findings on routine biopsy, and submucosal lesions, by endoscopic resection. Management is generally based upon the confidence of diagnosis and whether the lesion causes symptoms. We suggest endoscopic resection of all granular cell tumors and squamous papillomas because, while rare, these lesions have malignant potential. Dysphagia aortica should be considered in the differential diagnosis of dysphagia in the elderly. PMID:25632181

  15. Minimal Invasive Surgery for Esophageal Cancer

    Microsoft Academic Search

    A. H. Hölscher; Ch. Gutschow

    2004-01-01

    Thoracoscopic esophagectomy is only established in some centers and affords a cervical anastomosis because intrathoracic anastomosis as a routine is technically too difficult. Laparoscopic mobilisation of the stomach (gastrolysis) is an important contribution for minimal invasive surgery of esophageal cancer. This procedure reduces the stress of the two cavity operation for the patient and allows the construction of a comparable

  16. Elimination diets in the management of eosinophilic esophagitis

    PubMed Central

    Wechsler, Joshua B; Schwartz, Sally; Amsden, Katie; Kagalwalla, Amir F

    2014-01-01

    Eosinophilic esophagitis, an increasingly recognized chronic inflammatory disorder isolated to the esophagus, is triggered by an abnormal allergic response to dietary antigens. Current treatment includes swallowed topical steroids and dietary modification, which aim to resolve symptoms and prevent long-term complications such as formation of strictures. The dietary approach has become more widely accepted because long-term steroid therapy is associated with potential risks. Dietary treatment includes elemental and elimination diets. An exclusive elemental diet, which requires replacement of all intact protein with amino acid-based formula, offers the best response of all available therapies, with remission in up to 96% of subjects proving it to be superior to all other available therapies including topical steroids. However, compliance with this approach is challenging because of poor taste and monotony. The high cost of formula and the associated psychosocial problems are additional drawbacks of this approach. Empiric and allergy test-directed elimination diets have gained popularity given that elimination of a limited number of foods is much easier and as such is more readily acceptable. There is a growing body of literature supporting this type of therapy in both children and adults. This paper reviews the evidence for all types of dietary therapy in eosinophilic esophagitis. PMID:24920928

  17. Elimination diets in the management of eosinophilic esophagitis.

    PubMed

    Wechsler, Joshua B; Schwartz, Sally; Amsden, Katie; Kagalwalla, Amir F

    2014-01-01

    Eosinophilic esophagitis, an increasingly recognized chronic inflammatory disorder isolated to the esophagus, is triggered by an abnormal allergic response to dietary antigens. Current treatment includes swallowed topical steroids and dietary modification, which aim to resolve symptoms and prevent long-term complications such as formation of strictures. The dietary approach has become more widely accepted because long-term steroid therapy is associated with potential risks. Dietary treatment includes elemental and elimination diets. An exclusive elemental diet, which requires replacement of all intact protein with amino acid-based formula, offers the best response of all available therapies, with remission in up to 96% of subjects proving it to be superior to all other available therapies including topical steroids. However, compliance with this approach is challenging because of poor taste and monotony. The high cost of formula and the associated psychosocial problems are additional drawbacks of this approach. Empiric and allergy test-directed elimination diets have gained popularity given that elimination of a limited number of foods is much easier and as such is more readily acceptable. There is a growing body of literature supporting this type of therapy in both children and adults. This paper reviews the evidence for all types of dietary therapy in eosinophilic esophagitis. PMID:24920928

  18. Abnormal enteric nerve morphology in atretic esophagus of fetal rats with adriamycin-induced esophageal atresia.

    PubMed

    Cheng, W; Bishop, A E; Spitz, L; Polak, J M

    1999-01-01

    Gastroesophageal reflux is common in children after successful repair of esophageal atresia (EA), and may be related to a congenital neuronal abnormality of the esophagus. This study employed a fetal rat model of adriamycin-induced EA to investigate whether the innervation of the esophagus is abnormal in EA. The fetal rats were divided into four groups: (1) normal controls; (2) a saline-injected controls; (3) adriamycin administered but without the development of EA; and (4) adriamycin-induced EA. The distal esophageal segments were immunostained with a general neural marker, protein gene product 9.5 (PGP). Immunoreactivity per cross-sectional area (/xsa) was measured with an image analyzer. The extent of the esophageal circumference encircled by PGP-stained nerve tissue was assessed. While there was no significant difference in PGP immunoreactivity/xsa between the groups, the near-complete ring of nerve tissue along the plane of the myenteric plexus was replaced by clusters of nerve tissue in the atretic group (normal vs EA, P = 0. 001, Mann-Whitney U test). The abnormal distribution of nerve tissue in the atretic esophagus may be contributing factor in the esophageal dysmotility seen in EA. PMID:9914345

  19. Variations of gastric corpus microbiota are associated with early esophageal squamous cell carcinoma and squamous dysplasia.

    PubMed

    Nasrollahzadeh, Dariush; Malekzadeh, Reza; Ploner, Alexander; Shakeri, Ramin; Sotoudeh, Masoud; Fahimi, Saman; Nasseri-Moghaddam, Siavosh; Kamangar, Farin; Abnet, Christian C; Winckler, Björn; Islami, Farhad; Boffetta, Paolo; Brennan, Paul; Dawsey, Sanford M; Ye, Weimin

    2015-01-01

    Observational studies revealed a relationship between changes in gastric mucosa and risk of esophageal squamous cell carcinoma (ESCC) which suggested a possible role for gastric microbiota in ESCC carcinogenesis. In this study we aimed to compare pattern of gastric corpus microbiota in ESCC with normal esophagus. Cases were included subjects with early ESCC (stage I-II) and esophageal squamous dysplasia (ESD) as the cancer precursor. Control groups included age and sex-matched subjects with mid-esophagus esophagitis (diseased-control), and histologically normal esophagus (healthy-control). DNA was extracted from snap-frozen gastric corpus tissues and 16S rRNA was sequenced on GS-FLX Titanium. After noise removal, an average of 3004 reads per sample was obtained from 93 subjects. We applied principal coordinate analysis to ordinate distances from beta diversity data. Pattern of gastric microbiota using Unifrac (p = 0.004) and weighted Unifrac distances (p = 0.018) statistically varied between cases and healthy controls. Sequences were aligned to SILVA database and Clostridiales and Erysipelotrichales orders were more abundant among cases after controling for multiple testing (p = 0.011). No such difference was observed between mid-esophagitis and healthy controls. This study is the first to show that composition of gastric corpus mucosal microbiota differs in early ESCC and ESD from healthy esophagus. PMID:25743945

  20. Variations of gastric corpus microbiota are associated with early esophageal squamous cell carcinoma and squamous dysplasia

    PubMed Central

    Nasrollahzadeh, Dariush; Malekzadeh, Reza; Ploner, Alexander; Shakeri, Ramin; Sotoudeh, Masoud; Fahimi, Saman; Nasseri-Moghaddam, Siavosh; Kamangar, Farin; Abnet, Christian C.; Winckler, Björn; Islami, Farhad; Boffetta, Paolo; Brennan, Paul; Dawsey, Sanford M.; Ye, Weimin

    2015-01-01

    Observational studies revealed a relationship between changes in gastric mucosa and risk of esophageal squamous cell carcinoma (ESCC) which suggested a possible role for gastric microbiota in ESCC carcinogenesis. In this study we aimed to compare pattern of gastric corpus microbiota in ESCC with normal esophagus. Cases were included subjects with early ESCC (stage I–II) and esophageal squamous dysplasia (ESD) as the cancer precursor. Control groups included age and sex-matched subjects with mid-esophagus esophagitis (diseased-control), and histologically normal esophagus (healthy-control). DNA was extracted from snap-frozen gastric corpus tissues and 16S rRNA was sequenced on GS-FLX Titanium. After noise removal, an average of 3004 reads per sample was obtained from 93 subjects. We applied principal coordinate analysis to ordinate distances from beta diversity data. Pattern of gastric microbiota using Unifrac (p = 0.004) and weighted Unifrac distances (p = 0.018) statistically varied between cases and healthy controls. Sequences were aligned to SILVA database and Clostridiales and Erysipelotrichales orders were more abundant among cases after controling for multiple testing (p = 0.011). No such difference was observed between mid-esophagitis and healthy controls. This study is the first to show that composition of gastric corpus mucosal microbiota differs in early ESCC and ESD from healthy esophagus. PMID:25743945

  1. A fully resolved active musculo-mechanical model for esophageal transport

    E-print Network

    Wenjun Kou; Amneet Pal Singh Bhalla; Boyce E. Griffith; John E. Pandolfino; Peter J. Kahrilas; Neelesh A. Patankar

    2015-01-09

    Esophageal transport is a physiological process that mechanically transports an ingested food bolus from the pharynx to the stomach via the esophagus, a multi-layered muscular tube. This process involves interactions between the bolus, the esophagus, and the neurally coordinated activation of the esophageal muscles. In this work, we use an immersed boundary (IB) approach to simulate peristaltic transport in the esophagus. The bolus is treated as a viscous fluid that is actively transported by the muscular esophagus, which is modeled as an actively contracting, fiber-reinforced tube. A simplified version of our model is verified by comparison to an analytic solution to the tube dilation problem. Three different complex models of the multi-layered esophagus, which differ in their activation patterns and the layouts of the mucosal layers, are then extensively tested. To our knowledge, these simulations are the first of their kind to incorporate the bolus, the multi-layered esophagus tube, and muscle activation into an integrated model. Consistent with experimental observations, our simulations capture the pressure peak generated by the muscle activation pulse that travels along the bolus tail. These fully resolved simulations provide new insights into roles of the mucosal layers during bolus transport. In addition, the information on pressure and the kinematics of the esophageal wall due to the coordination of muscle activation is provided, which may help relate clinical data from manometry and ultrasound images to the underlying esophageal motor function.

  2. Influence of endoscopic submucosal dissection on esophageal motility

    PubMed Central

    Bu, Bao-Guo; Linghu, En-Qiang; Li, Hui-Kai; Wang, Xiao-Xiao; Guo, Rong-Bin; Peng, Li-Hua

    2013-01-01

    AIM: To assess esophageal motility after esophageal endoscopic submucosal dissection (ESD). METHODS: Twelve patients (6 men and 6 women) aged 53-64 years (mean age, 58 years) who underwent regular examination 3-12 mo after esophageal ESD for neoplasms of the esophageal body were included in this study. The ESD procedure was performed under deep sedation using a combination of propofol and fentanyl, and involved a submucosal injection to lift the lesion and use of a dual-knife and an insulated-tip knife to create a circumferential incision around the lesion extending into the submucosa. Esophageal motility was examined using a high-resolution manometry system. Dysphagia was graded using a five-point scale according to the Mellow and Pinkas scoring system. Patient symptoms and the results of esophageal manometry were then analyzed. RESULTS: Of the 12 patients enrolled, 1 patient had grade 2 dysphagia, 1 patient had grade 1 dysphagia, and 3 patients complained of sporadic dysphagia. Ineffective esophageal motility was observed in 5 of 6 patients with above semi-circumference of resection extension. Of these 5 patients, 1 patient complained of grade 2 dysphagia (with esophageal stricture), one patient complained of grade 1 dysphagia, and 3 patients complained of sporadic dysphagia. Normal esophageal body manometry was observed in all 6 patients with below semi-circumference of resection extension. The 6 patients with normal esophageal motility did not complain of dysphagia. CONCLUSION: Extensive esophageal ESD may cause esophageal dysmotility in some patients, and might also have an influence on dysphagia although without esophageal stricture. PMID:23922477

  3. Green tea consumption and risk of esophageal cancer: a meta-analysis of epidemiologic studies

    PubMed Central

    2012-01-01

    Background Green tea has shown the role of chemoprevention for cancer. Recently, several studies suggested that green tea intake may have effect on esophageal cancer risk, whereas the results were inconsistent. Methods We performed a meta-analysis of all English and Chinese language studies of green tea consumption and esophageal cancer risk indexed in Medline, Embase, the Science Citation Index, the Chinese Biomedical Database and Wanfang Data from 1980 to June 2012. After reviewing each study, extracting data, and evaluating heterogeneity (Chi-square-based Q test and ?2) and publication bias (Begg and Egger test), a meta-analysis was performed to evaluate the association between high/medium/low green tea consumption and non-drinking esophageal cancer risk. Pooled relative risk (RR) or odds ratio (OR) with 95% confidence intervals (CIs) were calculated using the fixed- or random-effect models. Results Ten eligible epidemiologic studies including 33731 participants and 3557 cases for esophageal cancer were included. Eight of which were case–control studies, and two were cohort studies. Overall, there were no association between high/medium/low green tea consumption and non-drinking risk of esophageal cancer (High: highest vs non-drinker: RR/OR = 0.76, 95% CI: 0.49 to 1.02. Medium: drinker vs non-drinker: RR/OR = 0.86, 95% CI: 0.70 to 1.03. Low: lowest vs non-drinker: RR/OR = 0.83, 95% CI: 0.58 to 1.08). When stratified analyses according to study design (case–control and cohort studies), country (China and Japan), participates source (population-based and hospital-based case–control), and gender (female and male), there were significant association between high/medium/low green tea consumption and non-drinking risk of esophageal cancer among female (High: RR/OR = 0.32, 95% CI: 0.10 to 0.54. Medium: RR/OR = 0.43, 95% CI: 0.21 to 0.66. Low: RR/OR = 0.45, 95% CI: 0.10 to 0.79), but not the others. Conclusions We did not found significant association between green tea consumption and non-drinking esophageal cancer risk, but an evidence of protective effect was observed among female. PMID:23170950

  4. Hydraulically controlled magnetic bougienage for correction of long-gap esophageal atresia

    E-print Network

    Noh, Minkyun

    2014-01-01

    About one in 4000 babies in the United States is born with their esophageal disconnected and separated by a gap, which is called esophageal atresia. Esophageal atresia with a relatively short gap can be directly corrected ...

  5. Home self-dilatation for esophageal strictures.

    PubMed

    Zehetner, J; DeMeester, S R; Ayazi, S; Demeester, T R

    2014-01-01

    Esophageal strictures secondary to caustic ingestion, head and neck radiation and at the anastomosis post-esophagectomy tend to be refractory to one or several dilatations. One option for these strictures is home self-dilatation. The aim of this study was to assess the efficacy and safety of home self-dilatation for a refractory esophageal stricture. A retrospective chart review was performed of all patients from 1997 to 2009 that performed home self-dilatation for an esophageal stricture. Patients with proximal strictures without tortuosity or a shelf proximal to the stricture were selected for self-dilatation. The patients were taught self-dilatation by the surgeon and an experienced nurse, and an appropriate sized Maloney dilator was provided to the patient and returned when no longer needed. There were 16 patients (11 male and 5 female) with a median age of 60 years (range 38-78). The stricture was related to the anastomosis after esophagectomy in 12 patients, caustic injury in 3 patients and cervical chemoradiotherapy in 1 patient. Prior to initiation of self-dilatation patients had a median of four endoscopic dilatations. Self-dilatation was done with a Maloney dilator ranging in size from 45 to 60 French. The median duration of self-dilatation was 16 weeks. No patient had a perforation or complication related to self-dilatation. No patient required stenting or repetitive endoscopic dilatations because of failure of self-dilatation. Strictures recurred in two patients after cessation of self-dilatation and both responded to endoscopic dilatation followed by additional self-dilatation. Self-dilatation effectively resolves refractory esophageal strictures. It was well tolerated, and there were no complications in this series. Home self-dilatation should be considered the treatment of choice in appropriate patients with refractory esophageal strictures in the cervical esophagus. PMID:23387392

  6. Tonometer pHi Monitoring of Free Jejunal Grafts following Pharyngolaryngoesophagectomy for Hypopharyngeal or Cervical Esophageal Cancer

    Microsoft Academic Search

    Kinji Kamiya; Shohachi Suzuki; Hiroyuki Mineta; Hiroyuki Konno

    2007-01-01

    Background\\/Aims: Graft failure is a critical complication associated with vascular occlusion in esophageal reconstruction with a free jejunal graft following pharyngolaryngoesophagectomy. In this study, we evaluated the usefulness of intramucosal pH (pHi) measurement using a tonometer to assess the graft viability. Methods: Two consecutive studies, the early phase study and the late phase study, were performed. Nineteen patients who underwent

  7. Esophageal perforation post pneumatic dilatation for achalasia managed by esophageal stenting

    PubMed Central

    Elhanafi, Sherif; Othman, Mohamed; Sunny, Joseph; Said, Sarmad; Cooper, Chad J.; Alkhateeb, Haider; Quansah, Raphael; McCallum, Richard

    2013-01-01

    Patient: Female, 82 Final Diagnosis: Achalasia Symptoms: Nocturnal regurgtation • weight loss Medication: — Clinical Procedure: Esophageal stenting Specialty: Gastroenterology • Hepatology Objective: Unusual or unexpected effect of treatment Background: Pneumatic dilatation is one of the most effective methods for treating achalasia. Esophageal perforation is the most serious complication after pneumatic dilatation and has been reported to occur in the range of 1 to 4.3%. The appropriate management of esophageal perforation can range from conservative medical treatment to surgical intervention. Case Report: We report a case of an 82-year-old male who had an 8 month history of dysphagia for solid and liquids, a 10 lb weight loss and nocturnal regurgitation. The diagnosis of achalasia was established by endoscopic; barium and manometric criteria. He underwent a pneumatic dilation with a 30 mm Rigiflex balloon. A confined or limited esophageal perforation projecting into the mediastinum and located 1–2 cm above the diaphragm was confirmed by a gastrografin swallow study performed immediately after the procedure. There was some accompanying epigastric abdominal pain. Patient was treated later that day by placing a fully covered metallic esophageal stent in addition to antibiotics, proton pump inhibitor, and fasting. Patient was discharged home 3 days later able to eat liquid-soft foods. Follow up endoscopy 2 weeks later and a gastrografin swallow showed a completely healed perforation and the stent was removed. Symptomatically he has done well, with no dysphagia or heartburn at six and twelve months follow up. Conclusions: Early esophageal stenting for esophageal perforation after pneumatic dilation for achalasia is a treatment option which accelerates healing shortens recovery period, as well as decreasing hospital stay and costs. PMID:24349606

  8. Sorption mechanisms of Sr and Pb on zeolitized tuffs from the Nevada test site as a function of pH and ionic strength

    SciTech Connect

    Um, Wooyong; Papelis, Charalambos

    2003-11-01

    The sorption of divalent strontium, Sr{sup 2+}, and divalent lead, Pb{sup 2+}, on zeolitized tuffs from the Nevada Test Site (NTS) was investigated using macroscopic batch sorption experiments and x-ray absorption spectroscopy (XAS) as a function of geochemical parameters, including pH, ionic strength, and type of background electrolyte. The sorption of Sr{sup 2+} is dependent on the ionic strength of the medium and independent of pH, suggesting that Sr{sup 2+} sorption is controlled by ion exchange at permanent charge sites. At higher ionic strengths, background electrolyte cations compete effectively with Sr{sup 2+} for cation exchange sites and Sr{sup 2+} sorption is suppressed. At the two lower ionic strengths (0.01 and 0.1 M), Pb{sup 2+} sorption is also consistent with adsorption by cation exchange. At the highest ionic strength (1.0 M), however, exclusion of Pb{sup 2+} from cation exchange sites resulted in pH dependent adsorption, consistent with sorption on amphoteric surface hydroxyl sites or formation of surface precipitates. XAS was used to test these hypotheses. Based on XAS data, Sr{sup 2+} formed hydrated surface complexes coordinated with approximately eight oxygen atoms at an average distance of 2.60 ({+-}0.02) {angstrom}, regardless of conditions, consistent with the formation of mononuclear, outer-sphere surface complexes at the Ca2 site in the B channel of clinoptilolite. The coordination environment of sorbed Pb{sup 2+} was more complex and a function of pH and ionic strength. The first shell consisted of two to three oxygen atoms at an average distance of 2.20 ({+-}0.02) {angstrom}. At low pH and ionic strength, XAS data were consistent with Pb{sup 2+} adsorption at the Na1 and Ca2 cation exchange sites in channels A and B of clinoptilolite, respectively. At the highest ionic strength (1.0 M) and low pH, XAS provides evidence for formation of Pb{sup 2+} monodentate, corner-sharing inner-sphere complexes, while at higher pH, XAS analysis is consistent with formation of edge-sharing bidentate inner-sphere complexes. As surface coverage increased, appearance of a second Pb{sup 2+} peak suggests the formation of polynuclear, inner-sphere surface complexes. These results have significant implications for the transport of radionuclides and other contaminants at the NTS and other nuclear test sites and the modeling of these processes.

  9. Robot assisted thoracoscopic resection of giant esophageal leiomyoma

    PubMed Central

    Compean, Steven D.; Gaur, Puja; Kim, Min P.

    2014-01-01

    INTRODUCTION Esophageal leiomyoma represents the most common benign esophageal tumor. Robot-assisted thoracoscopic surgery has provided ability to remove it successfully using a minimally invasive approach. PRESENTATION OF CASE A 63-year old female with history of chronic chest pain presented with an esophageal mass on chest CT and endoscopic ultrasound. Robot-assisted surgery was performed using three robot arms, a camera and an assistant port. A 10 cm leiomyoma was enucleated and removed through a 2 cm myotomy. Completion endoscopy confirmed integrity of the esophagus. Patient's chest pain resolved postoperatively, and she was discharged on postoperative day 3. DISCUSSION Our case describes successful removal of the giant esophageal leiomyoma (10 cm) by robot assisted minimally invasive resection through a 2 cm myotomy. CONCLUSION Use of robot allows for removal of large esophageal leiomyoma. The improved dexterity and patient outcome offered by robot suggests its potential as the mainstay technique for giant esophageal leiomyoma removal. PMID:25460487

  10. Esophageal Involvement in Scleroderma: Clinical, Endoscopic, and Manometric Features

    PubMed Central

    Lahcene, M.; Oumnia, N.; Matougui, N.; Boudjella, M.; Tebaibia, A.; Touchene, B.

    2011-01-01

    Aim. To evaluate characteristics of esophageal involvement in scleroderma. Methods. The study was prospective and concerned 194 patients with a definite systemic sclerosis. Gastroesophageal endoscopy and esophageal manometry were performed in all the cases. Results. Symptoms were present in 118 cases (60.8%); they were signs of GERD or dysphagia, respectively, in 94 (48.4%) and 91 patients (46.9%). Reflux esophagitis was found in 73 cases (37.6%); it was mild or moderate in 47 cases (24.2%) and severe or complicated in the remaining cases. Manometry revealed a lower esophageal sphincter incompetence and esophageal motor disorders, respectively, in 118 (60.8%) and 157 cases (80.9%). Presence of these late was not related to age, duration, or skin extension of the disease, but with clinical complaint and/or mucosal damage. Conclusion. Esophageal involvement is frequent during scleroderma. Manometry is the most sensible examination and could be a screening procedure. PMID:22389793

  11. Detection of esophageal ulcerations with technetium-99m albumin sucralfate

    SciTech Connect

    Goff, J.S.; Adcock, K.A.; Schmelter, R.

    1986-07-01

    Technetium-99m albumin-sucralfate ((/sup 99m/Tc)Su) can be used to demonstrate peptic ulcer disease in man and animals. We evaluated the usefulness of (/sup 99m/Tc)Su for detecting various grades of esophagitis. (/sup 99m/Tc)Su adhered to the distal esophagus for up to 3 hr in five of six patients with esophageal ulcers but adhered to only two of nine with lesser degrees of esophagitis. No adherence was seen in five patients without esophagitis. Thus, (/sup 99m/Tc)Su may not be useful for detecting any but the most severe grade of esophagitis. Based on these results, we speculate that the previously documented beneficial effects of sucralfate on mild to moderate esophagitis may be due to other mechanisms besides adherence to the ulcerated mucosa.

  12. Interrelationship between esophageal challenge with mechanical and chemical stimuli and salivary protective mechanisms.

    PubMed

    Namiot, Z; Rourk, R M; Piascik, R; Hetzel, D P; Sarosiek, J; McCallum, R W

    1994-04-01

    Using our newly developed model of esophageal perfusion in humans, we were able to study the esophagosalivary reflex in 20 healthy volunteers (12M, 8F; mean age 40 yr). The placement of the intraesophageal catheter resulted in a 6.3-fold increase in the salivation rate over the baseline value (2.27 +/- 0.28 vs. 0.36 +/- 0.06 ml/min; p = 0.02), whereas inflation of the catheter balloons evoked a 6.9-fold increase (2.52 +/- 0.21; p < 0.001) in the rate of salivation. A stepwise and significant decline of salivation (p = 0.02), observed during subsequent perfusion with NaCl was prevented when perfusion with HCl and HCl/pepsin solutions was implemented. The placement of the intraesophageal catheter resulted in a significant increase of salivary pH over its basal value (7.77 +/- 0.05 vs. 6.89 +/- 0.11; p < 0.001). A gradual decline of salivary pH during subsequent perfusion with NaCl was eliminated when saline was replaced with HCl or HCl/pepsin (7.76 +/- 0.04 vs. 7.46 +/- 0.09; p < 0.01). Intraesophageal tubing enormously potentiated the viscosity of saliva (44.50 +/- 9.0 vs. 9.3 +/- 1.0 mPa.s; p < 0.001). A subsequent decline of viscosity during continuous perfusion with saline was also prevented when HCl was substituted for NaCl (29.95 +/- 4.5 vs. 19.50 +/- 3.30; p < 0.05). A significant potentiation of salivary volume, viscosity, and pH during esophageal stimulation of mechano- and chemoreceptors may suggest a contributing role of the esophagosalivary reflex in the maintenance of the esophageal mucosal integrity under the impact gastroesophageal reflux. PMID:8147362

  13. Influence of Ionizing Radiation on Stromal-Epithelial Communication in Esophageal Carcinogenesis

    NASA Astrophysics Data System (ADS)

    Huff, Janice; Patel, Zarana; Grugan, Katharine; Rustgi, Anil; Cucinotta, Francis A.

    Esophageal cancer is the 6th leading cause of cancer death worldwide and is associated with a variety of risk factors including tobacco use, heavy alcohol consumption, human papilloma virus infection, and certain dietary factors such as trace mineral and vitamin deficiencies. A connection with ionizing radiation exposure is revealed by the high excess relative risk for esophageal squamous cell carcinoma observed in the survivors of the atomic bomb detonations in Japan. Esophageal carcinomas are also seen as secondary malignancies in patients who received radiotherapy for breast and thoracic cancers; additionally, patients with head/neck and oral squamous cell cancers are at increased risk for metachronous esophageal squamous cell cancers. This malignancy is rapidly fatal, mainly because it remains asymptomatic until late, advanced stages when the disease is rarely responsive to treatment. In normal epithelium, the stromal microenvironment is essential for the maintenance and modulation of cell growth and differentiation. Cross talk between the epithelial and stromal compartments can influence many aspects of malignant progression, including tumor cell proliferation, migration, invasion and recruitment of new blood vessels. To test the hypothesis that radiation exposure plays a role in esophageal carcinogenesis via non-targeted mechanisms involving stromal-epithelial cell communication, we are studying radiation effects on hTERT-immortalized human esophageal epithelial cells and genetic variants grown in co-culture with human esophageal stromal fibrob-lasts (Okawa et al., Genes Dev. 2007. 21: 2788-2803). We examined how irradiation of stromal fibroblasts affected epithelial migration and invasion, behaviors associated with cancer promotion and progression. These assays were conducted in modified Boyden chambers using conditioned media from irradiated fibroblasts. Our results using low LET gamma radiation showed a dose-dependent increase in migration of epithelial cells when exposed to conditioned media from irradiated vs. non-irradiated fibroblasts. We also observed enhanced invasion through a basement membrane matrix in similarly treated cells. Candidate factors that me-diate these effects were identified using antibody capture arrays, and their increased secretion in irradiated fibroblasts was confirmed using ELISAs. We are currently analyzing the effect of these individual factors on epithelial migration and invasion, as well as their influence on cell survival and DNA repair. Our current studies using high-LET radiation will elucidate radiation quality effects on these processes. These results should further our understanding of the mechanisms by which radiation impacts the tissue microenvironment and how it influences cancer development processes.

  14. De Novo Esophageal Carcinoma in Post-liver Transplant Patient

    PubMed Central

    Tank, A. H.; Sutariya, V. K.; Modi, P. R.

    2014-01-01

    De novo esophageal malignancy following liver transplantation is very rare. Esophageal squamous cell carcinoma following liver transplant is closely associated with history of alcohol intake and tobacco chewing. We report on a 45-year-old man, chronic tobacco chewer and alcoholic who underwent liver transplantation for alcoholic cirrhosis and developed esophageal squamous cell carcinoma 23 months following the procedure. He was treated surgically and has had a tumor-free survival after 34 months of regular follow-up. PMID:25426286

  15. The role of pepsin in acid injury to esophageal epithelium

    Microsoft Academic Search

    Nelia A. Tobey; S. Seraj Hosseini; Canan Caymaz-Bor; Holly R. Wyatt; Geraldine S. Orlando; Roy C. Orlando

    2001-01-01

    OBJECTIVES:The development of reflux esophagitis in humans is a process resulting from esophageal exposure to refluxed gastric contents. There is no doubt that damage to the esophageal epithelium requires exposure to gastric acid; however, the role of refluxed pepsin as contributor to this damage seems to be underappreciated.METHODS:The role of physiological concentrations of pepsin was examined in Ussing chambered rabbit

  16. Expandable stents for iatrogenic perforation of esophageal malignancies

    Microsoft Academic Search

    Russell E. White; Caesar Mungatana; Mark Topazian

    2003-01-01

    The management of patients with iatrogenic perforation of esophageal cancers is controversial. We reviewed the management\\u000a of perforated esophageal malignancies at a single institution with a large volume of patients with esophageal cancer. Cases\\u000a of iatrogenic perforation of the esophagus occurring during a 3-year period were identified from the hospital endoscopy database.\\u000a Inpatient and outpatient records were reviewed, and subjects

  17. Surgical treatment of primary esophageal small-cell carcinoma

    Microsoft Academic Search

    Yong-gang Wang; Liang-jun Wang; De-chao Zhang; Ru-gang Zhang; Da-wei Zhang

    2000-01-01

    Objective: To study the clinical biocharacteristics of primary esophageal small-cell carcinoma (PESC) and factors influencing\\u000a prognosis and to find rational indications for combination therapy. Methods: To analyze the clinical materials of 47 patients\\u000a who had undergone an operation with PESC and to compare it with those patients with esophageal squamous-cell carcinoma (ESCC)\\u000a or primary esophageal adenocarcinoma (PEAC). Results: The overall

  18. A Phase I/II Study of Genasense (G3139) in Combination With Cisplatin and Fluorouracil in Patients With Advanced Esophageal, Gastro-Esophageal Junction and Gastric Cancer

    ClinicalTrials.gov

    2013-05-15

    Adenocarcinoma of the Esophagus; Adenocarcinoma of the Gastroesophageal Junction; Diffuse Adenocarcinoma of the Stomach; Intestinal Adenocarcinoma of the Stomach; Mixed Adenocarcinoma of the Stomach; Recurrent Esophageal Cancer; Recurrent Gastric Cancer; Squamous Cell Carcinoma of the Esophagus; Stage IIIA Esophageal Cancer; Stage IIIA Gastric Cancer; Stage IIIB Esophageal Cancer; Stage IIIB Gastric Cancer; Stage IIIC Esophageal Cancer; Stage IIIC Gastric Cancer; Stage IV Esophageal Cancer; Stage IV Gastric Cancer

  19. The history of lymphadenectomy for esophageal cancer and the future prospects for esophageal cancer surgery.

    PubMed

    Fujita, Hiromasa

    2015-02-01

    I would herein like to look back upon surgery for esophageal cancer, particularly on lymphadenectomy, and to speculate a little on the future prospects for esophageal surgery. There are two schools of thought on lymphadenectomy in esophageal cancer: one believes in en bloc esophagectomy, which is commonly performed in Western countries; the other believes in three-field lymphadenectomy, which is commonly performed in Japan. We esophageal surgeons at Kurume University have contributed to some advances in three-field lymphadenectomy. For example, we initiated functional mediastinal dissection to ensure patient safety, and we proposed the lymph node compartment theory to assess the clinical importance of regional nodes. Oncological surgery has progressed in terms of its safety, radicality and functional preservation, leading to improved quality-of-life for patients after surgery. This then evolved to the current development of multimodal and individualized tailor-made treatments. I believe that surgery for esophageal cancer will become bipolarized in the future. One strand will evolve as salvage surgery for residual or recurrent tumors, which non-surgical therapies have failed to cure, and the other strand will evolve as less invasive surgery, adjuvant surgery, for cancers at the relatively early stage, for which micro-metastasis can be cured by non-surgical therapies. PMID:24519395

  20. Esophageal cancer: Recent advances in screening, targeted therapy, and management

    PubMed Central

    Gaur, Puja; Kim, Min P.; Dunkin, Brian J.

    2014-01-01

    The incidence of esophageal cancer remains on the rise worldwide and despite aggressive research in the field of gastrointestinal oncology, the survival remains poor. Much remains to be defined in esophageal cancer, including the development of an effective screening tool, identifying a good tumor marker for surveillance purposes, ways to target esophageal cancer stem cells as well as circulating tumor cells, and developing minimally invasive protocols to treat early-stage disease. The goal of this chapter is to highlight some of the recent advances and ongoing research in the field of esophageal cancer. PMID:25395880

  1. Evaluation and treatment of esophageal varices in the cirrhotic patient.

    PubMed

    Ashkenazi, Eyal; Kovalev, Yulia; Zuckerman, Eli

    2013-02-01

    Portal hypertension is the leading cause of morbidity and mortality in liver cirrhosis. Complications of portal hypertension in cirrhotic patients include esophageal and gastric varices, portal hypertensive gastropathy, ascites, hepatorenal syndrome, hepatopulmonary syndrome and portopulmonary hypertension. The hepatic venous pressure gradient should be at least 10 mmHg for esophageal varices to appear, and more than 12 mmHg for acute esophageal variceal bleeding. This article reviews the pathophysiology responsible for portal hypertension and its complications, and the treatments used for esophageal varices in the setting of primary and secondary prophylaxis and during active bleeding. PMID:23516775

  2. Eosinophils in the Esophagus—Peptic or Allergic Eosinophilic Esophagitis? Case Series of Three Patients with Esophageal Eosinophilia

    Microsoft Academic Search

    Peter Ngo; Glenn T. Furuta; Donald A. Antonioli; Victor L. Fox

    2006-01-01

    OBJECTIVES:Scattered eosinophils in the distal esophagus traditionally provide the hallmark for peptic esophagitis, but the upper limit of eosinophils and the longitudinal extent of peptic inflammation along the esophagus are unknown. Recently, adults and children with upper intestinal symptoms and >20 eosinophils\\/high-power field (eos\\/HPF) have been given the diagnosis of allergic esophagitis. Standardized diagnostic criteria for allergic esophagitis are lacking

  3. Endoscopic submucosal dissection for malignant esophageal lesions.

    PubMed

    Hammad, Hazem; Kaltenbach, Tonya; Soetikno, Roy

    2014-01-01

    The incidence of esophageal cancer has been increasing while the prognosis remains very poor. Endoscopic submucosal dissection (ESD) was developed in Japan for en bloc resection of early gastric cancer with excellent results. The use of ESD in early squamous cell cancer (SCC) of the esophagus in Japan has been increasing with long-term results comparable to those in early gastric cancer. The use of ESD in Barrett's neoplasia in western countries has been challenged by the low complete resection rates and the risk of metachronous lesions from surrounding non-dysplastic Barrett's epithelium. Efforts to combine ESD with other treatment modalities such as radiofrequency ablation in Barrett's neoplasia and chemoradiation in SCC appear to be promising. The use of steroid therapy (local or systemic) has been demonstrated to prevent post-ESD stenosis, which is the most common complication after esophageal ESD. PMID:24659252

  4. Difficult esophageal atresia: trick and treat.

    PubMed

    Conforti, Andrea; Morini, Francesco; Bagolan, Pietro

    2014-10-01

    Although most patients with esophageal atresia (EA) and tracheo-esophageal fistula (TEF) may benefit from "standard" management, which is deferred emergency surgery, some may present unexpected elements that change this paradigm. Birth weight, associated anomalies, and long gap can influence the therapeutic schedule of the patients with EA/TEF and can make their treatment tricky. As a consequence, detailed information on these aspects gives the power to develop a decision-making process as correct as possible. In this article, we will review the most important factors influencing the treatment of patients with EA/TEF and will share our experience on the diagnostic and therapeutic tips that may provide pivotal help in the management of such patients. PMID:25459010

  5. Peroral endoscopic myotomy for esophageal achalasia

    PubMed Central

    Inoue, Haruhiro; Ikeda, Haruo; Sato, Hiroki; Sato, Chiaki; Hokierti, Chananya

    2014-01-01

    Peroral endoscopic myotomy (POEM) is one of the alternative treatment for achalasia. Due to concept of natural orifice transluminal endoscopic surgery (NOTES), it becomes popular and widely accepted. With the endoluminal technique, submucosal tunnel was created followed by endoscopic myotomy. POEM is not only indicated in classical achalasia but also other abnormal esophageal motility disorders. Moreover, failures of endoscopic treatment or surgical attempted cases are not contraindicated for POEM. The second attempted POEM is also safe and technically feasible. Even though the legend of success of POEM is fruitful, the possible complications are very frightened. Good training and delicate practice will reduce rate of complications. This review provides a summary of current state-of-the-art of POEM, including indication equipments, technique and complications. This perfect procedure may become the treatment of choice of achalasia and some esophageal motility disorders in the near future. PMID:25333007

  6. Comparison of batch leaching tests and influence of pH on the release of metals from construction and demolition wastes.

