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1

Ambulatory 24-hour esophageal pH monitoring  

Microsoft Academic Search

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

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

1988-01-01

2

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

PubMed Central

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.

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

2013-01-01

3

Age and gender-related differences in 24-hour esophageal pH monitoring of normal subjects  

Microsoft Academic Search

Twenty-four-hour esophageal pH monitoring is currently the most sensitive test for diagnosing gastroesophageal reflux. Little is known, however, about the effect of aging and gender on esophageal acid exposure in asymptomatic individuals. Thirty asymptomatic volunteers underwent 24-hr esophageal pH monitoring. Fifteen were <65 years (eight female, seven male) and 15 were =65 years (seven female, eight male). In this asymptomatic

Ronnie Fass; Richard E. Sampliner; Cindy Mackel; Dan McGee; William Rappaport

1993-01-01

4

Drugs, bugs, and esophageal pH profiles.  

PubMed Central

Until relatively recently, gastroesophageal reflux disease (GERD) was thought to be a relatively trivial problem, and pharmaceutical companies initially had remarkably little interest in clinical trials for GERD. Over the last ten years, GERD therapy has become the subject of intense interest, since reflux disease is now recognized as a major market for antisecretory and prokinetic drugs. Even low-technology antacids are now known to effectively neutralize esophageal acid prevent acid reflux for up to 90 minutes. Esophageal pH profiling is known to be an excellent surrogate for clinical efficacy of GERD drugs, particularly in erosive esophagitis. Years ago, famotidine normalized esophageal mucosal exposure to pH < 4.0 only when administered in doses of 40 mg twice a day. Subsequent studies confirmed that multiple daily dosing of histamine-2 receptor antagonists (H2RAs) was mandatory for GERD treatment, with clear dose-response relationships for each agent. Proton pump inhibitors (PPIs) have each been carefully assessed in terms esophageal and gastric pH profiles. Omeprazole has a particularly flat dose response curve, making it difficult to differentiate pH or clinical effects of 20 vs. 40 mg doses. Improved rapidity of onset and/or enhanced potency is demonstrable in pH data obtained with lansoprazole, rabeprazole and pantoprazole. Such differences will translate to improved clinical efficacy, based on the meta-analyses of Richard Hunt and his group in Canada that correlate pH effects and symptom relief/healing. PPI's have dependably surpassed H2RAs and prokinetic drugs in management of the more severe grades of esophagitis. Helicobacter pylori has a peculiar relationship to GERD. There has been some concern that PPIs given to patients with H. pylori might accelerate development of severe atrophic gastritis. It is also now known that eradication of H. pylori may increase symptomatic GERD (possibly as a result of increased gastric acid secretion once the bacteria have been eliminated). New data confirm nocturnal breakthrough of acid secretion and esophageal acid exposure in three-fourths of patients on omeprazole 20 mg twice daily. This nocturnal acidity can be controlled more effectively with a nighttime dose of an H2RA than with a third dose of omeprazole. Control of acid secretion and improved gastric and esophageal pH profiles are goals of modern GERD therapy, and the product that most cost effectively normalizes esophageal acid exposure will have a substantial advantage in the ever-growing GERD marketplace.

Robinson, M.

1999-01-01

5

Ambulatory Esophageal pH Monitoring: New Directions  

Microsoft Academic Search

pH testing remains a commonly used evaluative tool in clinical practice. However, the original tool that included a nasally placed pH catheter was plagued with a variety of shortcomings, primarily the effect of the procedure on patients’ lifestyle and thus on reflux-provoking activities. The miniaturization of evaluative techniques in gastroenterology was the impetus for the development of the wireless pH

Ram Dickman; Ronnie Fass

2006-01-01

6

Proximal Sensor Data from Routine Dual-Sensor Esophageal pH Monitoring Is Often Inaccurate  

Microsoft Academic Search

Dual-sensor esophageal pH monitoring is routinely used to diagnose GERD. However, the proximal sensor may not be in proximal esophagus in patients with shortened esophagi. Our objective was to determine how often the proximal sensor was misplaced and to determine the effect on pH monitoring. Superior margins of the upper and lower esophageal sphincters (UES and LES) were determined prospectively

Matt McCollough; Abdul Jabbar; Robert Cacchione; Jeff W. Allen; Steve Harrell; John M. Wo

2004-01-01

7

Novel Device to Sample the Esophageal Microbiome--The Esophageal String Test  

PubMed Central

A growing number of studies implicate the microbiome in the pathogenesis of intestinal inflammation. Previous work has shown that adults with esophagitis related to gastroesophageal reflux disease have altered esophageal microbiota compared to those who do not have esophagitis. In these studies, sampling of the esophageal microbiome was accomplished by isolating DNA from esophageal biopsies obtained at the time of upper endoscopy. The aim of the current study was to identify the esophageal microbiome in pediatric individuals with normal esophageal mucosa using a minimally invasive, capsule-based string technology, the Enterotest™. We used the proximal segment of the Enterotest string to sample the esophagus, and term this the “Esophageal String Test” (EST). We hypothesized that the less invasive EST would capture mucosal adherent bacteria present in the esophagus in a similar fashion as mucosal biopsy. EST samples and mucosal biopsies were collected from children with no esophageal inflammation (n?=?15) and their microbiome composition determined by 16S rRNA gene sequencing. Microbiota from esophageal biopsies and ESTs produced nearly identical profiles of bacterial genera and were different from the bacterial contents of samples collected from the nasal and oral cavity. We conclude that the minimally invasive EST can serve as a useful device for study of the esophageal microbiome.

Wagner, Brandie D.; Kelly, Caleb J.; Stevens, Mark J.; Moore, Wendy; Fang, Rui; Schroeder, Shauna; Masterson, Joanne C.; Robertson, Charles E.; Pace, Norman R.; Ackerman, Steven J.; Furuta, Glenn T.

2012-01-01

8

24-Hour Esophageal pH Test  

MedlinePLUS

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9

Diagnostic difficulties during combined multichannel intraluminal impedance and pH monitoring in patients with esophagitis or Barrett's esophagus.  

PubMed

Gastroesophageal reflux disease (GERD) is one of the most common esophageal diseases in developed countries. It is widely believed that GERD symptoms are caused by acid refluxate within the esophagus, so ambulatory 24 hour pH-monitoring became the gold standard in detecting gastroesophageal reflux. Traditional ambulatory pH monitoring is unable to detect a gastroesophageal reflux with pH >4. The introduction of multichannel intraluminal impedance and pH (MII-pH) brought new possibilities in detecting GERD. In this technique impedance identifies reflux episode whereas pH sensor further characterizes it as either acid (pH <4) or non-acid (pH > or =4). This is a great progress in diagnosing GERD but MII has also some imperfections related to pathological changes in the esophageal mucosa such as esophagitis or Barrett oesophagus, which are connecting with a very low baseline impedance values. Changes in the esophageal mucosa may also impair the esophageal motility and esophageal transit leading to some fluid retention in the esophagus. It should be stressed that very low impedance baseline creates a difficulty in interpreting the MII-pH study. In such a case it might be almost impossible to interpret the study as the interpreter does not see characteristic drop in impedance progressing either orally (reflux episode) or swallow but only almost flat impedance lines. Therefore, future studies are needed to further evaluate this problem. PMID:18217418

Wa?ko-Czopnik, D; B?o?ski, W; Paradowski, L

2007-01-01

10

Axial force measurement for esophageal function testing  

PubMed Central

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.

Gravesen, Flemming H; Funch-Jensen, Peter; Gregersen, Hans; Drewes, Asbj?rn Mohr

2009-01-01

11

Computerized 24-hour ambulatory esophageal pH monitoring and esophagogastroduodenoscopy in the reflux patient. A comparative study.  

PubMed Central

Ambulatory 24-hour esophageal pH monitoring and esophagogastroduodenoscopy were performed in 72 patients with symptoms suggestive of gastroesophageal reflux. Additionally, 22 asymptomatic healthy volunteers underwent pH monitoring. In patients with classic reflux symptoms and endoscopic esophagitis, a mean of 5.41 minutes/hour of reflux below pH 4 was found compared to 0.70 minutes/hour in controls (p less than 0.0001). The mean number and duration of reflux events in this group were 1.51 events/hour and 4.0 minutes/event, compared with 0.31 events/hour and 2.26 minutes/event in volunteers (p less than 0.001, p less than 0.01). A new system for ambulatory esophageal pH monitoring is presented using a pH-sensitive radiotelemetry pill or a pH probe and computerized methods for ambulatory data collection, analysis, and storage. An overall sensitivity of 76% was obtained with a 91% selectivity for detection of acid reflux in 51 patients having classic symptoms of gastroesophageal reflux. Ambulatory pH monitoring was positive for acid reflux in seven of 11 patients with normal endoscopic findings. Conversely, eight of 12 patients with normal pH monitoring had endoscopic esophagitis. In 19 patients presenting with atypical symptoms or previous gastric surgery, endoscopic findings were normal in 15. Nine of these 15 were identified as acid refluxers by pH monitoring. A combined approach using both pH monitoring and endoscopy is warranted for maximal detection and quantification of disease. A clear clinical role for pH monitoring is seen in the early diagnosis of acid reflux, particularly in patients having normal endoscopic findings with nonspecific gastrointestinal complaints or previous gastric operations.

Vitale, G C; Cheadle, W G; Sadek, S; Michel, M E; Cuschieri, A

1984-01-01

12

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

Microsoft Academic Search

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

Peter J Kahrilas; Eamonn M. M Quigley

1996-01-01

13

Esophageal pH and Combined Impedance-pH Monitoring in Children  

PubMed Central

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.

2014-01-01

14

Barostat or Dynamic Balloon Distention Test: Which Technique is Best Suited for Esophageal Sensory Testing?  

PubMed Central

Background Esophageal sensation is commonly assessed by barostat-assisted balloon distension (BBD) or dynamic balloon distension (DBD) technique, but their relative merits are unknown. Our aim was to compare the usefulness and tolerability of both techniques. Methods Sixteen healthy volunteers (M/F= 6/10) randomly underwent graded esophageal balloon distensions, using either BBD (n=8) or DBD (n=8). BBD was performed by placing a 5 cm long highly compliant balloon attached to a barostat, and DBD by placing a 5 cm long balloon attached to a leveling container. Intermittent phasic balloon distensions were performed in increments of 6 mm Hg. Sensory thresholds and biomechanical properties were assessed and compared. Key Results Sensory thresholds for first perception (mean ± SD; 21 ± 6 vs. 21.2 ± 5, mm Hg, p=0.9), discomfort (38 ± 8 vs. 35 ± 9, p=0.5), and pain (44 ± 4 vs. 45 ± 3, p=0.7) were similar with BBD and DBD techniques. However, more subjects tolerated DBD (7/8, 88%) when compared to BBD (4/8, 50 %). Forceful expulsion of balloon into stomach (n=4), pulling around the mouth (n=4), chest discomfort (n=2) and retching (n=2) were overlapping reasons for intolerance with BBD. Esophageal wall distensibility was similar with both techniques. Conclusions Both techniques provided comparable data on biomechanical properties. However, DBD was better tolerated than BBD for evaluation of esophageal sensation. Hence, we recommend DBD for performing esophageal balloon distension test.

Remes-Troche, Jose M.; Attaluri, Ashok; Chahal, Premjit; Rao, Satish S.C.

2014-01-01

15

48-Hour Bravo Esophageal pH Test  

MedlinePLUS

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16

Esophageal intubation with indirect clinical tests during emergency tracheal intubation: a report on patient morbidity  

Microsoft Academic Search

Study ObjectiveTo determine the consequences of esophageal intubation (EI) when using standard indirect clinical tests to detect endotracheal tube (ETT) placement in the emergency setting outside the operating room (OR).

Thomas C. Mort

2005-01-01

17

Altered esophageal pain threshold in irritable bowel syndrome  

Microsoft Academic Search

Gut motility disorders and altered pain perception were reported in patients with irritable bowel syndrome (IBS). To verify foregut involvement in IBS, we studied 30 patients using esophageal manometry and 24-hr pH monitoring of the distal esophagus. Two subgroups of patients underwent esophageal provocative tests (bethanechol 50 µg\\/kg subcutaneously and esophageal balloon distension test). Twelve healthy volunteers formed a control

Mario Costantini; Giacomo Carlo Sturniolo; Giovanni Zaninotto; Renata D'Incŕ; Rita Polo; Remo Naccarato; Ermanno Ancona

1993-01-01

18

Esophageal Cancer Screening  

MedlinePLUS

... the disease is found and treated at an early stage . There is no standard or routine screening test for esophageal cancer. Screening for esophageal cancer is under study with screening clinical trials taking place in many parts of the ...

19

Evaluation of esophageal diseases.  

PubMed

The diagnosis of esophageal disease can be made by history alone in 80 percent of patients. Primary symptoms include dysphagia, odynophagia, heartburn and central chest pain. Although these symptoms may overlap, one esophageal symptom often predominates. This observation and an understanding of the available diagnostic tests enable the clinician to develop an algorithmic approach to the diagnosis of esophageal diseases. PMID:3942041

Dabaghi, R E; Scott, L D

1986-01-01

20

Observations of Acid Reflux and Motor Function in Distal Esophagus Using Simultaneous Measurements of Intra-esophageal pH and Pressure in 8 Directions With Novel Sensor Catheter - A Feasibility Study  

PubMed Central

Background/Aims Esophagogastric junctional lesions, such as mucosal breaks with Los Angeles grade A or B reflux esophagitis, lacerations in Mallory Weiss syndrome, and short segment Barrett's esophagus, are mainly found in the right anterior wall of the distal esophagus. Asymmetrical lower esophageal sphincter pressure and resting radial asymmetrical acid reflux may be causes of this asymmetrical distribution of reflux esophagitis and short segment Barrett's esophagus. We developed a novel pH and pressure catheter to investigate the asymmetrical distributions of pH and intra-esophageal pressure in the distal esophagus. Methods One healthy male volunteer was enrolled in this study. Acid reflux and motor function in distal esophagus was investigated using simultaneous measurements of intra-esophageal pH and pressure in 8 directions with novel sensor catheter. Results Thirty-six acid and weak acid reflux events were observed, of which 22 were circumferential refluxes with pH drops in all channels and 14 were partial refluxes with pH drops in some channels. Increase in transient circumferential intraesophageal pressure was observed just after 72.7% of the circumferential reflux and 42.9% of the partial reflux events. Conclusions Using a novel sensor catheter, 2 different types of acid reflux events were identified in the present study.

Aimi, Masahito; Morito, Yoshiya; Fukazawa, Kousuke; Adachi, Kyoichi; Kinoshita, Yoshikazu

2013-01-01

21

Transport of Fentanyl Through Pig Buccal and Esophageal Epithelia in Vitro . Influence of Concentration and Vehicle pH  

Microsoft Academic Search

Purpose. To validate pig esophageal epithelium as a model for the permeability barrier of the buccal mucosa, the transport of fentanyl across the two tissues was compared in vivo. Methods. The epithelia were separated by immersing the excised mucosae into an isotonic saline solution at 60Y65-C. Fentanyl was delivered as the citrate salt at a concentration of 1 or 2

Isabel Diaz del Consuelo; Françoise Falson; Richard H. Guy; Yves Jacques

2005-01-01

22

Food allergy testing in eosinophilic esophagitis: what the gastroenterologist needs to know.  

PubMed

Eosinophilic esophagitis (EoE) is a clinicopathologic disease of increasing prevalence in children and adults. The triggering antigen in EoE is often a food that initiates a cascade of Th2-associated interleukins such as interleukin-5 and interleukin-13 and chemokines such as eotaxin-3 as well as esophageal eosinophilia and mastocytosis. Amino acid-based formulas have high efficacy rates in EoE and constitute the first evidence for food-triggered esophageal eosinophilia. Animal models have demonstrated the sufficiency of food antigens in triggering both the inflammatory and remodeling complications of EoE. Food elimination diets that are followed by single food introduction with repeat biopsy have proven the efficacy of empiric and allergy testing based elimination diets in children and adults. Although the ideal allergy test for identifying food antigens in EoE remains to be elucidated, the utility of food skin prick combined with atopy patch testing has been shown in large pediatric cohorts. By comparison, smaller, non-U.S. adult cohorts have not had similar results. Currently, a positive test on food allergy evaluation suggests a food trigger for EoE but does not substitute for biopsy-based tissue evaluation after food removal and reintroduction. The higher rates of food anaphylaxis in children with EoE, potential loss of tolerance to immunoglobulin E-positive foods that can occur with food avoidance, and the high rates of other atopic diatheses in EoE subjects all support the evaluation of EoE subject by an allergist, consideration for allergy testing, and an integrated approach by allergists, gastroenterologists, and pathologists in EoE management. PMID:24035776

Aceves, Seema S

2014-08-01

23

[The role of esophageal sphincter tonus and of gastric motility in the extent of reflux esophagitis].  

PubMed

Thirty-two patients with symptomatic gastroesophageal reflux disease were investigated by esophagogastroduodenoscopy, 24 h pH monitoring, esophageal manometry and measurement of gastric emptying of solids, in order to elucidate the relative importance of lower esophageal sphincter tone, amount of acid reflux and gastric emptying on the degree of esophagitis. The mechanical competency of lower esophageal sphincter was significantly deranged in patients with moderate/severe esophagitis than in patients with mild esophagitis. The gastric emptying time was significantly delayed in patients with moderate/severe esophagitis than in patients with mild esophagitis. No relationship was observed between amount of acid reflux, lower esophageal sphincter function and gastric emptying time. Our results suggest that resting pressure of lower esophageal sphincter and the gastric motor function play a major role in severity of reflux esophagitis. PMID:1553047

Cogliandolo, A; Gulino, F M; Pustorino, S; Migliorato, D; Bottari, M; Saitta, F P; Micali, B

1992-01-01

24

Human esophageal microvascular endothelial cells respond to acidic pH stress by PI3K/AKT and p38 MAPK-regulated induction of Hsp70 and Hsp27.  

PubMed

The heat shock response maintains cellular homeostasis following sublethal injury. Heat shock proteins (Hsps) are induced by thermal, oxyradical, and inflammatory stress, and they chaperone denatured intracellular proteins. Hsps also chaperone signal transduction proteins, modulating signaling cascades during repeated stress. Gastroesophageal reflux disease (GERD) affects 7% of the US population, and it is linked to prolonged esophageal acid exposure. GERD is characterized by enhanced and selective leukocyte recruitment from esophageal microvasculature, implying activation of microvascular endothelium. We investigated whether phosphatidylinositol 3-kinase (PI3K)/Akt and MAPK regulate Hsp induction in primary cultures of human esophageal microvascular endothelial cells (HEMEC) in response to acid exposure (pH 4.5). Inhibitors of signaling pathways were used to define the contribution of PI3K/Akt and MAPKs in the heat shock response and following acid exposure. Acid significantly enhanced phosphorylation of Akt and MAPKs in HEMEC as well as inducing Hsp27 and Hsp70. The PI3K inhibitor LY-294002, and Akt small interfering RNA inhibited Akt activation and Hsp70 expression in HEMEC. The p38 MAPK inhibitor (SB-203580) and p38 MAPK siRNA blocked Hsp27 and Hsp70 mRNA induction, suggesting a role for MAPKs in the HEMEC heat shock response. Thus acidic pH exposure protects HEMEC through induction of Hsps and activation of MAPK and PI3 kinase pathway. Acidic exposure increased HEMEC expression of VCAM-1 protein, but not ICAM-1, which may contribute to selective leukocyte (i.e., eosinophil) recruitment in esophagitis. Activation of esophageal endothelial cells exposed to acidic refluxate may contribute to GERD in the setting of a disturbed mucosal squamous epithelial barrier (i.e., erosive esophagitis, peptic ulceration). PMID:16790501

Rafiee, Parvaneh; Theriot, Monica E; Nelson, Victoria M; Heidemann, Jan; Kanaa, Yasmin; Horowitz, Scott A; Rogaczewski, Aaron; Johnson, Christopher P; Ali, Irshad; Shaker, Reza; Binion, David G

2006-11-01

25

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 ...

26

[Reflux esophagitis].  

PubMed

Chronic Esophageal reflux induces reflux esophagitis, which is a common finding in gastroenterological practice. Reflux esophagitis produce symptoms like pirosis, regurgitation and in some cases respiratory complains resembling asthma or angina-like chest pain. The pathophysiology of this disease is based on a multifactorial origin, which usually results in the chronic evolution of the disease. In recent years, there have appeared new evidences pointing out to alterations in the relaxing mechanisms of the lower esophageal sphincter; however, some patients having reflux esophagitis show normal shincteric pressure. The sweep action of esophageal smooth muscle is a key point for sending back to stomach the eventually refluxed material; it has been demonstrated that this sweeping action is impaired in many patients having reflux esophagitis. Incompetence of lower esophageal sphincter seems to be related a local to neural alteration rather than to smooth muscle functional disturbance. Recent findings stablis a link between local nitric oxide release and relaxation of the lower esophageal sphincter. Esophageal mucosaldisplay an intrinsic resistance to HCL, pepsin, bilis and enzymes deleterious action by a blockade of back-defusion of hydrogen ions contained in the refluxed material. Nevertheless, some other luminal and non-luminal factors are involved in this mucosalprotection. When these intrinsic resistance factors are abated, tisular lesions like ersion, ulcer and Barret's mucosal changes can occur; is of particular interest because its potential malignant evolution. Esophageal reflux usually resolves with medical treatmen, but in some particular cases surgical correction is indicated for improving the antireflux barrier. PMID:7768423

Salas Coll, C A

1994-01-01

27

Sucralfate Prevents Experimental Peptic Esophagitis in Rabbits.  

National Technical Information Service (NTIS)

Sucralfate was tested in a rabbit model for the ability to prevent experimental esophagitis. Esophagitis was assessed by gross appearance and microscopic examination by an uninformed observer. In addition, the permeability of the esophagus to a number of ...

E. J. Schweitzer B. L. Bass L. F. Johnson J. W. Harmon

1985-01-01

28

Esophageal manometry in gastroesophageal reflux disease.  

PubMed

High-resolution manometry (HRM) allows nuanced evaluation of esophageal motor function, and more accurate evaluation of lower esophageal sphincter (LES) function, in comparison with conventional manometry. Pathophysiologic correlates of gastroesophageal reflux disease (GERD) and esophageal peristaltic performance are well addressed by this technique. HRM may alter the surgical decision by assessment of esophageal peristaltic function and exclusion of esophageal outflow obstruction before antireflux surgery. Provocative testing during HRM may assess esophageal smooth muscle peristaltic reserve and help predict the likelihood of transit symptoms following antireflux surgery. HRM represents a continuously evolving new technology that compliments the evaluation and management of GERD. PMID:24503360

Mello, Michael; Gyawali, C Prakash

2014-03-01

29

Herpetic esophagitis  

SciTech Connect

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.

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

1981-12-01

30

Esophageal culture  

MedlinePLUS

Culture - esophageal ... where it is placed in a special dish (culture media) and checked daily to see if any ... There is no preparation needed for a culture. For information on how to prepare for the removal of a piece of esophageal tissue, see EGD .

31

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, ...

32

Eosinophilic esophagitis  

PubMed Central

Eosinophilic esophagitis (EoE) is an atopic condition of the esophagus that has become increasingly recognized over the last decade. Diagnosis of the disorder is dependent on the patient’s clinical manifestations and histologic findings on esophageal mucosal biopsies. Patients with eosinophilic esophagitis should be referred to both an allergist and gastroenterologist for optimal management, which may include dietary modifications, pharmacologic agents such as corticosteroids, leukotriene modifiers and biologics as well as mechanical dilatation of the esophagus. The epidemiology, pathophysiology, diagnosis, treatment, and prognosis of EoE are discussed in this review.

2011-01-01

33

Esophageal infarction.  

PubMed

Esophageal infarction or acute necrotizing esophagitis is a rare condition that has a dramatic endoscopic appearance of a "black esophagus." The esophageal involvement can vary from the distal third to the total esophagus. Excluding corrosive injury and other well-known rare causes of black esophagus, the etiology of this condition is unknown. Ischemia due to hypoperfusion state is thought to play a central role in the pathogenesis. The treatment is supportive with acid suppression and gastrointestinal rest. Mortality is high due to comorbid conditions. PMID:17298765

Hawari, Rami; Pasricha, Pankaj J

2007-02-01

34

Esophageal motility and outcomes following laparoscopic paraesophageal hernia repair and fundoplication  

Microsoft Academic Search

Background: The addition of an antireflux procedure to all giant paraesophageal hernia (PEH) repairs remains controversial. In addition there are no series evaluating the impact of hernia repair and fundoplication on esophageal physiology. This study examines the outcomes of PEH repair with fundoplication and examines the results of preoperative and postoperative motility and pH testing.Methods: An analysis of a data

Lee L Swanstrom; Blair A Jobe; Luke R Kinzie; Karen D Horvath

1999-01-01

35

Testing the pH of Soft Drinks  

ERIC Educational Resources Information Center

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…

Christmann, Edwin P.; Holy, Adam J.