    PubMed

    Galvín, Adela P; Ayuso, Jesús; Jiménez, Jose Ramón; Agrela, Francisco

    2012-01-01

    Construction and demolition wastes are suitable for use in road construction. However, leaching characterization of recycled materials is required to determine their pollutant potential and the consequence of their application in different scenarios. The motivation of this paper is derived from the increasing use of different leaching test methods. In Europe, the confusion resulting from the wide variety of tests used to evaluate environmental properties of construction materials implies that an evaluation of the current practices and the attempt to consolidate the approaches are required. Two equilibrium-based leaching tests (the Dutch test and the European standard) were conducted to assess the environmental impact of four recycled aggregates. Three natural limestone aggregates were used as controls. Both tests measure the potential release of hazardous elements under extreme conditions using different leaching parameters (L/S ratio, pH value and contact time). The results proved that pH is the most relevant factor on the assessment of the differences between leaching methods due to its strong control on the pollutant release. To classify the materials according to their environmental effects, the concentration limit values of the metals imposed by Council Decision 2003/33/EC were used as a reference. The comparison allowed the classification of the recycled aggregates as inert wastes, with the exception of the MR-2 aggregate, which was classified as non-hazardous material. PMID:21978425

  7. Reversal of lower esophageal sphincter hypotension and esophageal aperistalsis after treatment for hypothyroidism

    SciTech Connect

    Eastwood, G.L.; Braverman, L.E.; White, E.M.; Vander Salm, T.J.

    1982-08-01

    A 65-year-old woman suffered from both chronic gastroesophageal reflux, which was complicated by columnar metaplasia (Barrett's epithelium), and profound hypothyroidism. An esophageal motility tracing showed absence of peristalsis in the lower esophagus and the lower esophageal sphincter (LES) could not be identified. Thyroid replacement therapy, in conjunction with antacid and cimetidine treatment, was associated not only with improvement in the gastroesophageal reflux symptoms, but also with a return of esophageal peristalsis and LES pressure to normal. To support our clinical observations, we rendered four cats hypothyroid with /sup 131/I and documented a fall in LES pressure. We propose that abnormal smooth-muscle function of the esophagus may be another manifestation of the gastrointestinal motility disturbances which are associated with hypothyroidism.

  8. Eosinophilic Esophagitis in Infants and Toddlers

    Microsoft Academic Search

    Scott P. Pentiuk; Claire Kane Miller; Ajay Kaul

    2007-01-01

    Feeding refusal is often described in conjunction with the diagnosis of eosinophilic esophagitis (EE) in pediatric patients;\\u000a however, there are little data regarding the specific clinical manifestations and effective management of this condition in\\u000a very young children. The aim of this study was to evaluate the presentation of EE in infants and toddlers referred to the\\u000a Interdisciplinary Feeding Team Clinic

  9. Esophagoplasty for caustic esophageal burns in children

    Microsoft Academic Search

    Oktay Mutaf

    1992-01-01

    One hundred and two children with caustic esophageal strictures requiring esophagoplasty are reported. Seventy-one had a retrosternal colon transplant: two-stage esophagocolostomy in 59 and one-stage cervical anastomosis in 12. In the retrosternal group there were 2 cases of total transplant necrosis and 3 cases of terminal necrosis of the cervical end of the transplant; 12 patients developed anastomotic stenosis at

  10. Significance of feeding dysfunction in eosinophilic esophagitis

    PubMed Central

    Menard-Katcher, Calies; Henry, Michelle; Furuta, Glenn T; Atkins, Dan; Maune, Nancy Creskoff; Haas, Angela M

    2014-01-01

    Feeding dysfunction is a frequent presenting symptom of eosinophilic esophagitis (EoE). Here we present 3 children of various ages whose manifestations of EoE associated feeding dysfunction led to significant and life altering impact on their growth and development. Early identification of presenting symptoms of EoE will allow for prompt diagnosis and initiation of appropriate treatments. Recognition of salient features of dysfunction and treatment by feeding therapists and nutritionists led to symptom resolution and growth. PMID:25152606

  11. Endoscopic management of impacted esophageal foreign bodies.

    PubMed

    Chen, T; Wu, H-F; Shi, Q; Zhou, P-H; Chen, S-Y; Xu, M-D; Zhong, Y-S; Yao, L-Q

    2013-01-01

    There are many reports on the endoscopic management of ingested foreign bodies in the upper gastrointestinal tract, however, little is known about the management of a specific subset of esophageal foreign bodies - impacted esophageal foreign bodies (IEFBs), especially perforating esophageal foreign bodies (PEFBs). The aim of this retrospective study on 78 cases was to report experience and outcome in the endoscopic management of the IEFBs in Chinese patients. From January 2006 to July 2011, a total of 750 patients with suspected upper gastrointestinal foreign bodies were admitted to the endoscopy center. Among these 750 patients, 78 cases that met the defined criteria of IEFBs were retrospectively enrolled in the present study, including 12 cases (12/78, 15.4%) with PEFBs. The major types of IEFBs were poultry bones (35.9%) and fish bones (17.9%). Most of the IEFBs (80.8%) were located in the upper esophagus, as were two thirds (66.7%) of the PEFBs. Foreign-body retrieval forceps were the most frequently used accessory devices. Extraction of IEFBs failed in eight patients (10.3%) during the endoscopic procedure. The difficult points in endoscopic management were PEFBs, IEFBs with sharp points, and those with impaction for more than 24 hours. IEFBs should be treated as early as possible, and their endoscopic management is safe and effective. Endoscopic management is the first choice for PEFBs when the duration of impaction is less than 24 hours and there are no abscesses outside of the esophageal tract as determined by a computed tomography scan. PMID:22973974

  12. Pharyngo-Esophageal Dysphagia in Parkinson's Disease

    Microsoft Academic Search

    Norman A. Leopold; Marion C. Kagel

    1997-01-01

    .   The radiologic characteristics of pharyngo-esophageal (PE) dysfunction in Parkinson's disease (PD) are not well established,\\u000a partly because most previous studies have examined only small numbers of patients. We administered a dynamic videofluoroscopic\\u000a swallowing function study to 71 patients with idiopathic PD. Using the Hoehn and Yahr disease severity scale, patients were\\u000a subdivided into those with mild\\/moderate disease, subgroup I

  13. Glossopexy as an alternative to aortopexy in infants with repaired esophageal atresia and upper airway obstruction

    Microsoft Academic Search

    Francesco Cozzi; Francesco Morini; Alessandra Casati; Daniela Camanni; Augusto Zani; Denis A. Cozzi

    2002-01-01

    Background\\/Purpose: Clinical manifestations of airway obstruction in infants with repaired esophageal atresia or tracheoesophageal fistula (EA\\/TEF) are attributed conventionally to tracheomalacia. In the current study, the authors tested the hypothesis that a retrodisplacement of the tongue (glossoptosis), by causing a functional upper airway obstruction (obstructive apnea\\/hypopnea), may play a role in the pathogenesis of the respiratory problems. Methods: The records

  14. Micromachined “Side-Viewing” Optical Sensor Probe for Detection of Esophageal Cancers

    PubMed Central

    Garcia-Uribe, A.; Balareddy, K. C.; Zou, J.; Wojcik, A. K.; Wang, K. K.; Wang, L. V.

    2014-01-01

    In this paper, we report the design, fabrication and testing of a new miniaturized optical sensor probe with “side viewing” capability for oblique incidence diffuse reflectance spectrometry. The sensor probe consists of a lithographically patterned polymer waveguides chip and two micromachined positioning substrates and source/collection fibers to achieve 45° light incidence and collection of spatially resolved diffuse reflectance. Diffuse reflectance of human esophageal surface has been successfully measured for differentiation of cancerous tissues from normal ones. PMID:25580057

  15. Esophageal carcinoid tumor treated by endoscopic resection.

    PubMed

    Yagi, Makoto; Abe, Yasuhiko; Sasaki, Yu; Nomura, Eiki; Sato, Takeshi; Iwano, Daisuke; Yoshizawa, Kazuya; Sakuta, Kazuhiro; Kanno, Nana; Nishise, Syouichi; Ueno, Yoshiyuki

    2015-05-01

    The present report describes a rare case of esophageal carcinoid tumor that was treated by endoscopic resection. A 43-year-old woman underwent esophagogastroduodenoscopy at her family clinic for screening of the upper digestive tract and a small lesion resembling a submucosal tumor was detected in the lower esophagus. A biopsy sample from the lesion was diagnosed as esophageal carcinoid tumor and the patient visited our hospital for detailed examination. The tumor was approximately 3?mm in diameter and its surface appeared to be covered with normal squamous epithelium. The tumor had a shiny reddish surface without ulceration or erosion. Magnifying endoscopy with narrow-band imaging showed structures resembling reticular vessels under the epithelium. Endoscopic ultrasonography depicted the tumor as a low-echoic mass within the lamina propria. Computed tomography did not detect the tumor and no metastatic lesions were evident in other organs. With the patient's informed consent, the tumor was resected using endoscopic submucosal dissection, with a sufficient free margin in both the vertical and horizontal directions. Magnifying endoscopic examination showed the resected tumor to have abundant reticular vessels. Finally, the tumor was diagnosed immunopathologically as an esophageal carcinoid tumor (neuroendocrine cell tumor, grade 1), without lymphatic or vascular invasion. PMID:25283957

  16. Esophageal Toxicity From High-Dose, Single-Fraction Paraspinal Stereotactic Radiosurgery

    SciTech Connect

    Cox, Brett W., E-mail: coxb@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Jackson, Andrew; Hunt, Margie [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)] [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Bilsky, Mark [Department of Surgery (Neurosurgical Division), Memorial Sloan-Kettering Cancer Center, New York, New York (United States)] [Department of Surgery (Neurosurgical Division), Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Yamada, Yoshiya [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)] [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

    2012-08-01

    Purpose: To report the esophageal toxicity from single-fraction paraspinal stereotactic radiosurgery (SRS) and identify dosimetric and clinical risk factors for toxicity. Methods and Materials: A total of 204 spinal metastases abutting the esophagus (182 patients) were treated with high-dose single-fraction SRS during 2003-2010. Toxicity was scored using the National Cancer Institute Common Toxicity Criteria for Adverse Events, version 4.0. Dose-volume histograms were combined to generate a comprehensive atlas of complication incidence that identifies risk factors for toxicity. Correlation of dose-volume factors with esophageal toxicity was assessed using Fisher's exact test and logistic regression. Clinical factors were correlated with toxicity. Results: The median dose to the planning treatment volume was 24 Gy. Median follow-up was 12 months (range, 3-81). There were 31 (15%) acute and 24 (12%) late esophageal toxicities. The rate of grade {>=}3 acute or late toxicity was 6.8% (14 patients). Fisher's exact test resulted in significant median splits for grade {>=}3 toxicity at V12 = 3.78 cm{sup 3} (relative risk [RR] 3.7, P=.05), V15 = 1.87 cm{sup 3} (RR 13, P=.0013), V20 = 0.11 cm{sup 3} (RR 6, P=0.01), and V22 = 0.0 cm{sup 3} (RR 13, P=.0013). The median split for D2.5 cm{sup 3} (14.02 Gy) was also a significant predictor of toxicity (RR 6; P=.01). A highly significant logistic regression model was generated on the basis of D2.5 cm{sup 3}. One hundred percent (n = 7) of grade {>=}4 toxicities were associated with radiation recall reactions after doxorubicin or gemcitabine chemotherapy or iatrogenic manipulation of the irradiated esophagus. Conclusions: High-dose, single-fraction paraspinal SRS has a low rate of grade {>=}3 esophageal toxicity. Severe esophageal toxicity is minimized with careful attention to esophageal doses during treatment planning. Iatrogenic manipulation of the irradiated esophagus and systemic agents classically associated with radiation recall reactions are associated with development of grade {>=}4 toxicity.

  17. A novel approach to cancer staging: application to esophageal cancer

    PubMed Central

    Blackstone, Eugene H.; Apperson-Hansen, Carolyn; Rice, Thomas W.

    2009-01-01

    A novel 3-step random forests methodology involving survival data (survival forests), ordinal data (multiclass forests), and continuous data (regression forests) is introduced for cancer staging. The methodology is illustrated for esophageal cancer using worldwide esophageal cancer collaboration data involving 4627 patients. PMID:19502615

  18. Nonoperative management of esophageal strictures following esophagomyotomy for achalasia

    Microsoft Academic Search

    Henry P. Parkman; Carrie P. Ogorek; Arthur D. Harris; Sidney Cohen

    1994-01-01

    The optimal management of reflux-induced esophageal strictures that occur after esophagomytomy for achalasia is uncertain. This paper presents our experience with the nonsurgical treatment of postesophagomyotomy strictures in achalasia patients using endoscopic dilation and gastric acid suppression. Six patients with achalasia who had undergone prior esophagomyotomy subsequently developed recurrent dysphagia and were found to have an esophageal stricture. Esophagrams typically

  19. Eosinophilic Esophagitis: Red on Microscopy, White on Endoscopy

    Microsoft Academic Search

    Alex Straumann; Hans-Peter Spichtin; Kathleen A. Bucher; Pius Heer; Hans-Uwe Simon

    2004-01-01

    Background\\/Aims: The presenting symptom of eosinophilic esophagitis, a chronic TH2-type inflammatory disease, is uniform dysphagia attacks. Histology reveals a dense mucosal infiltration with eosinophils. Unfortunately, endoscopic findings are often unremarkable or misleading. This study characterizes the endoscopic manifestations of eosinophilic esophagitis and analyzes the nature and clinical features of the frequently observed white alterations. Methods: Thirty adult patients (22 males,

  20. Clinical and Endoscopic Features of Eosinophilic Esophagitis in Adults

    Microsoft Academic Search

    John Croese; Stephen K. Fairley; John W. Masson; André K. H. Chong; David A. Whitaker; Peter A. Kanowski; Neal I. Walker

    2003-01-01

    BackgroundEosinophilic esophagitis in adults is regarded as unusual, being diagnosed mostly in young men presenting with dysphagia. Mucosal furrows are a sentinel endoscopic feature. This study examined the demographic and clinical profile of adults with eosinophilic esophagitis seen from 1981 to 2002.

  1. Evolving Options in the Management of Esophageal Perforation

    Microsoft Academic Search

    Clayton J. Brinster; Sunil Singhal; Lawrence Lee; M. Blair Marshall; Larry R. Kaiser; John C. Kucharczuk

    2004-01-01

    Esophageal perforation remains a devastating event that is difficult to diagnose and manage. The majority of injuries are iatrogenic and the increasing use of endo- scopic procedures can be expected to lead to an even higher incidence of esophageal perforation in coming years. Accurate diagnosis and effective treatment depend on early recognition of clinical features and accurate interpretation of diagnostic

  2. Prevention of esophageal strictures after endoscopic submucosal dissection

    PubMed Central

    Kobayashi, Shinichiro; Kanai, Nobuo; Ohki, Takeshi; Takagi, Ryo; Yamaguchi, Naoyuki; Isomoto, Hajime; Kasai, Yoshiyuki; Hosoi, Takahiro; Nakao, Kazuhiko; Eguchi, Susumu; Yamamoto, Masakazu; Yamato, Masayuki; Okano, Teruo

    2014-01-01

    Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have recently been accepted as less invasive methods for treating patients with early esophageal cancers such as squamous cell carcinoma and dysplasia of Barrett’s esophagus. However, the large defects in the esophageal mucosa often cause severe esophageal strictures, which dramatically reduce the patient’s quality of life. Although preventive endoscopic balloon dilatation can reduce dysphagia and the frequency of dilatation, other approaches are necessary to prevent esophageal strictures after ESD. This review describes several strategies for preventing esophageal strictures after ESD, with a particular focus on anti-inflammatory and tissue engineering approaches. The local injection of triamcinolone acetonide and other systemic steroid therapies are frequently used to prevent esophageal strictures after ESD. Tissue engineering approaches for preventing esophageal strictures have recently been applied in basic research studies. Scaffolds with temporary stents have been applied in five cases, and this technique has been shown to be safe and is anticipated to prevent esophageal strictures. Fabricated autologous oral mucosal epithelial cell sheets to cover the defective mucosa similarly to how commercially available skin products fabricated from epidermal cells are used for skin defects or in cases of intractable ulcers. Fabricated autologous oral-mucosal-epithelial cell sheets have already been shown to be safe. PMID:25386058

  3. The efficacy of ozone therapy in experimental caustic esophageal burn

    Microsoft Academic Search

    Ahmet Guven; Gokhan Gundogdu; Serdar Sadir; Turgut Topal; Esra Erdogan; Ahmet Korkmaz; ?lhami Surer; Haluk Ozturk

    2008-01-01

    IntroductionOzone has been proposed as an antioxidant enzyme activator, immunomodulator and cellular metabolic activator. This study was designed to investigate the efficacy of ozone therapy in the prevention of esophageal damage and stricture formation developed after esophageal caustic injuries in the rat.

  4. Vitamin supplement use and risk for oral and esophageal cancer

    Microsoft Academic Search

    Jeanine Barone; Emanuela Taioli; James R. Hebert; Ernst L. Wynder

    1992-01-01

    In a hospital?based case?control study, 290 oral cancer cases and 133 esophageal cancer cases were queried as to smoking status, alcohol consumption, and dietary exposures, including vitamin supplement history. Among oral cancer cases, vitamin E use appeared to exert a protective effect. Vitamins C and E had protective effects among esophageal cancer cases. When stratified by smoking status, the protective

  5. Four Strategies for the Management of Esophageal Coins in Children

    Microsoft Academic Search

    Joyce V. Soprano; Kenneth D. Mandl

    Objective. To compare clinical outcomes and costs under 4 strategies for the management of esophageal coins in children. Methods. We developed a decision analysis model of 4 possible strategies for managing esophageal coins: 1) endoscopic removal under general anesthesia; 2) esoph- ageal bougienage, 3) an outpatient 12- to 24-hour obser- vation period to allow spontaneous coin passage; and 4) an

  6. Endoscopic submucosal dissection of esophageal granular cell tumor

    PubMed Central

    2014-01-01

    Background Esophageal granular cell tumor (GCT) is a rare benign tumor with malignant potential. With wide application of endoscopic techniques, the esophageal GCT discovery rate and treatment strategy has changed. This study was to preliminarily evaluate outcomes of endoscopic diagnosis and treatment for esophageal GCT. Methods Fourteen patients (eight men, six women; median age, 48.5 years) with esophageal GCT diagnosed and treated by esophageal endoscopy. Esophagoscopy, endoscopic ultrasound (EUS), and endoscopic submucosal dissection (ESD) techniques were employed in diagnosis and resection. Results Esophageal GCTs are tumors which arise from the submucosal layer, and vary in color but with a yellowish color on endoscopy being most common. On EUS, features were homogenous (ten cases) or mildly heterogeneous (four cases) hypoechoic solid pattern originating from the muscularis mucosa (six cases) or submucosal layer (eight cases) of the esophageal wall. Tumors ranged from 4 to 26 mm (mean 12.1 mm). ESD was performed in all patients without complication. Clinical diagnosis was confirmed by pathology and immunohistochemical examination (positive for S-100 and vimentin). The en bloc resection rate was 92.9% (13/14) pathologically. Operation time was 25 to 60 minutes, mean 38.2?±?10.1 minutes. No recurrence was observed during a mean follow-up of 16.6?±?12.7 (range, 4 to 40) months. Conclusions Esophagoscopy and EUS increased the esophageal GCT discovery rate, and its features were summarized. Minimally invasive ESD is feasible and safe for excisional biopsy, providing pathological diagnosis and treatment. PMID:25030028

  7. Balloon catheter dilatation in children with congenital and acquired esophageal anomalies

    Microsoft Academic Search

    Wu Yeming; Stig Somme; Shi Chenren; Jin Huiming; Zhu Ming; Donald C. Liu

    2002-01-01

    Background\\/Purpose: Esophageal stricture requiring dilatation often is the sequelae in children with a history of congenital or acquired esophageal anomalies. Balloon catheter dilatation (BCD) for esophageal stricture is well established in adults, yet its role in children is less well described. The authors report their initial experience using BCD in children with esophageal stricture, assessing outcome. Methods: Between January 1994,

  8. Esophageal resection and by-pass: A 6 year experience with a low postoperative mortality

    Microsoft Academic Search

    Jean-Marie Collard; Jean-Bernard Otte; Marc Reynaert; Luc Michel; Marie-Anne Carlier; Paul-Jacques Kestens

    1991-01-01

    From 1984 to 1989, 175 esophageal cancer patients, 10 patients admitted for severe caustic esophagitis, and 1 patient with pyothorax due to iatrogenic perforation of the esophagus underwent an esophageal resection or bypass operation. One hundred sixty-eight esophageal resections were performed on 167 patients; 13 were total, 106 subtotal and 49 distal. Nineteen digestive transplants were pulled up to the

  9. Photographic documentation of the High Power Engine Propulsion HiPEP after a duration test. Also ph

    NASA Technical Reports Server (NTRS)

    2005-01-01

    Photographic documentation of the High Power Engine Propulsion HiPEP after a duration test. Also photographed are the instrumentation and installation articles to reveal post test conditions such as corrosion and pitting.

  10. High prevalence of esophageal dysmotility in asymptomatic obese patients

    PubMed Central

    Côté-Daigneault, Justin; Leclerc, Pierre; Joubert, Josette; Bouin, Mickael

    2014-01-01

    BACKGROUND: Obesity is an important health problem affecting >500 million people worldwide. Esophageal dysmotility is a gastrointestinal pathology associated with obesity; however, its prevalence and characteristics remain unclear. Esophageal dysmotilities have a high prevalence among obese patients regardless of gastrointestinal symptoms. OBJECTIVE: To identify the prevalence of esophageal dysmotility among obese patients. The secondary goals were to characterize these pathologies in obese patients and identify risk factors. METHOD: A prospective study from January 2009 to March 2010 at the University of Montreal Hospital Centre (Montreal, Quebec) was performed. Every patient scheduled for bariatric surgery underwent preoperatory esophageal manometry and was included in the study. Manometry was performed according to a standardized protocol with the following measures: superior esophageal sphincter – coordination and release during deglutition; esophageal body – presence, propagation, length, amplitude and type of esophageal waves of contraction; lower esophageal sphincter – localization, tone, release, intragastic pressure and intraesophageal pressure. All reference values were those used in the digestive motility laboratory. A gastrointestinal symptoms questionnaire was completed on the day manometry was performed. Chart reviews were performed to identify comorbidities and treatments that could influence the results. RESULTS: A total of 53 patients were included (mean [± SD] age 43±10 years; mean body mass index 46±7 kg/m2; 70% female). Esophageal manometry revealed dysmotility in 51% (n=27) of the patients. This dysmotility involved the esophageal body in 74% (n=20) of the patients and the inferior sphincter in 11% (n=3). Mixed dysmotility (body and inferior sphincter) was found in 15% (n=4) of cases. The esophageal body dysmotilities were hypomotility in 85% (n=23) of the patients, either from insignificant waves (74% [n=20]), nonpropagated waves (11% [n=3]) or low-amplitude waves (33% [n=9]). Gastroesophageal symptoms were found in 66% (n=35) of obese patients, including heartburn (66% [n=23]), regurgitation (26% [n=9]), dysphagia (43% [n=15]), chest pain (6% [n=2]) and dyspepsia (26% [n=9]). Among symptomatic patients, 51% (n=18) had normal manometry and 49% (n=17) had abnormal manometry (statistically nonsignificant). Among asymptomatic patients (n=18), 44% (n=8) had normal manometry and 56% (n=10) had abnormal manometry (statistically nonsignificant). Furthermore, no statistical differences were found between the normal manometry group and the abnormal manometry group with regard to medication intake or comorbidities. CONCLUSION: Esophageal dysmotilities had a high prevalence in obese patients. Gastrointestinal symptoms cannot predict the presence of esophageal dysmotility. Hypomotility of the esophageal body is the most common dysmotility, especially from the absence of significant waves. PMID:24945185

  11. Proton pump inhibitor responsive esophageal eosinophilia, a distinct disease entity?

    PubMed Central

    Munday, William; Zhang, Xuchen

    2014-01-01

    Recent studies have suggested the existence of a patient population with esophageal eosinophilia that responds to proton pump inhibitor therapy. These patients are being referred to as having proton pump inhibitor responsive esophageal eosinophilia (PPI-REE), which is currently classified as a distinct and separate disease entity from both gastroesophageal reflux disease (GERD) and eosinophilic esophagitis (EoE). The therapeutic effect of proton pump inhibitor (PPI) on PPI-REE is thought to act directly at the level of the esophageal mucosa with an anti-inflammatory capacity, and completely independent of gastric acid suppression. The purpose of this manuscript is to review the mechanistic data of the proposed immune modulation/anti-inflammatory role of the PPI at the esophageal mucosa, and the existence of PPI-REE as a distinct disease entity from GERD and EoE. PMID:25132757

  12. Stromal cells participate in the murine esophageal mucosal injury response

    PubMed Central

    Binkley, Jana; Darwech, Isra; Swietlicki, Elzbieta; McDonald, Keely; Newberry, Rodney; Rubin, Deborah C.

    2013-01-01

    We identified ?-smooth muscle actin (?-SMA)- and vimentin-expressing spindle-shaped esophageal mesenchymal cells in the adult and neonate murine esophageal lamina propria. We hypothesized that these esophageal mesenchymal cells express and secrete signaling and inflammatory mediators in response to injury. We established primary cultures of esophageal mesenchymal cells using mechanical and enzymatic digestion. We demonstrate that these primary cultures are nonhematopoietic, nonendothelial, stromal cells with myofibroblast-like features. These cells increase secretion of IL-6 in response to treatment with acidified media and IL-1?. They also increase bone morphogenetic protein (Bmp)-4 secretion in response to sonic hedgehog. The location of these cells and their biological functions demonstrate their potential role in regulating esophageal epithelial responses to injury and repair. PMID:23370675

  13. Bevacizumab and Combination Chemotherapy Before Surgery in Treating Patients With Locally Advanced Esophageal or Stomach Cancer

    ClinicalTrials.gov

    2014-03-17

    Adenocarcinoma of the Esophagus; Adenocarcinoma of the Gastroesophageal Junction; Diffuse Adenocarcinoma of the Stomach; Intestinal Adenocarcinoma of the Stomach; Mixed Adenocarcinoma of the Stomach; Squamous Cell Carcinoma of the Esophagus; Stage IA Esophageal Cancer; Stage IA Gastric Cancer; Stage IB Esophageal Cancer; Stage IB Gastric Cancer; Stage IIA Esophageal Cancer; Stage IIA Gastric Cancer; Stage IIB Esophageal Cancer; Stage IIB Gastric Cancer; Stage IIIA Esophageal Cancer; Stage IIIA Gastric Cancer; Stage IIIB Esophageal Cancer; Stage IIIB Gastric Cancer; Stage IIIC Esophageal Cancer; Stage IIIC Gastric Cancer

  14. A fully resolved active musculo-mechanical model for esophageal transport

    E-print Network

    Kou, Wenjun; Griffith, Boyce E; Pandolfino, John E; Kahrilas, Peter J; Patankar, Neelesh A

    2015-01-01

    Esophageal transport is a physiological process that mechanically transports an ingested food bolus from the pharynx to the stomach via the esophagus, a multi-layered muscular tube. This process involves interactions between the bolus, the esophagus, and the neurally coordinated activation of the esophageal muscles. In this work, we use an immersed boundary (IB) approach to simulate peristaltic transport in the esophagus. The bolus is treated as a viscous fluid that is actively transported by the muscular esophagus, which is modeled as an actively contracting, fiber-reinforced tube. A simplified version of our model is verified by comparison to an analytic solution to the tube dilation problem. Three different complex models of the multi-layered esophagus, which differ in their activation patterns and the layouts of the mucosal layers, are then extensively tested. To our knowledge, these simulations are the first of their kind to incorporate the bolus, the multi-layered esophagus tube, and muscle activation i...

  15. Reflux Esophagitis: Sequelae and Differential Diagnosis in Infants and Children Including Eosinophilic Esophagitis

    Microsoft Academic Search

    Beverly Barrett Dahms

    2004-01-01

    Gastroesophageal reflux disease (GERD) is a common condition in infants and children and has many clinical mimics. Most pediatric pathology departments process many mucosal biopsies from the proximal gastrointestinal tract to evaluate the presence or absence of reflux esophagitis. Since this subject was last reviewed in the 1997 edition of Perspectives in Pediatric Pathology devoted to gastrointestinal diseases in children

  16. Advanced esophageal cancer with tracheobronchial fistula successfully treated by?esophageal bypass surgery

    PubMed Central

    Kimura, Masahiro; Ishiguro, Hideyuki; Tanaka, Tatsuya; Takeyama, Hiromitsu

    2015-01-01

    Introduction When esophageal cancer infiltrates the respiratory tract and forms a fistula, a patient’s quality of life falls remarkably. Abstinence from oral feeding is necessary to prevent respiratory complications including pneumonia. Surgery is sometimes necessary to maintain quality of life. The aim of this study was to examine clinical outcomes of esophageal cancer complicated by tracheobronchial fistula. Presentation of case Twelve patients who underwent esophageal bypass between 2006 and 2011 in our hospital were studied. Patient characteristics, therapeutic course, outcome, and operation type were compared. Six patients among 8 who could not tolerate oral feeding could do so after bypass surgery. Ten patients were able to enjoy oral intake up until the last few days of life. Three patients survived for more than 10 months. In spite of undergoing an operation, 1 patient survived for only 2 months and another for 4 months. The only complication was postoperative delirium in 1 patient. Discussion While surgical bypass is more invasive than procedures such as endoscopic stenting, we had few complications after operative intervention and were able to maintain quality of life in our patients. Conclusion This bypass procedure is a treatment option for patients with tracheobronchial fistula from advanced esophageal cancer. PMID:25765740

  17. Delayed release dexlansoprazole in the treatment of GERD and erosive esophagitis

    PubMed Central

    Wittbrodt, Eric T; Baum, Charles; Peura, David A

    2009-01-01

    Although proton pump inhibitors (PPI) have a record of remarkable effectiveness and safety in the management of gastroesophageal reflux disease (GERD), several treatment challenges with PPI have emerged. Dexlansoprazole MR is the (R)-enantiomer of lansoprazole contained in a formulation that produces two distinct releases of drug and significantly extends the duration of active plasma concentrations and % time pH > 4 beyond that of conventional single-release PPI. Dexlansoprazole MR can be administered without regard to meals or the timing of meals in most patients. Dexlansoprazole MR 60 mg demonstrated similar efficacy for healing of erosive esophagitis at 8 weeks compared with lansoprazole 30 mg, and dexlansoprazole MR 30 mg was superior to placebo for maintenance of healed erosive esophagitis at 6 months with 99% of nights and 96% of days heartburn-free over 6 months in patients taking dexlansoprazole MR 30 mg. Superior relief of heartburn occurred in patients taking dexlansoprazole MR 30 mg (55% heartburn-free 24-hour periods) vs placebo (14%) for symptomatic nonerosive GERD. The safety profile of dexlansoprazole MR is similar to that of lansoprazole. The extended pharmacodynamic effects, added convenience, and efficacy and safety of dexlansoprazole MR offer a novel approach to gastric pH control in patients with acid-related disorders. PMID:21694835

  18. Delayed release dexlansoprazole in the treatment of GERD and erosive esophagitis.

    PubMed

    Wittbrodt, Eric T; Baum, Charles; Peura, David A

    2009-01-01

    Although proton pump inhibitors (PPI) have a record of remarkable effectiveness and safety in the management of gastroesophageal reflux disease (GERD), several treatment challenges with PPI have emerged. Dexlansoprazole MR is the (R)-enantiomer of lansoprazole contained in a formulation that produces two distinct releases of drug and significantly extends the duration of active plasma concentrations and % time pH > 4 beyond that of conventional single-release PPI. Dexlansoprazole MR can be administered without regard to meals or the timing of meals in most patients. Dexlansoprazole MR 60 mg demonstrated similar efficacy for healing of erosive esophagitis at 8 weeks compared with lansoprazole 30 mg, and dexlansoprazole MR 30 mg was superior to placebo for maintenance of healed erosive esophagitis at 6 months with 99% of nights and 96% of days heartburn-free over 6 months in patients taking dexlansoprazole MR 30 mg. Superior relief of heartburn occurred in patients taking dexlansoprazole MR 30 mg (55% heartburn-free 24-hour periods) vs placebo (14%) for symptomatic nonerosive GERD. The safety profile of dexlansoprazole MR is similar to that of lansoprazole. The extended pharmacodynamic effects, added convenience, and efficacy and safety of dexlansoprazole MR offer a novel approach to gastric pH control in patients with acid-related disorders. PMID:21694835

  19. Lab-scale fermentation tests of microchip with integrated electrochemical sensors for pH, temperature, dissolved oxygen and viable biomass concentration.

    PubMed

    Krommenhoek, Erik E; van Leeuwen, Michiel; Gardeniers, Han; van Gulik, Walter M; van den Berg, Albert; Li, Xiaonan; Ottens, Marcel; van der Wielen, Luuk A M; Heijnen, Joseph J

    2008-03-01

    This article shows the development and testing of a microchip with integrated electrochemical sensors for measurement of pH, temperature, dissolved oxygen and viable biomass concentration under yeast cultivation conditions. Measurements were done both under dynamic batch conditions as well as under prolonged continuous cultivation conditions. The response of the sensors compared well with conventional measurement techniques. The biomass sensor was based on impedance spectroscopy. The results of the biomass sensor matched very well with dry weight measurements and showed a limit of detection of approximately 1 g/L. The dissolved oxygen concentration was monitored amperometrically using an ultra-microelectrode array, which showed an accuracy of approximately 0.2 mg/L and negligible drift. pH was monitored using an ISFET with an accuracy well below 0.1 pH unit. The platinum thin-film temperature resistor followed temperature changes with approximately 0.1 degrees C accuracy. The dimensions of the multi sensor chip are chosen as such that it is compatible with the 96-well plate format. PMID:17929319

  20. Esophageal motility changes in acute and late periods of caustic esophageal burns and their relation to prognosis in children

    Microsoft Academic Search

    Oktay Mutaf

    2002-01-01

    Background\\/Purpose: Esophageal burns as a result of accidental swallowing of caustic material are seen frequently in children. Severe motor function disorders of the esophagus after caustic burns are already reported covering the late periods. The aim of this study was to detect, follow, and report the clinical results of esophageal motility changes in acute as well as the late periods

  1. Exploring the Link Between Eosinophilic Esophagitis and Esophageal Foreign Bodies in the Pediatric Population A CASE REPORT

    Microsoft Academic Search

    Patrick M. Vannelli; Nader N. Youssef; John J. Oppenheimer; Joel R. Rosh

    Eosinophilic esophagitis (EE) has a clinical presentation similar to gastroesophageal reflux disease but is often refractory to acid suppressing medications and patients often continue to be symptomatic. In addition, acute dysphagia associated with food impaction of the esophagus has been reported to be associated with eosinophilic esophagitis. We report on 61 consecutive patients who presented with acute dysphagia and had

  2. Stent placement provides safe esophageal closure in thoracic NOTES™ procedures

    PubMed Central

    Turner, Brian G.; Cizginer, Sevdenur; Kim, Min-Chan; Mino-Kenudson, Mari; Ducharme, Richard W.; Surti, Vihar C.; Sylla, Patricia; Brugge, William R.; Rattner, David W.

    2012-01-01

    Background Safe esophageal closure remains a challenge in transesophageal Natural Orifice Transluminal Endoscopic Surgery (NOTES). Previously described methods, such as suturing devices, clips, or submucosal tunneling, all have weaknesses. In this survival animal series, we demonstrate safe esophageal closure with a prototype retrievable, antimigration stent. Methods Nine Yorkshire swine underwent thoracic NOTES procedures. A double-channel gastroscope equipped with a mucosectomy device was used to create an esophageal mucosal defect. A 5-cm submucosal tunnel was created and the muscular esophageal wall was incised with a needle-knife. Mediastinoscopy and thoracoscopy were performed in all swine; lymphadenectomy was performed in seven swine. A prototype small intestinal submucosal (SurgiSIS) covered stent was deployed over the mucosectomy site and tunnel. Three versions of the prototype stent were developed. Prenecropsy endoscopy confirmed stent location and permitted stent retrieval. Explanted esophagi were sent to pathology. Results Esophageal stenting was successful in all animals. Stent placement took 15.8 ± 4.8 minuted and no stent migration occurred. Prenecropsy endoscopy revealed proximal ingrowth of esophageal mucosa and erosion with Stent A. Mucosal inflammation and erosion was observed proximally with Stent B. No esophageal erosion or pressure damage from proximal radial forces was seen with Stent C. On necropsy, swine 5 had a 0.5-cm periesophageal abscess. Histology revealed a localized inflammatory lesion at the esophageal exit site in swine 1, 3, and 9. The mucosectomy site was partially healed in three swine and poorly healed in six. All swine thrived clinically, except for a brief period of mild lethargy in swine 9 who improved with short-term antibiotic therapy. The submucosal tunnels were completely healed and no esophageal bleeding or stricture formation was observed. All swine survived 13.8 ± 0.4 days and gained weight in the postoperative period. Conclusions Esophageal stenting provides safe closure for NOTES thoracic procedures but may impede healing of the mucosectomy site. PMID:20820811

  3. Altered Esophageal Histamine Receptor Expression in Eosinophilic Esophagitis (EoE): Implications on Disease Pathogenesis.

    PubMed

    Merves, Jamie; Chandramouleeswaran, Prasanna Modayur; Benitez, Alain J; Muir, Amanda B; Lee, Anna J; Lim, Diana M; Dods, Kara; Mehta, Isha; Ruchelli, Eduardo D; Nakagawa, Hiroshi; Spergel, Jonathan M; Wang, Mei-Lun

    2015-01-01

    Eosinophilic Esophagitis (EoE) is a chronic allergic disorder, whose pathobiology is incompletely understood. Histamine-producing cells including mast cells and basophils have been implicated in EoE. However, very little is currently known about the role of histamine and histamine receptor (HR) expression and signaling in the esophageal epithelium. Herein, we characterized HR (H1R, H2R, H3R, and H4R) expression in human esophageal biopsies and investigate the role of histamine signaling in inducible cytokine expression in human esophageal epithelial cells in vitro. HR expression was quantified in esophageal biopsies from non-EoE control (N = 23), inactive EoE (<15 eos/hpf, N = 26) and active EoE (>15 eos/hpf, N = 22) subjects using qRT-PCR and immunofluorescent localization. HR expression and histamine-mediated cytokine secretion were evaluated in human primary and telomerase-immortalized esophageal epithelial cells. H1R, H2R, and H4R expression were increased in active EoE biopsies compared to inactive EoE and controls. H2R was the most abundantly expressed receptor, and H3R expression was negligible in all 3 cohorts. Infiltrating eosinophils expressed H1R, H2R, and H4R, which contributed to the observed increase in HR in active subjects. H1R and H2R, but not H3R or H4R, were constitutively expressed by primary and immortalized cells, and epithelial histamine stimulation induced GM-CSF, TNF?, and IL-8, but not TSLP or eotaxin-3 secretion. Epithelial priming with the TLR3 ligand poly (I:C) induced H1R and H2R expression, and enhanced histamine-induced GM-CSF, TNF?, and IL-8 secretion. These effects were primarily suppressed by H1R antagonists, but unaffected by H2R antagonism. Histamine directly activates esophageal epithelial cytokine secretion in vitro in an H1R dependent fashion. However, H1R, H2R and H4R are induced in active inflammation in EoE in vivo. While systemic antihistamine (anti-H1R) therapy may not induce clinical remission in EoE, our study suggests that further study of histamine receptor signaling in EoE is warranted and that targeting of additional histamine receptors may lead to novel treatment strategies for this important disease. PMID:25723478

  4. Altered Esophageal Histamine Receptor Expression in Eosinophilic Esophagitis (EoE): Implications on Disease Pathogenesis

    PubMed Central

    Merves, Jamie; Chandramouleeswaran, Prasanna Modayur; Benitez, Alain J.; Muir, Amanda B.; Lee, Anna J.; Lim, Diana M.; Dods, Kara; Mehta, Isha; Ruchelli, Eduardo D.; Nakagawa, Hiroshi; Spergel, Jonathan M.; Wang, Mei-Lun

    2015-01-01

    Eosinophilic Esophagitis (EoE) is a chronic allergic disorder, whose pathobiology is incompletely understood. Histamine-producing cells including mast cells and basophils have been implicated in EoE. However, very little is currently known about the role of histamine and histamine receptor (HR) expression and signaling in the esophageal epithelium. Herein, we characterized HR (H1R, H2R, H3R, and H4R) expression in human esophageal biopsies and investigate the role of histamine signaling in inducible cytokine expression in human esophageal epithelial cells in vitro. HR expression was quantified in esophageal biopsies from non-EoE control (N = 23), inactive EoE (<15 eos/hpf, N = 26) and active EoE (>15 eos/hpf, N = 22) subjects using qRT-PCR and immunofluorescent localization. HR expression and histamine-mediated cytokine secretion were evaluated in human primary and telomerase-immortalized esophageal epithelial cells. H1R, H2R, and H4R expression were increased in active EoE biopsies compared to inactive EoE and controls. H2R was the most abundantly expressed receptor, and H3R expression was negligible in all 3 cohorts. Infiltrating eosinophils expressed H1R, H2R, and H4R, which contributed to the observed increase in HR in active subjects. H1R and H2R, but not H3R or H4R, were constitutively expressed by primary and immortalized cells, and epithelial histamine stimulation induced GM-CSF, TNF?, and IL-8, but not TSLP or eotaxin-3 secretion. Epithelial priming with the TLR3 ligand poly (I:C) induced H1R and H2R expression, and enhanced histamine-induced GM-CSF, TNF?, and IL-8 secretion. These effects were primarily suppressed by H1R antagonists, but unaffected by H2R antagonism. Histamine directly activates esophageal epithelial cytokine secretion in vitro in an H1R dependent fashion. However, H1R, H2R and H4R are induced in active inflammation in EoE in vivo. While systemic antihistamine (anti-H1R) therapy may not induce clinical remission in EoE, our study suggests that further study of histamine receptor signaling in EoE is warranted and that targeting of additional histamine receptors may lead to novel treatment strategies for this important disease. PMID:25723478

  5. Prediagnostic serum levels of inflammatory biomarkers are correlated with future development of lung and esophageal cancer.

    PubMed

    Keeley, Brieze R; Islami, Farhad; Pourshams, Akram; Poustchi, Hossein; Pak, Jamie S; Brennan, Paul; Khademi, Hooman; Genden, Eric M; Abnet, Christian C; Dawsey, Sanford M; Boffetta, Paolo; Malekzadeh, Reza; Sikora, Andrew G

    2014-09-01

    This study tests the hypothesis that prediagnostic serum levels of 20 cancer-associated inflammatory biomarkers correlate directly with future development of head and neck, esophageal, and lung cancers in a high-risk prospective cohort. This is a nested case-control pilot study of subjects enrolled in the Golestan Cohort Study, an ongoing epidemiologic project assessing cancer trends in Golestan, Iran. We measured a panel of 20 21 cytokines, chemokines, and inflammatory molecules using Luminex technology in serum samples collected 2 or more years before cancer diagnosis in 78 aerodigestive cancer cases and 81 controls. Data was analyzed using Wilcoxon rank sum test, odds ratios, receiver operating characteristic areas of discrimination, and multivariate analysis. Biomarkers were profoundly and globally elevated in future esophageal and lung cancer patients compared to controls. Odds ratios were significant for association between several biomarkers and future development of esophageal cancer, including interleukin-1R? (IL-1Ra; 35.9), interferon ?2 (IFN-a2; 34.0), fibroblast growth factor-2 (FGF-2; 17.4), and granulocyte/macrophage colony-stimulating factor (GM-CSF; 17.4). The same pattern was observed among future lung cancer cases for G-CSF (27.7), GM-CSF (13.3), and tumor necrosis factor-? (TNF-a; 8.6). By contrast, the majority of biomarkers studied showed no significant correlation with future head and neck cancer development. This study provides the first direct evidence that multiple inflammatory biomarkers are coordinately elevated in future lung and esophageal cancer patients 2 or more years before cancer diagnosis. PMID:25040886

  6. High dose intravenous methylprednisolone resolves esophageal stricture resistant to balloon dilatation with intralesional injection of dexamethasone

    Microsoft Academic Search

    Nobuyuki Morikawa; Toshiro Honna; Tatsuo Kuroda; Koji Watanabe; Hideaki Tanaka; Hajime Takayasu; Akihiro Fujino; Hiroko Tanemura; Makoto Matsukubo

    2008-01-01

    One of the most serious problems in patients with long-gap esophageal atresia or corrosive esophagitis is esophageal stricture,\\u000a which may require esophageal resection and replacement. We describe two cases with persistent esophageal stricture successfully\\u000a managed by high dose intravenous methylprednisolone following balloon dilatation. High-dose methylprednisolone with gradual\\u000a tapering (daily 25, 15, 10, 5, 2 mg\\/kg for 4 days each) plus cimetidine and

  7. Comparative Study of Esophageal Stent and Feeding Gastrostomy/Jejunostomy for Tracheoesophageal Fistula Caused by Esophageal Squamous Cell Carcinoma

    PubMed Central

    Chiu, Yi-Chun; Lu, Hung-I; Huang, Cheng-Hua; Rau, Kun-Ming; Liu, Chien-Ting

    2012-01-01

    Background A malignant tracheoesophageal/bronchoesophageal fistula (TEF) is a life-threatening complication of esophageal squamous cell carcinoma. A feeding gastrostomy/jejunostomy had been the most common treatment method for patients with TEF before the era of stenting. The aim of this retrospective study is to compare the prognosis of esophageal squamous cell carcinoma patients with TEF treated with an esophageal metallic stent to those treated with a feeding gastrostomy/jejunostomy. Methods We retrospectively reviewed a total of 1011 patients with esophageal squamous cell carcinoma between 1996 and 2011 at Kaohsiung Chang Gung Memorial Hospital, and 86 patients with TEF (8.5%) were identified. The overall survival and other clinical data were compared between 30 patients treated with an esophageal metallic stent and 35 patients treated with a feeding gastrostomy/jejunostomy. Results Among the 65 patients receiving either an esophageal metallic stent or a feeding gastrostomy/jejunostomy, univariate analysis showed that treatment modality with an esophageal metallic stent (P?=?0.007) and radiotherapy treatment after fistula diagnosis (P?=?0.04) were predictive of superior overall survival. In the multivariate comparison, treatment modality with an esophageal metallic stent (P?=?0.026, odds ratio: 1.859) represented the independent predictive factor of superior overall survival. There were no significant differences between groups in mean decrease in serum albumin or mean body weight loss. Compared to the feeding gastrostomy/jejunostomy group, a significantly higher proportion of patients in the stenting group (53% versus 14%, P?=?0.001) were able to receive chemotherapy within 30 days after fistula diagnosis, indicating better infection control in the stenting group. Conclusions Compared with a feeding gastrostomy/jejunostomy, an esophageal metallic stent significantly improves overall survival in patients with malignant TEF in our retrospective analysis. Esophageal metallic stent placement may be considered the first-line of treatment for patients with malignant TEF. PMID:22912737

  8. Pathophysiological mechanisms linking obesity and esophageal adenocarcinoma

    PubMed Central

    Alexandre, Leo; Long, Elizabeth; Beales, Ian LP

    2014-01-01

    In recent decades there has been a dramatic rise in the incidence of esophageal adenocarcinoma (EAC) in the developed world. Over approximately the same period there has also been an increase in the prevalence of obesity. Obesity, especially visceral obesity, is an important independent risk factor for the development of gastro-esophageal reflux disease, Barrett’s esophagus and EAC. Although the simplest explanation is that this mediated by the mechanical effects of abdominal obesity promoting gastro-esophageal reflux, the epidemiological data suggest that the EAC-promoting effects are independent of reflux. Several, not mutually exclusive, mechanisms have been implicated, which may have different effects at various points along the reflux-Barrett’s-cancer pathway. These mechanisms include a reduction in the prevalence of Helicobacter pylori infection enhancing gastric acidity and possibly appetite by increasing gastric ghrelin secretion, induction of both low-grade systemic inflammation by factors secreted by adipose tissue and the metabolic syndrome with insulin-resistance. Obesity is associated with enhanced secretion of leptin and decreased secretion of adiponectin from adipose tissue and both increased leptin and decreased adiponectin have been shown to be independent risk factors for progression to EAC. Leptin and adiponectin have a set of mutually antagonistic actions on Barrett’s cells which appear to influence the progression of malignant behaviour. At present no drugs are of proven benefit to prevent obesity associated EAC. Roux-en-Y reconstruction is the preferred bariatric surgical option for weight loss in patients with reflux. Statins and aspirin may have chemopreventative effects and are indicated for their circulatory benefits. PMID:25400997

  9. Pathophysiological mechanisms linking obesity and esophageal adenocarcinoma.

    PubMed

    Alexandre, Leo; Long, Elizabeth; Beales, Ian Lp

    2014-11-15

    In recent decades there has been a dramatic rise in the incidence of esophageal adenocarcinoma (EAC) in the developed world. Over approximately the same period there has also been an increase in the prevalence of obesity. Obesity, especially visceral obesity, is an important independent risk factor for the development of gastro-esophageal reflux disease, Barrett's esophagus and EAC. Although the simplest explanation is that this mediated by the mechanical effects of abdominal obesity promoting gastro-esophageal reflux, the epidemiological data suggest that the EAC-promoting effects are independent of reflux. Several, not mutually exclusive, mechanisms have been implicated, which may have different effects at various points along the reflux-Barrett's-cancer pathway. These mechanisms include a reduction in the prevalence of Helicobacter pylori infection enhancing gastric acidity and possibly appetite by increasing gastric ghrelin secretion, induction of both low-grade systemic inflammation by factors secreted by adipose tissue and the metabolic syndrome with insulin-resistance. Obesity is associated with enhanced secretion of leptin and decreased secretion of adiponectin from adipose tissue and both increased leptin and decreased adiponectin have been shown to be independent risk factors for progression to EAC. Leptin and adiponectin have a set of mutually antagonistic actions on Barrett's cells which appear to influence the progression of malignant behaviour. At present no drugs are of proven benefit to prevent obesity associated EAC. Roux-en-Y reconstruction is the preferred bariatric surgical option for weight loss in patients with reflux. Statins and aspirin may have chemopreventative effects and are indicated for their circulatory benefits. PMID:25400997

  10. Esophageal stricture in a cougar (Puma concolor).

    PubMed

    Desmarchelier, Marion; Lair, Stéphane; Defarges, Alice; Lécuyer, Manon; Langlois, Isabelle

    2009-06-01

    A 7-mo-old female cougar (Puma concolor) was presented with a 2-wk history of anorexia and a 1-wk history of regurgitation. Barium contrast esophagogram and gastroesophagoscopy revealed the presence of a segmental intraluminal esophageal stricture in the middle third of the esophagus. The stricture was potentially secondary to a previous anesthetic episode. Three endoscopic balloon dilations allowed increasing the luminal diameter to a size that enabled the cougar to eat food softened with water without any signs of discomfort or regurgitation. Two months after being discharged, the cougar was doing well, had gained weight and was eating horsemeat softened with water. PMID:19569481

  11. Strategies to improve outcomes in esophageal adenocarcinoma.

    PubMed

    Cowie, Andrew; Noble, Fergus; Underwood, Timothy

    2014-06-01

    Esophageal adenocarcinoma is one of the fastest rising cancers in Western society. Incidence has increased by 600% within the last 30 years. Rates of diagnosis and death run parallel due to the poor prognosis and a lack of effective treatments. Potentially curative treatments are followed by high rates of disease recurrence. For the majority of patients, who present with advanced disease, we have no effective treatment. We discuss the key areas of progress in this demanding field and offer our views on the direction of future research and treatment. PMID:24621143

  12. Cell sheets engineering for esophageal regenerative medicine

    PubMed Central

    Kanai, Nobuo; Yamato, Masayuki

    2014-01-01

    Recently, cell-based therapies, regenerative medicine, and tissue engineering have been progressing rapidly. We have developed a novel strategy for regenerative medicine to recover tissue functions using temperature-responsive cell culture surfaces. To overcome of conventional methods such as the usage of single-cell suspension injection, we have applied transplantable cell sheets fabricated with temperature-responsive culture surfaces for cell delivery. In the field of gastroenterology, transplantable cell sheets from autologous oral mucosal epithelial cells can prevent esophageal stricture following extensive endoscopic mucosal resection. PMID:25333004

  13. Emphysematous gastritis associated with ulcerative esophagitis.

    PubMed

    Hassan, S; Abbass, K; Markert, R; Akram, S

    2011-11-01

    Emphysematous gastritis is a rare form of gastritis characterized by gaseous dissection of the stomach wall usually secondary to invasion by gas forming organisms, corrosive ingestion, trauma, or gastric infarction. We report a unique case of emphysematous gastritis secondary to ulcerative esophagitis without an underlying history of trauma, ischemia, or ingestion of corrosive agents. The patient responded well to conservative management. Emphysematous gastritis is a deadly infectious disease. Early recognition and management are crucial as there is no specific approach to treatment despite advances in medical science. PMID:22195369

  14. The effect of sodium dodecyl sulfate and Pluronic F127 on the electrophoretic separation of protein and polypeptide test mixtures at acid pH.

    PubMed

    Miksík, Ivan; Eckhardt, Adam; Forgács, Esther; Cserháti, Tibor; Deyl, Zdenek

    2002-06-01

    Using a test mixture consisting of standard proteins (cytochrome c, chymotrypsinogen A, hen egg albumin, bovine serum albumin, aldolase, catalase and ferritin) and synthetic polypeptides (polylysine, polyaspartic, polyglutamic acid and polyproline) it was revealed that using sodium dodecyl sulfate (SDS) as background electrolyte modifier at acid pH (2.5) allows selective separation of highly positively charged polypeptides (polylysine) provided that their relative molecular mass is sufficiently low (3300 Da). The altered elution sequence of standard proteins as compared to a separation done without SDS may help their identification. Addition of Pluronic F127 offers clear-cut separations of standard proteins up to a relative molecular mass of 5 x 10(4) Da and allows to reveal protein/polypeptide microheterogeneity where applicable. None of the systems tested is suitable for the separation of acidic polypeptides and polyproline. PMID:12116132

  15. Endoscopic assessment and management of early esophageal adenocarcinoma

    PubMed Central

    Hammoud, Ghassan M; Hammad, Hazem; Ibdah, Jamal A

    2014-01-01

    Esophageal carcinoma affects more than 450000 people worldwide and the incidence is rapidly increasing. In the United States and Europe, esophageal adenocarcinoma has superseded esophageal squamous cell carcinoma in its incidence. Esophageal cancer has a high mortality rates secondary to the late presentation of most patients at advanced stages. Endoscopic screening is recommended for patients with multiple risk factors for cancer in Barrett’s esophagus. These risk factors include chronic gastroesophageal reflux disease, hiatal hernia, advanced age, male sex, white race, cigarette smoking, and obesity. The annual risk of esophageal cancer is approximately 0.25% for patients without dysplasia and 6% for patients with high-grade dysplasia. Twenty percent of all esophageal adenocarcinoma in the United States is early stage with disease confined to the mucosa or submucosa. The significant morbidity and mortality of esophagectomy make endoscopic treatment an attractive option. The American Gastroenterological Association recommends endoscopic eradication therapy for patients with high-grade dysplasia. Endoscopic modalities for treatment of early esophageal adenocarcinoma include endoscopic resection techniques and endoscopic ablative techniques such as radiofrequency ablation, photodynamic therapy and cryoablation. Endoscopic therapy should be precluded to patients with no evidence of lymphovascular invasion. Local tumor recurrence is low after endoscopic therapy and is predicted by poor differentiation of tumor, positive lymph node and submucosal invasion. Surgical resection should be offered to patients with deep submucosal invasion. PMID:25132925

  16. An optimized lead system for long-term esophageal electrocardiography.

    PubMed

    Niederhauser, T; Haeberlin, A; Marisa, T; Mattle, D; Abächerli, R; Goette, J; Jacomet, M; Vogel, R

    2014-04-01

    Long-term electrocardiography (ECG) featuring adequate atrial and ventricular signal quality is highly desirable. Routinely used surface leads are limited in atrial signal sensitivity and recording capability impeding complete ECG delineation, i.e. in the presence of supraventricular arrhythmias. Long-term esophageal ECG might overcome these limitations but requires a dedicated lead system and recorder design. To this end, we analysed multiple-lead esophageal ECGs with respect to signal quality by describing the ECG waves as a function of the insertion level, interelectrode distance, electrode shape and amplifier's input range. The results derived from clinical data show that two bipolar esophageal leads, an atrial lead with short (15 mm) interelectrode distance and a ventricular lead with long (80 mm) interelectrode distance provide non-inferior ventricular signal strength and superior atrial signal strength compared to standard surface lead II. High atrial signal slope in particular is observed with the atrial esophageal lead. The proposed esophageal lead system in combination with an increased recorder input range of ±20 mV minimizes signal loss due to excessive electrode motion typically observed in esophageal ECGs. The design proposal might help to standardize long-term esophageal ECG registrations and facilitate novel ECG classification systems based on the independent detection of ventricular and atrial electrical activity. PMID:24577330

  17. The effect of concurrent esophageal pathology on bariatric surgical planning.

    PubMed

    Bradley, Daniel Davila; Louie, Brian E; Chen, Judy; Aye, Ralph W; McMahon, Ross; Farivar, Alexander S

    2015-01-01

    In the presence of esophageal pathology, there is risk of worse outcomes after laparoscopic adjustable gastric banding (LAGB) and sleeve gastrectomy (SG). This study reviewed how an esophageal workup affected a bariatric operative plan in patients with concurrent esophageal pathology. We retrospectively reviewed patients planning bariatric surgery referred with significant reflux, dysphagia, and hiatal hernia (>3 cm) to determine how and why a thorough esophageal workup changed a bariatric operative plan. We identified 79 patients for analysis from 2009 to 2013. In 10/41 patients (24.3%) planning LAGB and 5/9 patients planning SG (55.5%), a Roux was preferred because of severe symptoms of reflux and aspiration, dysphagia, manometric abnormalities (aperistaltic or hypoperistaltic esophagus with low mean wave amplitudes), large hiatal hernia (>5 cm), and/or presence of Barrett's esophagus. Patients without these characteristics had a decreased risk of foregut symptoms after surgery. We recommend a thorough esophageal workup in bariatric patients with known preoperative esophageal pathology. The operative plan might need to be changed to a Roux to prevent adverse outcomes including dysphagia, severe reflux, or suboptimal weight loss. An esophageal workup may improve surgical decision making and improve patient outcomes. PMID:25213580

  18. New Endoscopic Indicator of Esophageal Achalasia: “Pinstripe Pattern”

    PubMed Central

    Minami, Hitomi; Isomoto, Hajime; Miuma, Satoshi; Kobayashi, Yasutoshi; Yamaguchi, Naoyuki; Urabe, Shigetoshi; Matsushima, Kayoko; Akazawa, Yuko; Ohnita, Ken; Takeshima, Fuminao; Inoue, Haruhiro; Nakao, Kazuhiko

    2015-01-01

    Background and Study Aims Endoscopic diagnosis of esophageal achalasia lacking typical endoscopic features can be extremely difficult. The aim of this study was to identify simple and reliable early indicator of esophageal achalasia. Patients and Methods This single-center retrospective study included 56 cases of esophageal achalasia without previous treatment. As a control, 60 non-achalasia subjects including reflux esophagitis and superficial esophageal cancer were also included in this study. Endoscopic findings were evaluated according to Descriptive Rules for Achalasia of the Esophagus as follows: (1) esophageal dilatation, (2) abnormal retention of liquid and/or food, (3) whitish change of the mucosal surface, (4) functional stenosis of the esophago-gastric junction, and (5) abnormal contraction. Additionally, the presence of the longitudinal superficial wrinkles of esophageal mucosa, “pinstripe pattern (PSP)” was evaluated endoscopically. Then, inter-observer diagnostic agreement was assessed for each finding. Results The prevalence rates of the above-mentioned findings (1–5) were 41.1%, 41.1%, 16.1%, 94.6%, and 43.9%, respectively. PSP was observed in 60.7% of achalasia, while none of the control showed positivity for PSP. PSP was observed in 26 (62.5%) of 35 cases with shorter history < 10 years, which usually lacks typical findings such as severe esophageal dilation and tortuosity. Inter-observer agreement level was substantial for food/liquid remnant (k = 0.6861) and PSP (k = 0.6098), and was fair for abnormal contraction and white change. The accuracy, sensitivity, and specificity for achalasia were 83.8%, 64.7%, and 100%, respectively. Conclusion “Pinstripe pattern” could be a reliable indicator for early discrimination of primary esophageal achalasia. PMID:25664812

  19. Regulation of CDX2 expression in esophageal adenocarcinoma.

    PubMed

    Vaninetti, Nadine; Williams, Lara; Geldenhuys, Laurette; Porter, Geoffrey A; Guernsey, Duane L; Casson, Alan G

    2009-10-01

    Reflux of acidic gastric contents and bile acids into the lower esophagus has been identified to have a central role in esophageal malignancy and is reported to upregulate caudal-related homologue 2 (CDX2), a regulatory gene involved in embryonic development and axial patterning of the alimentary tract. The aim of this study was to characterize the expression of CDX2 in a well-defined series of human esophageal tissues, comprising reflux-induced esophagitis, premalignant Barrett esophagus (BE), and primary esophageal adenocarcinoma (EADC). To explore potential molecular regulatory mechanisms, we also studied the expression of beta-catenin, SOX9, and CDX2 promoter methylation in esophageal tissues, in addition to the effect of bile acids and nitric oxide (NO) on CDX2 expression in the normal human esophageal cell line Het1A. Relative to matched normal esophageal epithelia, CDX2 was overexpressed in esophagitis (37% for RNA; cytoplasmic immunoreactivity in 48% of tissues), a high proportion (91%) of BE tissues, and in EADC (57% for RNA; cell nuclear immunopositivity in 80%). An association with beta-catenin expression was seen, but not with SOX9 or CDX2 promoter methylation. In Het1A cells, CDX2 was upregulated following exposure to bile acids and NO, alone and in combination. These results further implicate CDX2 and beta-catenin in the molecular pathogenesis of human EADC. The observed synergistic effect of NO on the efficacy of bile acid-induction of CDX2 suggests a novel role for NO in modulating the development of the Barrett phenotype and esophageal adenocarcinogenesis. PMID:19415720

  20. Esophageal obstruction 14 years after treatment for Hodgkin's disease

    SciTech Connect

    Kaplinsky, C.; Kornreich, L.; Tiomny, E.; Cohen, I.J.; Loven, D.; Zaizov, R. (Beilinson Medical Center, Petah Tiqva (Israel))

    1991-08-15

    The incidence of late radiation injury of the esophagus is not precisely determined but, overall, the occurrence of clinically apparent damage is infrequent. The authors report a complete esophageal obstruction in a 21-year-old man, 14 years after chemo-radiation therapy for Hodgkin's lymphoma. Although endoscopy failed to demonstrate a gross morphologic abnormality, an esophagogram detected abnormal peristalsis and stricture, and esophageal manometry coupled with dynamic isotopic study clearly demonstrated a multilevel secondary neuronal damage. Data in the literature suggest that alteration in motility is by far the most frequent radiologic manifestation. Further prospective studies will probably clarify the actual incidence of late esophageal damage after chemo-radiation therapy.

  1. Acute Esophageal Necrosis: An Uncommon Cause of Hematemesis

    PubMed Central

    Zacharia, George Sarin; Sandesh, K; Ramachandran, TM

    2014-01-01

    Acute esophageal necrosis or black esophagus is an uncommon clinical entity, diagnosed at the upper gastrointestinal endoscopy with the presence of strikingly black necrotic esophagus. Very often no definite etiology will be identified even though a large list of potential associations has been postulated. Upper gastrointestinal bleeding is the most common clinical presentation, others being epigastric pain, retrosternal chest discomfort and dysphagia. Only about a hundred cases of acute esophageal necrosis have been described in medical literature till this date. We report a case of acute esophageal necrosis in an elderly female who had presented with hematemesis. PMID:25170416

  2. [Advances in the research of scar stricture after esophageal burn].

    PubMed

    Zhao, Shi-lei; Gu, Chun-dong

    2013-10-01

    Caustic esophageal burn is a common ailment in clinical practice. In some patients, scar stricture was formed in the late stage of injury, and it seriously undermined quality of life of the patients. We adopted various clinical interventions at an early stage in order to relieve and alleviate the formation and development of corrosive esophageal stricture as a result of chemical injury as well as to avoid invasive operations to make it more acceptable for the patients. This article summarized the progress in etiology, pathological changes, identification, early prevention, and surgical management of corrosive esophageal stricture. PMID:24360005

  3. A Japanese case series of 12 patients with esophageal eosinophilia

    Microsoft Academic Search

    Yasuhiko AbeKatsunori; Katsunori Iijima; Shuichi Ohara; Tomoyuki Koike; Nobuyuki Ara; Kaname Uno; Naoki Asano; Akira Imatani; Katsuaki Kato; Daisuke Shibuya; Tooru Shimosegawa

    2011-01-01

    Background  Eosinophilic esophagitis (EoE) has been a rarely recognized condition in Asian populations, and its clinical manifestation\\u000a is rarely documented. Our aim was to describe clinically, endoscopically, and pathologically the features of patients with\\u000a esophageal eosinophilia, including EoE.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Twelve patients histologically proven to have esophageal eosinophilia were investigated. The histological diagnostic cutoff\\u000a value was defined as a peak of ?15 eosinophils\\/high-power

  4. Genetic landscape of esophageal squamous cell carcinoma.

    PubMed

    Gao, Yi-Bo; Chen, Zhao-Li; Li, Jia-Gen; Hu, Xue-Da; Shi, Xue-Jiao; Sun, Zeng-Miao; Zhang, Fan; Zhao, Zi-Ran; Li, Zi-Tong; Liu, Zi-Yuan; Zhao, Yu-Da; Sun, Jian; Zhou, Cheng-Cheng; Yao, Ran; Wang, Su-Ya; Wang, Pan; Sun, Nan; Zhang, Bai-Hua; Dong, Jing-Si; Yu, Yue; Luo, Mei; Feng, Xiao-Li; Shi, Su-Sheng; Zhou, Fang; Tan, Feng-Wei; Qiu, Bin; Li, Ning; Shao, Kang; Zhang, Li-Jian; Zhang, Lan-Jun; Xue, Qi; Gao, Shu-Geng; He, Jie

    2014-10-01

    Esophageal squamous cell carcinoma (ESCC) is one of the deadliest cancers. We performed exome sequencing on 113 tumor-normal pairs, yielding a mean of 82 non-silent mutations per tumor, and 8 cell lines. The mutational profile of ESCC closely resembles those of squamous cell carcinomas of other tissues but differs from that of esophageal adenocarcinoma. Genes involved in cell cycle and apoptosis regulation were mutated in 99% of cases by somatic alterations of TP53 (93%), CCND1 (33%), CDKN2A (20%), NFE2L2 (10%) and RB1 (9%). Histone modifier genes were frequently mutated, including KMT2D (also called MLL2; 19%), KMT2C (MLL3; 6%), KDM6A (7%), EP300 (10%) and CREBBP (6%). EP300 mutations were associated with poor survival. The Hippo and Notch pathways were dysregulated by mutations in FAT1, FAT2, FAT3 or FAT4 (27%) or AJUBA (JUB; 7%) and NOTCH1, NOTCH2 or NOTCH3 (22%) or FBXW7 (5%), respectively. These results define the mutational landscape of ESCC and highlight mutations in epigenetic modulators with prognostic and potentially therapeutic implications. PMID:25151357

  5. Electrodes for long-term esophageal electrocardiography.

    PubMed

    Niederhauser, Thomas; Haeberlin, Andreas; Marisa, Thanks; Jungo, Michael; Goette, Josef; Jacomet, Marcel; Abacherli, Roger; Vogel, Rolf

    2013-09-01

    The emerging application of long-term and high-quality ECG recording requires alternative electrodes to improve the signal quality and recording capability of surface skin electrodes. The esophageal ECG has the potential to overcome these limitations but necessitates novel recorder and lead designs. The electrode material is of particular interest, since the material has to ensure conflicting requirements like excellent biopotential recording properties and inertness. To this end, novel electrode materials like PEDOT and silver-PDMS as well as established electrode materials such as stainless steel, platinum, gold, iridium oxide, titanium nitride, and glassy carbon were investigated by long-term electrochemical impedance spectroscopy and model-based signal analysis using the derived in vitro interfacial properties in conjunction with a dedicated ECG amplifier. The results of this novel approach show that titanium nitride and iridium oxide featuring microstructured surfaces did not degrade when exposed to artificial acidic saliva. These materials provide low electrode potential drifts and insignificant signal distortion superior to surface skin electrodes making them compatible with accepted standards for ambulatory ECG. They are superior to the noble and polarizable metals such as platinum, silver, and gold that induced more signal distortions and are superior to esophageal stainless steel electrodes that corrode in artificial saliva. The study provides rigorous criteria for the selection of electrode materials for prolonged ECG recording by combining long-term in vitro electrode material properties with ECG signal quality assessment. PMID:23649132

  6. Targeting AMCase reduces esophageal eosinophilic inflammation and remodeling in a mouse model of egg induced eosinophilic esophagitis

    PubMed Central

    Cho, Jae Youn; Rosenthal, Peter; Miller, Marina; Pham, Alexa; Aceves, Seema; Sakuda, Shohei; Broide, David H

    2014-01-01

    Studies of AMCase inhibition in mouse models of lung eosinophilic inflammation have produced conflicting results with some studies demonstrating inhibition of eosinophilic inflammation and others not. No studies have investigated the role of AMCase inhibition in eosinophilic esophagitis (EoE). We have used a mouse model of egg (OVA) induced EoE to determine whether pharmacologic inhibition of AMCase with allosamidin reduced eosinophilic inflammation and remodeling in the esophagus in EoE. Administration of intra-esophageal OVA for 6 weeks to BALB/c mice induced increased levels of esophageal eosinophils, mast cells, and features of esophageal remodeling (fibrosis, basal zone hyperplasia, deposition of the extracellular matrix protein fibronectin). Administration of intraperitoneal (ip) allosamidin to BALB/c mice significantly inhibited AMCase enzymatic activity in the esophagus. Pharmacologic inhibition of AMCase with ip allosamidin inhibited both OVA induced increases in esophageal eosinophilic inflammation and OVA induced esophageal remodeling (fibrosis, epithelial basal zone hyperplasia, extracellular matrix deposition of fibronectin). This inhibition of eosinophilic inflammation in the esophagus by ip allosamidin was associated with reduced eotaxin-1 expression in the esophagus. Oral allosamidin inhibited eosinophilic inflammation in the epithelium but did not inhibit esophageal remodeling. These studies suggest that pharmacologic inhibition of AMCase results in inhibition of eosinophilic inflammation and remodeling in the esophagus in a mouse model of egg induced EoE partially through effects in the esophagus on reducing chemokines (i.e. eotaxin-1) implicated in the pathogenesis of EoE. PMID:24239745

  7. In vitro release testing of matrices based on starch-methyl methacrylate copolymers: effect of tablet crushing force, dissolution medium pH and stirring rate.