2005-01-01

36

21 CFR 862.1550 - Urinary pH (nonquantitative) test system.  

Code of Federal Regulations, 2012 CFR

...ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CLINICAL CHEMISTRY AND CLINICAL TOXICOLOGY DEVICES Clinical Chemistry Test Systems § 862.1550 Urinary pH (nonquantitative) test system. (a)...

2012-04-01

37

Esophageal dysphagia.  

PubMed

Esophageal dysphagia can arise from a variety of causes such as motility disorders, mechanical and inflammatory diseases. Adequate management includes a detailed history, evaluation with upper endoscopy, barium radiography and manometry. Treatment is usually tailored to the underlying disease process and in some cases, as in inoperable cancer, palliative management may be necessary. PMID:18940638

Lawal, Adeyemi; Shaker, Reza

2008-11-01

38

Understanding Esophageal Dilation  

MedlinePLUS

Understanding Esophageal Dilation What is Esophageal Dilation? Esophageal dilation is a procedure that allows your doctor to dilate, or stretch, a narrowed area of your esophagus [swallowing tube]. Doctors ...

39

A prospective evaluation of esophageal testing and a double-blind, randomized study of omeprazole in a diagnostic and therapeutic algorithm for chronic cough  

Microsoft Academic Search

OBJECTIVE:Recent studies suggest an association between chronic cough and gastroesophageal reflux. Our study aims were 1) to define the prevalence of acid reflux induced cough in the general community, 2) to examine the ability of esophageal testing to identify gastroesophageal reflux related cough, and 3) to assess the utility of omeprazole in a chronic cough algorithm.METHODS:Patients with chronic cough of

Tina M Ours; Mani S Kavuru; Robert J Schilz; Joel E Richter

1999-01-01

40

Integration and validation testing for PhEDEx, DBS and DAS with the PhEDEx LifeCycle agent  

NASA Astrophysics Data System (ADS)

The ever-increasing amount of data handled by the CMS dataflow and workflow management tools poses new challenges for cross-validation among different systems within CMS experiment at LHC. To approach this problem we developed an integration test suite based on the LifeCycle agent, a tool originally conceived for stress-testing new releases of PhEDEx, the CMS data-placement tool. The LifeCycle agent provides a framework for customising the test workflow in arbitrary ways, and can scale to levels of activity well beyond those seen in normal running. This means we can run realistic performance tests at scales not likely to be seen by the experiment for some years, or with custom topologies to examine particular situations that may cause concern some time in the future. The LifeCycle agent has recently been enhanced to become a general purpose integration and validation testing tool for major CMS services. It allows cross-system integration tests of all three components to be performed in controlled environments, without interfering with production services. In this paper we discuss the design and implementation of the LifeCycle agent. We describe how it is used for small-scale debugging and validation tests, and how we extend that to large-scale tests of whole groups of sub-systems. We show how the LifeCycle agent can emulate the action of operators, physicists, or software agents external to the system under test, and how it can be scaled to large and complex systems.

Boeser, C.; Chwalek, T.; Giffels, M.; Kuznetsov, V.; Wildish, T.

2014-06-01

41

[Esophageal atresia].  

PubMed

Most of the children operated for esophageal atresia will survive the neonatal period. However, medium-term and late complications are frequent in this population. Gastroesophageal reflux disease is observed in 26 to 75% of the cases and can be responsible for peptic esophagitis, anastomotic stenosis, and Barrett esophagus, which is a risk factor for adenocarcinoma of the esophagus. Dysphagia is frequently observed, sometimes several years after the surgery, affecting up to 45% of children at the age of 5 years. Growth retardation is present in nearly one-third of children at the age of 5 years. Ear, nose, and throat and respiratory complications are also very frequent but tend to improve with time. Tracheomalacia is found in 75% of these children at birth, sometimes responsible for severe complications (malaise, bradycardia). Respiratory symptoms are dominated by chronic cough, wheezing, and infections reported in 29% of the children by the age of 5 years. Restrictive, obstructive syndromes and bronchial hyperactivity can be observed, but usually remain moderate. All these complications can influence the patient's quality of life, which is moderately impaired compared to healthy controls. The high frequency of late sequelae in esophageal atresia justifies regular and multidisciplinary follow-up through adulthood. PMID:22835908

Gottrand, F; Sfeir, R; Thumerelle, C; Gottrand, L; Fayoux, P; Storme, L; Lamblin, M-D; Seguy, D; Michaud, L

2012-09-01

42

Detection of Bovine Mastitis by Bromothymol Blue pH Indicator Test  

Microsoft Academic Search

A simple bromothymol blue indicator test was evaluated for farm diagnosis of mastitis. The test required highly ab- sorbent blotting paper impregnated with four spots of bromothymol blue. Indicator color scores (1 to 4) for quarter foremilks increased with somatic cell count and pH, although variability within each color score was large. Sensitivity of the bromo- thymol blue test ranged

R. J. Marschke; B. J. Kitchen

1985-01-01

43

Esophageal functional impairments in experimental eosinophilic esophagitis  

PubMed Central

Eosinophilic esophagitis (EoE) is an emerging chronic esophageal disease. Despite the increasing diagnosis of EoE globally, the causes of EoE and other esophageal eosinophilic disorders are not clearly understood. EoE pathology includes accumulation of inflammatory cells (e.g., eosinophils, mast cells), characteristic endoscopic features (e.g., furrows, the formation of fine concentric mucosal rings, exudates), and functional impairments (e.g., esophageal stricture, dysmotility). We hypothesized that the esophageal structural pathology and functional impairments of EoE develop as a consequence of the effector functions of the accumulated inflammatory cells. We analyzed eosinophils (anti-major basic protein immunostaining), esophageal stricture (X-ray barium swallowing), and esophageal motility (isometric force) in two established transgenic murine models of EoE (CD2-IL-5 and rtTA-CC10-IL-13) and a novel eosinophil-deficient model (?dblGATA/CD2-IL-5). Herein, we show the following: 1) CD2-IL-5 and doxycycline (DOX)-induced rtTA-CC10-IL-13 mice have chronic eosinophilic and mast cell esophageal inflammation; 2) eosinophilic esophageal inflammation promotes esophageal stricture in both transgenic murine models; 3) the eosinophil-deficient ?dblGATA/CD-2-IL-5 mice were protected from the induction of stricture, whereas the eosinophil-competent CD2-IL-5 mice develop esophageal stricture; 4) esophageal stricture is not reversible in DOX-induced rtTA-CC10-IL-13 mice (8 wk DOX followed by 8 wk no-DOX); and 5) IL-5 transgene-induced (CD2-IL-5) EoE evidences esophageal dysmotility (relaxation and contraction) that is independent of the eosinophilic esophageal inflammation: CD2-IL-5 and ?dblGATA/CD2-IL-5 mice have comparable esophageal dysmotility. Collectively, our present study directly implicates chronic eosinophilic inflammation in the development of the esophageal structural impairments of experimental EoE.

Mavi, Parm; Rajavelu, Priya; Rayapudi, Madhavi; Paul, Richard J.

2012-01-01

44

Esophageal motility abnormalities in gastroesophageal reflux disease  

PubMed Central

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.

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

2014-01-01

45

Clinical characteristics and sensitivity to food and inhalants among children with eosinophilic esophagitis  

PubMed Central

Background To understand the clinical characteristics and the diagnostic procedures in pediatric patients with eosinophilic esophagitis and to evaluate the sensitivity of the patients to food and inhalant allergens. A cross-sectional study was performed in 35 children with eosinophilic esophagitis during the time period from January 2010 to January 2011. The clinical and epidemiological data were obtained using a questionnaire and medical chart analysis. The body mass index for age was used for the nutritional evaluation (via the Z score). The sensitivity to foods and inhalants was evaluated by performing a skin prick test and atopy patch test. Results Patients (35 in total, median age 10 years) with a diagnosis of eosinophilic esophagitis were evaluated. The most prevalent symptoms in the patients were vomiting (71.4%) and abdominal pain (51.4%). Endoscopic alterations were observed in 97.2% of the patients. A good nutritional state was observed in 82.8% of the children. The tests demonstrated the presence of food sensitivities and/or aeroallergens in 27 (77.1%) patients, whereas 8 (22.9%) patients did not test positive in any of the tests performed. Among the patients with positive tests, 24 (68.5%) exhibited sensitivity to aeroallergens and 16 (45.7%) were sensitive to foods. The comparison between the sensitive and insensitive groups displayed statistically significant results with respect to sex, symptom prevalence, and 24-hour esophageal pH monitoring. Conclusions The patients evaluated in this study displayed clinical characteristics of eosinophilic esophagitis similar to those reported in the literature. The sensitivity to foods determined by the tests was less than that observed in prior studies; however, a marked sensitivity to aeroallergens was observed. The different allergen sensitivity profiles observed in this study suggests that, similar to asthma, the eosinophiic esophagitis disease may exhibit several phenotypes.

2014-01-01

46

Evaluation of Esophageal Motor Function With High-resolution Manometry.  

PubMed

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

Conklin, Jeffrey L

2013-07-01

47

In Vivo Model to Test Implanted Biosensors for Blood pH  

NASA Technical Reports Server (NTRS)

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.

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

1997-01-01

48

Caspofungin Susceptibility Testing of Isolates from Patients with Esophageal Candidiasis or Invasive Candidiasis: Relationship of MIC to Treatment Outcome  

Microsoft Academic Search

The caspofungin clinical trial database offers an opportunity to assess susceptibility results for Candida pathogens obtained from patients with candidiasis and allows for correlations between efficacy outcomes and MICs. Candida isolates have been identified from patients enrolled in four studies of esophageal candidiasis and two studies of invasive candidiasis. The MICs of caspofungin for all baseline isolates were measured at

Nicholas Kartsonis; John Killar; Lori Mixson; Chao-Min Hoe; Carole Sable; Kenneth Bartizal; Mary Motyl

2005-01-01

49

Achalasia and Esophageal Motility Disorders  

MedlinePLUS

... that is visible under x-rays, creating a picture of the lining of the esophagus and stomach. Discoordinated muscular activity within the esophagus can sometimes be seen using this test. One of the best tests to evaluate for achalasia and other esophageal ...

50

Dietary treatment of eosinophilic esophagitis.  

PubMed

Emerging evidence supports impaired epithelial barrier function as the key initial event in the development of eosinophilic esophagitis (EoE) and other allergic diseases. Symptom resolution, histologic remission, and prevention of both disease and treatment-related complications are the goals of treatment. Successful dietary treatments include elemental, empirical elimination and allergy test directed diets. Dietary therapy with exclusive elemental diet offers the best response. Cow's milk, wheat, egg, soy, peanut/tree nut, and fish/shellfish are the 6 food antigens most likely to induce esophageal inflammation. PMID:24813522

Gonsalves, Nirmala; Kagalwalla, Amir F

2014-06-01

51

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

Code of Federal Regulations, 2012 CFR

...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...

2012-04-01

52

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

...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...

2014-04-01

53

Esophageal disease in pediatrics  

PubMed Central

The following on esophageal disease in pediatrics contains commentaries on acquisition of neuromuscular maturation; physiology of esophageal peristaltic and sphincteric reflexes; implications for clinical practice; and conditions that predispose to severe gastroesophageal reflux disease (GERD) in children with potential risk for esophageal cancer.

Jadcherla, Sudarshan R.; Nurko, Samuel

2013-01-01

54

Robotic benign esophageal procedures.  

PubMed

Robotic master-slave devices can assist surgeons to perform minimally invasive esophageal operations with approaches that have already been demonstrated using laparoscopy and thoracoscopy. Robotic-assisted surgery for benign esophageal disease is described for the treatment of achalasia, epiphrenic diverticula, refractory reflux, paraesophageal hernias, duplication cysts, and benign esophageal masses, such as leiomyomas. Indications and contraindications for robotic surgery in benign esophageal disease should closely approximate the indications for laparoscopic and thoracoscopic procedures. Given the early application of the technology and paucity of clinical evidence, there are currently no procedures for which robotic esophageal surgery is the clinically proven preferred approach. PMID:24780427

Hanna, Jennifer M; Onaitis, Mark W

2014-05-01

55

[The detection rate of the esophageaL GERD complications among residents of the Leningrad Region (according to the data of esophagogastroduodenoscopy tests)].  