    PubMed

    Ferrero, C; Jiménez-Castellanos, M R

    2014-01-30

    Direct-compressed matrix tablets were obtained from a variety of potato starch-methyl methacrylate copolymers(1) as sustained-release agents, using anhydrous theophylline as a model drug. The aim of this work was to investigate the influence of the copolymer type, the tablet crushing force and dissolution variables such as the pH of the dissolution medium and the agitation intensity on the in vitro drug release behaviour of such matrices. Commercial sustained-release theophylline products (Theo-Dur(®) 100mg, Theolair(®) 175 mg) were used as standards. Test formulations were compacted into tablets at three different crushing force ranges (70-80, 90-100 and 110-120 N) to examine the effect of this factor on the porous network and drug release kinetics. In vitro release experiments were conducted in a pH-changing medium (1.2-7.5) with basket rotation speeds in the range 25-100 r.p.m. to simulate the physiological conditions of the gastrointestinal tract. The release rate of theophylline was practically not affected by pH in the case of Theo-Dur(®) and HSMMA matrices. In contrast, Theolair(®) and CSMMA tablets demonstrated a biphasic drug release pattern, which appeared to be sensitive to the pH of the dissolution medium. An increase in the crushing force of the copolymer matrices was accompanied by a reduction of the matrix porosity, although the porous network depends markedly on the type of copolymer, having a strong influence on the drug release kinetics. Mathematical modelling of release data shows a Fickian diffusion or anomalous transport mechanism. Based on the similarity factor f2, FD-HSMMA, OD-CSMMA and FD-CSMMA at 90-100 N were selected for agitation studies. In general, all formulations showed an agitation speed-dependent release, with Theo-Dur(®) and FD-CSMMA matrices being the less susceptible to this factor. PMID:24333902

  8. CDX2 protein expression compared to alcian blue staining in the evaluation of esophageal intestinal metaplasia

    PubMed Central

    Johnson, Dennis R; Abdelbaqui, Maisoun; Tahmasbi, Maryam; Mayer, Zoltan; Lee, Hung-Wei; Malafa, Mokenge P; Coppola, Domenico

    2015-01-01

    AIM: To compare the sensitivity and specificity of CDX2 and alcian blue (AB) pH 2.5 staining in identifying esophageal intestinal metaplasia. METHODS: One hundred and ninty-nine biopsies from 186 patients were retrospectively reviewed and categorized as Barrett’s esophagus (BE) (n = 108); non-Barrett’s esophagus (NBE) (n = 48); columnar blue cells (CB) and esophageal glands (EG) (n = 43). The biopsies were stained with AB and immunostained for CDX2 using a mouse monoclonal antibody from Biogenex (clone CDX2-88) and the Ventana Discovery X automated immunostainer. The positive and negative predictive value of each group was used to determine the predictive power of CDX2 and AB in diagnosing intestinal metaplasia. RESULTS: All of the 108 BE biopsies (100%) were positive for AB and 102 of them (94.4%) were positive for CDX2. The six BE patients (5.6%) who failed to stain with CDX2 were found to have lost the focus of intestinal metaplasia upon deeper sectioning for immunostaining. Both AB and CDX2 were negative in 43 out of 48 (89.6%) NBE cases. Five NBE patients (10.4%) were falsely positive for AB due to the presence of EG and CB in these biopsies. These cases were all CDX2 negative. In addition, 5 AB negative NBE were found to be CDX2 positive. Based on these results the CDX2 immunostain had similar sensitivity but higher specificity (100% vs about 91%) than AB in detecting intestinal type metaplasia in these samples. Our data shows that CDX2 has a better PPV in detecting intestinal metaplasia as compared to AB (95.6% vs 71.5%, respectively). CONCLUSION: CDX2 has a better positive predictive value than AB in detecting intestinal metaplasia. CDX2 may be useful when challenged by gastro-esophageal biopsies containing mimikers of BE. PMID:25759548

  9. [Esophageal diseases: gastroesophageal reflux disease, Barrett's esophagus, achalasia and eosinophilic esophagitis].

    PubMed

    Calvet, Xavier; Villoria, Albert

    2013-10-01

    Important new advances were presented in esophageal disease in Digestive Disease Week 2013. A highlight was confirmation of the high efficacy of weight loss to treat symptoms of reflux and an interesting pilot study suggesting that a simple ligature with supra- and infracardial bands could be an effective technique in esophageal reflux. If the excellent results and safety and efficacy of this technique are confirmed in the long term, it could revolutionize the management of gastroesophageal reflux disease. Also of note this year was the presentation of multiple studies validating a new technique, peroral endoscopic myotomy (POEM) for the endoscopic treatment of achalasia. This technique seems to have excellent efficacy and safety. PMID:24160952

  10. Management of tracheoesophageal fistula as a complication of esophageal dilatations in caustic esophageal burns

    Microsoft Academic Search

    Oktay Mutaf; Ali Avano?lu; Aydin Mevsim; Geylani Özok

    1995-01-01

    The authors report on eight patients with caustic esophageal burns in whom tracheoesophageal fistula (TEF) developed during dilatation programs. This study covered a period of 17 years between 1975 and 1992. The age of the patients ranged from 1.5 to 8 years (mean age, 3.4 years). TEF developed after 5 to 43 months after injury (mean, 20.05 months). In each

  11. Bullous Systemic Lupus Erythematosus Associated with Esophagitis Dissecans Superficialis

    PubMed Central

    Jaffe, Eric A.

    2015-01-01

    Bullous systemic lupus erythematosus is one of the rare autoantibody mediated skin manifestation of systemic lupus erythematosus (SLE) demonstrating subepidermal blistering with neutrophilic infiltrate histologically. We present a case of a 40-year-old Hispanic female who presented with a several months' history of multiple blistering pruritic skin lesions involving the face and trunk, a photosensitive rash over the face and neck, swelling of the right neck lymph node, and joint pain involving her elbows and wrist. Her malady was diagnosed as bullous systemic lupus erythematosus based on the immunological workup and biopsy of her skin lesions. The patient also complained of odynophagia and endoscopy revealed esophagitis dissecans superficialis which is a rare endoscopic finding characterized by sloughing of the esophageal mucosa. The bullous disorders typically associated with esophagitis dissecans superficialis are pemphigus and rarely bullous pemphigoid. However, this is the first reported case of bullous systemic lupus erythematosus associated with esophagitis dissecans superficialis. PMID:25821624

  12. Esophageal Involvement of Pemphigus Vulgaris Associated with Upper Gastrointestinal Bleeding

    PubMed Central

    Chang, Sooyun; Kim, Sun Wook; Jin, Moo-Nyun; Lee, Jung-Hee; Kim, Hyun Ju; Hong, Sung Pil; Kim, Tae Il

    2014-01-01

    Esophageal involvement of pemphigus vulgaris is rare, and when present, the most common presenting symptoms reported in the medical literature are odynophagia and dysphagia. Here, we present two cases of pemphigus vulgaris presenting with upper gastrointestinal hemorrhage because of esophageal involvement of the disease. In case 1, a 41-year-old female patient with a prior diagnosis of pemphigus vulgaris presented with hematemesis. Esophagogastroduodenoscopy showed diffuse mucosal exfoliation and oozing bleeding of the oropharynx and esophagus. The patient recovered after the administration of high-dose corticosteroids and immunosuppressants. In case 2, a 30-year-old female patient with known pemphigus vulgaris also presented with hematemesis, showing similar endoscopic findings to the first case. She also responded to the same treatment. Esophageal involvement of pemphigus vulgaris responds to high-dose corticosteroids and immunosuppressants. Thus, in patients with pemphigus vulgaris with signs or symptoms of upper gastrointestinal bleeding, an early endoscopy for the evaluation of esophageal involvement is beneficial. PMID:25325007

  13. Endoscopic approaches for early-stage esophageal cancer: current options.

    PubMed

    Patel, Vaishali; Burbridge, Rebecca A

    2015-01-01

    Early esophageal cancer is confined to the mucosa or submucosa of the esophagus. While most esophageal cancer is detected at an advanced stage (requiring surgical resection, chemotherapy, and radiation), early-stage mucosal lesions may be detected through Barrett's surveillance programs or incidentally on diagnostic upper endoscopies performed for other reasons. These early-stage cancers are often amenable to endoscopic therapies, including mucosal resection, ablation, and cryotherapy. Studies suggest equivalent survival rates and reduced morbidity but higher recurrence rates with endoscopic removal of early-stage cancers compared to surgical resection. There is emerging data regarding the efficacy and long-term outcomes of endoscopic therapy for early esophageal cancer that is promising, and further research is needed to better define the role of endoscopic therapy in the management of early esophageal cancer. PMID:25416315

  14. Surgical indications and optimization of patients for resectable esophageal malignancies

    PubMed Central

    Grimm, Joshua C.; Valero, Vicente

    2014-01-01

    Esophageal cancer is a devastating diagnosis with very dire long-term survival rates. This is largely due to its rather insidious progression, which leads to most patients being diagnosed with advanced disease. Recently, however, a greater understanding of the pathogenesis of esophageal malignancies has afforded surgeons and oncologists with new opportunities for intervention and management. Coupled with improvements in imaging, staging, and medical therapies, surgeons have continued to enhance their knowledge of the nuances of esophageal resection, which has resulted in the development of minimally invasive approaches with similar overall oncologic outcomes. This marriage of more efficacious induction therapy and diminished morbidity after esophagectomy offers new promise to patients diagnosed with this aggressive form of cancer. The following review will highlight these most recent advances and will offer insight into our own approach to patients with resectable esophageal malignancy. PMID:24624289

  15. Reflux esophagitis in war-related sulfur mustard lung disease

    PubMed Central

    Roushan, Nader; Zali, Fateme; Abtahi, Hamidreza; Asadi, Mehrnaz; Taslimi, Reza; Aletaha, Najme

    2014-01-01

    Background Sulfur mustard (SM) has acute and chronic effects on skin and mucosal surfaces. The aim of the study was to evaluate the frequency of esophagitis in a historical cohort of veterans who had been exposed to SM in Iran-Iraq war nearly 25 years ago. Methods: One hundred two veterans with dyspepsia and/or heartburn underwent esophago-gastroduodenoscopy. Of them, 52 cases had been exposed to SM and had chronic mustard lung disease. Controls included 50 veterans without SM exposure. Esophagitis was defined according to standard criteria. Results: 81.6% of cases and 70.6% of controls had heart burn and/or regurgitation (p= 0.224). Esophagitis was seen in 40% of cases and 26.5% of controls (p= 0.155). Conclusion: Based on our findings, SM exposure seems not to be associated with increased esophagitis. PMID:25250271

  16. Fatal aorto-esophageal fistula in child: a case report.

    PubMed

    Pehlivan, Sultan; Kara, Dogus Ozdemir; Turkkan, Dilhan; Akçan, Ramazan; Gokmen, Asude; Akduman, Baris; Karapirli, Mustafa

    2014-02-01

    Esophageal foreign body ingestion is especially frequent in childhood and may cause fatal complications in case of late diagnosis and delayed treatment. We present a case of 2-year old girl who was admitted to emergency department with massive bleeding. However, she died due to an unrecognized foreign body resulted an aorto-esophageal fistula. At autopsy an aorto-esophageal fistula was detected by gross examination. Tissue samples were obtained from the organs and fistula region. In histopathological examination, a calcified body with multinucleated giant cell and surrounding granulation tissue was detected at the bleeding site. An ulcerated fistula tract ran from the intima to the adventitia, passing through layers of esophageal wall was also noticed. The mortality rate for foreign body ingestion is less than 1%, except in cases of perforation. Therefore the presented case is among rare examples of fatal foreign body ingestions. PMID:24485434

  17. Notch signaling drives stemness and tumorigenicity of esophageal adenocarcinoma.

    PubMed

    Wang, Zhiqiang; Da Silva, Thiago G; Jin, Ke; Han, Xiaoqing; Ranganathan, Prathibha; Zhu, Xiaoxia; Sanchez-Mejias, Avencia; Bai, Feng; Li, Bin; Fei, Dennis Liang; Weaver, Kelly; Carpio, Rodrigo Vasquez-Del; Moscowitz, Anna E; Koshenkov, Vadim P; Sanchez, Lilly; Sparling, Lynne; Pei, Xin-Hai; Franceschi, Dido; Ribeiro, Afonso; Robbins, David J; Livingstone, Alan S; Capobianco, Anthony J

    2014-11-01

    Esophageal adenocarcinoma ranks sixth in cancer mortality in the world and its incidence has risen dramatically in the Western population over the last decades. Data presented herein strongly suggest that Notch signaling is critical for esophageal adenocarcinoma and underlies resistance to chemotherapy. We present evidence that Notch signaling drives a cancer stem cell phenotype by regulating genes that establish stemness. Using patient-derived xenograft models, we demonstrate that inhibition of Notch by gamma-secretase inhibitors (GSI) is efficacious in downsizing tumor growth. Moreover, we demonstrate that Notch activity in a patient's ultrasound-assisted endoscopic-derived biopsy might predict outcome to chemotherapy. Therefore, this study provides a proof of concept that inhibition of Notch activity will have efficacy in treating esophageal adenocarcinoma, offering a rationale to lay the foundation for a clinical trial to evaluate the efficacy of GSI in esophageal adenocarcinoma treatment. PMID:25164006

  18. Variability in Diagnostic Criteria for Eosinophilic Esophagitis: A Systematic Review

    Microsoft Academic Search

    Evan S. Dellon; Ademola Aderoju; John T. Woosley; Robert S. Sandler; Nicholas J. Shaheen

    2007-01-01

    BACKGROUND:Eosinophilic esophagitis (EoE) is an emerging clinicopathologic entity defined by abnormal esophageal eosinophilic infiltration. Our understanding of this disease is hampered by the lack of a uniform diagnostic standard. The aim of this systematic review was to determine the range of diagnostic strategies and histologic criteria in the EoE literature.METHODS:The MEDLINE-indexed literature from 1950 through December 31, 2006 was independently

  19. Helicobacter pylori infection inhibits reflux esophagitis by inducing atrophic gastritis

    Microsoft Academic Search

    Tomoyuki Koike; Shuichi Ohara; Hitoshi Sekine; Katsunori Iijima; Katsuaki Kato; Tooru Shimosegawa; Takayoshi Toyota

    1999-01-01

    OBJECTIVE:Although it is widely accepted that Helicobacter pylori (H. pylori) infection is an important cause of atrophic gastritis, few studies have examined the relationship between H. pylori-induced atrophic gastritis and the occurrence of reflux esophagitis. The present study was aimed to examine the relationship between H. pylori infection, atrophic gastritis, and reflux esophagitis in Japan.METHODS:A total of 175 patients with

  20. Changing pattern of esophageal cancer incidence in New Mexico

    Microsoft Academic Search

    Kenneth J Vega; M Mazen Jama

    2000-01-01

    OBJECTIVE:Multiple reports indicate that esophageal adenocarcinoma incidence has increased during the past 20 yr, especially in non-Hispanic white men. We retrospectively reviewed adenocarcinoma and squamous cell carcinoma cases in our heterogeneous state population to determine the effect of ethnicity on histology.METHODS:We searched the New Mexico Tumor Registry for all cases of esophageal cancer from 1973 to 1997. Inclusion criteria included

  1. Atypical presentation of an impacted radiolucent esophageal foreign body

    Microsoft Academic Search

    Tariq Parray; Sonia Shah; Jesus S. Apuya; Shailesh Shah

    2010-01-01

    Patients with impacted esophageal foreign bodies usually present with gastrointestinal and rarely with respiratory symptoms.\\u000a Impacted esophageal foreign bodies may be identified by radiologic studies. Ingested radiolucent foreign bodies may be more\\u000a difficult to diagnose, especially if the patient presents with minimal symptoms. We report a rare case of a child who presented\\u000a with stridor and obstructive sleep apnea. The

  2. Esophageal foreign bodies: Types and techniques for removal

    Microsoft Academic Search

    Milton T. Smith; Roy K. H. Wong

    2006-01-01

    Opinion statement  Patients with esophageal foreign bodies require prompt diagnosis and therapy. The first tasks are to determine the type of\\u000a object, time since ingestion, location of the object, and the likelihood of associated complications. Patients who have evidence\\u000a of complete esophageal occlusion or who have ingested a sharp or pointed object require urgent treatment due to the increased\\u000a risk of

  3. [Efficacy of sorption therapy in patients with cicatricial esophageal stenosis].

    PubMed

    Chikinev, Iu V; Antonov, A R; Korobe?nikov, A V

    2006-01-01

    We examined 110 patients treated conservatively for cicatricial esophageal stenosis including expansion on the string. The patients were divided into three groups: controls (n = 35), receiving adjuvant SUMS-1 (n = 38) and given adjuvant enterosgel (n = 37). According to electron microscopy, enterosorbents make esophageal mucosa denser by decreasing interstitial spaces as a result of microcirculatory improvement and reduction of edema. Enterosorbents elevate total protein and sugar in the blood. PMID:17002045

  4. Esophageal Gastrointestinal Stromal Tumors Presenting as Mediastinal Mass

    PubMed Central

    Kafeel, M.; Cheedella, N.K.S.; Wang, J.C.

    2013-01-01

    Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract and are predominant in the stomach and intestine but rare in the esophagus. Here, we report a case of esophageal GIST which presented as a mediastinal mass on chest X-ray and dyspnea. The case was initially diagnosed as leiomyosarcoma, which could create a diagnostic dilemma. Therefore, recognizing this uncommon presentation as a mediastinal mass with esophageal GIST is important in the differential diagnosis. PMID:24348397

  5. Mechanics and hemodynamics of esophageal varices during peristaltic contraction.

    PubMed

    Miller, Larry S; Kim, Joseph K; Dai, Qing; Mekapati, Jyothi; Izanec, James; Chung, Chan; Liu, Ji-Bin; Sanderson, Andrew; Bohning, Matt; Desipio, Josh; Gandegok, Jasneet; Harberson, Justin J; Schneck, Carson; Nicosia, Mark A; Thangada, Vinod; Thomas, Beje; Copeland, Brian; Miller, Elan; Miller, Aaron; Ahmed, Naji; Brasseur, James G

    2004-10-01

    Our hypothesis states that variceal pressure and wall tension increase dramatically during esophageal peristaltic contractions. This increase in pressure and wall tension is a natural consequence of the anatomy and physiology of the esophagus and of the esophageal venous plexus. The purpose of this study was to evaluate variceal hemodynamics during peristaltic contraction. A simultaneous ultrasound probe and manometry catheter was placed in the distal esophagus in nine patients with esophageal varices. Simultaneous esophageal luminal pressure and ultrasound images of varices were recorded during peristaltic contraction. Maximum variceal cross-sectional area and esophageal luminal pressures at which the varix flattened, closed, and opened were measured. The esophageal lumen pressure equals the intravariceal pressure at variceal flattening due to force balance laws. The mean flattening pressures (40.11 +/- 16.77 mmHg) were significantly higher than the mean opening pressures (11.56 +/- 25.56 mmHg) (P < or = 0.0001). Flattening pressures >80 mmHg were generated during peristaltic contractions in 15.5% of the swallows. Variceal cross-sectional area increased a mean of 41% above baseline (range 7-89%, P < 0.0001) during swallowing. The peak closing pressures in patients that experience future variceal bleeding were significantly higher than the peak closing pressures in patients that did not experience variceal bleeding (P < 0.04). Patients with a mean peak closing pressure >61 mmHg were more likely to bleed. In this study, accuracy of predicting future variceal bleeding, based on these criteria, was 100%. Variceal models were developed, and it was demonstrated that during peristaltic contraction there was a significant increase in intravariceal pressure over baseline intravariceal pressure and that the peak intravariceal pressures were directly proportional to the resistance at the gastroesophageal junction. In conclusion, esophageal peristalsis in combination with high resistance to blood flow through the gastroesophageal junction leads to distension of the esophageal varices and an increase in intravariceal pressure and wall tension. PMID:15361363

  6. Evaluation and treatment of primary esophageal motility disorders.

    PubMed Central

    Patti, M G; Way, L W

    1997-01-01

    Achalasia, diffuse esophageal spasm, and nutcracker esophagus constitute the main primary esophageal motility disorders. During the past decade major progress has been made in understanding their pathophysiology and in the ability to establish a precise diagnosis. In addition, minimally invasive surgical intervention has radically changed the therapeutic approach, and thoracoscopic or laparoscopic myotomy is probably the best treatment for most patients. Images Figure 1. PMID:9168684

  7. Chemopreventive effects of tolfenamic acid against esophageal tumorigenesis in rats

    Microsoft Academic Search

    Pius Maliakal; Maen Abdelrahim; Umesh T. Sankpal; Cima Maliakal; Cheryl H. Baker; Stephen Safe; Luis J. Herrera; Ala Abudayyeh; Sumanth Kaja; Riyaz Basha

    Summary  The primary objective of this study is to identify small molecules that target critical transcription factors for potential\\u000a application in the chemoprevention of esophageal cancer. Specificity proteins (Sp) play a critical role in the growth and\\u000a metastasis of several malignancies including esophageal cancer. Researchers at the M. D. Anderson Cancer Center Orlando Cancer\\u000a Research Institute have reported previously that tolfenamic

  8. Drug-induced esophagitis detected by double-contrast radiography

    SciTech Connect

    Creteur, V. (Hospital of the Univ. of Pennsylvania, Philadelphia); Laufer, I.; Kressel, H.Y.; Caroline, D.F.; Goren, R.A.; Evers, K.A.; Glick, S.N.; Gatenby, R.A.

    1983-05-01

    Patients with esophageal symptoms following drug ingestion underwent double-contrast upper gastrointestinal studies, and radiographic findings are described. Superficial esophageal ulceration and subtle mucosal abnormalities, which have not been seen on single-contrast radiographs, were confirmed on double-contrast radiographs. Erosions or ulcers usually occur in the region of the aortic arch and occasionally lower in the esophagus. Repeat esophagrams after withdrawal of the medication indicate resolution of the symptoms.

  9. Free radical scavengers prevent reflux esophagitis in rats

    Microsoft Academic Search

    Gerold J. Wetscher; Paul R. Hinder; Debasis Bagchi; Galen Perdikis; Elizabeth J. Redmond; Karl Glaser; Thomas E. Adrian; Ronald A. Hinder

    1995-01-01

    Free radical damage in reflux esophagitis of rats induced by 24-hr duodenojejunal ligation was studied. Oxygen free radicals were selectively blocked. Groups were: sham operation, reflux, reflux+superoxide dismutase (SOD), catalse, dimethylthiourea, allopurinol, and inactivated SOD or inactivated catalase alone or in the combination SOD+catalase or SOD+catalase+dimethylthiourea+allopurinol. Macroscopic esophagitis was inhibited only by SOD, alone or in combination with other agents.

  10. Esophageal Surgery for Malignant Disease in the Elderly

    Microsoft Academic Search

    Philip A. Rascoe; John C. Kucharczuk

    \\u000a Neoplasms of the esophagus and gastroesophageal junction are aggressive tumors that often present at an advanced stage, and\\u000a that historically have been associated with poor survival despite therapy. 16,470 Americans are diagnosed with and 14,280\\u000a die of esophageal cancer annually, and the incidence is increasing. In fact, the incidence of esophageal adenocarcinoma (EAC)\\u000a has increased in the last 25 years,

  11. PAH exposure in esophageal tissue and risk of esophageal squamous cell carcinoma in northeastern Iran

    PubMed Central

    Abedi-Ardekani, Behnoush; Kamangar, Farin; Hewitt, Stephen M.; Hainaut, Pierre; Sotoudeh, Masoud; Abnet, Christian C.; Taylor, Philip R.; Boffetta, Paolo; Malekzadeh, Reza; Dawsey, Sanford M.

    2012-01-01

    Objective To evaluate the association of polycyclic aromatic hydrocarbon (PAH) exposure in esophageal epithelial tissue and esophageal squamous cell carcinoma (ESCC) case status in an ESCC case-control study in a high-risk population in northeastern Iran. Design Immunohistochemical staining of tissue microarrays (TMAs) of non-tumoral esophageal biopsies from ESCC cases and control subjects. Immunohistochemistry was performed using monoclonal antibodies 8E11 and 5D11, raised against benzo[a]pyrene (B[a]P) diol epoxide (BPDE)-I-modified guanosine and BPDE-I-modified DNA, respectively. Staining intensity was quantified by image analysis, and the average staining in three replicates was calculated. Setting Rural region in northeastern Iran. Participants Cases were patients with biopsy-proven ESCC. Controls were GI clinic patients with no endoscopic or biopsy evidence of ESCC. Main outcome measure Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) for the association between antibody staining intensity and ESCC case status. Results Cultured ESCC cells exposed to B[a]P in vitro showed dose-dependent staining with 8E11, but not with 5D11. With 8E11, sufficient epithelial tissue was available in the TMA cores to analyze 91 cases and 103 controls. Compared to the lowest quintile of 8E11 staining in the controls, adjusted ORs (95% CIs) for the 2nd to 5th quintiles were 2.42, 5.77, 11.3, and 26.6 (5.21–135), respectively (P for trend < 0.001). With 5D11, 89 cases and 101 controls were analyzed. No association between staining and case status was observed (ORs (95% CIs) for the 2nd to 5th quintiles were 1.26, 0.88, 1.06, and 1.63 (0.63–4.21), P for trend = 0.40). Conclusions Dramatically higher levels of 8E11 staining were observed in non-tumoral esophageal epithelium from ESCC patients than from control subjects. This finding strengthens the evidence for a causal role for PAHs in esophageal carcinogenesis in northeastern Iran. PMID:20584779

  12. Research advances in esophageal diseases: bench to bedside

    PubMed Central

    di Pietro, Massimiliano

    2013-01-01

    Over the last year, significant steps have been made toward understanding the pathogenesis of esophageal diseases and translating this knowledge to clinical practice. Gastroesophageal reflux disease (GERD) is the most common outpatient diagnosis in gastroenterology and has a high prevalence in the general population. As many as 40% of patients with GERD have incomplete response to medical therapy, and the pathophysiological mechanisms underlying lack of response are now better understood. Novel medical and minimally invasive interventions are available to optimize management of GERD. Esophageal cancer, regardless of the histological subtype, has among the worst survival statistics among all malignancies. Taking advantage of technological advances in genome sequencing, the mutational spectra in esophageal cancer are now emerging, offering novel avenues for targeted therapies. Early diagnosis is another strand for improving survival. While genome-wide association studies are providing insights into genetic susceptibility, novel approaches to early detection of cancer are being devised through the use of biomarkers applied to esophageal samples and as part of imaging technologies. Dysmotility and eosinophilic esophagitis are the differential diagnoses in patients with dysphagia. New pathophysiological classifications have improved the management of motility disorders. Meanwhile, exciting progress has been made in the endoscopic management of these conditions. Eosinophilic esophagitis is still a relatively new entity, and the pathogenesis remains poorly understood. However, it is now clear that an allergic reaction to food plays an important role, and dietary interventions as well as biologic agents to block the inflammatory cascade are novel, promising fields of clinical research. PMID:24167725

  13. Sentinel node navigation surgery in early-stage esophageal cancer.

    PubMed

    Takeuchi, Hiroya; Kawakubo, Hirofumi; Takeda, Flavio; Omori, Tai; Kitagawa, Yuko

    2012-01-01

    The sentinel node (SN) concept has revolutionized the surgical staging of both melanoma and breast cancer over the past two decades. However, the validity of the SN hypothesis has been controversial for esophageal cancer, because SN mapping for esophageal cancer is technically complicated, and the number of early-stage esophageal cancer is very limited. Nevertheless previous studies nicely demonstrated that SN mapping may be feasible in patients with early-stage esophageal cancer. Transthoracic extended esophagectomy with three-field radical lymph node dissection has been recognized as a curative procedure for thoracic esophageal cancer in Japan. However, uniform application of this highly invasive procedure might increase the morbidity and markedly reduce the quality of life (QOL) after surgery. Although further accumulation of evidence based on multicenter clinical trials using a standard protocol is needed, SN mapping and SN navigation surgery would provide significant information to perform individualized selective lymphadenectomy which might reduce the morbidity and retain the patients' QOL. In addition, technical innovation including the development of new tracers is expected to confirm the accuracy and reliability of SN mapping in esophageal cancer. PMID:22673610

  14. Anorectal Malformations Associated with Esophageal Atresia in Neonates

    PubMed Central

    Byun, Shin Yun; Lim, Ryoung Kyoung; Park, Kyung Hee; Kim, Hae Young

    2013-01-01

    Purpose Anorectal malformations are often associated with other anomalies, reporting frequency with 40-70%. Gastrointestinal anomalies have been known to be relatively less common than associated anomalies of other organ system. This study was performed to assess a distinctive feature of cases associated with esophageal atresia. Methods Clinical data (from January 2000 through December 2011) on the 196 subjects with anorectal malformations, managed in our Hospital, were reviewed. Total 14 neonates were identified with accompanying esophageal atresia and retrospective analysis was conducted. Results The incidence was 7.1% and there were 8 male and 6 female subjects. Only 2 cases were associated with esophageal atresia without tracheoesophageal fistula. Although variable cases of anorectal malformation in female subjects, almost cases were anorectal malformations with rectourethral fistula in male. Other associated anomalies were identified in all cases, with more than 3 anomalies in 10 cases. There were 4 VACTERL (Vertebral abnormalities, Anal atresia, Cardiac anomalies, Tracheoesophageal fistula, Esophageal atresia, Renal and Limb anomalies) associations accounting for 28.6%, but could not identify chromosomal anomaly. Most cases were managed with staged procedure, usually primary repair of esophageal atresia and diverting colostomy. Overall mortality rate was 21.4%, mainly caused by heart problems. Conclusion This study shows that early diagnosis and rational surgical approach with multidisciplinary plan are mandatory in managing anorectal malformations with esophageal atresia, when considering a high frequency of associated anomaly and a relative high mortality. PMID:24010103

  15. The effects of assay temperature upon the pH optima of enzymes from poikilotherms: A test of the imidazole alphastat hypothesis

    Microsoft Academic Search

    J. R. Hazel; W. S. Garlick; P. A. Sellner

    1978-01-01

    The effects of assay temperature and pH upon the activities of acetyl CoA carboxylase, fatty acid synthetase, NADH- and succinate-cytochrome c reductases, and NADH-ferricyanide reductase were examined in tissues of rainbow trout. In all cases pH optima shifted to alkaline pH values as the assay temperature was reduced. For trout liver acetyl CoA carboxylase the pH optimum increased from 6.8

  16. Appropriateness of Using Patient-Derived Xenograft Models for Pharmacologic Evaluation of Novel Therapies for Esophageal/Gastro-Esophageal Junction Cancers

    PubMed Central

    Dodbiba, Lorin; Teichman, Jennifer; Fleet, Andrew; Thai, Henry; Starmans, Maud H. W.; Navab, Roya; Chen, Zhuo; Girgis, Hala; Eng, Lawson; Espin-Garcia, Osvaldo; Shen, Xiaowei; Bandarchi, Bizhan; Schwock, Joerg; Tsao, Ming-Sound; El-Zimaity, Hala; Der, Sandy D.; Xu, Wei; Bristow, Robert G.; Darling, Gail E.; Boutros, Paul C.

    2015-01-01

    The high morbidity and mortality of patients with esophageal (E) and gastro-esophageal junction (GEJ) cancers, warrants new pre-clinical models for drug testing. The utility of primary tumor xenografts (PTXGs) as pre-clinical models was assessed. Clinicopathological, immunohistochemical markers (p53, p16, Ki-67, Her-2/neu and EGFR), and global mRNA abundance profiles were evaluated to determine selection biases of samples implanted or engrafted, compared with the underlying population. Nine primary E/GEJ adenocarcinoma xenograft lines were further characterized for the spectrum and stability of gene/protein expression over passages. Seven primary esophageal adenocarcinoma xenograft lines were treated with individual or combination chemotherapy. Tumors that were implanted (n=55) in NOD/SCID mice had features suggestive of more aggressive biology than tumors that were never implanted (n=32). Of those implanted, 21/55 engrafted; engraftment was associated with poorly differentiated tumors (p=0.04) and older patients (p=0.01). Expression of immunohistochemical markers were similar between patient sample and corresponding xenograft. mRNA differences observed between patient tumors and first passage xenografts were largely due to loss of human stroma in xenografts. mRNA patterns of early vs late passage xenografts and of small vs large tumors of the same passage were similar. Complete resistance was present in 2/7 xenografts while the remaining tumors showed varying degrees of sensitivity, that remained constant across passages. Because of their ability to recapitulate primary tumor characteristics during engraftment and across serial passaging, PTXGs can be useful clinical systems for assessment of drug sensitivity of human E/GEJ cancers. PMID:25826681

  17. GWAS identifies four novel eosinophilic esophagitis loci.

    PubMed

    Sleiman, Patrick M A; Wang, Mei-Lun; Cianferoni, Antonella; Aceves, Seema; Gonsalves, Nirmala; Nadeau, Kari; Bredenoord, Albert J; Furuta, Glenn T; Spergel, Jonathan M; Hakonarson, Hakon

    2014-01-01

    Eosinophilic esophagitis (EoE) is an allergic disorder characterized by infiltration of the oesophagus with eosinophils. We had previously reported association of the TSLP/WDR36 locus with EoE. Here we report genome-wide significant associations at four additional loci; c11orf30 and STAT6, which have been previously associated with both atopic and autoimmune diseases, and two EoE-specific loci, ANKRD27 that regulates the trafficking of melanogenic enzymes to epidermal melanocytes and CAPN14, that encodes a calpain whose expression is highly enriched in the oesophagus. The identification of five EoE loci, not only expands our aetiological understanding of the disease but may also represent new therapeutic targets to treat the most debilitating aspect of EoE, oesophageal inflammation and remodelling. PMID:25407941

  18. Gastro-esophageal Reflux Disease (GERD)

    NSDL National Science Digital Library

    Patient Education Institute

    This patient education program discusses Gastro-Esophageal Reflux Disease, or GERD, including the anatomy of the digestive system, causes and effects, signs and symptoms, possible complications, and treatment options for GERD with their benefits and side effects. This resource is a MedlinePlus Interactive Health Tutorial from the National Library of Medicine, designed and developed by the Patient Education Institute. NOTE: This tutorial requires a special Flash plug-in, version 4 or above. If you do not have Flash, you will be prompted to obtain a free download of the software before you start the tutorial. You will also need an Acrobat Reader, available as a free download, in order to view the Reference Summary.

  19. Context-dependent adaption of EpCAM expression in early systemic esophageal cancer.

    PubMed

    Driemel, C; Kremling, H; Schumacher, S; Will, D; Wolters, J; Lindenlauf, N; Mack, B; Baldus, S A; Hoya, V; Pietsch, J M; Panagiotidou, P; Raba, K; Vay, C; Vallböhmer, D; Harréus, U; Knoefel, W T; Stoecklein, N H; Gires, O

    2014-10-01

    The role of the epithelial cell adhesion molecule EpCAM in cancer progression remains largely unclear. High expression of EpCAM in primary tumors is often associated with more aggressive phenotypes and EpCAM is the prime epithelial antigen in use to isolate circulating tumor cells (CTCs) and characterize disseminated tumor cells (DTCs). However, reduced expression of EpCAM was associated with epithelial-to-mesenchymal transition (EMT) and reports on a lack of EpCAM on CTCs emerged. These contradictory observations might reflect a context-dependent adaption of EpCAM expression during metastatic progression. To test this, EpCAM expression was monitored in esophageal cancer at different sites of early systemic disease. Although most of the primary esophageal tumors expressed high levels of EpCAM, the majority of DTCs in bone marrow lacked EpCAM. In vitro, downregulation of EpCAM expression at the plasma membrane was observed in migrating and invading cells, and was associated with a partial loss of the epithelial phenotype and with significantly decreased proliferation. Accordingly, induction of EMT through the action of TGF? resulted in substantial loss of EpCAM cell surface expression on esophageal cancer cells. Knock-down or natural loss of EpCAM recapitulated these effects as it reduced proliferation while enhancing migration and invasion of cancer cells. Importantly, expression of EpCAM on DTCs was significantly associated with the occurrence of lymph node metastases and with significantly decreased overall survival of esophageal cancer patients. We validated this observation by showing that high expression of EpCAM promoted tumor outgrowth after xenotransplantation of esophageal carcinoma cells. The present data disclose a dynamic expression of EpCAM throughout tumor progression, where EpCAM(high) phenotypes correlate with proliferative stages, whereas EpCAM(low/negative) phenotypes associated with migration, invasion and dissemination. Thus, differing expression levels of EpCAM must be taken into consideration for therapeutic approaches and during clinical retrieval of disseminated tumor cells. PMID:24141784

  20. Influence of Ionizing Radiation on Stromal-Epithelial Intercellular Communication in Esophageal Carcinogenesis

    NASA Technical Reports Server (NTRS)

    Patel, Zarana S.; Kalabis, Jiri; Rustgi, Anil K.; Cucinotta, Francis A.; Huff, Janice L.