PubMed

This article presents the analysis of 24384 endoscopic investigations of the upper gastrointestinal tract in population of Leningrad region with symptoms of dyspepsia during the period 2007-2011.The results revealed erosive esophagitis in 5.4%, peptic strictures of the esophagus--0.2%, the columnar-lining esophagus (Barrett's esophagus)--1.1%, and esophageal adenocarcinoma--0.045%. This data shows a high prevalence of esophageal complications of GERD in a local population of Russians. PMID:24501940

Vasilevski?, D I; Silant'ev, D S; Mikhaleva, K V; Filin, A V; Vorob'ev, S L; Mednikov, S N; Luft, A V; Kulagin, V I; Bagnenko, S F

2013-01-01

56

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

PubMed

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

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

1991-01-01

57

Rapid antibiotic susceptibility testing in a microfluidic pH sensor.  

PubMed

For appropriate selection of antibiotics in the treatment of pathogen infection, rapid antibiotic susceptibility testing (AST) is urgently needed in clinical practice. This study reports the utilization of a microfluidic pH sensor for monitoring bacterial growth rate in culture media spiked with different kinds of antibiotics. The microfluidic pH sensor was fabricated by integration of pH-sensitive chitosan hydrogel with poly(dimethylsiloxane) (PDMS) microfluidic channels. For facilitating the reflectometric interference spectroscopic measurements, the chitosan hydrogel was coated on an electrochemically etched porous silicon chip, which was used as the substrate of the microfluidic channel. Real-time observation of the pH change in the microchannel can be realized by Fourier transform reflectometric interference spectroscopy (FT-RIFS), in which the effective optical thickness (EOT) was selected as the optical signal for indicating the reversible swelling process of chitosan hydrogel stimulated by pH change. With this microfluidic pH sensor, we demonstrate that confinement of bacterial cells in a nanoliter size channel allows rapid accumulation of metabolic products and eliminates the need for long-time preincubation, thus reducing the whole detection time. On the basis of this technology, the whole bacterial growth curve can be obtained in less than 2 h, and consequently rapid AST can be realized. Compared with conventional methods, the AST data acquired from the bacterial growth curve can provide more detailed information for studying the antimicrobial behavior of antibiotics during different stages. Furthermore, the new technology also provides a convenient method for rapid minimal inhibition concentration (MIC) determination of individual antibiotics or the combinations of antibiotics against human pathogens that will find application in clinical and point-of-care medicine. PMID:23360389

Tang, Yanyan; Zhen, Li; Liu, Jingqing; Wu, Jianmin

2013-03-01

58

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

PubMed

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 eosinophilic microabscesses, edema, basal zone hyperplasia, lamina propria papillae elongation, eosinophils and fibrosis. Clinical and endoscopic findings were obtained. Eosinophilic esophagitis was diagnosed with epithelial eosinophils > or = 15 in > or = 2 high-power fields (hpfs) or > or = 25 in any hpf. Analysis was performed with Mann-Whitney, chi2 and ANOVA tests. Of 157 cases, 41 had eosinophilic esophagitis. Male gender (81%) and age < or = 45 (54%) were commoner in patients with eosinophilic esophagitis (P = 0.001, 0.010, respectively). Dysphagia was more common in eosinophilic esophagitis patients (63%, P < 0.001); heartburn was more common in noneosinophilic esophagitis patients (53%, P < 0.001). Endoscopic rings were more common in eosinophilic esophagitis patients (27%, P = 0.023); hiatus hernia was more common in noneosinophilic esophagitis patients (11%, P = 0.022). Eosinophils were more numerous in eosinophilic esophagitis biopsies (mean 39/hpf, P < or = 0.001). Only eosinophilic esophagitis biopsies had eosinophilic microabscesses (42%, P < or = 0.001). Edema, basal zone hyperplasia, lamina propria papillae elongation and lamina propria eosinophils were commoner in eosinophilic esophagitis (P < or = 0.001-0.002), while lamina propria fibrosis was specific for eosinophilic esophagitis (39%, P < 0.001). Eosinophilic esophagitis is a disease with a predilection for young males with dysphagia and rings on endoscopy. Biopsies in eosinophilic esophagitis have high epithelial eosinophil counts, averaging nearly 40/hpf. Increased awareness of eosinophilic esophagitis is necessary, since treatment with allergen elimination or anti-inflammatory therapy may be more effective than acid suppression. PMID:16258505

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

2006-01-01

59

Intramural esophageal dissection associated with esophageal perforation.  

PubMed

Intramural esophageal dissection (IED) is a rare clinical entity involving a mucosal injury and creation of a true and false lumen within the esophagus. We report on a case of IED caused by repeated vomiting due to a small bowel obstruction associated with a small amount of pneumomediastinum on CT. IED has traditionally been believed not to be associated with esophageal perforation. Our case adds to the few reported instances where IED has been associated with extraluminal air leakage, the mildest form of esophageal perforation and demonstrates imaging not previously published in the radiology literature. Our case was successfully managed conservatively. PMID:23819141

Monu, Nicholas C; Murphy, Brian L

2013-01-01

60

Does surgery correct esophageal motor dysfunction in gastroesophageal reflux.  

PubMed Central

The high incidence of dysphagia in patients with symptomatic gastroesophageal reflux (GER) but no evidence of peptic stricture suggests esophageal motor dysfunction. Conventional methods for detecting dysfunction (radiologic and manometric examinations) often fail to detect abnormality in these patients. Radionuclide transit (RT), a new method for detecting esophageal motor dysfunction, was used to prospectively assess function in 29 patients with symptomatic GER uncomplicated by stricture before and three months after antireflux surgery (HILL). The preoperative incidence of dysphagia and esophageal dysfunction was 73% and 52%, respectively. During operation (Hill repair), intraoperative measurement of the lower esophageal sphincter pressure was performed and the LESP raised to levels between 45 and 55 mmHg. The preoperative lower esophageal sphincter pressure was raised from a mean of 8.6 mmHg, to mean of 18.5 mmHg after operation. No patient has free reflux after operation. Postoperative studies on 20 patients demonstrated persistence of all preoperative esophageal dysfunction despite loss of dysphagia. RT has demonstrated a disorder of esophageal motor function in 52% of patients with symptomatic GER that may be responsible for impaired esophageal clearance. This abnormality is not contraindication to surgery. The results indicate that construction of an effective barrier to reflex corrects symptoms of reflux, even in the presence of impaired esophageal transit. Radionuclide transit is a safe noninvasive test for assessment of esophageal function.

Russell, C O; Pope, C E; Gannan, R M; Allen, F D; Velasco, N; Hill, L D

1981-01-01

61

[The esophageal motor pattern and the acid exposure of the distal esophagus in patients with gastroesophageal reflux].  

PubMed

Low-compliance standard manometry and 24-hour ambulatory pH monitoring were performed in 42 patients with typical gastro-esophageal reflux (GER) symptoms in order to assess correlations between esophageal motility pattern and pH profile. Our results show: 1) 36% of GER patients had a normal esophageal acid exposure; 2) pH profile and manometric pattern did not differ in patients with mild esophagitis from those without esophagitis; 3) low esophageal sphincter pressure in GER patients was significantly lower than in control subjects, irrespective of acid exposure; 4) the main motility disorders in the distal esophagus of reflux patients was the increased simultaneous wave rate which seemed to affect both recumbent esophageal clearance and reflux time. PMID:8079036

Pustorino, S; Federico, G; Calipari, G; Martinez, P; Pizzimenti, C; Barbera, G; Salvia, M A; Migliorato, D; Consolo, F

1994-01-01

62

Eosinophilic esophagitis: case report.  

PubMed

Eosinophilic esophagitis is an inflammatory condition of the esophagus characterized by eosinophilic infiltration. It is a condition mainly affecting children; the adult form has only recently gained recognition as a distinct entity. The major symptom among adults with eosinophilic esophagitis is dysphagia. It is often misdiagnosed as gastroesophageal reflux disease because of the similarity in symptoms. An endoscopic biopsy is required to distinguish between the conditions. The cause of eosinophilic esophagitis is poorly understood, but food allergy has been implicated. Topical steroids are the most effective and convenient method for the treatment of eosinophilic esophagitis in adults. The long-term prognosis of eosinophilic esophagitis is uncertain; however, data suggests a benign course. We herein present two eosinophilic esophagitis cases that were the first to be diagnosed in our clinic. PMID:17602357

Mungan, Zeynel; Pinarba?i, Binnur; Kaymako?lu, Sabahattin

2007-06-01

63

Snapshot of Esophageal Cancer  

MedlinePLUS

... prevention of Barrett esophagus and esophageal adenocarcinoma. Several early-phase clinical trials of molecularly targeted cancer regimens are being conducted through NCI’s Accelerating Clinical ...

64

Recurrent Spontaneous Esophageal Dissection  

PubMed Central

Introduction: Spontaneous esophageal dissection is a rare disorder of the esophagus. Case Description: We present what is believed to be the first reported case of recurrent esophageal dissection in a previously healthy 33-year-old man with chronic eosinophilic esophagitis. He had two episodes of spontaneous dissection of the midesophagus separated by a 5-month interval. Both episodes responded to treatment with endoscopic intervention. He has remained free of additional recurrences after definitive endoscopic therapy and oral steroid therapy. A complete description of the case, relevant radiologic imaging, and a review of the relevant literature are provided. Discussion: Endoscopic therapy is an option for the management of recurrent esophageal dissection.

Stephens, Nicholas A.; Walker, Peter A.; Jayanty, Vikram; Raijman, Isaac; Khalil, Kamal

2014-01-01

65

Esophageal Cancer  

MedlinePLUS

... test performed under sedation in which a flexible telescope is passed through your mouth and down your esophagus into your stomach. The telescope permits the physician performing the test to look ...

66

Sucralfate versus cimetidine in the treatment of reflux esophagitis, with special reference to the esophageal motor function  

SciTech Connect

Sixty patients entered a double-blind clinical trial comparing the effect of 1 g of sucralfate granulate given four times daily and cimetidine, 400 mg twice daily. Twenty-six patients treated with sucralfate and 26 treated with cimetidine were examined with short-term pH monitoring before and after 12 weeks of treatment. Thirty patients, 19 treated with cimetidine and 11 treated with sucralfate, had esophageal motility studied by a radionuclide test before and after 12 weeks of treatment. The efficacy of the treatments was judged by symptoms and endoscopic response after 4, 8, and 12 weeks of treatment. The endpoint healing rate was approximately 60% in both groups and symptoms were relieved in half of the patients in both groups (difference not significant). The effect of the treatments on pH and number of spikes reflected the different pharmacodynamic profiles of the drugs, whereas the mean transit time (MTT) was not changed by the treatments. The residual activity after radionuclide transit in the sitting position was significantly increased after treatment with cimetidine. The data support the hypothesis that primary dysmotility might be involved in the pathogenesis of reflux esophagitis in about 33% of the patients. Possibilities for a combination therapy with sucralfate and cimetidine are stressed.

Jorgensen, F.; Elsborg, L. (Department of Internal Medicine and Gastroenterology B, Frederiksberg University Hospital of Copenhagen (Denmark))

1991-08-08

67

Impaired Esophageal Bolus Transit in Patients with Gastroesophageal Reflux Disease and Abnormal Esophageal Acid Exposure  

PubMed Central

Background/Aims We assessed the bolus transit and motility characteristics in gastroesophageal reflux disease (GERD) patients with abnormal esophageal pH monitoring. Methods We retrospectively reviewed the combined impedance-esophageal manometry data from consecutive patients who had abnormal acid exposure during 24-hour esophageal pH monitoring. We compared these data to the results from functional heartburn (FH) and asymptomatic volunteers. Results The data from 33 GERD patients (mean age of 51 years, 18 males), 14 FH patients (mean age of 51 years, one male), and 20 asymptomatic volunteers (mean age of 27 years, nine males) were analyzed. Ineffective esophageal motility was diagnosed in 10% of the volunteers, 21% of the FH patients, and 15% of the GERD patients. Ineffective contraction was more frequent in GERD and FH patients than in volunteers (16% and 20% vs 6%, respectively; p<0.05). Additionally, 10% of the volunteers, 21% of the FH patients and 36% of the GERD patients had an abnormal bolus transit. Complete bolus transit was less frequent, and bolus transit was slower in GERD patients than in volunteers for liquid (70% vs 85%) and viscous swallows (57% vs 73%). A longer acid clearance time was associated with abnormal bolus transit in the GERD group. Conclusions Patients with GERD have mild peristaltic dysfunction and incomplete and slower esophageal bolus transit. These conditions predispose them to prolonged acid contact with the esophagus.