    2010-01-01

    Esophageal cancer is the 6th leading cause of cancer death worldwide. Its development is associated with a variety of risk factors including tobacco use, heavy alcohol consumption, human papilloma virus infection, and certain dietary factors such as trace mineral and vitamin deficiencies. An association with ionizing radiation exposure is revealed by the high excess relative risk for squamous cell carcinoma of the esophagus observed in the survivors of the atomic bomb detonations in Japan. It is also seen as a secondary malignancy in patients who received radiotherapy for breast and thoracic cancers; additionally, patients with head/neck and oral squamous cell cancers are at increased risk for metachronous esophageal squamous cell cancers. This malignancy is rapidly fatal, mainly because it remains asymptomatic until late, advanced stages when the disease is rarely curable. The stromal microenvironment plays an essential role in the maintenance and modulation of normal epithelial cell growth and differentiation and cross talk between the epithelial and stromal compartments can influence many aspects of malignant progression, including tumor cell proliferation, migration, invasion and recruitment of new blood vessels. To test the hypothesis that radiation exposure plays a role in esophageal carcinogenesis via non-targeted mechanisms involving stromal-epithelial cell communication, we are studying radiation effects on hTERT-immortalized human esophageal epithelial cells and genetic variants grown in co-culture with human esophageal stromal fibroblasts (Okawa et al., Genes & Dev. 2007. 21: 2788-2803). We examined how radiation treatment of stromal fibroblasts affected epithelial migration and invasion, behaviors associated with cancer promotion and progression. Chemotactic and haptotactic migration of epithelial cells stimulated by conditioned media from irradiated fibroblasts was measured using assays conducted in Transwell cell culture chambers. Our results using low LET radiation showed a dose-dependent increase in migration of epithelial cells when exposed to conditioned media from irradiated vs. non-irradiated fibroblasts. We also observed enhanced invasion through a basement membrane simulant. To identify chemotactic proteins secreted by irradiated stromal fibroblasts, we used antibody capture cytokine arrays and have identified several proteins as candidates. Increased secretion of these factors by irradiated fibroblasts was confirmed using ELISA. We are currently analyzing the contribution of these individual factors on epithelial migration and invasion, as well as their influence on cell survival and DNA repair. Studies using high-LET radiation will help determine radiation quality effects on these processes. These results should further our understanding of the mechanisms by which radiation impacts the tissue microenvironment and how it influences cancer development processes.

  1. Pharyngeal pH monitoring in 222 patients with suspected laryngeal reflux.

    PubMed

    Eubanks, T R; Omelanczuk, P E; Maronian, N; Hillel, A; Pope, C E; Pellegrini, C A

    2001-01-01

    To determine the existence of and characterize gastroesophagopharyngeal reflux in patients with symptoms of airway irritation, we monitored pharyngeal pH over a 24-hour period in 222 consecutive patients. Pharyngeal reflux was defined as a drop in pH to less than 4 at the pharyngeal sensor, which occurred simultaneously with acidification of the distal esophagus. Patients were divided into two groups: those with pharyngeal reflux (PR+) and those without (PR-). The Mann-Whitney U test and Student's t test were used to assess intergroup comparisons. Episodes of pharyngeal reflux (range 1 to 36, average 4.4) were identified in 90 PR+ patients (40%). No pharyngeal reflux was identified in the remaining 132 patients (PR-). Episodes of pharyngeal reflux were rapidly cleared (average duration 1.5 minutes), and occurred while in the upright position in 77 (86%) of 90 patients and while in the supine position in 11 (12%) of 90 patients. Twenty-three patients (25%) experienced symptoms in association with an episode of pharyngeal reflux. In the distal esophagus, the percentage of time the pH was below 4 during the upright position and the total percentage of time the pH was below 4 were greater in PR+ patients (6.4% and 5.8%, respectively) when compared to PR- patients (2.6% and 2.6%, respectively). Laryngoscopic findings did not distinguish PR+ from PR- patients. Pharyngeal reflux occurs most commonly in the upright position and can be identified in more than 40% of patients thought to have acid-induced laryngeal symptoms. Even though these episodes are short lived and rapidly cleared, symptoms occur concomitantly in 25% of patients with proven pharyngeal reflux. Patients with laryngeal symptoms and documented pharyngeal reflux have greater amounts of esophageal reflux when compared to patients with laryngeal symptoms and no demonstrable pharyngeal reflux. PMID:11331482

  2. Everolimus and Combination Chemotherapy in Treating Patients With Metastatic Stomach or Esophageal Cancer

    ClinicalTrials.gov

    2014-11-06

    Adenocarcinoma of the Esophagus; Adenocarcinoma of the Gastroesophageal Junction; Diffuse Adenocarcinoma of the Stomach; Intestinal Adenocarcinoma of the Stomach; Mixed Adenocarcinoma of the Stomach; Recurrent Esophageal Cancer; Recurrent Gastric Cancer; Stage IV Esophageal Cancer; Stage IV Gastric Cancer

  3. Flavonoid consumption and esophageal cancer among Black and White men in the United States

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Flavonoids and proanthocyanidins are bioactive polyphenolic components of fruits and vegetables that may account for part of the protective effect of raw fruit and vegetable consumption in esophageal cancer. We studied the relationship between esophageal cancer and dietary proanthocyanidins, flavon...

  4. International Survey on Evaluation and Management of Eosinophilic Esophagitis.

    PubMed

    2012-09-15

    BACKGROUND: Recommendations regarding evaluation and management of eosinophilic esophagitis (EoE) remain incompletely defined. This survey assesses: how providers across the world diagnose, evaluate, and treat EoE and how educational activities affect management. METHODS: A web-based survey was sent to the members of World Allergy Organization, American College of Allergy, Asthma, and Immunology, and American Academy of Allergy, Asthma, and Immunology. A ¿2 analysis compared responses based on personal and practice demographics and participation in educational activities. RESULTS: Of the 200 respondents, 68.5% were from the United States. The majority were allergists, who require biopsy to diagnose EoE, perform allergy testing, and obtain follow-up biopsy after treatment. The following variables had significant differences: (1) US practitioners were more likely to test for immediate-type hypersensitivity to foods and obtain follow-up endoscopic biopsies after the initial treatment; (2) Practitioners encountering patients with EoE more frequently were more likely to ask about personal and family history of atopy, test for immediate-type hypersensitivity to aeroallergens and foods, and recommend follow-up biopsy after treatment; and (3) Practitioners who participate more often in EoE workshops were more likely to perform patch testing for foods, while attendance at EoE lectures increased EoE management confidence. CONCLUSIONS: Diagnostic and management strategies differ based on practice location, EoE patient load, and participation in educational activities. Practitioners who attend more EoE lectures are more confident managing EoE. PMID:23663354

  5. Esophageal variceal pressure influence on the effect of ligation

    PubMed Central

    Li, Zhi-Qun; LingHu, En-Qiang; Hu, Min; Li, Wei-Min; Huang, Qi-Yang; Zhao, Yong-Wei

    2015-01-01

    AIM: To explore the effect of in vitro porcine esophageal variceal pressure on complete ligation degree for polycyclic ligators. METHODS: An in vitro model of experimental porcine venous vessels was used to test various venous pressures. Three treatment groups were designated according to the preset pressure range: P1 = 25-30 cmH2O; P2 = 35-40 cmH2O; P3 = 45-50 cmH2O. The effect of pressure on ligation was assessed and compared among the groups. RESULTS: Complete ligation was achieved at a rate of 56.25% (18/32) in group P1, 37.5% (12/32) in group P2, and 33.33% (11/33) in group P3 (?2 = 3.6126; P = 0.0573). CONCLUSION: Higher variceal pressures impair the ligation completion rate. Therefore, measuring variceal pressure may help predict the effect of endoscopic ligation and guide treatment choice. PMID:25852273

  6. Ordering of mutations in preinvasive disease stages of esophageal carcinogenesis

    PubMed Central

    Forshew, Tim; Barbera, Mariagnese; Murtaza, Muhammed; Ong, Chin-Ann J.; Lao-Sirieix, Pierre; Dunning, Mark J; Smith, Laura; Smith, Mike L.; Anderson, Charlotte L.; Carvalho, Benilton; O’Donovan, Maria; Underwood, Timothy J.; May, Andrew P; Grehan, Nicola; Hardwick, Richard; Davies, Jim; Oloumi, Arusha; Aparicio, Sam; Caldas, Carlos; Eldridge, Matthew D.; Edwards, Paul A.W.; Rosenfeld, Nitzan; Tavaré, Simon; Fitzgerald, Rebecca C

    2014-01-01

    Cancer genome sequencing studies have identified numerous driver genes but the relative timing of mutations in carcinogenesis remains unclear. The gradual progression from pre-malignant Barrett’s esophagus to esophageal adenocarcinoma (EAC) provides an ideal model to study the ordering of somatic mutations. We identified recurrently-mutated genes and assessed clonal structure using whole-genome sequencing and amplicon-resequencing of 112 EACs. We next screened a cohort of 109 biopsies from two key transition points in the development of malignancy; benign metaplastic never-dysplastic Barrett’s esophagus (NDBE, n=66), and high-grade dysplasia (HGD, n=43). Unexpectedly, the majority of recurrently mutated genes in EAC were also mutated in NDBE. Only TP53 and SMAD4 were stage-specific, confined to HGD and EAC, respectively. Finally, we applied this knowledge to identify high-risk Barrett’s esophagus in a novel non-endoscopic test. In conclusion, mutations in EAC driver genes generally occur exceptionally early in disease development with profound implications for diagnostic and therapeutic strategies. PMID:24952744

  7. Ordering of mutations in preinvasive disease stages of esophageal carcinogenesis.

    PubMed

    Weaver, Jamie M J; Ross-Innes, Caryn S; Shannon, Nicholas; Lynch, Andy G; Forshew, Tim; Barbera, Mariagnese; Murtaza, Muhammed; Ong, Chin-Ann J; Lao-Sirieix, Pierre; Dunning, Mark J; Smith, Laura; Smith, Mike L; Anderson, Charlotte L; Carvalho, Benilton; O'Donovan, Maria; Underwood, Timothy J; May, Andrew P; Grehan, Nicola; Hardwick, Richard; Davies, Jim; Oloumi, Arusha; Aparicio, Sam; Caldas, Carlos; Eldridge, Matthew D; Edwards, Paul A W; Rosenfeld, Nitzan; Tavaré, Simon; Fitzgerald, Rebecca C

    2014-08-01

    Cancer genome sequencing studies have identified numerous driver genes, but the relative timing of mutations in carcinogenesis remains unclear. The gradual progression from premalignant Barrett's esophagus to esophageal adenocarcinoma (EAC) provides an ideal model to study the ordering of somatic mutations. We identified recurrently mutated genes and assessed clonal structure using whole-genome sequencing and amplicon resequencing of 112 EACs. We next screened a cohort of 109 biopsies from 2 key transition points in the development of malignancy: benign metaplastic never-dysplastic Barrett's esophagus (NDBE; n=66) and high-grade dysplasia (HGD; n=43). Unexpectedly, the majority of recurrently mutated genes in EAC were also mutated in NDBE. Only TP53 and SMAD4 mutations occurred in a stage-specific manner, confined to HGD and EAC, respectively. Finally, we applied this knowledge to identify high-risk Barrett's esophagus in a new non-endoscopic test. In conclusion, mutations in EAC driver genes generally occur exceptionally early in disease development with profound implications for diagnostic and therapeutic strategies. PMID:24952744

  8. An implantable, batteryless, and wireless capsule with integrated impedance and pH sensors for gastroesophageal reflux monitoring.

    PubMed

    Cao, Hung; Landge, Vaibhav; Tata, Uday; Seo, Young-Sik; Rao, Smitha; Tang, Shou-Jiang; Tibbals, H F; Spechler, Stuart; Chiao, J-C

    2012-11-01

    In this study, a device for gastroesophageal reflux disease (GERD) monitoring has been prototyped. The system consists of an implantable, batteryless and wireless transponder with integrated impedance and pH sensors; and a wearable, external reader that wirelessly powers up the transponder and interprets the transponded radio-frequency signals. The transponder implant with the total size of 0.4 cm × 0.8 cm × 3.8 cm harvests radio frequency energy to operate dual-sensor and load-modulation circuitry. The external reader can store the data in a memory card and/or send it to a base station wirelessly, which is optional in the case of multiple-patient monitoring in a hospital or conducting large-scale freely behaving animal experiments. Tests were carried out to verify the signal transduction reliability in different situations for antenna locations and orientation. In vitro, experiments were conducted in a mannequin model by positioning the sensor capsule inside the wall of a tube mimicking the esophagus. Different liquids with known pH values were flushed through the tube creating reflux episodes and wireless signals were recorded. Live pigs under anesthesia were used for the animal models with the transponder implant attached on the esophageal wall. The reflux episodes were created while the sensor data were recorded wirelessly. The data were compared with those recorded independently by a clinically used wireless pH sensor capsule placed next to our implant transponder. The results showed that our transponder detected every episode in both acid and nonacid nature, while the commercial pH sensor missed events that had similar, repeated pH values, and failed to detect pH values higher than 10. Our batteryless transponder does not require a battery thus allowing longer diagnosis and prognosis periods to monitor drug efficacy, as well as providing accurate assessment of GERD symptoms. PMID:22922690

  9. Gastric secretion of acid and pepsin in patients with esophageal stricture and appropriate controls

    Microsoft Academic Search

    Basil I. Hirschowitz

    1996-01-01

    Most cases of esophageal stricture are associated with acid\\/peptic reflux esophagitis. While patients with strictures commonly have disordered lower esophageal sphincters and poor clearance and neutralization mechanisms, it is not known whether they also have abnormal gastric secretion. This study examined fasting, basal, and stimulated acid and pepsin secretion. With an endoscopic diagnosis of esophagitis, patients with stricture (N=9), Zollinger-Ellison

  10. Thoracic Discitis as a Complication of Self-Expanding Metallic Stents in Esophageal Carcinoma

    SciTech Connect

    McQueen, A. S.; Eljabu, W.; Latimer, J., E-mail: joanne.latimer@nth.nhs.uk; Raju, P. P. J. [University Hospital of North Tees, Department of Radiology (United Kingdom)

    2011-02-15

    The role of metallic stents in the palliation of esophageal cancer is well established. Self-expanding metal stents (SEMSs) are frequently used, as they provide an effective and safe method of relieving malignant dysphagia. A number of complications are associated with the use of SEMSs, including esophageal perforation. We report a case of thoracic discitis occurring in a patient with advanced esophageal malignancy, treated with SEMSs. We propose that the likely etiology in this patient was esophageal perforation by a metallic stent.

  11. Esophageal complications following aluminium phosphide ingestion: an emerging issue among survivors of poisoning.

    PubMed

    Jain, Rajendra K; Gouda, Narendra B; Sharma, Virendra K; Dubey, Tribhuvan N; Shende, Atul; Malik, Rajesh; Tiwari, Gurudutt

    2010-12-01

    Aluminium phosphide ingestion is the most common agricultural poisoning in suburban and rural India and with a high mortality rate. Among survivors of acute poisoning there are recent sporadic reports of esophageal complications such as esophageal strictures and tracheo-esophageal fistula. The present study was carried out to determine the incidence, natural history, and treatment outcome of local esophageal complications in survivors of aluminium phosphide poisoning with complaints of dysphagia. All confirmed cases of poisoning with aluminium phosphide ingestion were admitted in Hamidia Hospital, Gandhi Medical College, Bhopal, Madhya Pradesh, India, from October 2007 to October 2008. Survivors with complaints of dysphagia underwent a barium study and upper gastrointestinal endoscopy to determine site and nature of esophageal complications. All cases of strictures were treated with fluoroscopy-guided Savary-Gilliard bougie dilation, and patients with tracheo-esophageal fistula underwent surgery. Of 104 confirmed cases, 31 survived. Ten survivors with dysphagia were found to have single short-segment esophageal stricture and two patients with odynophagia and swallow-cough sequence had tracheo-esophageal fistula. All cases of esophageal strictures responded successfully to Savary-Gilliard dilation in six to ten sessions without any major complications. Patients with tracheo-esophageal fistula were treated successfully via surgery. Nearly one-third of survivors of aluminium phosphide ingestion developed esophageal complications. Hence, we conclude that all survivors of aluminium phosphide poisoning must undergo barium swallow and endoscopic examination for early detection of esophageal complications. Prevention of esophageal complications after aluminium phosphide ingestion needs to be given adequate attention because tracheo-esophageal fistula and esophageal stricture are associated with high morbidity. When one finds esophageal stricture or fistula, the possibility of aluminium phosphide ingestion should always be considered. PMID:19727954

  12. Esophageal Function and Occurrence of Barrett’s Esophagus in Zollinger-Ellison Syndrome

    Microsoft Academic Search

    Doris B. Strader; Stanley B. Benjamin; Murray Orbuch; Trina A. Lubenskÿ; Fathia Gibril; Christian Weber; Vitaly Å. Fishbeyn; Robert T. Jensen; David C. Metz

    1995-01-01

    Manifestations of esophageal disease are present in up to 60% of patients with Zollinger-Ellison syndrome (ZES), although esophageal function has been studied in only a few patients and the prevalence of Barrett’s mucosa is unknown in these patients. It is unclear whether the high prevalence of esophageal disease is related to gastric acid hypersecretion alone or to abnormalities of esophageal

  13. Mechanical Properties of the Esophagus in Eosinophilic Esophagitis

    PubMed Central

    Kwiatek, Monika A.; Hirano, Ikuo; Kahrilas, Peter J.; Rothe, Jami; Luger, Daniel; Pandolfino, John E.

    2010-01-01

    Background and Aim This study aimed to analyze the mechanical properties of the esophagus in eosinophilic esophagitis (EoE) using the functional luminal imaging probe (EndoFLIP®, Crospon Medical Devices, Galway, Ireland). Methods 35 EoE patients (24M, 23-67y) and 15 controls (6M, 21–68y) were included. Subjects were evaluated during endoscopy with the EndoFLIP® probe comprised of a compliant cylindrical bag (maximal diameter 25mm) with 16 impedance planimetry segments. Stepwise bag distensions from 2 to 40mL were conducted and the associated intra-bag pressure and intra-luminal geometry were analyzed. Results The EndoFLIP® clearly displayed the tubular esophageal geometry and detected esophageal narrowing and localized strictures. Stepwise distension progressively opened the esophageal lumen until a distension plateau was reached such that the narrowest cross-sectional area (CSA) of the esophagus maximized despite further increases in intra-bag pressure. The esophageal distensibility (CSA vs. pressure) was reduced in EoE patients (p=0.02) with the distension plateau of EoE patients substantially lower than that of controls (median CSA 267 vs. 438 mm2, p<0.01). Neither mucosal eosinophil count, age, gender, nor current PPI treatment predicted this limiting caliber of the esophagus (p?0.20). Conclusion Esophageal distensibility, defined by the change in the narrowest measurable CSA within the distal esophagus vs. intra-luminal pressure, was significantly reduced in EoE patients compared to controls. Measuring esophageal distensibility may be an important adjunct to the management of EoE as it is capable of providing an objective means to measure the outcome of medical or dilation therapy. PMID:20858491

  14. Bacterial biota in reflux esophagitis and Barrett’s esophagus

    PubMed Central

    Pei, Zhiheng; Yang, Liying; Peek, Richard M; Levine, Steven M; Pride, David T; Blaser, Martin J

    2010-01-01

    AIM To identify the bacterial flora in conditions such as Barrett’s esophagus and reflux esophagitis to determine if they are similar to normal esophageal flora. METHODS Using broad-range 16S rDNA PCR, esophageal biopsies were examined from 24 patients [9 with normal esophageal mucosa, 12 with gastroesophageal reflux disease (GERD), and 3 with Barrett’s esophagus]. Two separate broad-range PCR reactions were performed for each patient, and the resulting products were cloned. In one patient with Barrett’s esophagus, 99 PCR clones were analyzed. RESULTS Two separate clones were recovered from each patient (total = 48), representing 24 different species, with 14 species homologous to known bacteria, 5 homologous to unidentified bacteria, and 5 were not homologous (<97% identity) to any known bacterial 16S rDNA sequences. Seventeen species were found in the reflux esophagitis patients, 5 in the Barrett’s esophagus patients, and 10 in normal esophagus patients. Further analysis concentrating on a single biopsy from an individual with Barrett’s esophagus revealed the presence of 21 distinct bacterial species. Members of four phyla were represented, including Bacteroidetes, Firmicutes, Proteobacteria, and Actinobacteria. Microscopic examination of each biopsy demonstrated bacteria in intimate association with the distal esophageal epithelium, suggesting that the presence of these bacteria is not transitory. CONCLUSION These findings provide evidence for a complex, residential bacterial population in esophageal reflux-related disorders. While much of this biota is present in the normal esophagus, more detailed comparisons may help identify potential disease associations. PMID:16437628

  15. Birthplace and esophageal cancer incidence patterns among Asian-Americans.

    PubMed

    Kim, J Y; Winters, J K; Kim, J; Bernstein, L; Raz, D; Gomez, S L

    2014-12-01

    The incidence of esophageal adenocarcinoma in the United States has risen rapidly over the last 30 years, whereas the incidence of esophageal squamous cell carcinoma has fallen dramatically. In contrast, parts of Asia have extremely high rates of squamous cell carcinoma, but virtually no adenocarcinoma. Within the United States, Asian-Americans as a whole, have low rates of esophageal adenocarcinoma and higher rates of squamous cell carcinoma. It is unclear what the patterns are for those Asians born in the United States. The relative influence of ethnicity and environment on the incidence of esophageal cancer in this population is unknown. We identified all cases of esophageal adenocarcinoma and squamous cell carcinoma from the California Cancer Registry 1988-2004, including 955 cases among 6 different Asian ethnicities. Time trends were examined using Joinpoint software to calculate the annual percentage changes in regression models. Rates of esophageal squamous cell carcinoma varied substantially among different Asian ethnic groups, but squamous cell carcinoma was much more common than adenocarcinoma in both foreign-born and US-born Asian-Americans. Rates of squamous cell carcinoma were slightly higher among US-born Asian men (4.0 per 100,000) compared with foreign-born Asian men (3.2 per 100,000) and White men (2.2 per 100,000), P = 0.03. Rates of adenocarcinoma were also slighter higher among US-born Asian men (1.2 per 100,000) compared with foreign-born Asian men (0.7 per 100,000), P = 0.01. Rates of squamous cell carcinoma decreased for both US-born and foreign-born Asians during this period, whereas adenocarcinoma remained low and stable. These results provide better insight into the genetic and environmental factors affecting the changing incidence of esophageal cancer histologies in the United States and Asia. PMID:25487184

  16. Regression of esophageal papillomatous polyposis caused by high-risk type human papilloma virus

    Microsoft Academic Search

    Hideaki Kato; Etsuro Orito; Takeo Yoshinouchi; Ryuzo Ueda; Takahiro Koizumi; Mitsuo Yoshinouchi; Masashi Mizokami

    2003-01-01

    Esophageal squamous papilloma is an uncommon benign squamous epithelial polypoid tumor and is usually identified as a solitary lesion in the lower esophagus. Chronic mucosal irritation and infection with human papilloma virus (HPV) are two proposed etiologies. However, the natural history of esophageal squamous papilloma is unknown, and whether it can develop to esophageal cancer is also controversial. The authors

  17. Thoughts on the Complex Relationship Between Gastroesophageal Reflux Disease and Eosinophilic Esophagitis

    Microsoft Academic Search

    Stuart Jon Spechler; Robert M. Genta; Rhonda F. Souza

    2007-01-01

    Recent data suggest that the interaction between gastroesophageal reflux disease (GERD) and eosinophilic esophagitis can be complex, and that the notion of establishing a clear distinction between the two disorders may be too simplistic. There are at least four situations in which GERD might be associated with esophageal eosinophils: (a) GERD causes esophageal injury that results in a mild eosinophilic

  18. Failed Nissen fundoplication in two patients who had persistent vomiting and eosinophilic esophagitis

    Microsoft Academic Search

    Chris A Liacouras

    1997-01-01

    The following report describes two patients who had chronic symptoms of gastroesophageal reflux and persistent histological esophagitis, despite aggressive medical antireflux therapy, who continued to have esophagitis and remained symptomatic post antireflux surgery (Nissen fundoplication). Both patients demonstrated a severe eosinophilic esophagitis with normal gastric and duodenal histology before and after surgery. Postoperatively, each received the diagnosis of allergic enteritis

  19. Use of Mitomycin C for Refractory Esophageal Stricture following Tracheoesophageal Fistula Repair

    PubMed Central

    Lakoma, Anna; Fallon, Sara C.; Mathur, Shawn; Kim, Eugene S.

    2013-01-01

    Esophageal stricture is a well-described complication following tracheoesophageal fistula repair. Herein, we report two patients who had persistent esophageal strictures after several months of repeat balloon dilatations. Each patient was treated with a single application of topical mitomycin C in addition to esophageal dilatation, which resulted in complete resolution of the stricture.

  20. Pralatrexate and Oxaliplatin in Treating Patients With Unresectable or Metastatic Esophageal, Stomach, or Gastroesophageal Junction Cancer

    ClinicalTrials.gov

    2015-03-05

    Adenocarcinoma of the Esophagus; Adenocarcinoma of the Gastroesophageal Junction; Diffuse Adenocarcinoma of the Stomach; Intestinal Adenocarcinoma of the Stomach; Mixed Adenocarcinoma of the Stomach; Recurrent Esophageal Cancer; Recurrent Gastric Cancer; Squamous Cell Carcinoma of the Esophagus; Stage III Esophageal Cancer; Stage III Gastric Cancer; Stage IV Esophageal Cancer; Stage IV Gastric Cancer

  1. The endoscopic assessment of esophagitis: A progress report on observer agreement

    Microsoft Academic Search

    D Armstrong; JR Bennett; AL Blum; J Dent; FT De Dombal; JP Galmiche; L Lundell; M Margulies; JE Richter; SJ Spechler; GN Tytgat; L Wallin

    1996-01-01

    BACKGROUND & AIMS: The study and management of reflux esophagitis require an endoscopic classification system founded on esophageal lesions that can be reproducibly identified. The aim of this study was to investigate interobserver agreement for the identification of endoscopic lesions typical of reflux esophagitis. METHODS: Paired comparisons of observers' descriptions were obtained. Seventeen endoscopists assessed 100 still images, and 42

  2. Cytogenetic studies of esophageal squamous cell carcinomas in the northern Chinese population by comparative genomic hybridization

    Microsoft Academic Search

    Fang Wei; Jiang Ni; Shan-Shan Wu; Hao Liu; Xin Xu; Ya-Ling Han; Yan Cai; Jian-Wei Zhang; Xian-Jun Chen; Hui Pang; Ning Lu; Liang Ji; Min Wu; Ming-Rong Wang

    2002-01-01

    Esophageal cancer is the fourth most prevalent malignancy in China. So far, the genetic events involved in esophageal cancer remain largely unknown. To identify chromosomal alterations in this disease, comparative genomic hybridization was performed on 25 primary tumors of esophageal squamous cell carcinomas. Results exhibited nonrandom copy number changes in chromosome DNA, with higher incidence in gain than in loss.

  3. Esophagitis in sprague-dawley rats is mediated by free radicals

    Microsoft Academic Search

    Gerold J. Wetscher; Galen Perdikis; David H. Kretchmar; Ronald G. Stinson; Debasis Bagchi; Elizabeth J. Redmond; Thomas E. Adrian; Ronald A. Hinder

    1995-01-01

    Free radical-mediated esophagitis was studied during duodenogastroesophageal reflux (mixed reflux) or acid reflux in rats. The influence of reflux on esophageal glutathione levels was also examined. Mixed reflux caused more gross mucosal injury than acid reflux. Gross mucosal injury occurred in the mid-esophagus. Total glutathione (GSH) in the esophageal mucosa of control rats was highest in the distal esophagus. The

  4. Reflux esophagitis in humans is mediated by oxygen-derived free radicals

    Microsoft Academic Search

    Gerold J. Wetscher; Ronald A. Hinder; Debasis Bagchi; Paul R. Hinder; Manashi Bagchi; Galen Perdikis; Thomas McGinn

    1995-01-01

    Background: Oxidative stress in reflux esophagitis was investigated before and after antireflux surgery.Patients and methods: Oxidative stress was studied in the distal and proximal esophagus of control patients (without esophagitis, but with other gastrointestinal disorders), of patients with various grades of esophagitis (including Barrett's esophagus), and in patients who had a Nissen fundoplication. Oxidative stress was assessed by chemiluminescence, lipid

  5. Gastroesophageal reflux in asymptomatic obese subjects: An esophageal impedance-pH study

    PubMed Central

    Akyüz, Filiz; Uyan?koglu, Ahmet; Ermis, Fatih; Ar?c?, Serpil; Akyüz, Ümit; Baran, Bülent; Pinarbasi, Binnur; Gul, Nurdan

    2015-01-01

    AIM: To investigate the relationship between reflux and body mass index (BMI) in the asymptomatic obese population using the impedance-pH technique. METHODS: Gastroesophageal reflux is frequent in the obese population. However, the relationship between acid reflux and BMI in asymptomatic obese people is unclear. Forty-six obese (BMI > 25 kg/m2) people were enrolled in this prospective study. We evaluated the demographic findings and 24-h impedance pH values of the whole group. Gas, acid (pH < 4), weak acid (pH = 4-7) and weak alkaline (pH ? 7) reflux parameters were analyzed. RESULTS: The mean age of patients was 49.47 ± 12.24 years, and half of them were men. The mean BMI was 30.64 ± 3.95 kg/m2 (25.14-45.58 kg/m2). BMI of 23 was over 30 kg/m2. Seventeen patients had a comorbidity (hypertension, diabetes mellitus, or ischemic heart disease). Endoscopic examination revealed esophagitis in 13 of the 28 subjects (10 Grade A, 3 Grade B). The subjects were divided into two groups according to BMI (< 30 and > 30 kg/m2). Demographic and endoscopic findings, and impedance results were similar in these two groups. However, there was a positive correlation between BMI and total and supine pH < 4 episodes (P = 0.002, r = 0.414; P = 0.000, r = 0.542), pH < 4 reflux time (P = 0.015, r = 0.319; P = 0.003, r = 0.403), and DeMeester score (P = 0.012, r = 0.333). CONCLUSION: Acid reflux is correlated with BMI in asymptomatic obese individuals. PMID:25780302

  6. 4-Aminobutyrate Aminotransferase (ABAT): Genetic and Pharmacological Evidence for an Involvement in Gastro Esophageal Reflux Disease

    PubMed Central

    Hammond, Paul; Davidson, Geoffrey; Knutsson, Mikael; Walentinsson, Anna; Jensen, Jörgen M.; Lehmann, Anders; Agreus, Lars; Lagerström-Fermer, Maria

    2011-01-01

    Gastro-esophageal reflux disease (GERD) is partly caused by genetic factors. The underlying susceptibility genes are currently unknown, with the exception of COL3A1. We used three independent GERD patient cohorts to identify GERD susceptibility genes. Thirty-six families, demonstrating dominant transmission of GERD were subjected to whole genome microsatellite genotyping and linkage analysis. Five linked regions were identified. Two families shared a linked region (LOD 3.9 and 2.0) on chromosome 16. We used two additional independent GERD patient cohorts, one consisting of 219 trios (affected child with parents) and the other an adult GERD case control cohort consisting of 256 cases and 485 controls, to validate individual genes in the linked region through association analysis. Sixty six single nucleotide polymorphism (SNP) markers distributed over the nine genes present in the linked region were genotyped in the independent GERD trio cohort. Transmission disequilibrium test analysis followed by multiple testing adjustments revealed a significant genetic association for one SNP located in an intron of the gene 4-aminobutyrate aminotransferase (ABAT) (Padj?=?0.027). This association did not replicate in the adult case-control cohort, possibly due to the differences in ethnicity between the cohorts. Finally, using the selective ABAT inhibitor vigabatrin (?-vinyl GABA) in a dog study, we were able to show a reduction of transient lower esophageal sphincter relaxations (TLESRs) by 57.3±11.4 % (p?=?0.007) and the reflux events from 3.1±0.4 to 0.8±0.4 (p?=?0.007). Our results demonstrate the direct involvement of ABAT in pathways affecting lower esophageal sphincter (LES) control and identifies ABAT as a genetic risk factor for GERD. PMID:21552517

  7. Predictors of Postoperative Complications After Trimodality Therapy for Esophageal Cancer

    SciTech Connect

    Wang, Jingya [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Wei, Caimiao [Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Tucker, Susan L. [Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Myles, Bevan; Palmer, Matthew [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Hofstetter, Wayne L.; Swisher, Stephen G. [Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Ajani, Jaffer A. [Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Cox, James D.; Komaki, Ritsuko; Liao, Zhongxing [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Lin, Steven H., E-mail: SHLin@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2013-08-01

    Purpose: While trimodality therapy for esophageal cancer has improved patient outcomes, surgical complication rates remain high. The goal of this study was to identify modifiable factors associated with postoperative complications after neoadjuvant chemoradiation. Methods and Materials: From 1998 to 2011, 444 patients were treated at our institution with surgical resection after chemoradiation. Postoperative (pulmonary, gastrointestinal [GI], cardiac, wound healing) complications were recorded up to 30 days postoperatively. Kruskal-Wallis tests and ?{sup 2} or Fisher exact tests were used to assess associations between continuous and categorical variables. Multivariate logistic regression tested the association between perioperative complications and patient or treatment factors that were significant on univariate analysis. Results: The most frequent postoperative complications after trimodality therapy were pulmonary (25%) and GI (23%). Lung capacity and the type of radiation modality used were independent predictors of pulmonary and GI complications. After adjusting for confounding factors, pulmonary and GI complications were increased in patients treated with 3-dimensional conformal radiation therapy (3D-CRT) versus intensity modulated radiation therapy (IMRT; odds ratio [OR], 2.018; 95% confidence interval [CI], 1.104-3.688; OR, 1.704; 95% CI, 1.03-2.82, respectively) and for patients treated with 3D-CRT versus proton beam therapy (PBT; OR, 3.154; 95% CI, 1.365-7.289; OR, 1.55; 95% CI, 0.78-3.08, respectively). Mean lung radiation dose (MLD) was strongly associated with pulmonary complications, and the differences in toxicities seen for the radiation modalities could be fully accounted for by the MLD delivered by each of the modalities. Conclusions: The radiation modality used can be a strong mitigating factor of postoperative complications after neoadjuvant chemoradiation.

  8. pH Scale

    NSDL National Science Digital Library

    Wendy Adams

    2011-01-01

    In this online interactive simulation, learners will test the pH of liquids like coffee, spit, and soap to determine whether each is acidic, basic, or neutral. Learners will visualize the relative number of hydroxide ions and hydronium ions in a solution, and they can switch between logarithmic and linear scales. Learners will also investigate whether changing the volume or diluting with water affects the pH. They can experiment by designing their own liquids! This activity includes an online simulation, sample learning goals, a teacher's guide, and translations in over 30 languages.