Cho, Yu Kyung; Lim, Chul Hyun; Kim, Jin Su; Park, Jae Myung; Lee, In Seok; Kim, Sang Woo; Choi, Kyu-Yong

2012-01-01

68

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.

69

Drug-induced esophagitis.  

PubMed

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

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

2009-01-01

70

Brain metastasis from esophageal carcinoma.  

PubMed

Esophageal carcinoma rarely metastasizes to brain. In our center, among 504 cases of esophageal cancer registered for treatment during a 15-year (1990-2005) period, brain metastasis from esophageal carcinoma was detected in only 1 case. An unusual case of esophageal carcinoma that presented with brain metastasis is reported here. PMID:19542674

Agrawal, Rashi; Shukla, Prity; Shukla, Vikas; Chauhan, Arvind

2009-01-01

71

Update on endoscopic diagnosis, management and surveillance strategies of esophageal diseases.  

PubMed

In the last few decades, upper gastrointestinal endoscopy has become the most complementary test for investigation of esophageal diseases. Its accessibility and safety guarantee wide clinical utilization in patients with suspected benign and malignant diseases of the esophagus. Recent technological advances in endoscopic imaging and tissue analysis obtained from the esophagus have been useful to better understand and manage highly relevant diseases such as gastroesophageal reflux disease, eosinophilic esophagitis and esophageal cancer. Using endoscopy to elucidate esophageal disorders in children has been another field of intensive and challenging research. This editorial highlights the latest advances in the endoscopic management of esophageal diseases, and focuses on Barrett's esophagus, esophageal cancer, eosinophilic esophagitis, as well as esophageal disorders in the pediatric population. PMID:22523612

Fornari, Fernando; Wagner, Rafaela

2012-04-16

72

Effects of Place of Articulation and Aspiration on Voice Onset Time in Mandarin Esophageal Speech  

Microsoft Academic Search

The ability of Mandarin esophageal speakers to distinguish between aspirated and unaspirated stops, and to distinguish between different places of articulation of stops were examined. Aspirated and unaspirated voiceless stops produced by normal laryngeal (NL) and standard esophageal (SE) speakers were studied. VOT values of the five different stops (\\/ph, th, kh, p, t\\/) of Mandarin followed by the vowel

Hanjun Liu; Manwa L. Ng; Mingxi Wan; Supin Wang; Yi Zhang

2007-01-01

73

The soluble hyaluronidase from bull testes is a fragment of the membrane-bound PH-20 enzyme.  

PubMed

The membrane-bound PH-20 hyaluronidase is known to be essential for fertilization. Here we addressed the question whether the soluble hyaluronidase from bull teste is related to the PH-20 polypeptide. The sequence of the membrane-bound PH-20 hyaluronidase from bovine sperm was determined via cDNA cloning. In parallel, from a commercial preparation of bovine hyaluronidase the major 60-kDa form was purified to apparent homogeneity. The soluble enzyme was digested with two different proteases and with cyanogen bromide and the amino acid sequence of 44 different fragments was determined. All the peptide sequences could be aligned to the sequence deduced from the cloned cDNAs. Our results thus show that the soluble 60-kDa hyaluronidase from bovine testes is a glycoprotein derived from the sperm PH-20 enzyme. As compared to the primary translation product of the PH-20 mRNA, it lacks the signal peptide at the amino terminus and 56 amino acids at the carboxyl end. These results demonstrate that the soluble 60-kDa enzyme is a fragment of the PH-20 hyaluronidase. It is currently not known whether the soluble testes hyaluronidase has a distinct biological function. PMID:9280317

Meyer, M F; Kreil, G; Aschauer, H

1997-08-18

74

Esophageal function in patients with angina-type chest pain and normal coronary angiograms.  

PubMed Central

Ten per cent of patients with angina pectoris have normal coronary arteries and cardiac function and, despite this reassurance, continue to have chest pain. Since pain of cardiac or esophageal origin is clinically difficult to differentiate, 50 patients with severe chest pain, normal cardiac function, and normal coronary arteriography with ergotamine provocation were evaluated with a symptomatic questionnaire and esophageal function test. On 24-hour esophageal pH monitoring, 23 patients had abnormal reflux, and 27 were normal. There was no difference in the incidence and severity of chest pain, esophageal symptoms, or medication taken between refluxers and nonrefluxers. Ten refluxers and ten nonrefluxers had chest pain on exercise electrocardiography. Thirteen refluxers documented chest pain during the pH monitoring period, and in 12 it coincided with a reflux episode. Fifteen nonrefluxers documented chest pain during the monitoring period, and in only one did it coincide with a reflux episode. Of the 23 refluxers, 12 were treated with medical therapy and 11 by a surgical antireflux procedure, and all followed for two to three years. Ten (91%) of the 11 surgically treated patients are totally free of chest pain compared with five (42%) of the 12 medically treated patients. All 12 patients who had chest pain coincide with a documented reflux episode responded positively to antireflux therapy, eight surgical and four medical. It is concluded that 46% of patients complaining of angina pectoris with normal cardiac function and coronary arteriography have gastroesophageal reflux as a possible etiology. Seventy-three per cent of these patients have total abolition of chest pain by either surgical or medical antireflux therapy. Patients whose experience of chest pain coincided with a documented reflux episode on 24-hour esophageal pH monitoring had a 100% response to medical or surgical therapy. Overall, surgical therapy gave better results (91%) but was associated with an 18% temporary morbidity. Objective evaluation of reflux status and its correlation to the symptom of chest pain by 24-hour pH monitoring allows for selective therapy in these difficult to manage patients.

DeMeester, T R; O'Sullivan, G C; Bermudez, G; Midell, A I; Cimochowski, G E; O'Drobinak, J

1982-01-01

75

Metastasis of Esophageal Cancer.  

National Technical Information Service (NTIS)

Metastatic involvement (59.2%) was noted in esophageal cancer during autopsy on 710 cases, with lymphogenic metastasis predominating over hematogenic metastasis. In those dying soon after radiation therapy there were metastasis in 49% and in 30% after sur...

A. I. Pirogov V. D. Ryndin

1974-01-01

76

Esophageal Cancer Prevention  

MedlinePLUS

... the type of cells that become malignant (cancerous): Squamous cell carcinoma : Cancer that begins in squamous cells , the thin, ... chance of developing esophageal cancer increases with age. Squamous cell carcinoma of the esophagus is more common in blacks ...

77

Genetics of Eosinophilic Esophagitis.  

National Technical Information Service (NTIS)

Eosinophilic esophagitis (EE) is an emerging worldwide food allergic disorder associated with polysensitization to multiple food allergens, resulting in greatly restricted diets and chronic gastroesophageal reflux disease-like symptoms in many individuals...

M. Rothenberg

2012-01-01

78

Genetics of Eosinophilic Esophagitis.  

National Technical Information Service (NTIS)

Eosinophilic esophagitis (EE) is an emerging worldwide food allergic disorder associated with polysensitization to multiple food allergens, resulting in greatly restricted diets and chronic gastroesophageal reflux disease-like symptoms in many individuals...

M. E. Rothenberg

2011-01-01

79

Isolated cervical esophageal reconstruction for rare esophageal tumors  

Microsoft Academic Search

Background. Isolated defects in the cervical esophagus in patients who have not undergone total laryngec- tomy are uncommon. We report 2 cases of rare esophageal tumors requiring reconstruction of the cervical esophagus after tumor resection. Methods and Results. The patients were a 51-year-old woman with an esophageal granular cell tumor and a 54-year- old woman with an esophageal schwannoma. Both

Vincent P. Marin; Peirong Yu; Randal S. Weber

2006-01-01

80

FABRICATION, WELDING AND TESTING OF 17-7 PH STAINLESS STEEL  

Microsoft Academic Search

The fabrication and heat treatment of a scroll, elbows, and transitions ; made from l7-7 PH stainless steel plate in thickhesses varying from one-quarter ; inch to three inches are reported. Inert gas-shielded tungsten-arc welding ; procedures for l7-7 PH stainless steel are presented in detail. The material ; handling and welding techniques necessary to achieve ultra-high quality multipass ;

1958-01-01

81

Testing Novel pH Proxies through Inorganic Calcite Precipitations and K/Pg Foraminifera  

NASA Astrophysics Data System (ADS)

Ocean pH proxies help constrain the carbon system in the paleocean and can be used to infer atmospheric CO2 when coupled with estimates of total alkalinity, aqueous pCO2 or dissolved inorganic carbon. This project investigates two novel pH proxies (cerium abundance and kinetically-controlled oxygen isotopes) through a series of precipitations of inorganic calcite, as well as the previously established boron isotope pH proxy. Precipitations are performed using varied pH and carbonate saturation states that span the range of typical ocean values as well as a 'free drift' that allows pH and saturation state to vary. The light rare earth element cerium speciates, depending on local oxidation-reduction conditions, between the soluble Ce3+ and highly insoluble Ce4+ ions, causing a relative depletion of cerium in ocean water. This project demonstrates how a suite rare earth elements, including cerium, partitions into inorganic calcite and how partitioning varies with changing pH and carbonate saturation state. Oxygen isotope fractionation is primarily controlled by temperature, but this project examines how pH and carbonate saturation state correlate with oxygen isotope values under kinetic conditions during the initial stage of precipitation. The effect of diagenesis on each proxy is simulated by dissolution of precipitated calcite in a pressure vessel. Results from the precipitations are used to inform a record of well-preserved benthic and planktonic foraminifera from DSDP Site 356 that range in age from the K/Pg boundary to the period when the ?13C gradient between the surface and deep ocean returned to pre-event levels. The pH record is used to infer the magnitude and length of the perturbation to the oceanic carbon system following the extinction event, particularly in terms of export productivity.

Super, J. R.; Pagani, M.; Wang, Z.

2013-12-01

82

Clinical implications and pathogenesis of esophageal remodeling in eosinophilic esophagitis.  

PubMed

In eosinophilic esophagitis (EoE), remodeling changes are manifest histologically in the epithelium and subepithelium where lamina propria fibrosis, expansion of the muscularis propria, and increased vascularity occur. The clinical symptoms and complications of EoE are largely consequences of esophageal remodeling. Available therapies have demonstrated variable ability to reverse existing remodeling changes of the esophagus. Systemic therapies have the potential of addressing subepithelial remodeling. Esophageal dilation remains a useful, adjunctive therapeutic maneuver in symptomatic adults with esophageal stricture. As novel treatments emerge, it is essential that therapeutic end points account for the fundamental contributions of esophageal remodeling to overall disease activity. PMID:24813517

Hirano, Ikuo; Aceves, Seema S

2014-06-01

83

Problemas de alimentaçăo em crianças com doença do refluxo gastroesofágico*** Feeding disorders in children with gastro-esophageal reflux disease  

Microsoft Academic Search

Background: feeding\\/eating disorders are frequent in pediatric patients and, in some cases, can be associated to an upper digestive motility disorder. Gastro-esophageal reflux is, nowadays, considered a risk factor for the development of feeding\\/eating disorders. Aim: to verify the occurrence of feeding\\/eating disorders in patients with Gastro-Esophageal Reflux Disease (GERD) determined by the 24-H esophageal pH monitoring evaluation. Method: an

Larissa Vieira Drent; Elizete Aparecida; Lomazi da Costa Pinto

2007-01-01

84

Esophageal Perforation in Adults  

PubMed Central

Objective: To evaluate the outcome of aggressive conservative therapy in patients with esophageal perforation. Summary Background Data: The treatment of esophageal perforation remains controversial with a bias toward early primary repair, resection, and/or proximal diversion. This review evaluates an alternate approach with a bias toward aggressive drainage of fluid collections and frequent CT and gastographin UGI examinations to evaluate progress. Methods: From 1992 to 2004, 47 patients with esophageal perforation (10 proximal, 37 thoracic) were treated (18 patients early [<24 hours], 29 late). There were 31 male and 16 females (ages 18–90 years). The etiology was iatrogenic (25), spontaneous (14), trauma (3), dissecting thoracic aneurysm (3), and 1 each following a Stretta procedure and Blakemore tube placement. Results: Six of 10 cervical perforations underwent surgery (3 primary repair, 3 abscess drainage). Nine of 10 perforations healed at discharge. In 37 thoracic perforations, 2 underwent primary repair (1 iatrogenic, 1 spontaneous) and 4 underwent limited thoracotomy. Thirty-4 patients (4 cervical, 28 thoracic) underwent nonoperative treatment. Thirteen of the 14 patients with spontaneous perforation (thoracic) underwent initial nonoperative care. Overall mortality was 4.2% (2 of 47 patients). These deaths represent 2 of 37 thoracic perforations (5.4%). There were no deaths in the 34 patients treated nonoperatively. Esophageal healing occurred in 43 of 45 surviving patients (96%). Subsequent operations included colon interposition in 2, esophagectomy for malignancy in 3, and esophagectomy for benign stricture in 2. Conclusions: Aggressive treatment of sepsis and control of esophageal leaks leak lowers mortality and morbidity, allow esophageal healing, and avoid major surgery in most patients.