  9. Physical activity is associated with reduced risk of esophageal cancer, particularly esophageal adenocarcinoma: a systematic review and meta-analysis

    PubMed Central

    2014-01-01

    Background Physical activity has been inversely associated with risk of several cancers. We performed a systematic review and meta-analysis to evaluate the association between physical activity and risk of esophageal cancer (esophageal adenocarcinoma [EAC] and/or esophageal squamous cell carcinoma [ESCC]). Methods We conducted a comprehensive search of bibliographic databases and conference proceedings from inception through February 2013 for observational studies that examined associations between recreational and/or occupational physical activity and esophageal cancer risk. Summary adjusted odds ratio (OR) estimates with 95% confidence intervals (CI) were estimated using the random-effects model. Results The analysis included 9 studies (4 cohort, 5 case–control) reporting 1,871 cases of esophageal cancer among 1,381,844 patients. Meta-analysis demonstrated that the risk of esophageal cancer was 29% lower among the most physically active compared to the least physically active subjects (OR, 0.71; 95% CI, 0.57-0.89), with moderate heterogeneity (I2?=?47%). On histology-specific analysis, physical activity was associated with a 32% decreased risk of EAC (4 studies, 503 cases of EAC; OR, 0.68; 95% CI, 0.55-0.85) with minimal heterogeneity (I2?=?0%). There were only 3 studies reporting the association between physical activity and risk of ESCC with conflicting results, and the meta-analysis demonstrated a null association (OR, 1.10; 95% CI, 0.21-5.64). The results were consistent across study design, geographic location and study quality, with a non-significant trend towards a dose–response relationship. Conclusions Meta-analysis of published observational studies indicates that physical activity may be associated with reduced risk of esophageal adenocarcinoma. Lifestyle interventions focusing on increasing physical activity may decrease the global burden of EAC. PMID:24886123

  10. Volumetric modulated arc radiotherapy for esophageal cancer

    SciTech Connect

    Vivekanandan, Nagarajan, E-mail: viveknaren@hotmail.com [Department of Medical Physics, Cancer Institute, Chennai (India); Sriram, Padmanaban; Syam Kumar, S.A.; Bhuvaneswari, Narayanan; Saranya, Kamalakannan [Department of Medical Physics, Cancer Institute, Chennai (India)

    2012-04-01

    A treatment planning study was performed to evaluate the performance of volumetric arc modulation with RapidArc (RA) against 3D conformal radiation therapy (3D-CRT) and conventional intensity-modulated radiation therapy (IMRT) techniques for esophageal cancer. Computed tomgraphy scans of 10 patients were included in the study. 3D-CRT, 4-field IMRT, and single-arc and double-arc RA plans were generated with the aim to spare organs at risk (OAR) and healthy tissue while enforcing highly conformal target coverage. The planning objective was to deliver 54 Gy to the planning target volume (PTV) in 30 fractions. Plans were evaluated based on target conformity and dose-volume histograms of organs at risk (lung, spinal cord, and heart). The monitor unit (MU) and treatment delivery time were also evaluated to measure the treatment efficiency. The IMRT plan improves target conformity and spares OAR when compared with 3D-CRT. Target conformity improved with RA plans compared with IMRT. The mean lung dose was similar in all techniques. However, RA plans showed a reduction in the volume of the lung irradiated at V{sub 20Gy} and V{sub 30Gy} dose levels (range, 4.62-17.98%) compared with IMRT plans. The mean dose and D{sub 35%} of heart for the RA plans were better than the IMRT by 0.5-5.8%. Mean V{sub 10Gy} and integral dose to healthy tissue were almost similar in all techniques. But RA plans resulted in a reduced low-level dose bath (15-20 Gy) in the range of 14-16% compared with IMRT plans. The average MU needed to deliver the prescribed dose by RA technique was reduced by 20-25% compared with IMRT technique. The preliminary study on RA for esophageal cancers showed improvements in sparing OAR and healthy tissue with reduced beam-on time, whereas only double-arc RA offered improved target coverage compared with IMRT and 3D-CRT plans.

  11. A Versatile Orthotopic Nude Mouse Model for Study of Esophageal Squamous Cell Carcinoma

    PubMed Central

    Ip, Joseph Chok Yan; Ko, Josephine Mun Yee; Yu, Valen Zhuoyou; Chan, Kwok Wah; Lam, Alfred K.; Law, Simon; Tong, Daniel King Hung; Lung, Maria Li

    2015-01-01

    Increasing evidence indicates tumor-stromal interactions play a crucial role in cancer. An in vivo esophageal squamous cell carcinoma (ESCC) orthotopic animal model was developed with bioluminescence imaging established with a real-time monitoring platform for functional and signaling investigation of tumor-stromal interactions. The model was produced by injection of luciferase-labelled ESCC cells into the intraesophageal wall of nude mice. Histological examination indicates this orthotopic model is highly reproducible with 100% tumorigenesis among the four ESCC cell lines tested. This new model recapitulates many clinical and pathological properties of human ESCC, including esophageal luminal stricture by squamous cell carcinoma with nodular tumor growth, adventitia invasion, lymphovascular invasion, and perineural infiltration. It was tested using an AKT shRNA knockdown of ESCC cell lines and the in vivo tumor suppressive effects of AKT knockdown were observed. In conclusion, this ESCC orthotopic mouse model allows investigation of gene functions of cancer cells in a more natural tumor microenvironment and has advantages over previous established models. It provides a versatile platform with potential application for metastasis and therapeutic regimen testing.

  12. Retrograde submucosal tunneling technique for management of complete esophageal obstruction.

    PubMed

    Babich, Jay P; Diehl, David L; Entrup, Michael H

    2012-08-01

    Complete esophageal obstruction is a challenging problem that is not amendable to standard dilation techniques. Multiple endoscopic techniques as well as radical surgical procedures have been developed with the goal of restoring a patent esophageal lumen. In patients with complete esophageal obstruction, an antegrade-retrograde technique has been described, but this generally depends on the ability to transilluminate across the stricture. Successful transillumination allows for safe direct puncture across the stricture, followed by dilation. In long-segment strictures (greater than 2-3 cm), transillumination may not be possible. We report a case of a 63 year-old woman who developed a complete esophageal obstruction from radiation therapy (RT) for hypopharyngeal squamous cell carcinoma. She did have enteral access via a percutaneous endoscopic gastrostomy (PEG) tube which had been placed prior to beginning RT. A combined antegrade (through the mouth) and retrograde (through PEG site) approach was done, but transillumination across the stricture failed. Fluoroscopy demonstrated a 4 cm long stricture. The creation of a submucosal tunnel from the retrograde direction decreased the stricture length to 15 mm and transillumination was achieved. This allowed safe puncture of the stricture, placement of a guidewire, then successful dilation. The patient can now tolerate soft foods and maintain her weight. Submucosal tunneling can be used to achieve transillumination for the combined antegrade-retrograde approach to complete esophageal obstruction. PMID:22874710

  13. Epidemiology of Esophageal Cancer in Japan and China

    PubMed Central

    Lin, Yingsong; Totsuka, Yukari; He, Yutong; Kikuchi, Shogo; Qiao, Youlin; Ueda, Junko; Wei, Wenqiang; Inoue, Manami; Tanaka, Hideo

    2013-01-01

    In preparation for a collaborative multidisciplinary study of the pathogenesis of esophageal cancer, the authors reviewed the published literature to identify similarities and differences between Japan and China in esophageal cancer epidemiology. Esophageal squamous cell carcinoma (ESCC) is the predominant histologic type, while the incidence of esophageal adenocarcinoma remains extremely low in both countries. Numerous epidemiologic studies in both countries show that alcohol consumption and cigarette smoking are contributing risk factors for ESCC. There are differences, however, in many aspects of esophageal cancer between Japan and China, including cancer burden, patterns of incidence and mortality, sex ratio of mortality, risk factor profiles, and genetic variants. Overall incidence and mortality rates are higher in China than in Japan, and variation in mortality and incidence patterns is greater in China than in Japan. During the study period (1987–2000), the decline in age-adjusted mortality rates was more apparent in China than in Japan. Risk factor profiles differed between high- and low-incidence areas within China, but not in Japan. The association of smoking and drinking with ESCC risk appears to be weaker in China than in Japan. Genome-wide association studies in China showed that variants in several chromosome regions conferred increased risk, but only genetic variants in alcohol-metabolizing genes were significantly associated with ESCC risk in Japan. A well-designed multidisciplinary epidemiologic study is needed to examine the role of diet and eating habits in ESCC risk. PMID:23629646

  14. Lymph Node Metastases in Esophageal Carcinoma: An Endoscopist's View

    PubMed Central

    Cho, Jin Woong; Jang, Jae Young; Shin, Sung Kwan; Choi, Kee Don; Lee, Jun Haeng; Kim, Sang Gyun; Sung, Jae Kyu; Jeon, Seong Woo; Choi, Il Ju; Kim, Gwang Ha; Jee, Sam Ryong; Lee, Wan Sik; Jung, Hwoon-Yong

    2014-01-01

    One of the most important prognostic factors in esophageal carcinoma is lymph node metastasis, and in particular, the number of affected lymph nodes, which influences long-term outcomes. The esophageal lymphatic system is connected longitudinally and transversally; thus, the pattern of lymph node metastases is very complex. Early esophageal cancer frequently exhibits skipped metastasis, and minimal surgery using sentinel node navigation cannot be performed. In Korea, most esophageal cancer cases are squamous cell carcinoma (SCC), although the incidence of adenocarcinoma has started to increase recently. Most previous reports have failed to differentiate between SCC and adenocarcinoma, despite the fact that the Union for International Cancer Control (7th edition) and American Joint Committee on Cancer staging systems both consider these separately because they differ in cause, biology, lymph node metastasis, and outcome. Endoscopic tumor resection is an effective and safe treatment for lesions with no associated lymph node metastasis. Esophageal mucosal cancer confined to the lamina propria is an absolute indication for endoscopic resection, and a lesion that has invaded the muscularis mucosae can be cured by local resection if invasion to the lymphatic system has not occurred. PMID:25505718

  15. Silane surface modification for improved bioadhesion of esophageal stents

    NASA Astrophysics Data System (ADS)

    Karakoy, Mert; Gultepe, Evin; Pandey, Shivendra; Khashab, Mouen A.; Gracias, David H.

    2014-08-01

    Stent migration occurs in 10-40% of patients who undergo placement of esophageal stents, with higher migration rates seen in those treated for benign esophageal disorders. This remains a major drawback of esophageal stent therapy. In this paper, we propose a new surface modification method to increase the adhesion between self-expandable metallic stents (SEMS) and tissue while preserving their removability. Taking advantage of the well-known affinity between epoxide and amine terminated silane coupling agents with amine and carboxyl groups that are abundant in proteins and related molecules in the human body; we modified the surfaces of silicone coated esophageal SEMS with these adhesive self-assembled monolayers (SAMs). We utilized vapor phase silanization to modify the surfaces of different substrates including PDMS strips and SEMS, and measured the force required to slide these substrates on a tissue piece. Our results suggest that surface modification of esophageal SEMS via covalent attachment of protein-binding coupling agents improves adhesion to tissue and could offer a solution to reduce SEMS migration while preserving their removability.

  16. C-Met Inhibitor AMG 337, Oxaliplatin, Leucovorin Calcium, and Fluorouracil in Treating Patients With Advanced Stomach or Esophageal Cancer

    ClinicalTrials.gov

    2015-01-16

    Adenocarcinoma of the Esophagus; Adenocarcinoma of the Gastroesophageal Junction; Diffuse Adenocarcinoma of the Stomach; Gastrointestinal Cancer; Intestinal Adenocarcinoma of the Stomach; Mixed Adenocarcinoma of the Stomach; Stage IIIA Esophageal Cancer; Stage IIIA Gastric Cancer; Stage IIIB Esophageal Cancer; Stage IIIB Gastric Cancer; Stage IIIC Esophageal Cancer; Stage IIIC Gastric Cancer; Stage IV Esophageal Cancer; Stage IV Gastric Cancer

  17. Usefulness of biodegradable stents constructed of poly-l -lactic acid monofi laments in patients with benign esophageal stenosis

    Microsoft Academic Search

    Yasuharu Saito; Toyohiko Tanaka; Akira Andoh; Hideki Minematsu; Kazunori Hat; Tomoyuki Tsujikawa; Norihisa Nitta; Kiyoshi Murat

    AIM: To report 13 patients with benign esophageal stenosis treated with the biodegradable stent. METHODS: We developed a Ultraflex-type stent by knitting poly-l -lactic acid monofi laments. RESULTS: Two cases were esophageal stenosis caused by drinking of caustic liquid, 4 cases were due to surgical resection of esophageal cancers, and 7 cases were patients with esophageal cancer who received the

  18. Distribution and variability of esophageal eosinophilia in patients undergoing upper endoscopy.

    PubMed

    Dellon, Evan S; Speck, Olga; Woodward, Kimberly; Covey, Shannon; Rusin, Spencer; Shaheen, Nicholas J; Woosley, John T

    2015-03-01

    The variability of eosinophilic infiltrates in eosinophilic esophagitis is not well described. This study aimed to determine the distribution of esophageal eosinophilia and the utility of histologic cut-points for eosinophilic esophagitis diagnosis in subjects undergoing endoscopy. We performed a prospective study of adults undergoing outpatient endoscopy. Research protocol esophageal biopsies were obtained from all subjects. Incident cases of eosinophilic esophagitis were diagnosed per consensus guidelines. Biopsies were interpreted following a validated protocol, and maximum eosinophil counts (eosinophils per high-power field; eos/hpf) were determined. Histologic analyses were performed on a per-patient, per-biopsy, and per-hpf basis. There were 213 patients, yielding 923 esophageal biopsies with 4588 hpfs. Overall, 48 patients (23%), 165 biopsy fragments (18%), and 449 hpfs (10%) had ?15 eos/hpf; most subjects had no or low levels of eosinophils. In the eosinophilic esophagitis cases, 119 biopsy fragments (63%) and 332 hpfs (36%) had ?15 eos/hpf. There was a mean 104-fold difference between the lowest and highest hpf eosinophil count for the eosinophilic esophagitis patients; 85% of the biopsies from eosinophilic esophagitis cases also had at least one hpf with <15 eos/hpf. The cut-point of 15 eos/hpf had a sensitivity of 100% and a specificity of 96% for diagnosis of eosinophilic esophagitis. In conclusion, most patients have little to no esophageal eosinophilia. In patients with eosinophilic esophagitis, there was marked variability in the eosinophil counts by biopsy and by hpf within a given biopsy. Additionally, the 15 eos/hpf cut-point was highly sensitive and specific for eosinophilic esophagitis. Multiple esophageal biopsies from different locations should be obtained to optimize eosinophilic esophagitis diagnosis. PMID:25216228

  19. Polyglycolic acid sheet application to prevent esophageal stricture after endoscopic submucosal dissection for esophageal squamous cell carcinoma.

    PubMed

    Iizuka, Toshiro; Kikuchi, Daisuke; Yamada, Akihiro; Hoteya, Shu; Kajiyama, Yoshiaki; Kaise, Mitsuru

    2014-11-20

    Background and study aim: Esophageal stricture following endoscopic submucosal dissection (ESD) can be a serious complication in patients with large mucosal defects. This preliminary study examined the efficacy of using a polyglycolic acid (PGA) sheet with fibrin glue for the prevention of esophageal stricture after ESD. Patients and methods: A total of 15 patients were enrolled. After resection, PGA sheets were placed over the surgical wound. The size of the mucosal defect was estimated by dividing the circumference of the esophagus into 12 parts of equal size. The occurrence of esophageal stricture at 6 weeks, along with the proportion of patients who had PGA sheet remaining in place 1 week and 2 weeks after ESD, and the occurrence of adverse events were investigated. Results: The size of mucosal defects in the 15 patients were 7/12 (n?=?4), 8?/12 (n?=?5), 9/12 (n?=?4), 10/12 (n?=?1) and 11/12 (n?=?1). Esophageal stricture occurred in 1/13 patients (7.7?%; two patients were not included in the analysis because they had required surgical resection during the follow-up period). The PGA sheet remained at 1 week after ESD in 13/15 patients (86.7?%) and at 2 weeks after ESD in 6/15 patients (40?%). No adverse events were observed. Conclusion: PGA sheets may have the potential to prevent esophageal stricture. PMID:25412087

  20. Coexistence of esophageal blue nevus, hair follicles and basaloid squamous carcinoma: A case report

    PubMed Central

    Wang, Dong-Guan; Li, Xin-Gong; Gao, Hong; Sun, Xi-Yin; Zhou, Xiao-Qiu

    2008-01-01

    We present the case of a 57-year-old man who underwent esophagectomy for esophageal carcinoma found at barium meal and gastroscopic examination. He was diagnosed as esophageal basaloid squamous carcinoma (BSC) and gastric stromal tumor, which were associated with focal proliferation of melanocytes/pigmentophages and hair follicles in esophageal mucosa. Melanocytic hyperplasia (melanocytosis) has previously been recognized as an occasional reactive lesion, which can accompany esophageal inflammation and invasive squamous carcinoma. The present case is unusual because of its hyperplasia of not only melanocytes but also hair follicles. To our knowledge, this is the first report of esophageal blue nevus and hair follicle coexisting with BSC. PMID:18636677

  1. Hiccups as a Presenting Symptom of Eosinophilic Esophagitis

    PubMed Central

    Levy, Alexander N.; Rahaman, Soroya M.; Bonis, Peter A.; Javid, Golrokh; Leung, John

    2012-01-01

    Eosinophilic esophagitis (EoE) is a chronic esophageal disease increasingly recognized in adults for its gastrointestinal manifestations. This paper discusses a young woman with EoE who presented with persistent hiccups and intermittent dyspepsia. The patient was initially treated with trials of both H2 blocker and proton pump inhibitor. However, her hiccups resolved only after treatment with topical fluticasone. A repeat upper endoscopy while on steroid treatment demonstrated both histologic remission of EoE and resolution of esophageal trachealization. Our patient's clinical course supports an association between hiccups and EoE, suggesting that EoE be considered in the differential diagnosis of patients with refractory hiccups. PMID:22740808

  2. A rare cause of chronic dysphagia: eosinophilic esophagitis

    PubMed Central

    Destek, Sebahattin; Gul, Vahit Onur; Ahioglu, Serkan; Tatar, Zeynep; Erbil, Yesim

    2014-01-01

    Eosinophilic esophagitis (EE) is attributable to environmental factors, allergens and several immunological causes. The most typical symptoms include dysphagia and sensation of food impingement in the retrosternal area. Although its clinical features resemble those of gastroesophageal reflux, proton pump inhibitors are not effective for its treatment. The diagnosis of EE is dependent on the pathological detection of eosinophilic infiltration in esophageal mucosa. In this study, we evaluated a patient who applied to our clinic with complaints of long-term difficulty in swallowing, sensation of food sticking while eating and weight loss; the patient was diagnosed with EE, following biochemical, radiological, endoscopic and pathological assessments and was treated with steroids. The results show that EE should be considered in the differential diagnosis of patients with dysphagia and food impingement in the retrosternal area, and the diagnosis should be confirmed through multiple esophageal biopsies. PMID:25249002

  3. Esophageal Sarcoidosis: A Review of Cases and an Update

    PubMed Central

    Hajar, Rabab; Virdi, Ravi; Singh, Jaspreet; Mustacchia, Paul

    2013-01-01

    Sarcoidosis is a chronic disorder that can virtually affect any organ system in the body. Histologically, it is characterized by the presence of T lymphocytes, mononuclear phagocytes, and noncaseating granulomas. Most commonly affected are the intrathoracic structures, with 90% of the reported cases involving the lungs. Esophageal involvement in sarcoidosis is extremely rare. Dysphagia is the most common presentation in these patients and can be attributed to various mechanisms such as direct esophageal wall infiltration, extrinsic compression, cranial neuropathy, and brainstem involvement. A thorough online literature review revealed only 23 reported cases of esophageal involvement in sarcoidosis. This paper reviews these reported cases in detail along with newer diagnostic and treatment options, including direction of future therapy. PMID:23533794

  4. Esophageal and esophagogastric junction cancers, version 1.2015.

    PubMed

    Ajani, Jaffer A; D'Amico, Thomas A; Almhanna, Khaldoun; Bentrem, David J; Besh, Stephen; Chao, Joseph; Das, Prajnan; Denlinger, Crystal; Fanta, Paul; Fuchs, Charles S; Gerdes, Hans; Glasgow, Robert E; Hayman, James A; Hochwald, Steven; Hofstetter, Wayne L; Ilson, David H; Jaroszewski, Dawn; Jasperson, Kory; Keswani, Rajesh N; Kleinberg, Lawrence R; Korn, W Michael; Leong, Stephen; Lockhart, A Craig; Mulcahy, Mary F; Orringer, Mark B; Posey, James A; Poultsides, George A; Sasson, Aaron R; Scott, Walter J; Strong, Vivian E; Varghese, Thomas K; Washington, Mary Kay; Willett, Christopher G; Wright, Cameron D; Zelman, Debra; McMillian, Nicole; Sundar, Hema

    2015-02-01

    Esophageal cancer is the sixth most common cause of cancer deaths worldwide. Adenocarcinoma is more common in North America and Western European countries, originating mostly in the lower third of the esophagus, which often involves the esophagogastric junction (EGJ). Recent randomized trials have shown that the addition of preoperative chemoradiation or perioperative chemotherapy to surgery significantly improves survival in patients with resectable cancer. Targeted therapies with trastuzumab and ramucirumab have produced encouraging results in the treatment of advanced or metastatic EGJ adenocarcinomas. Multidisciplinary team management is essential for patients with esophageal and EGJ cancers. This portion of the NCCN Guidelines for Esophageal and EGJ Cancers discusses management of locally advanced adenocarcinoma of the esophagus and EGJ. PMID:25691612

  5. Endosymbiotic Bacteria in the Esophageal Organ of Glossiphoniid Leeches

    PubMed Central

    Kikuchi, Yoshitomo; Fukatsu, Takema

    2002-01-01

    We characterized the intracellular symbiotic bacteria of the hematophagous glossiphoniid leeches Placobdelloides siamensis and a Parabdella sp. These leeches have a specialized structure called an “esophageal organ,” the cells of which harbor bacterial symbionts. From the esophageal organ of each species, a 1.5-kb eubacterial 16S rRNA gene segment was amplified by PCR, cloned, and sequenced. Diagnostic PCR detected the symbiont in the esophageal organ and intestine. Phylogenetic analysis of the 16S rRNA gene(s) demonstrated that the symbionts from the leeches formed a monophyletic group in a well-defined clade containing endosymbiotic bacteria of plant sap-feeding insects in the ?-subdivision of the Proteobacteria. The nucleotide compositions of the 16S rRNA gene from the leech symbionts were highly AT biased (53.7%). PMID:12200323

  6. Esophageal Achalasia: An Uncommon Complication during Pregnancy Treated Conservatively

    PubMed Central

    Spiliopoulos, Dimitrios; Spiliopoulos, Michail; Awala, Alero

    2013-01-01

    A 38-year-old Caucasian woman, gravida 3 para 2, was admitted at 29 weeks of gestation because of vomiting, dysphagia for solids and liquids, and loss of weight. An enlargement of the anterior left neck region was noted on the palpation of the thyroid gland. An MRI of the neck showed a marked esophageal dilatation with the presence of food remnants along its length and the displacement of the trachea to the right. The findings of the upper gastrointestinal endoscopy and manometry were suggestive of esophageal achalasia. Conservative management with total parenteral nutrition (TPN) through a peripheral line proved to be successful. A healthy male baby was born by a cesarean section at 37 weeks. The patient underwent laparoscopic esophageal myotomy and fundoplication seven days postpartum. PMID:23365774

  7. Primary Prophylaxis of Bleeding from Esophageal Varices in Cirrhosis

    PubMed Central

    Merkel, Carlo; Montagnese, Sara; Amodio, Piero

    2013-01-01

    Prophylaxis of the first bleeding from esophageal varices became a clinical option more than 20 years ago, and gained a large diffusion in the following years. It is based on the use of nonselective beta-blockers, which decreases portal pressure, or on the eradication of esophageal varices by endoscopic band ligation of varices. In patients with medium or large varices either of these treatments is indicated. In patients with small varices only medical treatment is feasible, and in patients with medium and large varices with contraindication or side-effects due to beta-blockers, only endoscopic band ligation may be used. In this review the rationale and the results of the prophylaxis of bleeding from esophageal varices are discussed.

  8. [Differencial diagnosis of gastroesophageal reflux disease -- eosinophilic esophagitis: case report].

    PubMed

    Franzius, M; Stolte, M; Porschen, R

    2005-04-01

    We report on a 22-year-old man with dysphagia and repeated bolus impaction in the esophagus for 10 years. Bolus impactions were frequently mobilised using an endoscope. At endoscopy, esophagitis IV degrees was described. After treatment with omeprazol there was no improvement. The patient was submitted to our hospital for fundoplication. pH-metry demonstrated an increased reflux. At endoscopy of the esophagus, we found red stripes which did not show the typical appearance of erosions. Manometry and X-ray films of the esophagus did not reveal any pathological findings. In combination with anamnesis, symptoms, and endoscopy, the diagnosis of eosinophilic esophagitis was documented by histology. After administration of oral corticosteroids a rapid improvement of the clinical symptoms was observed. The diagnosis of eosinophilic esophagitis should be kept in mind in patients with chronic symptoms of gastroesophageal reflux persisting despite medical therapy, pathological pH-metry and repeated bolus impactions. PMID:15830305

  9. Multimodality therapy is recommended for limited-stage combined small cell esophageal carcinoma

    PubMed Central

    Wang, Huan-Huan; Zaorsky, Nicholas G; Meng, Mao-Bin; Wu, Zhi-Qiang; Zeng, Xian-Liang; Jiang, Bo; Jiang, Chao; Zhao, Lu-Jun; Yuan, Zhi-Yong; Wang, Ping

    2015-01-01

    Background and aim Limited-stage combined small cell esophageal carcinoma (LS-C-SCEC) is a rare, poorly understood, underdiagnosed disease, with components of both small cell esophageal cancer and non–small cell esophageal cancer. We investigated the optimal treatment strategy and prognostic factors in patients with LS-C-SCEC. Patients and methods LS-C-SCEC patients included in the analysis (from our hospital and the literature) were treated between January 1966 and December 2013. Patient treatment strategies included surgery (S), chemotherapy (CT), and radiation therapy (RT). The primary end point was overall survival (OS); the secondary end points included tumor complete response rates, patterns of failure, and toxicity. Kaplan–Meier curves were compared with the log-rank test. Univariate and multivariate analyses were used to determine prognosticators for OS. Results A total of 72 patients were included in the analysis: 24 (33%) from our hospital and 48 (67%) from the literature. The median OS of all patients was 15.0 months. Patients who received CT had a significantly longer median OS than did those who did not (OS 22.8 months vs 10.0 months) (P=0.03). Patients treated with multimodality therapy (including RT+CT [18%], S+CT [40%], or S+RT+CT [17%]) vs monotherapy (typically, S [18%]) had significantly improved OS (15.5 months vs 9.3 months) (P=0.02) and complete response rates. On multivariate analysis, tumor location (upper third of the esophagus) and type of treatment (monotherapy) were the only factors predictive of poor OS. Conclusion Multimodality therapy (including RT+CT, S+CT, or S+RT+CT) improves OS for patients with LS-C-SCEC compared with monotherapy (typically, S). Additional studies are necessary to personalize multimodal treatment approaches to individual patients. PMID:25709477

  10. Inflammatory and microRNA Gene Expression as Prognostic Classifiers of Barrett's Associated Esophageal Adenocarcinoma

    PubMed Central

    Nguyen, Giang Huong; Schetter, Aaron J.; Chou, David B.; Bowman, Elise D.; Zhao, Ronghua; Hawkes, Jason E.; Mathe, Ewy A.; Kumamoto, Kensuke; Zhao, Yiqiang; Budhu, Anuradha; Hagiwara, Nobutoshi; Wang, Xin Wei; Miyashita, Masao; Casson, Alan G.; Harris, Curtis C.

    2010-01-01

    Purpose Esophageal cancer is one of the most aggressive and deadly forms of cancer; highlighting the need to identify biomarkers for early detection and prognostic classification. Our recent studies have identified inflammatory gene and microRNA signatures derived from tumor and nontumor tissues as prognostic biomarkers of hepatocellular, lung, and colorectal adenocarcinoma. Here, we examine the relationship between expression of these inflammatory genes and miRNA expression in esophageal adenocarcinoma and patient survival. Experimental Design We measured the expression of 23 inflammation-associated genes in tumors and adjacent normal tissues from 93 patients (58 Barrett's and 35 Sporadic adenocarcinomas) by quantitative reverse transcription-polymerase chain reaction. These data were used to build an inflammatory risk model, based on multivariate Cox regression, to predict survival in a training cohort (n=47). We then determined if this model could predict survival in a cohort of 46 patients. Expression data for miRNA-375 was available for these patients and was combined with inflammatory gene expression. Results IFN?, IL-1?, IL-8, IL-21, IL-23, and PRG expression in tumor and nontumor samples were each associated with poor prognosis based on Cox regression ([Z-score]>1.5) and therefore, were used to generate an inflammatory risk score (IRS). Patients with a high IRS had poor prognosis compared to those with a low IRS in the training (P=0.002) and test (P=0.012) cohorts. This association was stronger in the group with Barrett's history. When combining with miRNA-375, the combined IRS/miR signature was an improved prognostic classifier than either one alone. Conclusion Transcriptional profiling of inflammation-associated genes and miRNA expression in resected esophageal Barrett's associated adenocarcinoma tissues may have clinical utility as predictors of prognosis. PMID:20947516

  11. Tryptase staining of mast cells may differentiate eosinophilic esophagitis from gastroesophageal reflux disease

    PubMed Central

    Dellon, Evan S.; Chen, Xiaoxin; Miller, C. Ryan; Fritchie, Karen J.; Rubinas, Tara C.; Woosley, John T.; Shaheen, Nicholas J.

    2015-01-01

    Objectives Mast cells may contribute to the pathogenesis of eosinophilic esophagitis (EoE), but their role in diagnosis is unknown. Our aim was to determine whether tryptase staining of esophageal mast cells differentiates EoE from GERD and has utility for diagnosis of EoE. Methods We performed a case-control study comparing patients with EoE, defined by consensus guidelines, to GERD patients with eosinophils on esophageal biopsy. Immunohistochemistry was performed with mast cell tryptase. The density (mast cells/mm2) and intensity (0–4 scale) of mast cell staining was compared between groups after masking the diagnosis. Receiver operating characteristic (ROC) curves were constructed, and the area under the curve (AUC) calculated to assess mast cell staining as both a stand-alone diagnostic test and an adjunctive assay with eosinophil counts. Results Fifty-four EoE (mean age: 24; 69% male; mean 146 eos/hpf) and 55 GERD (mean age 34; 60% male; mean 20 eos/hpf) patients were analyzed. The maximum epithelial tryptase density was higher in EoE than in GERD (162 ± 87 mast cells/mm2 vs 67 ± 54; p<0.001). Mast cells were diffusely distributed throughout the biopsy in more EoE than GERD patients (41% vs 7%; p<0.001). Tryptase density and eosinophil count were only weakly correlated (R2=0.09; p=0.002). The AUC was 0.84 for tryptase staining alone, and 0.96 for the combination of mast cells and eosinophils. Conclusions Patients with EoE have higher levels of tryptase positive mast cells compared to GERD patients, improving the diagnostic value of biopsies beyond eosinophil counts alone. Mast cell tryptase may have utility as a diagnostic assay for EoE. PMID:20978486

  12. Invariant natural killer T-cell neutralization is a possible novel therapy for human eosinophilic esophagitis

    PubMed Central

    Rayapudi, Madhavi; Rajavelu, Priya; Zhu, Xiang; Kaul, Ajay; Niranjan, Rituraj; Dynda, Scott; Mishra, Akanksha; Mattner, Jochen; Zaidi, Asifa; Dutt, Parmesh; Mishra, Anil

    2014-01-01

    Eosinophilic esophagitis (EoE) is a recently recognized inflammatory disorder that needs a potential therapeutic strategy. We earlier showed that iNKT cell-deficient mice are protected from allergen-induced EoE. Therefore, we now tested the hypothesis that iNKT cells are induced in the human EoE and is a novel possible target for the treatment of human EoE. Accordingly, we examine number of iNKT cells and eosinophils and expression of iNKT-associated cell surface receptors and chemokines by performing immunofluorescence, qPCR and ELISA in the esophageal biopsies and blood samples of normal subjects (comparison control) and EoE patients. Herein, we show that iNKT cell number, their receptor subcomponents V?24 and V?11 expression, and associated chemokine CXCL16 levels (or expression) are induced significantly in EoE patients compared with normal individuals. In addition, we show that CXCL16 levels (or expression) correlate with the mRNA levels of V?24 receptor but not well with esophageal eosinophilia in human EoE. Of note, we show that in vivo activation of iNKT cells is sufficient to induce EoE in mice. Furthermore, we show that anti-mCD1d- and anti-hV?24J?18-neutralizing antibody treatment protects allergen-induced experimental EoE. Taken together, we have shown first time that iNKT cells have a critical pathogenic role in human and experimental EoE. iNKT cell neutralization by humanized anti-CD1d and anti-V?24J?18 antibodies might be a novel and potential therapy for human EoE. PMID:25505954

  13. Hyperfractionated Concomitant Boost Proton Beam Therapy for Esophageal Carcinoma

    SciTech Connect

    Mizumoto, Masashi [Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki (Japan); Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki (Japan); Sugahara, Shinji [Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki (Japan); Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki (Japan); Tokyo Medical University Ibaraki Medical Center, Ibaraki (Japan); Okumura, Toshiyuki; Hashimoto, Takayuki; Oshiro, Yoshiko; Fukumitsu, Nobuyoshi [Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki (Japan); Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki (Japan); Nakahara, Akira [Department of Gastroenterological Medicine, University of Tsukuba, Tsukuba, Ibaraki (Japan); Terashima, Hideo [Department of Surgery, University of Tsukuba, Tsukuba, Ibaraki (Japan); Tsuboi, Koji [Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki (Japan); Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki (Japan); Sakurai, Hideyuki, E-mail: hsakurai@pmrc.tsukuba.ac.jp [Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki (Japan); Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki (Japan)

    2011-11-15

    Purpose: To evaluate the efficacy and safety of hyperfractionated concomitant boost proton beam therapy (PBT) for patients with esophageal cancer. Methods and Materials: The study participants were 19 patients with esophageal cancer who were treated with hyperfractionated photon therapy and PBT between 1990 and 2007. The median total dose was 78 GyE (range, 70-83 GyE) over a median treatment period of 48 days (range, 38-53 days). Ten of the 19 patients were at clinical T Stage 3 or 4. Results: There were no cases in which treatment interruption was required because of radiation-induced esophagitis or hematologic toxicity. The overall 1- and 5-year actuarial survival rates for all 19 patients were 79.0% and 42.8%, respectively, and the median survival time was 31.5 months (95% limits: 16.7- 46.3 months). Of the 19 patients, 17 (89%) showed a complete response within 4 months after completing treatment and 2 (11%) showed a partial response, giving a response rate of 100% (19/19). The 1- and 5-year local control rates for all 19 patients were 93.8% and 84.4 %, respectively. Only 1 patient had late esophageal toxicity of Grade 3 at 6 months after hyperfractionated PBT. There were no other nonhematologic toxicities, including no cases of radiation pneumonia or cardiac failure of Grade 3 or higher. Conclusions: The results suggest that hyperfractionated PBT is safe and effective for patients with esophageal cancer. Further studies are needed to establish the appropriate role and treatment schedule for use of PBT for esophageal cancer.