Vogel, Stephen B.; Rout, W Robert; Martin, Tomas D.; Abbitt, Patricia L.

2005-01-01

85

In vitro and in vivo analysis of the PABA test compared with the Lundh test--influence of intraluminal pH.  

PubMed Central

Lundh test and PABA test results were compared in 50 patients. In the resulting correlation curve three areas of interest were differentiated: (1) an area with mean tryptic activity, found in the Lundh test, below 4 U/ml, where an abnormal PABA test result was also seen; (2) an intermediate area from 4 to 9 U/ml, where PABA test results may be found in discordance with the Lundh test; (3) the normal level, where PABA excretion was shown to be independent of intestinal chymotrypsin activity. In experiments in vitro on the kinetics of the hydrolysis of BTPABA by chymotrypsin the profound influence of the pH on Km and Vmax was shown. This influence of the pH explains why in the intermediate area of pancreatic dysfunction normal PABA test results were found in a number of cases. A higher mean pH level of the Lundh test aspirates was found for patients with a normal PABA test result than for patients with an abnormal PABA test.

Hoek, F J; Sanders, G T; Teunen, A; Tijtgat, G N

1981-01-01

86

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 ...

87

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 (...

88

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

PubMed Central

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.

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

2014-01-01

89

Pathogenic role of mast cells in experimental eosinophilic esophagitis  

PubMed Central

Eosinophilic esophagitis (EoE) is a chronic allergic disease characterized by esophageal intraepithelial eosinophils, extracellular eosinophil granule deposition, induced mast cell accumulation, and epithelial cell hyperplasia. However, the processes involved in the development of a number of these characteristics are largely unknown. Herein, we tested the hypothesis whether induced mast cell accumulation in the esophagus has a role in promoting EoE pathogenesis. Accordingly, we induced experimental EoE in wild-type mice, mast cell-deficient WWv mice, and mast cell-reconstituted WWv mice. We report that esophageal mast cell numbers increase in parallel with eosinophils in a dose- and time-dependent manner following the induction of allergen-induced EoE. The induced mast cells are localized in the esophageal lamina propria and muscular mucosa but have no influence on promoting esophageal eosinophilia. The 5?-bromodeoxyuridine (BrdU) incorporation analysis indicated that mast cells have a significant role in muscle cell hyperplasia and hypertrophy. In addition, the wild-type and mast cell-reconstituted WWv mice showed a comparable number of BrdU+ cells in the esophageal muscular mucosa following allergen-induced EoE. In conclusion, we provide for the first time direct evidence that mast cell promotes muscle cell hyperplasia and hypertrophy and may have a significant role in promoting esophageal functional abnormalities in EoE.

Niranjan, Rituraj; Mavi, Parm; Rayapudi, Madhavi; Dynda, Scott

2013-01-01

90

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

PubMed

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

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

2014-02-01

91

Epidemiology of esophageal cancer  

PubMed Central

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.

Zhang, Yuwei

2013-01-01

92

BPC 157 therapy to detriment sphincters failure-esophagitis-pancreatitis in rat and acute pancreatitis patients low sphincters pressure.  

PubMed

Possibly, acute esophagitis and pancreatitis cause each other, and we focused on sphincteric failure as the common causative key able to induce either esophagitis and acute pancreatitis or both of them, and thereby investigate the presence of a common therapy nominator. This may be an anti-ulcer pentadecapeptide BPC 157 (tested for inflammatory bowel disease, wound treatment) affecting esophagitis, lower esophageal and pyloric sphincters failure and acute pancreatitis (10 ?g/kg, 10 ng/kg intraperitoneally or in drinking water). The esophagitis-sphincter failure procedure (i.e., insertion of the tubes into the sphincters, lower esophageal and pyloric) and acute pancreatitis procedure (i.e., bile duct ligation) were combined in rats. Esophageal manometry was done in acute pancreatitis patients. In rats acute pancreatitis procedure produced also esophagitis and both sphincter failure, decreased pressure 24 h post-surgery. Furthermore, bile duct ligation alone immediately declines the pressure in both sphincters. Vice versa, the esophagitis-sphincter failure procedure alone produced acute pancreatitis. What's more, these lesions (esophagitis, sphincter failure, acute pancreatitis when combined) aggravate each other (tubes into sphincters and ligated bile duct). Counteraction occurred by BPC 157 therapies. In acute pancreatitis patients lower pressure at rest was in both esophageal sphincters in acute pancreatitis patients. We conclude that BPC 157 could cure esophagitis/sphincter/acute pancreatitis healing failure. PMID:22204800

Petrovic, I; Dobric, I; Drmic, D; Sever, M; Klicek, R; Radic, B; Brcic, L; Kolenc, D; Zlatar, M; Kunjko, K; Jurcic, D; Martinac, M; Rasic, Z; Boban Blagaic, A; Romic, Z; Seiwerth, S; Sikiric, P

2011-10-01

93

Tracheo-esophageal fistula: Successful palliation after failed esophageal stent  

PubMed Central

The incidence of tracheo-esophageal (TO) fistula is on the rise, especially after palliative management for esophageal malignancies. We report a case of cancer of esophagus who after chemotherapy and radiotherapy developed TO fistula. Placement of an esophageal stent helped him in taking food orally, but his cough and dyspnoea continued to worsen. Fibreoptic bronchoscopy demonstrated a severely compressed trachea secondary to protrusion of esophageal stent which responded very well to an Ultraflex-covered tracheal stent and the patient achieved relief from cough and dyspnoea.

Chawla, Rakesh K.; Madan, Arun; Chawla, Kiran

2012-01-01

94

Tracheo-esophageal fistula: Successful palliation after failed esophageal stent.  

PubMed

The incidence of tracheo-esophageal (TO) fistula is on the rise, especially after palliative management for esophageal malignancies. We report a case of cancer of esophagus who after chemotherapy and radiotherapy developed TO fistula. Placement of an esophageal stent helped him in taking food orally, but his cough and dyspnoea continued to worsen. Fibreoptic bronchoscopy demonstrated a severely compressed trachea secondary to protrusion of esophageal stent which responded very well to an Ultraflex-covered tracheal stent and the patient achieved relief from cough and dyspnoea. PMID:22919174

Chawla, Rakesh K; Madan, Arun; Chawla, Kiran

2012-07-01

95

Esophageal Rupture as a Primary Manifestation in Eosinophilic Esophagitis  

PubMed Central

Eosinophilic esophagitis (EoE) is a chronic inflammatory process characterized by symptoms of esophageal dysfunction and, histologically, by eosinophilic infiltration of the esophagus. In adults, it commonly presents with dysphagia, food impaction, and chest or abdominal pain. Chronic inflammation can lead to diffuse narrowing of the esophageal lumen which may cause food impaction. Endoscopic procedures to relieve food impaction may lead to complications such as esophageal perforation due to the friability of the esophageal mucosa. Spontaneous transmural esophageal rupture, also known as Boerhaave's syndrome, as a primary manifestation of EoE is rare. In this paper, we present two adult patients who presented with esophageal perforation as the initial manifestation of EoE. This rare complication of EoE has been documented in 13 other reports (11 adults, 2 children) and only 1 of the patients had been previously diagnosed with EoE. A history of dysphagia was present in 1 of our patients and in the majority of previously documented patients. Esophageal perforation is a potentially severe complication of EoE. Patients with a history of dysphagia and patients with spontaneous esophageal perforation should warrant an evaluation for EoE.

Vernon, Natalia; Mohananey, Divyanshu; Ghetmiri, Ehsan; Ghaffari, Gisoo

2014-01-01

96

Axial-Load Fatigue Tests on 17-7 PH Stainless Steel Under Constant-Amplitude Loading  

NASA Technical Reports Server (NTRS)

Axial-load fatigue tests were conducted at room temperature on notched and unnotched sheet specimens of 17-7 PH stainless steel in Condition TH 1050. The notched specimens had theoretical stress-concentration factors of 2.32, 4.00, and 5.00. All specimens were tested under completely reversed loading. S-N curves are presented for each specimen configuration and ratios of fatigue strengths of unnotched specimens to those of notched specimens are given. Predictions of the fatigue behavior of notched specimens near the fatigue limit were made.

Leybold, Herbert A.

1960-01-01

97

The association between reflux esophagitis and airway hyper-reactivity in patients with gastro-esophageal reflux  

PubMed Central

Background: The association of gastro-esophageal reflux (GER) with a wide variety of pulmonary disorders was recognized. We aimed to evaluate the effect of GER-induced esophagitis on airway hyper-reactivity (AHR) in patients and the response to treatment. Materials and Methods: In this cohort study, 30 patients attending the gastrointestinal clinic of a university hospital with acid reflux symptoms were included. All patients were evaluated endoscopically and divided into case group with esophagitis and control group without any evidence of esophagitis. Spirometry and methacholine test were done in all patients before and after treatment of GER with pantoprazole 40 mg daily for six months. Results: There was a significant difference in the rate of positive methacholine test between the cases (40%) and the controls (6.7%) prior to anti-acid therapy (P < 0.0001). After six months of treatment, the frequency of positive methacholine test diminished from 40 to 13.3% in the case group (P < 0.05) but did not change in the controls (P = 0.15). Conclusion: The presence of esophagitis due to GER would increase the AHR and treatment with pantoperazole would decrease AHR in patients with proved esophagitis and no previous history of asthma after six months.

Karbasi, Ashraf; Ardestani, Mohammad Emami; Ghanei, Mostafa; Harandi, Ali Amini

2013-01-01

98

Eosinophilic esophagitis: Pathobiology and management  

Microsoft Academic Search

Patients with eosinophilic esophagitis present with symptoms similar to those found in GERD, along with dense esophageal eosinophilia\\u000a that persist despite aggressive acid blockade. A dramatic increase in prevalence of eosinophilic esophagitis over the past\\u000a several years has provided clinicians with a new explanation for previously unexplained dysphagia, food impaction, and vomiting.\\u000a In light of this recognition, an increasing number

Jessica J. Lee; Glenn T. Furuta

2007-01-01

99

Esophageal motility, vagal function and gastroesophageal reflux in a cohort of adult asthmatics  

PubMed Central

Background Asthmatics are known to have esophageal hypomotility. Vagal hypofunction and prolonged intra-esophageal acidification cause esophageal hypomotility. The contribution of gastroesophageal reflux (GER) and vagal function to esophageal motility in asthmatics is unclear. We studied the relationship between esophageal motility, GER and vagal function in a cohort of adult asthmatics. Methods Thirty mild, stable asthmatics (ATS criteria) and 30 healthy volunteers underwent 24-hour ambulatory esophageal monitoring, manometry, autonomic function testing and GER symptom assessment. 27 asthmatics underwent gastroscopy. A vagal function score calculated from 3 tests (valsalva maneuver, heart rate response to deep breathing and to standing from supine position) was correlated with esophageal function parameters. Results Asthmatics (mean age 34.8 (SD 8.4), 60% female) had more frequent GERD symptoms than controls (mean age 30.9 (SD 7.7), 50% female). 10/27 asthmatics had esophageal mucosal damage, 22 showed hypervagal response, none had a hyperadrenergic response. 14 asthmatics had ineffective esophageal motility. Higher GERD-score asthmatics had significantly fewer peristaltic and more simultaneous contractions than controls, and higher esophageal acid contact times than those with lower scores. All reflux parameters were significantly higher and acid clearance time prolonged in asthmatics than controls (p?test). There was no correlation between vagal function score and esophageal function parameters. Conclusions A cohort of adult asthmatics was found to have peristaltic dysfunction and pathological GER, but otherwise normal esophageal motility. The peristaltic dysfunction seems to be associated with vagal hyperreactivity rather than vagal hypofunction.