  14. Rapidly Growing Esophageal Carcinosarcoma Reduced by Neoadjuvant Radiotherapy Alone

    PubMed Central

    Ogasawara, Naotaka; Tamura, Yasuhiro; Funaki, Yasushi; Yamaguchi, Yoshiharu; Shimozato, Akihiro; Yanamoto, Kenichiro; Takahashi, Emiko; Miyachi, Masahiko; Sasaki, Makoto; Kasugai, Kunio

    2014-01-01

    Esophageal carcinosarcoma is a rare malignant neoplasm consisting of both carcinomatous and sarcomatous components. It is generally treated by surgery, radiotherapy and chemotherapy according to the protocols used for other esophageal cancers. However, the treatment of esophageal carcinosarcoma by radiotherapy alone before surgery has not been previously described. We report a patient with a rapidly growing esophageal carcinosarcoma that was efficiently reduced by neoadjuvant radiotherapy alone. A previously healthy 69-year-old man was admitted with dysphagia. Initial esophagogastroduodenoscopy (EGD) revealed a small nodular polypoid lesion of about 10 mm in the middle esophagus. A second EGD 1 month later showed that the tumor had expanded into a huge mass. A biopsy specimen revealed that the tumor comprised squamous cell carcinoma with spindle cell components, and the tumor was diagnosed as carcinosarcoma which was diagnosed as stage I (T1bN0M0). Due to renal dysfunction, the patient was treated with neoadjuvant radiotherapy (40 Gy) without chemotherapy. A third EGD 1 month later revealed remarkable tumor reduction. He then underwent total esophagectomy with regional lymph node dissection (pStage 0, pT1aN0M0). After surgical operation, the patient was followed up without adjuvant therapy. Whole body computed tomography revealed lung metastasis 14 months after surgery, and the patient died 2 months later. The neoadjuvant radiotherapy for esophageal carcinosarcoma was considered to have contributed to the subsequent surgery and his prolonged survival time. Thus, radiotherapy alone might be a suitable neoadjuvant therapy for esophageal carcinosarcomas. PMID:25076867

  15. A review of the evidence linking eosinophilic esophagitis and food allergy.

    PubMed

    Lin, Samantha K; Sabharwal, Geetika; Ghaffari, Gisoo

    2015-01-01

    Eosinophilic esophagitis (EoE) is a chronic inflammation of the esophagus that has been considered an allergic phenomenon based on its similarities to other allergic conditions. More specifically, EoE has been considered a form of food allergy because of patient sensitizations to foods and improvements in symptoms and inflammation after food eliminations. This article presents the currently available evidence regarding the classification of EoE as an allergic condition, the involvement of foods in disease pathogenesis, and the value of different types of allergy testing and elimination diets in management of EoE. Using the search engines PubMed and Ovid, English literature in the past 10 years was reviewed with the use of the following key words: eosinophilic esophagitis, EoE epidemiology, EoE pathophysiology, food allergy, eosinophils, skin-prick testing, atopy patch testing, elemental diet, test directed elimination diet, six food elimination diet. Studies of EoE epidemiology and pathophysiology support the link between EoE and allergy in general, and studies of food allergy testing and elimination diets have supported a link between EoE and food allergy. Although food elimination diets cause resolution of symptoms and pathology in pediatric EoE, the results of testing and diet elimination studies are not as clear in adults, and aeroallergen sensitizations may play a larger role in adult EoE pathophysiology. Although several studies in children and adults support considering EoE a form of food allergy, the usefulness of skin-prick testing and atopy patch testing for food allergies and the optimal elimination diet for disease management are still uncertain. PMID:25562553

  16. Molecular pathways: pathogenesis and clinical implications of microbiome alteration in esophagitis and Barrett esophagus.

    PubMed

    Yang, Liying; Francois, Fritz; Pei, Zhiheng

    2012-04-15

    Esophageal adenocarcinoma is preceded by the development of reflux-related intestinal metaplasia or Barrett esophagus, which is a response to inflammation of the esophageal squamous mucosa, reflux esophagitis. Gastroesophageal reflux impairs the mucosal barrier in the distal esophagus, allowing chronic exposure of the squamous epithelium to the diverse microbial ecosystem or microbiome and inducing chronic inflammation. The esophageal microbiome is altered in both esophagitis and Barrett esophagus, characterized by a significant decrease in gram-positive bacteria and an increase in gram-negative bacteria in esophagitis and Barrett esophagus. Lipopolysaccharides (LPS), a major structure of the outer membrane in gram-negative bacteria, can upregulate gene expression of proinflammatory cytokines via activation of the Toll-like receptor 4 and NF-?B pathway. The potential impact of LPS on reflux esophagitis may be through relaxation of the lower esophageal sphincter via inducible nitric oxide synthase and by delaying gastric emptying via cyclooxygenase-2. Chronic inflammation may play a critical role in the progression from benign to malignant esophageal disease. Therefore, analysis of the pathways leading to chronic inflammation in the esophagus may help to identify biomarkers in patients with Barrett esophagus for neoplastic progression and provide insight into molecular events suitable for therapeutic intervention in prevention of esophageal adenocarcinoma development in patients with reflux esophagitis and Barrett esophagus. PMID:22344232

  17. Molecular Pathways: Pathogenesis and clinical implications of microbiome alteration in esophagitis and Barrett’s esophagus

    PubMed Central

    Yang, Liying; Francois, Fritz; Pei, Zhiheng

    2013-01-01

    Esophageal adenocarcinoma is preceded by the development of reflux-related intestinal metaplasia or Barrett’s esophagus which is a response to inflammation of the esophageal squamous mucosa, reflux esophagitis. Gastroesophageal reflux impairs the mucosal barrier in the distal esophagus, allowing chronic exposure of the squamous epithelium to the diverse microbial ecosystem or microbiome, and inducing chronic inflammation. The esophageal microbiome is altered in both esophagitis and Barrett's esophagus, characterized by a significant decrease in Gram-positive bacteria and an increase in Gram-negative bacteria in esophagitis and Barrett's esophagus. Lipopolysaccharides (LPS), a major structure of the outer membrane in Gram-negative bacteria, can up-regulate gene expression of proinflammatory cytokines via activation of the TLR4 and NF-kB pathway. The potential impact of LPS on reflux esophagitis may be through relaxation of the lower esophageal sphincter via iNOS and by delaying gastric emptying via COX-2. Chronic inflammation may be play a critical role in the progression from benign to malignant esophageal disease. Therefore analysis of the pathways leading to chronic inflammation in the esophagus may help to identify biomarkers in Barrett's esophagus patients for neoplastic progression and provide insight into molecular events suitable for therapeutic intervention in prevention of esophageal adenocarcinoma development in patients with reflux esophagitis and Barrett's esophagus. PMID:22344232

  18. Caustic ingestion: a possible cause of eosinophilic esophagitis?

    PubMed

    Homan, Matjaž; Orel, Rok; Liacouras, Chris

    2013-04-01

    Eosinophilic esophagitis (EoE) is an emerging disease in both pediatric and adult patients. It is a chronic disease of the esophagus and refers to intense eosinophilic infiltration limited to the esophageal epithelium in the absence of gastroesophageal reflux disease. In most patients, EoE is thought to be part of an allergic response to food antigens or aeroallergens. One such trigger could be caustic damage of the mucosa. To the best of our knowledge, the following case report describes for the first time the possible association between caustic injury of the esophagus and EoE. PMID:23478872

  19. Acute esophageal necrosis: a case report and review.

    PubMed

    Lahbabi, Mounia; Ibrahimi, Adil; Aqodad, Nouredine

    2013-01-01

    Acute esophageal necrosis, commonly referred to as "black esophagus" or "acute necrotizing esophagitis", is a rare clinical disorder with an unclear etiology. The definition excludes patients with a history of recent caustic ingestion. Oesophageal necrosis can be diagnosed at endoscopy by the presence of black necroting appearing oesophagus. Contrary to the caustic oesophagitis whose treatment is often surgical, treatment of the acute necrositing oesophagitis is primarily medical. The prognosis for patients who develop acute necrotizing oesophagitis is generally poor. We report a new case of acute necrotizing oesophagitis and undertook a literature review of this rare diagnosis. PMID:23717723

  20. Acute respiratory failure secondary to esophageal dilation from undiagnosed achalasia.

    PubMed

    Layton, James; Ward, Paul W; Miller, David W; Roan, Ronald M

    2014-09-01

    Achalasia is an idiopathic motility disorder causing progressive dysphagia and dilation of the esophagus. Rarely this esophageal dilation can cause acute respiratory insufficiency and/or failure. We describe a 63-year-old woman presenting for total knee arthroplasty in whom induction of anesthesia was complicated by pulmonary aspiration requiring postoperative ventilation, hypotension requiring vasopressor therapy, and postextubation, recurrent, acute respiratory failure. Computed tomography of the chest performed for suspected pneumothorax revealed severe esophageal dilation with a mass effect. As this case describes, achalasia may present with the life-threatening complication of respiratory failure and requires a high index of suspicion for timely diagnosis and appropriate interventions. PMID:25611356

  1. Unexplained dysphagia: viscous swallow-induced esophageal dysmotility.

    PubMed

    Meshkinpour, H; Eckerling, G

    1996-01-01

    Dysphagia is a manifestation of several clinical conditions of diverse origin. In spite of the variation in these disease entities in terms of their etiology, clinical presentation, natural history, and treatment, the mechanism of this clinical complaint is not always clear. We studied a group of patients with dysphagia for solids in whom no anatomic or motor abnormalities were encountered on standard studies. The group consisted of 37 patients, 25 women and 12 men, who were complaining of dysphagia of 6 months or longer duration and they did not demonstrate structural or motor abnormalities on barium esophagogram, esophagoscopy, and standard esophageal manometry. A group of 24 age-matched patients, 14 women and 10 men, with noncardiac chest pain served as the patient control. Esophageal contractile activities were studied after 10 wet swallows (5 ml of water) and 10 viscous swallows (5 cubic cm of marshmallow). Resting lower esophageal sphincter pressure and its relaxation response to swallows, amplitude of peristaltic activities, rate of dysphagia provoked during the study, and the frequency of abnormal esophageal contractions were evaluated. Six abnormal esophageal contractile activities-failed peristalsis, dropout, repetitive, simultaneous, spontaneous contractions, and aperistalsis-were utilized to generate an esophageal peristaltic dysfunction index. The mean LESP was 8.1 +/- 4.7 in the dysphagia group and 16.1 +/- 4.3 in the chest pain group. The mean amplitude of peristaltic contractions was 47.1 +/- 16.1 and 89.0 +/- 27.0 mmHg after wet swallows for dysphagia and chest pain groups, respectively. These values were 58.2 +/- 12.4 and 92.4 +/- 22.1 for viscous swallows. Swallowing provoked dysphagia in 89% of the dysphagia group after viscous swallows and 9% after wet swallows. In contrast, only 11% and 3% of control group complained of dysphagia during the study. This group of patients probably represent a cohort of patients with a nonspecific esophageal motor disorder in whom both clinical symptom and their esophageal motor counterpart can only be elicited in response to viscous swallows. We strongly believe in addition of viscous swallows in evaluating dysphagic patients in whom symptoms remain unexplained in light of standard studies. PMID:8721071

  2. Esophageal rupture due to Sengstaken-Blakemore tube misplacement

    PubMed Central

    Chong, Chee-Fah

    2005-01-01

    The author presents three cases of esophageal rupture during the treatment of massive esophageal variceal bleeding with Sengstaken-Blakemore (SB) tube. In each case, simple auscultation was used to guide SB tube insertion, with chest radiograph obtained only after complete inflation of the gastric balloon. Two patients died of hemorrhagic shock and one died of mediastinitis. The author suggests that confirmation of SB tube placement by auscultation alone may not be adequate. Routine chest radiographs should be obtained before and after full inflation of the gastric balloon to confirm tube position and to detect tube dislocation. PMID:16425437

  3. Acute esophageal necrosis: a case report and review

    PubMed Central

    Lahbabi, Mounia; Ibrahimi, Adil; Aqodad, Nouredine

    2013-01-01

    Acute esophageal necrosis, commonly referred to as “black esophagus” or “acute necrotizing esophagitis”, is a rare clinical disorder with an unclear etiology. The definition excludes patients with a history of recent caustic ingestion. Oesophageal necrosis can be diagnosed at endoscopy by the presence of black necroting appearing oesophagus. Contrary to the caustic oesophagitis whose treatment is often surgical, treatment of the acute necrositing oesophagitis is primarily medical. The prognosis for patients who develop acute necrotizing oesophagitis is generally poor. We report a new case of acute necrotizing oesophagitis and undertook a literature review of this rare diagnosis. PMID:23717723

  4. Prediction of Lymph Node Status in Superficial Esophageal Carcinoma

    Microsoft Academic Search

    Ermanno Ancona; Sabrina Rampado; Mauro Cassaro; Giorgio Battaglia; Alberto Ruol; Carlo Castoro; Giuseppe Portale; Francesco Cavallin; Massimo Rugge

    2008-01-01

    Background  Esophageal carcinoma is among the cancers with the worst prognosis. Real chances for cure depend on both early recognition\\u000a and early treatment. The ability to predict lymph node involvement allows early curative treatment with less invasive approaches.\\u000a \\u000a \\u000a \\u000a Aims  To determine clinicohistopathological criteria correlated with lymph node involvement in patients with early esophageal cancer\\u000a (T1) and to identify the best candidate patients

  5. [Endoscopic sclerosing therapy in esophageal varices. Indications and personal technics].

    PubMed

    Zannini, G; Purri, P; Masciariello, S; Santini, M; Di Crescenzo, V G; Pagano, G; Sangiuolo, P

    1982-01-28

    Variceal bleeding in cirrhotic patients with poor liver function is associated with a high mortality. A non-operative treatment, endoscopic sclerotherapy, was employed in 16 patients. The preliminary results have been encouraging. It has been possible to eradicate esophageal varices in the cronic injection group. A longer follow-up period will be required to assess both the quantitative and the qualitative aspects of survival and to determine how long esophageal varices will remain eradicated as well as how frequently repeated injections will be required. PMID:7058013

  6. Molecular alterations and clinical relevance in esophageal squamous cell carcinoma.

    PubMed

    Shang, Li; Wang, Mingrong

    2013-12-01

    Esophageal squamous cell carcinoma (ESCC) is one of the most common types of gastrointestinal cancers, and the fourth leading cause of cancer-related deaths in China. Early detection and intervention in time may dramatically increase the survival of the patients by initiating treatment regimens during earlier stages of ESCC or even during precancerous stages. Molecular classification will be useful for subtyping esophageal tumors or precancerous lesions to improve current therapeutics or early intervention of the disease. In this review, we summarize the findings in investigating the molecular alterations and clinical relevance of ESCC. PMID:24002746

  7. Spontaneous esophageal perforation (Boerhaave syndrome): Diagnosis with CT-esophagography

    PubMed Central

    Tonolini, Massimo; Bianco, Roberto

    2013-01-01

    Spontaneous esophageal perforation (Boerhaave syndrome) is a very uncommon, life-threatening surgical emergency that should be suspected in all patients presenting with lower thoracic-epigastric pain and a combination of gastrointestinal and respiratory symptoms. Variable clinical manifestations and subtle or unspecific radiographic findings often result in critical diagnostic delays. Multidetector computed tomography complemented with CT-esophagography represents the ideal “one-stop shop” investigation technique to allow a rapid, comprehensive diagnosis of BS, including identification of suggestive periesophageal abnormalities, direct visualization of esophageal perforation and quantification of mediastinitis. PMID:23493470

  8. pH, healing rate, and symptom relief in patients with GERD.

    PubMed Central

    Huang, J. Q.; Hunt, R. H.

    1999-01-01

    Gastroesophageal reflux symptoms are common and occur in all of us from time to time. In others, reflux may be associated with ulcerative esophagitis. The symptoms may be aggravated by large meals, coffee, smoking and position. Physiological and pathological reflux can be separated by the frequency and duration of the exposure of the lower esophagus to acid. Pathological reflux results in symptoms and also esophagitis and ulceration in some patients. Although gastroesophageal reflux disease (GERD) is considered to result from a disorder of motility in the esophagus, gastric acid and peptic activity are deemed pivotal to the initiation and continuation of the esophageal damage and the development of symptoms. Acid exposure in the esophagus is normally less than 4 percent of the 24 hours with a pH below 4. An increase over 4 percent of the time with a pH less than 4 is considered pathological. Hence, antisecretory drugs have become the principle approach to the treatment of reflux symptoms and esophagitis since they reduce the acidity, of gastric juice and the activity of pepsin. Importantly, they also reduce the volume of gastric juice available for reflux into the esophagus. There is a clear relationship between the degree and duration of acid suppression and the relief of heartburn and healing of esophagitis. Pharmacodynamic studies with different dose regimens of the H2-receptor antagonists and the proton pump inhibitors show a difference in the degree and duration of the antisecretory effect, and this correlates closely with the results of clinical trials with respect to the healing of esophagitis and the relief of symptoms. Proton pump inhibitors achieve healing rates by week four, which are not achieved by H2-receptor antagonists even after 12 weeks of treatment. The advantage of proton pump inhibitors over H2-receptor antagonists is due to the greater degree, longer duration of effect and more complete inhibition of acid secretion that maintains intragastric pH above 4 for a maximal duration. Although there is no significant difference between proton pump inhibitors with respect to healing of esophagitis, symptom relief occurs earlier with lansoprazole than omeprazole, and this is probably due to the greater oral bioavailability and faster onset of action of lansoprazole when compared to omeprazole. PMID:10780580

  9. The Prevalence, Risk Factors, and Clinical Correlates of Erosive Esophagitis and Barrett's Esophagus in Iranian Patients with Reflux Symptoms

    PubMed Central

    Dowlatshahi, Shahab; Moradi Tabriz, Hedieh; Salamat, Fatemeh

    2014-01-01

    Background. Erosive esophagitis (EE) and Barrett's esophagus (BE) are the two important complications of gastroesophageal reflux disease. We aimed to investigate the prevalence of and the risk factors for EE and BE in an Iranian group of patients with reflux symptoms. We also examined the relationship between reflux symptoms and endoscopic findings. Methods. A total of 736 patients with gastroesophageal reflux disease (GERD) symptoms were enrolled and all underwent upper gastrointestinal endoscopy. Diagnosis of Barrett's esophagus was confirmed by pathologic examination and Helicobacter pylori (H. pylori) infection was demonstrated by rapid urease test. Results. Two hundred eighty-three and 34 patients were found to have EE and BE, respectively. Multivariate analysis showed that hiatal hernia (P < 0.001) and H. pylori infection (P < 0.002) were the two significantly related risk factors for esophagitis. Only age was related to BE, with BE patients being more likely to be older (P < 0.001) than others. Conclusions. Prevalence of EE and BE in Iranian reflux patients is similar to that seen in western countries. H. pylori infection and the presence of hiatal hernia may be strong risk factors for esophagitis as does older age for Barrett's esophagus. Finally, reflux symptoms have no significant relationship with endoscopic findings. PMID:24778642

  10. The Prevalence, Risk Factors, and Clinical Correlates of Erosive Esophagitis and Barrett's Esophagus in Iranian Patients with Reflux Symptoms.

    PubMed

    Sharifi, Alireza; Dowlatshahi, Shahab; Moradi Tabriz, Hedieh; Salamat, Fatemeh; Sanaei, Omid

    2014-01-01

    Background. Erosive esophagitis (EE) and Barrett's esophagus (BE) are the two important complications of gastroesophageal reflux disease. We aimed to investigate the prevalence of and the risk factors for EE and BE in an Iranian group of patients with reflux symptoms. We also examined the relationship between reflux symptoms and endoscopic findings. Methods. A total of 736 patients with gastroesophageal reflux disease (GERD) symptoms were enrolled and all underwent upper gastrointestinal endoscopy. Diagnosis of Barrett's esophagus was confirmed by pathologic examination and Helicobacter pylori (H. pylori) infection was demonstrated by rapid urease test. Results. Two hundred eighty-three and 34 patients were found to have EE and BE, respectively. Multivariate analysis showed that hiatal hernia (P < 0.001) and H. pylori infection (P < 0.002) were the two significantly related risk factors for esophagitis. Only age was related to BE, with BE patients being more likely to be older (P < 0.001) than others. Conclusions. Prevalence of EE and BE in Iranian reflux patients is similar to that seen in western countries. H. pylori infection and the presence of hiatal hernia may be strong risk factors for esophagitis as does older age for Barrett's esophagus. Finally, reflux symptoms have no significant relationship with endoscopic findings. PMID:24778642

  11. Chyluria after ligation of the thoracic duct: a rare complication after thoracoscopic-assisted esophagectomy for esophageal cancer.

    PubMed

    Takeno, Atsushi; Tamura, Shigeyuki; Miki, Hirofumi; Tanigawa, Noboru; Taniguchi, Hirokazu; Nakahira, Shin; Suzuki, Rei; Nakata, Ken; Takeda, Yutaka; Kato, Takeshi

    2014-04-01

    Chyluria is leakage of lymphatic fluid into the urine, following trauma to or obstruction of the lymphatic system. We herein report a rare case of chyluria after esophagectomy for esophageal cancer. A 69-year-old male complaining of epigastric pain and reflux symptoms was diagnosed with advanced esophageal cancer and regional lymph node metastases. After receiving neoadjuvant chemotherapy to control the regional lymph node metastases, the patient underwent transthoracic excision of the esophagus assisted by thoracoscopy, with excision of the azygos vein and thoracic duct, esophagostomy and tube gastrostomy. On postoperative day 22, the urine appeared ivory white in color, and urine tests showed a high triglyceride level, thus confirming the diagnosis of chyluria. The chyluria decreased temporarily after switching the patient from enteral nutrition (EN) to parental nutrition, but it emerged again after the resumption of EN. Lymphangiography at that stage showed the flow of lipiodol into the pelvis of the left kidney. Resolution of the chyluria was noted after lymphangiography. He underwent esophageal reconstruction with a gastric tube through an anterior mediastinal route, and was discharged 36 days after the second operation. He was thereafter followed up at the outpatient clinic with radiotherapy. PMID:23229840

  12. Primary aorto-esophageal fistula: Great masquerader of esophageal variceal bleeding.

    PubMed

    Kokatnur, Laxmi; Rudrappa, Mohan

    2015-02-01

    Aorto-esophageal fistula is a rare cause of upper gastrointestinal bleeding. Thoracic aneurysm, the most common cause of this condition, will slowly increase over time and can erode the wall of the aorta creating a fistula and leading to torrential bleeding. High clinical suspicion is required for timely diagnosis as common investigations routinely done for gastrointestinal (GI) bleeding, including esophagogastroduodenoscopy, fails to detect most cases. The classical triad of midthoracic pain, herald bleeding and fatal hematemesis described in this condition is seen in only one-third of cases. Physician should be wary of this condition, especially in elderly patients with uncontrolled GI bleeding and who are also at risk of thoracic aneurysm. Computed tomography angiogram detects most cases and emergent endovascular repair with stents controls the initial bleeding. Later, both the aorta and the esophagus are repaired and reconstructed in staged procedures. PMID:25722556

  13. Primary aorto-esophageal fistula: Great masquerader of esophageal variceal bleeding

    PubMed Central

    Kokatnur, Laxmi; Rudrappa, Mohan

    2015-01-01

    Aorto-esophageal fistula is a rare cause of upper gastrointestinal bleeding. Thoracic aneurysm, the most common cause of this condition, will slowly increase over time and can erode the wall of the aorta creating a fistula and leading to torrential bleeding. High clinical suspicion is required for timely diagnosis as common investigations routinely done for gastrointestinal (GI) bleeding, including esophagogastroduodenoscopy, fails to detect most cases. The classical triad of midthoracic pain, herald bleeding and fatal hematemesis described in this condition is seen in only one-third of cases. Physician should be wary of this condition, especially in elderly patients with uncontrolled GI bleeding and who are also at risk of thoracic aneurysm. Computed tomography angiogram detects most cases and emergent endovascular repair with stents controls the initial bleeding. Later, both the aorta and the esophagus are repaired and reconstructed in staged procedures. PMID:25722556

  14. Effect of pH on the anaerobic acidogenesis of agroindustrial wastewaters for maximization of bio-hydrogen production: a lab-scale evaluation using batch tests.

    PubMed

    Dareioti, Margarita Andreas; Vavouraki, Aikaterini Ioannis; Kornaros, Michael

    2014-06-01

    The aim of this study was to investigate the impact of pH on the production of bio-hydrogen and end-products from a mixture of olive mill wastewater, cheese whey and liquid cow manure (with a ratio of 55:40:5, v/v/v). Batch experiments were performed under mesophilic conditions (37°C) at a range of pH from 4.5 to 7.5. The main end-products identified were acetic, propionic, butyric, lactic acid and ethanol. The highest hydrogen production yield was observed at pH 6.0 (0.642 mol H2/mol equivalent glucose consumed), whereas the maximum VFAs concentration (i.e. 13.43 g/L) was measured at pH 6.5. The composition of acidified effluent in acetic and butyric acid was similar at pH 6.0 and 6.5, albeit an increase of propionic acid was observed in higher pH. Lactic acid was identified as a major metabolite which presented an intense accumulation (up to 11 g/L) before its further bioconversion to butyric acid and hydrogen. PMID:24759638

  15. pH Protocol

    NSDL National Science Digital Library

    The GLOBE Program, UCAR (University Corporation for Atmospheric Research)

    2005-06-02

    The purpose of this resource is to measure the pH of water. Students use either a pH meter or pH paper to measure the pH. If using the pH meter, the meter needs to be calibrated with buffer solutions that have pH values of 4, 7, and 10.

  16. Congenital Esophageal Stenosis: Clinical and Endoscopic Features in Adults

    Microsoft Academic Search

    Ziad Younes; David A. Johnson

    1999-01-01

    Background: Congenital esophageal stenosis (CES) is an uncommon anomaly that reportedly rarely goes undiagnosed until adulthood. One variant of CES includes patients with multiple cartilaginous rings described usually in the mid‐distal esophagus. Methods: Ten patients with CES seen over the past 7 years were interviewed and their clinical and endoscopic records reviewed. Results: Eight patients were male and age at

  17. Endoscopy in eosinophilic esophagitis: “feline” esophagus and perforation risk

    Microsoft Academic Search

    Mitchell Kaplan; Ece A. Mutlu; Shriram Jakate; Keith Bruninga; John Losurdo; Joseph Losurdo; Ali Keshavarzian

    2003-01-01

    Background & Aims: Idiopathic eosinophilic esophagitis is an underdiagnosed disease with typical endoscopic findings, which have not been well described. Methods: Charts and pathology reports at two tertiary care centers from June 1993 to April 2002 were reviewed to describe the endoscopic findings of this disease and to correlate them with clinical characteristics. Eight patients were identified as having eosinophilic

  18. Clinical and immunopathologic effects of swallowed fluticasone for eosinophilic esophagitis

    Microsoft Academic Search

    Richard J Noel; Philip E Putnam; Margaret H Collins; Amal H Assa’ad; Jesus R Guajardo; Sean C Jameson; Marc E Rothenberg

    2004-01-01

    Background & Aims: Eosinophilic esophagitis (EE) is a recently recognized clinical disorder that is understood poorly. We aimed to determine the efficacy of swallowed fluticasone propionate on the immunopathologic features associated with EE. Methods: A retrospective analysis was performed on 20 pediatric patients with EE. Inclusion criteria specified a peak eosinophil density of ?24 cells per 400× field in the

  19. An Audit of Endoscopic Complications in Adult Eosinophilic Esophagitis

    Microsoft Academic Search

    Matthew S. Cohen; Adam B. Kaufman; Juan P. Palazzo; Daniel Nevin; Anthony J. DiMarino; Sidney Cohen

    2007-01-01

    Background & Aims: Eosinophilic esophagitis (EoE) in adults, characterized by the triad of dysphagia, a ringed esophagus, and mucosal eosinophilic infiltration, has asso- ciated complications that include vertical mucosal lacera- tions, instrumental perforation, and emesis-induced rup- ture. The aim of this study was to determine whether clinical, endoscopic, and histologic features can be used to predict the risk for development

  20. [Hyperthermia combined with chemotherapy and irradiation for esophageal carcinoma].

    PubMed

    Sugimachi, K; Matsufuji, H; Kai, H; Kitamura, M; Maekawa, S

    1986-04-01

    For clinical application in cases of carcinoma of the esophagus, we developed an endotract electrode ("applicator") for radiofrequency (RF) and an RF-generator (13.56 MHz) automatically controlled by a computer monitoring the temperature of the lesion. We then designed a combined therapy of hyperthermia, chemotherapy and radiotherapy (so-called hyperthermo-chemo-radiotherapy: HCR), on the basis of the additive or synergistic effects of hyperthermia combined with radiation and/or anticancer drugs. We applied this combined therapy to patients with esophageal carcinoma, using our newly developed heating system. HCR therapy was preoperatively performed on thirty-three patients with esophageal carcinoma. In the histopathological study of resected specimens, seven out of thirty-three patients (21.2%) showed markedly effective improvement, in seventeen (51.5%) the effects were moderately effective and in nine (27.3%) there were no apparent effects. The effectiveness (markedly + moderately effective/all cases) of preoperative HCR therapy was 72.7% (24/33), and significantly higher than the 50% (54/108) obtained in one hundred and eight patients who were preoperatively prescribed radiotherapy alone or in combination with chemotherapy. We then applied the combined therapy with hyperthermia to sixteen patients with unresectable esophageal carcinoma and eleven of these patients (68.8%) showed partial and moderate responses in esophagography. This combined therapy with hyperthermia is highly effective, and shows great promise for treating patients with esophageal carcinoma. PMID:3729455

  1. Predictors of Esophageal Stricture Formation Post Endoscopic Mucosal Resection

    PubMed Central

    Qumseya, Bashar; Panossian, Abraham M.; Rizk, Cynthia; Cangemi, David; Wolfsen, Christianne; Raimondo, Massimo; Woodward, Timothy; Wallace, Michael B.

    2014-01-01

    Background/Aims Stricture formation is a common complication after endoscopic mucosal resection. Predictors of stricture formation have not been well studied. Methods We conducted a retrospective, observational, descriptive study by using a prospective endoscopic mucosal resection database in a tertiary referral center. For each patient, we extracted the age, sex, lesion size, use of ablative therapy, and detection of esophageal strictures. The primary outcome was the presence of esophageal stricture at follow-up. Multivariate logistic regression was used to analyze the association between the primary outcome and predictors. Results Of 136 patients, 27% (n=37) had esophageal strictures. Thirty-two percent (n=44) needed endoscopic dilation to relieve dysphagia (median, 2; range, 1 to 8). Multivariate logistic regression analysis showed that the size of the lesion excised is associated with increased odds of having a stricture (odds ratio, 1.6; 95% confidence interval, 1.1 to 2.3; p=0.01), when controlling for age, sex, and ablative modalities. Similarly, the number of lesions removed in the index procedure was associated with increased odds of developing a stricture (odds ratio, 2.3; 95% confidence interval, 1.3 to 4.2; p=0.007). Conclusions Stricture formation after esophageal endoscopic mucosal resection is common. Risk factors for stricture formation include large mucosal resections and the resection of multiple lesions on the initial procedure. PMID:24765598

  2. Nitinol Esophageal Stents: New Designs and Clinical Indications

    SciTech Connect

    Strecker, Ernst-Peter; Boos, Irene; Vetter, Sylvia; Strohm, Michael; Domschke, Sigurd [Department of Radiology and Nuclear Medicine, Diakonissen-Krankenhaus, Diakonissenstr. 28, D-76191 Karlsruhe (Germany)

    1996-11-15

    Purpose: To evaluate the clinical use of covered and noncovered, knitted nitinol stents in patients presenting new stent indications. Methods: Self-expandable, knitted nitinol stents were implanted in four patients for treatment of dysphagia. In two patients who had malignant strictures and had esophago-respiratory fistulae and in one patient with an esophagocutaneous fistula, polytetrafluoroethylene (PTFE)-covered stents were implanted. One patient received a noncovered stent, but a retrograde approach through a percutaneous endoscopic gastrostomy (PEG) fistula had to be chosen for recanalization of an esophageal occlusion. Two patients received stents for treatment of benign strictures. Results: Recanalization of the stricture and stent implantation were performed under fluoroscopic control without any procedure-related morbidity or mortality. Dysphagia improved in all patients and the esophageal fistulae could be sealed off by covered stents. During a maximum follow-up of 18 months, there was no stent migration or esophageal perforation. Complications observed were stent stenosis due to food impaction (1/4) and benign stent stenosis (2/2). Most complications could be treated by the interventional radiologist. Conclusion: Self-expandable, covered Nitinol stents provide an option for the treatment of dysphagia combined with esophageal fistulae. In combination with interventional radiology techniques, even complex strictures are accessible. For benign strictures, the value of stent treatment has not yet been proven.

  3. Treatment of corrosive esophageal strictures by long-term stenting

    Microsoft Academic Search

    Oktay Mutaf

    1996-01-01

    From 1975 through 1992, 932 patients with caustic esophageal burns were admitted to the author's institution. Deep circumferential burns were diagnosed esophagoscopically in 241 children within the first 48 hours postburn. Initial treatment consisted of periodic anterograde and\\/or retrograde dilations of the injured and scarring esophagus (n = 172). In 1989, a long-term stenting technique was introduced, and a total

  4. Esophageal replacement in children who have caustic pharyngoesophageal strictures

    Microsoft Academic Search

    Rosa S Choi; Craig W Lillehei; Dennis P Lund; Gerald B Healy; Carlo Buonomo; Joseph Upton; W. Hardy Hendren

    1997-01-01

    Caustic injury to the upper aerodigestive system with scarring of the pharynx, hypopharynx, and esophagus is a challenging reconstructive problem. The authors report on seven patients who required total esophageal replacement from the pharynx to the stomach. Injury occurred from alkali in six and acid in one. Age at injury ranged from 14 months to 14 years (mean, 4.5 years.)

  5. Management of esophageal varices in children by endoscopic variceal ligation

    Microsoft Academic Search

    Mitchell R. Price; Kennith H. Sartorelli; Frederick M. Karrer; Michael R. Narkewicz; Ronald J. Sokol; John R. Lilly

    1996-01-01

    Endoscopic variceal sclerotherapy (EVS) has been considered the mainstay of therapy for bleeding esophageal varices in adults. However, recent data have shown that endoscopic variceal ligation (EVL) is just as efficacious and has fewer complications than EVS. Although there are many reports concerning EVL in adults, only a few studies have been done in children. This report describes experience with

  6. Epigenetic Patterns in the Progression of Esophageal Adenocarcinoma1

    Microsoft Academic Search

    Cindy A. Eads; Reginald V. Lord; Kumari Wickramasinghe; Tiffany I. Long; Soudamini K. Kurumboor; Leslie Bernstein; Jeffrey H. Peters; Steven R. DeMeester; Tom R. DeMeester; Kristin A. Skinner; Peter W. Laird

    2001-01-01

    Esophageal adenocarcinoma (EAC) arises after normal squamous mu- cosa undergoes metaplasia to specialized columnar epithelium (intestinal metaplasia or Barrett's esophagus), which can then ultimately progress to dysplasia and subsequent malignancy. Epigenetic studies of this model have thus far been limited to the DNA methylation analysis of a few genes. In this study, we analyzed a panel of 20 genes using

  7. Keratinization of the esophageal epithelium of domesticated mammals.

    PubMed

    Meyer, Wilfried; Schoennagel, Britta; Kacza, Johannes; Busche, Roger; Hornickel, Isabelle Nina; Hewicker-Trautwein, Marion; Schnapper, Anke

    2014-01-01

    We studied the esophageal epithelium for keratinization characteristics from samples of domesticated mammals of three nutrition groups (herbivores: horse, cattle, sheep; omnivores: pig, dog, rat; carnivores: cat) using histochemistry (keratins, disulfides), sulfur measurements, and cryo-SEM. Keratins were found in all esophageal layers of all species, except for the equine Stratum corneum. The positive reaction staining of Pan-keratin was remarkable, but decreased in intensity toward the outer layers, whereas in the pig and cat, staining was confined to the corneal layer. The herbivores revealed positive staining reactions in the upper Stratum spinosum, particularly in the sheep. Regarding single keratins, CK6 immunostating was found in most esophageal layers, but only weakly or negatively in the porcine and equine Stratum corneum. CK13 staining was restricted to the sheep and here was found in all layers. CK14 could be detected in the equine and feline Stratum basale, and upper vital layers of the dog and rat. CK17 appeared only in the Stratum spinosum and Stratum granulosum, but in all layers of the dog and cat. Disulfides reacted strongest in the Stratum corneum of the herbivores, as corroborated by the sulfur concentrations in the esophagus. Our study emphasized that keratins are very important for the mechanical stability of the epithelial cells and cell layers of the mammalian esophagus. The role of these keratins in the esophageal epithelia is of specific interest owing to the varying feed qualities and mechanical loads of different nutrition groups, which have to be countered. PMID:23948668

  8. Preparation and Characterization of a Biologic Scaffold from Esophageal Mucosa

    PubMed Central

    Keane, Timothy J.; Londono, Ricardo; Carey, Ryan M.; Carruthers, Christopher A.; Reing, Janet E.; Dearth, Christopher L.; D’Amore, Antonio; Medberry, Christopher J.; Badylak, Stephen F.