2012-01-01

100

Esophageal Pressures, Polysomnography, and Neurobehavioral Outcomes of Adenotonsillectomy in Children  

PubMed Central

Background: Esophageal pressure monitoring during polysomnography in children offers a gold-standard, “preferred” assessment for work of breathing, but is not commonly used in part because prospective data on incremental clinical utility are scarce. We compared a standard pediatric apnea/hypopnea index to quantitative esophageal pressures as predictors of apnea-related neurobehavioral morbidity and treatment response. Methods: Eighty-one children aged 7.8 ± 2.8 (SD) years, including 44 boys, had traditional laboratory-based pediatric polysomnography, esophageal pressure monitoring, multiple sleep latency tests, psychiatric evaluations, parental behavior rating scales, and cognitive testing, all just before clinically indicated adenotonsillectomy, and again 7.2 ± 0.8 months later. Esophageal pressures were used, along with nasal pressure monitoring and oronasal thermocouples, not only to identify respiratory events but also more quantitatively to determine the most negative esophageal pressure recorded and the percentage of sleep time spent with pressures lower than ?10 cm H2O. Results: Both sleep-disordered breathing and neurobehavioral measures improved after surgery. At baseline, one or both quantitative esophageal pressure measures predicted a disruptive behavior disorder (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-defined attention-deficit/hyperactivity disorder, conduct disorder, or oppositional defiant disorder) and more sleepiness and their future improvement after adenotonsillectomy (each P < .05). The pediatric apnea/hypopnea index did not predict these morbidities or treatment outcomes (each P > .10). The addition of respiratory effort-related arousals to the apnea/hypopnea index did not improve its predictive value. Neither the preoperative apnea/hypopnea index nor esophageal pressures predicted baseline hyperactive behavior, cognitive performance, or their improvement after surgery. Conclusions: Quantitative esophageal pressure monitoring may add predictive value for some, if not all, neurobehavioral outcomes of sleep-disordered breathing. Trial registry: ClinicalTrials.gov; No.: NCT00233194; URL: www.clinicaltrials.gov

Ruzicka, Deborah L.; Hoban, Timothy F.; Fetterolf, Judith L.; Garetz, Susan L.; Guire, Kenneth E.; Dillon, James E.; Felt, Barbara T.; Hodges, Elise K.; Giordani, Bruno J.

2012-01-01

101

[Achalasia and esophageal cancer].  

PubMed

During the period included between January 1970 and December 1990, we studied 242 patients with manometric and radiological diagnosis of esophageal achalasia. Eight of these patients (3.3%) developed during the evolution of their disease an esophageal carcinoma. Eight cases showed histologic type of epidermoid carcinoma: 3 differentiated, 3 semi-differentiated and 2 anaplastic. Therapy for achalasia was: one patient, Heller myotomy, 4 patients, dilatations with bougies in numerous opportunities, and the other two patients receive no treatment for achalasia. Two patients reported tracheobronchial fistulas as complication of carcinoma. Treatment received for carcinoma included: three patients, radiotherapy (4000 rads); one patient, chemotherapy; one patient, chemotherapy and radiotherapy, one resection surgery and two patients feeding gastrostomy. All of the eight patients died within the year of diagnosis of epidermoid carcinoma. PMID:1300847

Corti, R E; Monastra, L; Fernández Marty, P; Barco, J C; Ferro, F E; Galindo, F; Musi, A O; Kogan, Z

1992-01-01

102

[Giant esophageal fibrovascular polyp].  

PubMed

Fibrovascular polyps are extremely rare benign neoplasias of the esophagus, which usually originate in the lower cricoid area. They do not produce any discomfort in the patient for a long time, however it may make itself evident by the patient's regurgitation of the polyp, producing asphyxia or, more frequently, dysphagia. The case of a 58 year old male patient is presented herein, with a 9 month record of dysphagia, weight loss and intermittent melena. The barium x-ray showed a distended esophagus, with a tumor running from the upper esophageal sphincter to the cardia. The endoscopy confirmed the presence of a pediculated tumor, implanted in the cervical esophagus. Surgeons suspected the potential malignancy of the tumor and performed a transhiatal esophagectomy. The final pathologic diagnosis was giant fibrovascular esophageal polyp. PMID:14532922

Palacios, Fernando; Contardo, Carlos; Guevara, Jorge; Vera, Augusto; Aguilar, Luis; Huamán, Manuel; Palomino, Américo; Yabar, Alejandro

2003-01-01

103

Esophageal intramucosal hematoma after peripheral blood stem cell transplantation: case report and review of literature  

PubMed Central

Esophageal complications occur after hematopoietic stem cell transplantation (HSCT). There are, however, only limited reports on the etiology or management of esophageal complications. Here, we report the occurrence of intramucosal hematoma presenting continuous esophageal hemorrhage in a 34 year-old man following the second peripheral blood stem cell transplantation for acute myeloid leukemia. His hematemesis started 2 months after HSCT and was repeated in supportive care. On day 156, he underwent total esophagectomy as a result of uncontrollable massive hematemesis. Histopathological testings of the resected esophagus confirmed intramucosal hematoma as a cause of hematemesis. This case highlights intramucosal hematoma as one of the important etiologies of esophageal complications following HSCT.

Kobayashi, Takashi; Seo, Sachiko; Morita, Shigeki; Goto, Akiteru; Masuda, Akiko; Shimizu, Nobuyuki; Nishida, Masato; Nunobe, Souya; Ichikawa, Motoshi; Takazawa, Yutaka; Seto, Yasuyuki; Fukayama, Masashi; Kurokawa, Mineo

2014-01-01

104

Esophageal intramucosal hematoma after peripheral blood stem cell transplantation: case report and review of literature.  

PubMed

Esophageal complications occur after hematopoietic stem cell transplantation (HSCT). There are, however, only limited reports on the etiology or management of esophageal complications. Here, we report the occurrence of intramucosal hematoma presenting continuous esophageal hemorrhage in a 34 year-old man following the second peripheral blood stem cell transplantation for acute myeloid leukemia. His hematemesis started 2 months after HSCT and was repeated in supportive care. On day 156, he underwent total esophagectomy as a result of uncontrollable massive hematemesis. Histopathological testings of the resected esophagus confirmed intramucosal hematoma as a cause of hematemesis. This case highlights intramucosal hematoma as one of the important etiologies of esophageal complications following HSCT. PMID:24966988

Kobayashi, Takashi; Seo, Sachiko; Morita, Shigeki; Goto, Akiteru; Masuda, Akiko; Shimizu, Nobuyuki; Nishida, Masato; Nunobe, Souya; Ichikawa, Motoshi; Takazawa, Yutaka; Seto, Yasuyuki; Fukayama, Masashi; Kurokawa, Mineo

2014-01-01

105

Effects of Rikkunshito (TJ-43) on Esophageal Motor Function and Gastroesophageal Reflux  

PubMed Central

Background/Aims Rikkunshito (TJ-43), an herbal medicine, has been demonstrated to relieve gastroesophageal reflux symptoms. However, the effects of TJ-43 on esophageal motor functions have not been fully determined. This double-blind crossover study was performed to investigate the effects of TJ-43 on esophageal motor functions and gastroesophageal reflux. Methods The subjects were 10 normal male volunteers. Lower esophageal sphincter pressure and esophageal body peristaltic contractions with and without 1-week administration of TJ-43 were examined in a crossover fashion. Post-prandial gastroesophageal reflux was also determined using a multi-channel impedance pH dual monitor. Results TJ-43 at a standard dose of 7.5 g/day did not significantly augment esophageal peristaltic contraction pressure measured in the proximal, middle and distal segments of the esophagus, whereas increment of resting lower esophageal sphincter pressure was observed in a supine position. In addition, TJ-43 administration did not decrease post-prandial gastroesophageal acid, non-acid reflux events or accelerate esophageal clearance time. Conclusions TJ-43 at a standard dose did not have a significant effect on esophageal motor activity or gastroesophageal reflux in healthy adults.

Morita, Terumi; Adachi, Kyoichi; Ohara, Shunji; Tanimura, Takashi; Koshino, Kenji; Uemura, Tomochika; Naora, Kohji; Kinoshita, Yoshikazu

2012-01-01

106

Esophageal and Gastric Injuries  

Microsoft Academic Search

\\u000a Traumatic lesions of the esophagus can be classified into. Primary lesions, Perforations, Ruptures, Secondary lesions, Fistulas,\\u000a Strictures Perforations: Perforations are due to internal or external forces. The vast majority of esophageal perforations\\u000a occur iatrogenic (e.g., endoscopy, dilatation, transesophageal echocardiography (TEE), Sengstaken–Blakemore tubes, endotracheal\\u000a tubes). Penetrating injuries due to external forces (e.g., stab wounds, gunshots) are less frequent. For the therapeutic

Paul M. Schneider; Georg Lurje; Peter Bauerfeind; Marc Schiesser

107

Screening and selection of peptides specific for esophageal cancer cells from a phage display peptide library  

PubMed Central

Background Esophageal cancer is a common malignant tumor of the gastrointestinal tract and is typically diagnosed at an advanced stage due to the absence of early clinical symptoms. Although surgery, chemotherapy, and radiotherapy represent the major treatment methods employed for this cancer, the prognosis of esophageal cancer remains poor. Methods A Ph.D.-12TM Phage Display Peptide Library was screened using an esophageal cancer cell line, Eca109, and a normal esophageal epithelial cell line to identify novel ligands that selectively bind the surface of esophageal cancer cells with high affinity. Results Two polypeptides were isolated that exhibited higher binding affinities and specificity for the Eca109 cells. These peptides were further validated using enzyme-linked immunosorbent assays (ELISAs), immunofluorescence assays, and immunohistochemistry assays. Conclusion Two polypeptides with high binding affinities to esophageal cancer cells were isolated from the Ph.D.-12TM Phage Display Peptide Library. Further studies are needed to characterize the biological effects of these polypeptides and to explore the potential for these peptides to be used for the early screening of esophageal cancer or for cell-targeted therapies that would reduce the toxic side effects of cancer treatment.

2014-01-01

108

Storage of platelets for tests of platelet function: comparison of two methods of pH control.  

PubMed

A comparison was made of two methods to control the pH of platelet-rich plasma (PRP) stored for tests of platelet function. Citrated PRP at 37 degrees C was maintained at pH 7.3-7.4 by incubation either in a controlled CO2/air environment or in a plastic syringe from which all air was expelled. At intervals over 2-5 hours platelet aggregation induced by ADP and collagen was measured. Plasma beta-thromboglobulin (beta TG) was assayed to assess liberation of beta TG from platelets during storage. Platelet aggregation responses were more stable when PRP was stored in a syringe. Liberation of beta TG from platelets did not occur in this system, but did occur in the CO2 system in many experiments. The differences between the two systems were not due to the lower pO2 levels in the syringe, but were probably related to the presence of an air/liquid interface in the CO2 system. The syringe system of storage is a simple method of pH control which offers better preservation of platelet function than a controlled CO2/air environment. PMID:3157241

Watts, S E; Tunbridge, L J; Duncan, E M; Lloyd, J V

1985-01-01

109

Effect of bolus composition on esophageal transit: concise communication  

SciTech Connect

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.

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

1982-10-01

110

Effect of bolus composition on esophageal transit: concise communication  

SciTech Connect

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.

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

1982-10-01

111

[Esophageal candidiasis as complication of inhaled steroid therapy].  