    2013-01-01

    Biologic scaffolds composed of extracellular matrix (ECM) are commonly used to facilitate a constructive remodeling response in several types of tissue, including the esophagus. Surgical manipulation of the esophagus is often complicated by stricture, but preclinical and clinical studies have shown that the use of an ECM scaffold can mitigate stricture and promote a constructive outcome after resection of full circumference esophageal mucosa. Recognizing the potential benefits of ECM derived from homologous tissue (i.e., site-specific ECM), the objective of the present study was to prepare, characterize, and assess the in-vivo remodeling properties of ECM from porcine esophageal mucosa. The developed protocol for esophageal ECM preparation is compliant with previously established criteria of decellularization and results in a scaffold that maintains important biologic components and an ultrastructure consistent with a basement membrane complex. Perivascular stem cells remained viable when seeded upon the esophageal ECM scaffold in vitro, and the in-vivo host response showed a pattern of constructive remodeling when implanted in soft tissue. PMID:23777917

  9. Doctors, Engineers Develop New Wireless System To Detect Esophageal Reflux

    E-print Network

    Chiao, Jung-Chih

    that takes photos as it goes through the digestive tract, and Bravo capsule, another wireless systemDoctors, Engineers Develop New Wireless System To Detect Esophageal Reflux Science Daily -- UT Southwestern Medical Center doctors and UT Arlington engineers have developed a wireless monitoring system

  10. Endoscopic diagnostic strategy of superficial esophageal squamous cell carcinoma.

    PubMed

    Muto, Manabu

    2013-03-01

    The prognosis of the esophageal squamous cell carcinoma is still poor. Early detection is ideal to improve patient survival. In particular, superficial cancer limited within the mucosal layer is a good candidate for minimally invasive treatment by endoscopic resection with curative intent. However, an effective endoscopic diagnostic strategy is not established worldwide. Herein, we review the published papers on this subject. PMID:23406378

  11. Comparative Genomic Hybridization of Esophageal Squamous Cell Carcinoma

    E-print Network

    Lin, Chi-Hung

    Comparative Genomic Hybridization of Esophageal Squamous Cell Carcinoma Correlations between.D. 7 1 Division of Medical Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China. 2 Institute of Clinical Medicine, National Yang-Ming University School

  12. Neural Network Based Decision Support System for Diagnosis of Esophagitis

    Microsoft Academic Search

    Santosh S. Saraf; G. R. Udupi; Santosh D. Hajare

    2007-01-01

    In this paper, we present a neural network based decision support system for diagnosis of Esophagitis. It is a condition of inflammation of the esophagus. The condition is detected by inserting an endoscope in the upper gastro-intestinal tract. The upper GI tract covers the esophagus, stomach and the duodenum. The endoscopist observes the area and captures images of the parts

  13. Preoperative Chemotherapy, Radiation Improve Survival in Esophageal Cancer

    Cancer.gov

    Patients with esophageal cancer who received chemotherapy and radiation before surgery survived, on average, nearly twice as long as patients treated with surgery alone, according to results of a randomized clinical trial published May 31, 2012, in the New England Journal of Medicine.

  14. Adding Targeted Therapy to Treatment for Esophageal Cancer

    Cancer.gov

    In this phase III clinical trial, people with confirmed HER2-positive locally advanced esophageal cancer will be randomly assigned to receive preoperative radiation therapy and chemotherapy, with or without trastuzumab. Following surgery, patients assigned to the trastuzumab arm of the study will receive maintenance therapy with trastuzumab for 1 year.

  15. Biomarkers in the molecular pathogenesis of esophageal (Barrett) adenocarcinoma

    PubMed Central

    Williams, L.J.; Guernsey, D.L.; Casson, A.G.

    2006-01-01

    Since the early 1970s, a dramatic change has occurred in the epidemiology of esophageal malignancy in both North America and Europe: the incidence of adenocarcinomas of the lower esophagus and esophagogastric junction is increasing. Several lifestyle factors are implicated in this change, including gastroesophageal reflux disease (gerd). Primary esophageal adenocarcinomas are thought to arise from Barrett esophagus, an acquired condition in which the normal esophageal squamous epithelium is replaced by a specialized metaplastic columnar-cell-lined epithelium. Today, gerd is recognized as an important risk factor in Barrett esophagus. Progression of Barrett esophagus to invasive adenocarcinoma is reflected histologically by the metaplasia–dysplasia–carcinoma sequence. Although several molecular alterations associated with progression of Barrett esophagus to invasive adenocarcinoma have been identified, relatively few will ultimately have clinical application. Currently, the histologic finding of high-grade dysplasia remains the most reliable predictor of progression to invasive esophageal adenocarcinoma. However other promising molecular biomarkers include aneuploidy; 17p loss of heterozygosity, which implicates the TP53 tumour suppressor gene; cyclin D1 protein overexpression; and p16 alterations. It is anticipated that models incorporating combinations of objective scores of sociodemographic and lifestyle risk factors (that is, age, sex, body mass index), severity of gerd, endoscopic and histologic findings, and a panel of biomarkers will be developed to better identify patients with Barrett esophagus at increased risk for malignant progression, leading to more rational endoscopic surveillance and screening programs. PMID:17576439

  16. Biomarkers in the molecular pathogenesis of esophageal (Barrett) adenocarcinoma.

    PubMed

    Williams, L J; Guernsey, D L; Casson, A G

    2006-02-01

    Since the early 1970s, a dramatic change has occurred in the epidemiology of esophageal malignancy in both North America and Europe: the incidence of adenocarcinomas of the lower esophagus and esophagogastric junction is increasing. Several lifestyle factors are implicated in this change, including gastroesophageal reflux disease (GERD). Primary esophageal adenocarcinomas are thought to arise from Barrett esophagus, an acquired condition in which the normal esophageal squamous epithelium is replaced by a specialized metaplastic columnar-cell-lined epithelium.Today, gerd is recognized as an important risk factor in Barrett esophagus. Progression of Barrett esophagus to invasive adenocarcinoma is reflected histologically by the metaplasia-dysplasia-carcinoma sequence. Although several molecular alterations associated with progression of Barrett esophagus to invasive adenocarcinoma have been identified, relatively few will ultimately have clinical application. Currently, the histologic finding of high-grade dysplasia remains the most reliable predictor of progression to invasive esophageal adenocarcinoma. However other promising molecular biomarkers include aneuploidy; 17p loss of heterozygosity, which implicates the TP53 tumour suppressor gene; cyclin D1 protein overexpression; and p16 alterations. It is anticipated that models incorporating combinations of objective scores of sociodemographic and lifestyle risk factors (that is, age, sex, body mass index), severity of gerd, endoscopic and histologic findings, and a panel of biomarkers will be developed to better identify patients with Barrett esophagus at increased risk for malignant progression, leading to more rational endoscopic surveillance and screening programs. PMID:17576439

  17. Mediastinoscope-assisted transhiatal esophagectomy for esophageal cancer

    Microsoft Academic Search

    A. Tangoku; S. Yoshino; T. Abe; H. Hayashi; T. Satou; T. Ueno; M. Oka

    2004-01-01

    Background: Transthoracic esophagectomy (TTE) is a radical strategy for treatment of esophageal cancer, and the morbidity and mortality are high. Transhiatal esophagectomy (THE) is advantageous because it avoids thoracotomy and has a shorter surgical time, but risk of intraoperative morbidity stresses the surgeon and lymph node sampling is not possible. Methods: Mediastinoscope-assited transhiatal esophagectomy (MATHE) was performed in 42 patients

  18. Reflections on esophageal columnar metaplasia (Barrett)-ANNO 2015.

    PubMed

    Tytgat, Guido Nj

    2015-02-01

    Esophageal columnar metaplasia (ECM) (Barrett's esophogus) continues to generate clinical and basic attention. Yet many questions remain unanswered and global consensus on important issues is often still lacking. This article discusses a selection of certain recent findings and reflects on some remaining uncertainties of this intriguing disease. PMID:25529483

  19. Nitric oxide: Mediator of nonadrenergic noncholinergic hyperpolarization of opossum esophageal circular smooth muscle

    SciTech Connect

    Du, C.; Murray, J.; Conklin, J.L.; Bates, J.N. (Univ. of Iowa, Iowa City (United States))

    1991-03-15

    The electromyogram recorded from circular smooth muscle (SM) of opossum esophagus, either during peristalsis or when the intrinsic esophageal nerves are stimulated by an electrical field (EFS), consists of a hyperpolarization followed by a depolarization. This membrane response results from the interaction of a nonadrenergic-noncholinergic (NANC) neurotransmitter with its receptors on SM membrane. N{sup G}-nitro-L-arginine (L-NNA), an inhibitor of nitric oxide synthase, and nitric oxide (NO) were used to test the hypothesis that NO is a mediator of this NANC nerve-induced response. The transmembrane potential difference of circular SM cells of opossum esophagus was recorded with glass microelectrode. The nerve-mediated membrane response was evoked by EFS. L-NNA (50uM) abolished the initial hyperpolarization and reduced the amplitude of and the time to maximal depolarization. L-arginine (1mM), the substrate for NO synthase, antagonized the effect of L-NNA. Neither L-NNA nor L-arginine altered the resting membrane potential. Exogenous NO produced hyperpolarization of SM membrane potential and attenuated the amplitude of EFS-induced hyperpolarization and depolarization. Nitrosocysteine, a NO-containing compound, also hyperpolarized the membrane potential. Effect of NO was neither blocked by L-NNA nor by TTX. The data support the hypothesis that NO or an NO-containing compound mediates NANC nerve-induced responses of the esophageal SM membrane.

  20. SIRT3 is a novel prognostic biomarker for esophageal squamous cell carcinoma.

    PubMed

    Yan, Shu-Mei; Han, Xian; Han, Pei-Jin; Chen, He-Mu; Huang, Li-Yun; Li, Yong

    2014-08-01

    Sirtuin-3 (SIRT3) protein is a member of Sirtuins family. It functions as a critical mitochondrial deacetylase, which is involved in a variety of diseases, such as cancer, cardiovascular disease and diabetes. However, its role in esophageal squamous cell carcinoma (ESCC) has never been investigated before. With the help of immunohistochemistry, we studied the clinical significance of SIRT3 expression in ESCC. The receiver operating characteristic method was used to define the SIRT3 IRS cutoff value. The correlations between SIRT3 expression and clinicopathological variables were assessed using Pearson's ? (2) test. To evaluate the clinical significance of SIRT3 expression, Kaplan-Meier analysis was used to compare postoperative survival between different SIRT3 expression groups of ESCC patients. High expression of SIRT3 in ESCC tissues was more frequently observed than corresponding adjacent non-malignant esophageal mucosa tissues. No correlations were found between SIRT3 expression and clinical parameters. Multivariate analysis revealed that SIRT3 expression was an independent prognostic factor in ESCC (HR 1.454, P = 0.034). Increased SIRT3 expression suggests unfavorable prognosis for ESCC patients. Further studies are warranted. PMID:25005846

  1. A three-protein signature and clinical outcome in esophageal squamous cell carcinoma.

    PubMed

    Cao, Hui-Hui; Zhang, Shi-Yi; Shen, Jin-Hui; Wu, Zhi-Yong; Wu, Jian-Yi; Wang, Shao-Hong; Li, En-Min; Xu, Li-Yan

    2015-03-10

    Current staging is inadequate to precisely predict clinical outcome of esophageal squamous cell carcinoma (ESCC) and determine treatment choices, which vary from operation alone to intensive multimodal regimens. The purpose of this study is to investigate the prognostic values of an immunohistochemistry-based three-protein signature model in patients with ESCC. We determined the protein expression of Annexin II, cofilin 1, ezrin, fascin, kindlin-2, moesin, MTSS1, myosin-9, profilin-1, Rac1, radixin, ROCK2, talin, tensin and villin 1 in a test cohort including 110 formalin-fixed, paraffin-embedded esophageal curative resection specimens by tissue microarrays (TMAs). A three-protein signature elicited from the protein cluster, Annexin II, kindlin-2, and myosin-9, was validated by TMAs on an independent cohort of 147 specimens. The expression of three-protein signature was highly predictive of ESCC overall survival (OS) and disease-free survival (DFS) in both generation and validation datasets. Regression analysis shows that this three-protein signature is an independent predictor for OS and DFS. Furthermore, the predictive ability of these 3 biomarkers in combination is more robust than that of each individual biomarker. This study demonstrates a clinically applicable prognostic model that accurately predicts ESCC patient survival and/or tumor recurrence, and thus could serve as a complement to current risk stratification approaches. PMID:25605255

  2. Multi-disciplinary approach for management of refractory benign occlusive esophageal strictures

    PubMed Central

    Hasan, Syed S.; Cohen, Dan C.; Pfanner, Timothy; Reznik, Scott; Duddempudi, Sushil

    2013-01-01

    Background: Benign occlusive esophageal strictures create substantial morbidity and have poor surgical outcomes. Various endoscopic techniques have been described to manage these strictures. The challenge remains to maintain adequate long-term esophageal patency and to limit the need for serial endoscopic dilations. Little has been reported regarding the management of these benign occlusive strictures. Methods: We report a case series describing the management of technically challenging benign occlusive esophageal strictures. Three patients with occlusive esophageal strictures of differing etiologies were treated using a variety of endoscopic methodologies. Results: The first patient sustained a caustic oropharyngeal injury resulting in a proximal esophageal stricture which was treated by using a combined antegrade retrograde dilation (CARD) with argon plasma coagulation (APC) and needle knife dissection resulting in the successful recanalization and patency of his stricture. A second patient developed an esophageal stricture following radiotherapy, and was treated with a CARD procedure and serial balloon dilations in combination with APC to successfully achieve esophageal luminal patency. The final patient acquired an occlusive esophageal stricture after treatment for thyroid cancer which was treated with endoscopic needle knife dissection followed by serial balloon dilations to successfully manage this stricture. Conclusions: Occlusive esophageal strictures pose a difficult challenge to gastroenterologists and little has been reported with regards to their endoscopic management. Using the CARD technique, needle knife dissection and APC, individually or in combination, luminal patency of occlusive esophageal strictures can be accomplished safely with good results. PMID:24003337

  3. PH DEPENDENT TOXICITY OF FIVE METALS TO THREE MARINE ORGANISMS

    EPA Science Inventory

    The pH of natural marine systems is relatively stable; this may explain why metal toxicity changes with pH have not been well documented. However, changes in metal toxicity with pH in marine waters are of concern in toxicity testing. During porewater toxicity testing pH can chang...

  4. Esophageal Carcinoma in African Americans: A Five-Decade Experience

    PubMed Central

    Nouri, Zahra; Nouraie, Mehdi; Razjouyan, Hadi; Lee, Edward E.; Dowlati, Ehsan; El-Seyed, El-Waleed; Laiyemo, Adeyinka; Brim, Hassan; Smoot, Duane T.

    2012-01-01

    Background Esophageal cancer accounts for a considerable proportion of carcinomas of the upper gastrointestinal tract in African Americans. Our aim was to describe the epidemiology of esophageal squamous cell cancer (ESCC) and esophageal adenocarcinoma (EA) among African Americans in the last five decades. Methods A total of 601 records of patients with documented esophageal cancer between 1959 and 2007 at Howard University Hospital were reviewed. Demographic characteristics, risk factors, clinical stage and histological findings were reviewed. The change in prevalence of the disease and the interaction between main risk factors with tumor stage of the patients were assessed over the years of this study. Result A total of 552 patients (91.8%) had ESCC while 49 patients (8.2%) had EA. The mean age at diagnosis was 60.1 and 60.6 years for ESCC and EA, respectively (P = 0.8). The peak incidence was in the 1980–1989 decade. Out of 136 ESCC patients with TNM staging information, 130 (95.6%) were diagnosed in stage 2 and above. The majority (73%) of the ESCC were in the mid- and upper third of the esophagus and associated with smoking and alcohol exposure. The majority (81%) of the EA were in the mid- and lower third. The most common presenting symptoms were dysphagia (77.7%), and weight loss (31.9%). Conclusion ESCC is the predominant esophageal cancer in African Americans and diagnosed in late stages, and its diagnosis in our institution has decreased since 1990. A combination of genetic factors, environmental influences (e.g., those related to diet), and the deleterious changes associated with smoking and alcohol consumption, and differences in tumor histology, are the obvious parameters that should be the focus of future studies, and early diagnosis at an earlier stage should be considered among blacks. PMID:21847566

  5. Role of metallic stents in benign esophageal stricture

    NASA Astrophysics Data System (ADS)

    Shim, Chan Sup

    2012-10-01

    Simple esophageal strictures, which are focal, straight, and large in diameter, usually require 1 - 3 dilation sessions to relieve symptoms. However, complex strictures, which are long, tortuous, or associated with a severely compromised luminal diameter, are usually more difficult to treat with conventional bougie or balloon dilation techniques, and often have high recurrence rates. Although the permanent placement of self-expandable metal stents (SEMS) has been used to manage refractory benign esophageal strictures, this procedure is associated with additional problems, such as stricture from tissue hyperplasia, stent migration, and fistula formation. Thus, several new types of stents have been developed, including temporary SEMS, self-expandable plastic stents (SEPS), and biodegradable stents. The use of these new products has produced varied results. Temporary SEMS that have been used to relieve benign esophageal conditions have caused granulation tissue at both ends of the stent because of contact between the mucosa and the exposed metal components of the stent, thus hindering stent removal. We examined the tissue response to two new types of SEMS, a flange-type and a straighttype, each coated with a silicone membrane on the outside of the metal mesh. These two SEMS were evaluated individually and compared with a conventional control stent in animal experiments. Although the newly designed stents resulted in reduced tissue hyperplasia, and were thus more easily separated from the esophageal tissue, some degree of tissue hyperplasia did occur. We suggest that newly designed DES (drug-eluting stents) may provide an alternative tool to manage refractory benign esophageal stricture.

  6. Prevalence of and impact of pantoprazole on nocturnal heartburn and associated sleep complaints in patients with erosive esophagitis.

    PubMed

    Kindt, S; Imschoot, J; Tack, J

    2011-11-01

    Studies in the United States have revealed that gastroesophageal reflux disease (GERD) patients often suffer from nocturnal symptoms, sleep disturbance, and impaired quality of life. In a large subset of patients, these symptoms persist in spite of acid suppressive therapy. The aim of the present study was to assess the prevalence of heartburn and associated sleep complaints and the response to standard medical therapy with pantoprazole in primary and secondary care esophagitis patients in Belgium. Questionnaires were provided to consecutive patients presenting to primary and secondary care physicians with esophagitis. The questionnaire evaluated the presence of typical reflux symptoms, alarm symptoms, risk factors, and sleep quality impairment as a result of reflux episodes. Results are shown as mean ± standard deviation and compared by Student's t-test or chi-square test. A total of 4061 primary and 5261 secondary care patients (50% female, mean age 53 ± 0.2 years, body mass index of 25.7 ± 0.1?kg/m(2) ) were recruited. Eighty-four percent of patients reported sleep disturbance attributable to nighttime reflux, including typical nighttime supine reflux symptoms (72%), difficulties to fall asleep (39%), waking up during the night (45%), morning fatigue (35%), and reflux symptoms when waking up in the morning (47%). Mild, moderate, or severe nighttime heartburn were reported by, respectively, 30, 35, and 12%, and these numbers were 26, 28, and 6% for nighttime regurgitation. Alcohol (19%), smoking (22%), higher esophagitis grades (grades 2, 3, and 4 in, respectively, 31, 7, and, 7%), alarm symptoms (27%), and more severe heartburn and regurgitation during daytime were all significantly associated with all dimensions of sleep disturbance (P < 0.0001). Obesity was only related to symptoms in supine position and when waking up (P < 0.0001). After 1.4 ± 0.0 months of treatment with pantoprazole, any sleep disturbance had improved in more than 75% of patients, with resolution of nighttime heartburn and regurgitation in, respectively, 75 and 83%. The majority of patients presenting with reflux symptoms and esophagitis in primary or secondary care experience nighttime heartburn and regurgitation, and sleep disturbance by nighttime symptoms is present in 84%. Smoking, alcohol use, higher grades of esophagitis, more severe typical reflux symptoms during daytime, and the presence of alarm symptoms are risk factors for GERD-related sleep disturbance. On standard therapy with pantoprazole, nighttime symptoms improved in more than 75%. These observations support a direct relationship between GERD and sleep disturbance. PMID:21418126

  7. Effect of curcumin on acidic pH-induced expression of IL-6 and IL-8 in human esophageal epithelial cells (HET-1A): role of PKC, MAPKs, and NF-kappaB.

    PubMed

    Rafiee, Parvaneh; Nelson, Victoria M; Manley, Sharon; Wellner, Michael; Floer, Martin; Binion, David G; Shaker, Reza

    2009-02-01

    Human esophageal epithelial cells play a key role in esophageal inflammation in response to acidic pH during gastroesophageal reflux disease (GERD), increasing secretion of IL-6 and IL-8. The mechanisms underlying IL-6 and IL-8 expression and secretion in esophageal epithelial cells after acid stimulation are not well characterized. We investigated the role of PKC, MAPK, and NF-kappaB signaling pathways and transcriptional regulation of IL-6 and IL-8 expression in HET-1A cells exposed to acid. Exposure of HET-1A cells to pH 4.5 induced NF-kappaB activity and enhanced IL-6 and IL-8 secretion and mRNA and protein expression. Acid stimulation of HET-1A cells also resulted in activation of MAPKs and PKC (alpha and epsilon). Curcumin, as well as inhibitors of NF-kappaB (SN-50), PKC (chelerythrine), and p44/42 MAPK (PD-098059) abolished the acid-induced expression of IL-6 and IL-8. The JNK inhibitor SP-600125 blocked expression/secretion of IL-6 but only partially attenuated IL-8 expression. The p38 MAPK inhibitor SB-203580 did not inhibit IL-6 expression but exerted a stronger inhibitory effect on IL-8 expression. Together, these data demonstrate that 1) acid is a potent inducer of IL-6 and IL-8 production in HET-1A cells; 2) MAPK and PKC signaling play a key regulatory role in acid-mediated IL-6 and IL-8 expression via NF-kappaB activation; and 3) the anti-inflammatory plant compound curcumin inhibits esophageal activation in response to acid. Thus IL-6 and IL-8 expression by acid may contribute to the pathobiology of mucosal injury in GERD, and inhibition of the NF-kappaB/proinflammatory cytokine pathways may emerge as important therapeutic targets for treatment of esophageal inflammation. PMID:19074641

  8. Bicarbonate Test

    MedlinePLUS

    ... identify or monitor an electrolyte imbalance or acid-base (pH) imbalance When to Get Tested? During a ... the body to help maintain the body's acid-base balance (pH) and secondarily to work with sodium , ...

  9. Recurrent cervical esophageal stenosis after colon conduit failure: use of myocutaneous flap.

    PubMed

    Sa, Young Jo; Kim, Young Du; Kim, Chi Kyung; Park, Jong Kyung; Moon, Seok Whan

    2013-01-14

    A 53-year-old male developed cervical esophageal stenosis after esophageal bypass surgery using a right colon conduit. The esophageal bypass surgery was performed to treat multiple esophageal strictures resulting from corrosive ingestion three years prior to presentation. Although the patient underwent several endoscopic stricture dilatations after surgery, he continued to suffer from recurrent esophageal stenosis. We planned cervical patch esophagoplasty with a pedicled skin flap of sternocleidomastoid (SCM) muscle. Postoperative recovery was successful, and the patient could eat a solid meal without difficulty and has been well for 18 mo. SCM flap esophagoplasty is an easier and safer method of managing complicated and recurrent cervical esophageal strictures than other operations. PMID:23345956

  10. Various upper endoscopic findings of acute esophageal thermal injury induced by diverse food: a case series.

    PubMed

    Lee, Yu Mi; Kim, Sun Moon; Kim, Ji Young; Song, Hyun Jung; Koo, Hoon Sup; Song, Kyung Ho; Kim, Yong Seok; Huh, Kyu Chan

    2014-09-01

    Esophageal thermal injury caused by food has been reported to occur mostly after drinking hot liquid food, and is known to produce alternating white and red linear mucosal bands. In addition, thermal injury caused by ingestion of hot solid foods is documented to be a cause of esophageal ulcers or pseudomembranes. From January 2006 to August 2012, five patients with suspected esophageal thermal injury underwent esophagogastroduodenoscopy with biopsy. A "candy-cane" appearance was observed in one case, pseudomembrane was observed in two cases, an esophageal ulcer was observed in one case, and a friable and edematous mucosa was noted in one case. We believe that the endoscopic findings of esophageal thermal injury depend on the following factors: causative materials, amount of food consumed, exposure period, and time to endoscopy after the incident. Therefore, physicians who encounter patients with suspected esophageal thermal injury should carefully take the patient's history considering these factors. PMID:25325006

  11. Various Upper Endoscopic Findings of Acute Esophageal Thermal Injury Induced by Diverse Food: A Case Series

    PubMed Central

    Lee, Yu Mi; Kim, Ji Young; Song, Hyun Jung; Koo, Hoon Sup; Song, Kyung Ho; Kim, Yong Seok; Huh, Kyu Chan

    2014-01-01

    Esophageal thermal injury caused by food has been reported to occur mostly after drinking hot liquid food, and is known to produce alternating white and red linear mucosal bands. In addition, thermal injury caused by ingestion of hot solid foods is documented to be a cause of esophageal ulcers or pseudomembranes. From January 2006 to August 2012, five patients with suspected esophageal thermal injury underwent esophagogastroduodenoscopy with biopsy. A "candy-cane" appearance was observed in one case, pseudomembrane was observed in two cases, an esophageal ulcer was observed in one case, and a friable and edematous mucosa was noted in one case. We believe that the endoscopic findings of esophageal thermal injury depend on the following factors: causative materials, amount of food consumed, exposure period, and time to endoscopy after the incident. Therefore, physicians who encounter patients with suspected esophageal thermal injury should carefully take the patient's history considering these factors. PMID:25325006

  12. Relationships Between Eosinophilic Inflammation, Tissue Remodeling and Fibrosis in Eosinophilic Esophagitis*

    PubMed Central

    Aceves, Seema S.; Ackerman, Steven J.

    2009-01-01

    SYNOPSIS The clinical and pathologic features of Eosinophilic Esophagitis (EE) include extensive tissue remodeling. Increasing evidence supports a key role for the eosinophil in multiple aspects of the esophageal remodeling and fibrosis seen in this allergic disease, including epithelial hyperplasia, subepithelial fibrosis, smooth muscle hyperplasia, and angiogenesis. These structural changes contribute to the endoscopic findings of esophageal thickening, luminal narrowing, furrowing, transient and fixed rings (trachealization) and stricture, as well as the clinical features of dysmotility, dysphagia and food impactions in pediatric and adult EE. This chapter reviews the clinical implications of esophageal remodeling and fibrosis in EE and discusses the possible pathogenic mechanisms inducing and regulating these responses. We focus specifically on eosinophil and cytokine interactions with the esophageal epithelium, vascular endothelium, resident fibroblasts, and smooth muscle. Current and potential therapeutic interventions are discussed that may impact the development or resolution of chronic esophageal remodeling and fibrosis in EE. PMID:19141355

  13. Proton pump inhibitors (PPIs) impact on tumour cell survival, metastatic potential and chemotherapy resistance, and affect expression of resistance-relevant miRNAs in esophageal cancer.

    PubMed

    Lindner, Kirsten; Borchardt, Christiane; Schöpp, Maren; Bürgers, Anja; Stock, Christian; Hussey, Damian J; Haier, Jörg; Hummel, Richard

    2014-09-01

    BackgroundNeoadjuvant treatment plays a crucial role in the therapy of advanced esophageal cancer. However, response to radiochemotherapy varies widely. Proton pump inhibitors (PPIs) have been demonstrated to impact on chemotherapy in a variety of other cancers. We analyzed the impact of PPI treatment on esophageal cancer cell lines, and investigated mechanisms that mediate the effect of PPI treatment in this tumour.MethodsWe investigated the effect of esomeprazole treatment on cancer cell survival, adhesion, migration and chemotherapy in human adeno-(OE19) and squamous-cell-carcinoma (KYSE410) cell lines. Furthermore, we investigated the effect of PPI treatment on intra-/extracellular pH and on expression of resistance-relevant miRNAs.ResultsEsomeprazole significantly inhibited tumour cell survival (in a dose-dependent manner), adhesion and migration in both tumour subtypes. Furthermore, esomeprazole augmented the cytotoxic effect of cisplatin and 5-FU in both tumour subtypes. Surprisingly, PPI treatment led to a significant increase of intracellular pH and a decrease of the extracellular pH. Finally, we found esomeprazole affected expression of resistance-relevant miRNAs. Specifically, miR-141 and miR-200b were upregulated, whereas miR-376a was downregulated after PPI treatment in both tumour types.ConclusionOur study demonstrates for the first time that PPIs impact on tumour cell survival, metastatic potential and sensitivity towards chemotherapy in esophageal cancer cell lines. Furthermore, we observed that in this tumour entity, PPIs do not lead to intracellular acidification, but affect the expression of resistance-relevant miRNAs. PMID:25175076

  14. Analysis of Intensity-Modulated Radiation Therapy (IMRT), Proton and 3D Conformal Radiotherapy (3D-CRT) for Reducing Perioperative Cardiopulmonary Complications in Esophageal Cancer Patients

    PubMed Central

    Ling, Ted C.; Slater, Jerry M.; Nookala, Prashanth; Mifflin, Rachel; Grove, Roger; Ly, Anh M.; Patyal, Baldev; Slater, Jerry D.; Yang, Gary Y.

    2014-01-01

    Background. While neoadjuvant concurrent chemoradiotherapy has improved outcomes for esophageal cancer patients, surgical complication rates remain high. The most frequent perioperative complications after trimodality therapy were cardiopulmonary in nature. The radiation modality utilized can be a strong mitigating factor of perioperative complications given the location of the esophagus and its proximity to the heart and lungs. The purpose of this study is to make a dosimetric comparison of Intensity-Modulated Radiation Therapy (IMRT), proton and 3D conformal radiotherapy (3D-CRT) with regard to reducing perioperative cardiopulmonary complications in esophageal cancer patients. Materials. Ten patients with esophageal cancer treated between 2010 and 2013 were evaluated in this study. All patients were simulated with contrast-enhanced CT imaging. Separate treatment plans using proton radiotherapy, IMRT, and 3D-CRT modalities were created for each patient. Dose-volume histograms were calculated and analyzed to compare plans between the three modalities. The organs at risk (OAR) being evaluated in this study are the heart, lungs, and spinal cord. To determine statistical significance, ANOVA and two-tailed paired t-tests were performed for all data parameters. Results. The proton plans showed decreased dose to various volumes of the heart and lungs in comparison to both the IMRT and 3D-CRT plans. There was no difference between the IMRT and 3D-CRT plans in dose delivered to the lung or heart. This finding was seen consistently across the parameters analyzed in this study. Conclusions. In patients receiving radiation therapy for esophageal cancer, proton plans are technically feasible while achieving adequate coverage with lower doses delivered to the lungs and cardiac structures. This may result in decreased cardiopulmonary toxicity and less morbidity to esophageal cancer patients. PMID:25489937

  15. Fatal necrotizing esophagitis due to Penicillium chrysogenum in a patient with acquired immunodeficiency syndrome

    Microsoft Academic Search

    M. Hoffman; E. Bash; S. A. Berger; M. Burke; I. Yust

    1992-01-01

    Although blue-green molds of the genusPenicillium are ubiquitous in the human environment, invasive penicilliosis is uncommon and primarily encountered among immunosuppressed patients. A patient with HIV infection who died of severe necrotizing esophagitis caused byPenicillium chrysogenum is reported and the relevant English language literature on human penicilliosis is reviewed. Although infectious esophagitis is commonly associated with AIDS,Penicillium esophagitis has not

  16. Reconstructive surgery for combined tracheo-esophageal injuries and their sequelae

    Microsoft Academic Search

    V. V. Sokolov; M. M. Bagirov

    2001-01-01

    Objective: To evaluate surgical options of treatment in combined tracheo-esophageal injuries and their sequelae and elaborate new ones. Methods: The overlooked diagnosis of combined tracheo-esophageal injury would lead to severe stenosis of the esophagus and trachea with tracheo-esophageal fistula. This condition requires a complex surgical intervention to be performed with non-standard procedure in every single case. Forty patients with combined

  17. Exposure to oral bisphosphonates and esophageal cancer risk: A UK General Practice Research Database cohort study

    PubMed Central

    Cardwell, Chris C; Abnet, Christian C; Cantwell, Marie M; Murray, Liam J

    2012-01-01

    Context Oral bisphosphonate use has increased dramatically in the USA. Recent case reports have suggested a link between bisphosphonate use and esophageal cancer, but this is yet to be robustly investigated. Objective To investigate the association between bisphosphonate use and esophageal cancer. Design, setting and participants Data were extracted from the UK General Practice Research to compare the incidence of esophageal and gastric cancer in a cohort of patients treated with oral bisphosphonates between January 1996 and December 2006 to a control cohort not treated with these drugs. Cancers were identified from relevant Read\\OXMIS codes in the patient’s clinical files. Cox proportional hazards modelling was used to calculate hazard ratios (HRs) and 95% CIs for esophageal and gastric cancer risk in bisphosphonate users compared to non bisphosphonate users, with adjustment for potential confounders. Main outcome measure The HR for the risk of esophageal and gastric cancer in the bisphosphonate users compared to the non bisphosphonate users. Results There were 41,826 members in each cohort; 81% female, mean (SD) age, 70.0 (11.4) years, excluding patients with under 6 months follow-up. 116 esophageal or gastric cancers (79 esophageal) occurred in the bisphosphonate cohort and 115 (72 esophageal) in the control cohort. Mean follow-up time was 4.5 and 4.4 years in the bisphosphonate and control cohorts, respectively. There was no difference in combined esophageal and gastric cancer risk between the cohorts for any bisphosphonate use; adjusted HR (95% CI), 0.96 (0.74, 1.25) or esophageal risk alone; adjusted HR (95% CI), 1.07 (0.77, 1.49). There was also no difference in esophageal or gastric cancer risk by level of bisphosphonate intake. Conclusion This large study does not provide evidence for an increased risk of esophageal (or gastric) cancer in persons using oral bisphosphonates. PMID:20699457

  18. The Miscellaneous Mystery of Esophageal Cancer: New pathogenetic and clinical insights

    Microsoft Academic Search

    B. A. Grotenhuis

    2010-01-01

    Esophageal cancer is the 8th most common type of malignancy and the 6th most\\u000acommon cause of cancer mortality in the world. Worldwide more than 400,000\\u000apatients are newly diagnosed with esophageal cancer each year. The majority of\\u000apatients (>90%) is diagnosed with the two most common histological subtypes:\\u000asquamous cell carcinoma or adenocarcinoma of the esophagus. Esophageal squamous\\u000acell

  19. Esophageal polyps in pediatric patients undergoing routine diagnostic upper gastrointestinal endoscopy: a multicenter study.

    PubMed

    Septer, S; Cuffari, C; Attard, T M

    2014-01-01

    Esophageal polyps are uncommon findings in pediatric patients, and reports have been limited to case reports. Esophageal polyps have been previously ascribed to esophagitis secondary to gastroesophageal reflux, medications, infections and recurrent vomiting. They have been associated with underlying conditions such as hiatal hernia, Barrett's esophagus, eosinophilic esophagitis and Crohn's disease. Presenting complaints of children with esophageal polyps have included vomiting, dysphagia, hematemesis and abdominal pain. The aim of this paper is to characterize the incidence, clinical presentation and progression, histologic subtypes and associated mucosal abnormalities in children with esophageal polyps. A retrospective multicenter study was performed at four institutions identifying diagnosis of esophageal polyps in pediatric patients (<21 years). Information was obtained from patient charts, endoscopy reports and histopathology reports. Specimens and slides were examined by experienced pediatric pathologists for all included cases. Esophageal polyps were identified in 13 patients (9?M) from 9438 esophagogastroduodenoscopies (0.14%). Mean age of subjects was 9.2 years. Vomiting was the most common indication for endoscopy. Polyp location was at the gastroesophageal junction in 7 of the 13 cases. Most polyps were inflammatory (n = 7). Esophagitis was noted in 69% of those with esophageal polyps. Repeat endoscopies in six patients at a mean interval of 8 months noted persistence of polyps in all six patients. This paper is the first to characterize esophageal polyps in pediatrics. These polyps are rare in children and often are associated with esophagitis. Presenting complaints seem to vary by age. Polyps did not consistently change with either time or acid suppression. The optimal management strategy has yet to be defined and likely depends on the underlying pathophysiologic process. PMID:23551692

  20. Esomeprazole (40 mg) compared with lansoprazole (30 mg) in the treatment of erosive esophagitis

    Microsoft Academic Search

    Donald O. Castell; Peter J. Kahrilas; Joel E. Richter; Nimish B. Vakil; David A. Johnson; Seth Zuckerman; Wendy Skammer; Jeffrey G. Levine

    2002-01-01

    OBJECTIVES: Esomeprazole, the S isomer of omeprazole, has been shown to have higher healing rates of erosive esophagitis than omeprazole. This study compared esomeprazole with lansoprazole for the healing of erosive esophagitis and resolution of heartburn.METHODS:This United States multicenter, randomized, double blind, parallel group trial was performed in 5241 adult patients (intent-to-treat population) with endoscopically documented erosive esophagitis, which was