PubMed

Gastrointestinal endoscopy was performed in two bronchial asthma patients using inhaled corticosteroid who complained of odynophagia. The endoscopic finding was high grade with white moss (Grade III) in both patients. Esophageal candidiasis is often recognized in bronchial asthmatic patients receiving long-term fluticasone propionate (FP) dry powder (Diskhaler) inhalation. We therefore examined the complicated context of esophageal candidiasis in patients with long-term FP inhalation. Out of 20 bronchial asthmatic patients who had been using FP inhalation long-term, seven showed signs of esophageal candidiasis. Three patients had mild grade (Grade I), one middle grade (Grade II) and three high grade (Grade III) candidiasis, with a frequency of 35%. This rate is higher than the usual spontaneous occurrence rate of esophageal candidiasis, and it is suggested that inhalation of corticosteroid medication can penetrate into the esophagus after deep inhalation. We tested this hypothesis in two studies. 1) To measure the esophageal concentration of FP, four healthy adults inhaled 200 microg FP once. Right after inhalation, FP concentration in the esophageal washing fluid was 3.3 microg. On another day, 30 minutes after the same dose of inhaled FP, one FP concentration in the esophageal washing fluid was 0.67 microg (immediately laydown), and another was 0.11 microg (remained standing). This indicates that even though FP dissipates quickly, it remains in the esophagus 30 minutes after inhalation. 2) We observed the process in one patient with high grade (Grade III) esophageal candidiasis. The time of inhalation was changed from just after getting up and just before going to bed to before breakfast and before dinner. Under this regimen, the signs of esophageal candidiasis improved from high to middle grade. Conclusion: If asthmatic patients do not go to sleep immediately after FP inhalation, the remaining FP in the esophagus decreases rapidly, thereby decreasing the risk of esophageal candidiasis. In addition, by changing the FP inhalation times to before breakfast and dinner, the remaining FP in the esophagus is washed away and does not remain in the esophagus. Therefore, this study, which avoided inhalation before going to bed, provides useful information for the prevention and improvement of esophageal candidiasis. PMID:14685037

Shuto, Hiroshi; Nagata, Makoto; Terashi, Yoshinori; Yamaguchi, Michiya; Takizawa, Takao; Shuto, Chizuru; Watanabe, Kensuke; Tosaka, Kaoru; Okano, Masahiko; Noguchi, Hisashi

2003-11-01

112

Clinical applications of esophageal manometry  

Microsoft Academic Search

In recent times, there has been considerable controversy over the accuracy, reproducibility, and importance of pressures measured in the esophagus and its sphincters. This has led to confusion about the potential clinical utility of esophageal manometry in the diagnosis of abnormalities of esophageal function. There are at least two important aspects that should be considered when formulating an opinion concerning

D. O. Castell

1982-01-01

113

Pill-induced esophageal injury  

Microsoft Academic Search

We report four cases of esophageal injury associated with the ingestion of commonly prescribed tablets or capsules. History and clinical characteristics of these cases suggest that the medications failed to transit the esophagus and acted locally to produce esophagitis. A search of English- and foreign-language medical journals documented 221 similar cases due to 26 different types of medication. While most

James Walter Kikendall; Arnold C. Friedman; Morakinyo Anthony Oyewole; David Fleischer; Lawrence F. Johnson

1983-01-01

114

Eosinophilic Esophagitis: Biology to Therapy  

PubMed Central

Eosinophilic esophagitis, a recently recognized and growing clinical disorder over the past decade, is characterized by antigen-driven eosinophil accumulation in the esophagus. Symptoms frequently mimic those of gastroesophageal reflux disease (GERD) but the two diseases are quite distinct in terms of their histopathology, genetic signature, response to therapy, hereditary risk and association with allergy. Disease pathogenesis involves the interplay of external and genetic factors, particularly food antigens and the eosinophil chemoattractant eotaxin-3, respectively. Transcript signatures and animal models have uncovered the importance of adaptive T cell immunity involving IL-5 and IL-13 elicited esophageal epithelial cell responses. Notably, symptoms, dysregulated esophageal gene expression and pathology are largely reversible following reduction of specific food antigen exposure, as well as anti-inflammatory therapy, but chronic treatment is necessary to prevent relapse. As such, eosinophilic esophagitis is a disease with the unique features of chronic esophagitis, atopy, immune sensitization to oral antigens, reversibility and familial association.

Rothenberg, Marc E.

2014-01-01

115

PhD TUTORIAL: Experimental tests of quantum nonlinear dynamics in atom optics  

Microsoft Academic Search

Cold atoms in optical potentials provide an ideal test bed to explore quantum nonlinear dynamics. Atoms are prepared in a magneto-optic trap or as a dilute Bose-Einstein condensate and subjected to a far detuned optical standing wave that is modulated. They exhibit a wide range of dynamics, some of which can be explained by classical theory while other aspects show

Winfried K. Hensinger; Norman R. Heckenberg; Gerard J. Milburn; Halina Rubinsztein-Dunlop

2003-01-01

116

The Trailing End Point Phenotype in Antifungal Susceptibility Testing Is pH Dependent  

Microsoft Academic Search

The interpretation of end points in azole antifungal drug susceptibility testing is problematic, in part due to incomplete growth inhibition of Candida species. Such trailing growth can cause the MICs of fluconazole for some isolates to be low (<1 mg\\/ml) after 24 h of growth but much higher (>64 mg\\/ml) after 48 h. Isolates having this type of growth have

KIEREN A. MARR; TIGE R. RUSTAD; JOHN H. REX; THEODORE C. WHITE

1999-01-01

117

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

Microsoft Academic Search

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 Ľ 126), BE (n Ľ 125) and EADC (n Ľ 56) enrolled in a 2-year

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

118

Storage of platelets for tests of platelet function: effects of pH on platelet aggregation and liberation of beta-thromboglobulin.  

PubMed

Platelet aggregation responses are influenced by conditions of storage of platelet-rich plasma (PRP). The aim of the present study was to further define the necessity for pH control during storage of PRP for tests of platelet function. Aliquots of citrated PRP were maintained at different pH levels by alteration of the CO2 content of the atmosphere in an incubation chamber. At intervals over 2-2 1/2 hours, plasma beta-thromboglobulin and 14C-serotonin were measured as well as platelet aggregation induced by ADP and collagen. At each time a dose response curve was studied for aliquots stored at each pH level. When two aliquots were maintained at different pH levels in the range 6.85-7.90, there was a significant increase in aggregation at the higher pH, even when the pH difference was as small as 0.2 units. In this range, pH did not influence the rate of deterioration of the aggregation response, but when pH was above 8.0, there was marked deterioration of the response. Increased pH was associated with an increase in plasma levels of beta-thromboglobulin and 14C-serotonin, which was more marked when pH was above 8.0. It appears that increases in pH are harmful to platelets and even small pH changes should be avoided during storage of platelet-rich plasma for tests of platelet function. PMID:6221437

Watts, S E; Tunbridge, L J; Lloyd, J V

1983-02-01

119

Test and Evaluation of the Interocean System, Inc. Model 500 CTD/O(2) pH In-situ Monitor System.  

National Technical Information Service (NTIS)

Test and evaluation results are reported for a system which is designed to measure temperature, conductivity, depth, dissolved oxygen, and pH to depths of 100 meters. The system is described and manufacturer's specifications are listed along with represen...

B. S. Pijanowski

1976-01-01

120

Chemoprevention of Esophageal Adenocarcinoma  

PubMed Central

The incidence of esophageal adenocarcinoma (EAC) is rising rapidly in Western countries, and effective chemoprevention for this malignancy is lacking. Endoscopic surveillance of patients with Barrett's esophagus is currently employed to diagnose EAC at earlier stages, but this strategy has several limitations. Non-steroidal anti-inflammatory drugs and proton pump inhibitors are the most promising agents for prevention of EAC, and a randomized controlled trial of aspirin and esomeprazole is ongoing. Other agents under investigation include green tea, berries, and antioxidants. Cost-effectiveness analyses have shown that chemopreventive agents need to be highly effective at preventing EAC in order to have benefit beyond endoscopic surveillance.

2008-01-01

121

Bile salts disrupt human esophageal squamous epithelial barrier function by modulating tight junction proteins.  

PubMed

Reflux of acid and bile acids contributes to epithelial tissue injury in gastro-esophageal reflux disease. However, the influence of refluxed material on human esophageal stratified epithelial barrier function and tight junction (TJ) proteins has not been fully elucidated. Here, we investigated the influence of acid and bile acids on barrier function and TJ protein distribution using a newly developed air-liquid interface (ALI) in vitro culture model of stratified squamous epithelium based on primary human esophageal epithelial cells (HEECs). Under ALI conditions, HEECs formed distinct epithelial layers on Transwell inserts after 7 days of culture. The epithelial layers formed TJ, and the presence of claudin-1, claudin-4, and occludin were detected by immunofluorescent staining. The NP-40-insoluble fraction of these TJ proteins was significantly higher by day 7 of ALI culture. Exposure of HEECs to pH 2, and taurocholic acid (TCA) and glycocholic acid (GCA) at pH 3, but not pH 4, for 1 h decreased transepithelial electrical resistance (TEER) and increased paracellular permeability. Exposure of cell layers to GCA (pH 3) and TCA (pH 3) for 1 h also markedly reduced the insoluble fractions of claudin-1 and -4. We found that deoxycholic acid (pH 7.4 or 6, 1 h) and pepsin (pH 3, 24 h) significantly decreased TEER and increased permeability. Based on these findings, ALI-cultured HEECs represent a new in vitro model of human esophageal stratified epithelium and are suitable for studying esophageal epithelial barrier functions. Using this model, we demonstrated that acid, bile acids, and pepsin disrupt squamous epithelial barrier function partly by modulating TJ proteins. These results provide new insights into understanding the role of TJ proteins in esophagitis. PMID:22575221

Chen, Xin; Oshima, Tadayuki; Shan, Jing; Fukui, Hirokazu; Watari, Jiro; Miwa, Hiroto

2012-07-15

122

Esophageal sensation in premature human neonates: temporal relationships and implications of aerodigestive reflexes and electrocortical arousals  

PubMed Central

Electrocortical arousal (ECA) as an effect of visceral provocation or of its temporal relationships with aerodigestive reflexes in premature neonates is not known. We tested the hypothesis that esophageal provocation results in both esophageal reflex responses and ECAs during sleep and that ECAs are dependent on the frequency characteristics of esophageal neuromotor responses. We defined the spatiotemporal relationship of ECAs in relation to 1) spontaneous pharyngoesophageal swallow sequences and gastroesophageal reflux (GER) events and 2) sensory-motor characteristics of esophageal reflexes. Sixteen healthy premature neonates born at 27.9 ± 3.4 wk were tested at 36.8 ± 1.9 wk postmenstrual age. Ninety-five midesophageal and 31 sham stimuli were given in sleep during concurrent manometry and videopolysomnography. With stimulus onset as reference point, we scored the response latency, frequency occurrence and duration of arousals, peristaltic reflex, and upper esophageal sphincter contractile reflex (UESCR). Changes in polysomnography-respiratory patterns and esophageal sensory-motor parameters were scored by blinded observers. Significantly (for each characteristic listed, P < 0.05), swallow sequences were associated with arousals and sleep state changes, and arousals were associated with incomplete peristalsis, response delays to lower esophageal sphincter relaxation, and prolonged esophageal clearance. GER events (73.5%) provoked arousals, and arousals were associated with response delays to peristaltic reflexes or clearance, sleep state modification, and prolonged respiratory arousal. Midesophageal stimuli (54%) provoked arousals and were associated with increased frequency, prolonged latency, prolonged response duration of peristaltic reflexes and UESCR, and increased frequency of sleep state changes and respiratory arousals. In human neonates, ECAs are provoked upon esophageal stimulation; the sensory-motor characteristics of esophageal reflexes are distinct when accompanied by arousals. Aerodigestive homeostasis is defended by multiple tiers of aerodigestive safety mechanisms, and when esophageal reflexes are delayed, cortical hypervigilance (ECAs) occurs.

Parks, Vanessa N.; Peng, Juan; Dzodzomenyo, Samuel; Fernandez, Soledad; Shaker, Reza; Splaingard, Mark

2012-01-01

123

Esophageal sensation in premature human neonates: temporal relationships and implications of aerodigestive reflexes and electrocortical arousals.  

PubMed

Electrocortical arousal (ECA) as an effect of visceral provocation or of its temporal relationships with aerodigestive reflexes in premature neonates is not known. We tested the hypothesis that esophageal provocation results in both esophageal reflex responses and ECAs during sleep and that ECAs are dependent on the frequency characteristics of esophageal neuromotor responses. We defined the spatiotemporal relationship of ECAs in relation to 1) spontaneous pharyngoesophageal swallow sequences and gastroesophageal reflux (GER) events and 2) sensory-motor characteristics of esophageal reflexes. Sixteen healthy premature neonates born at 27.9 ± 3.4 wk were tested at 36.8 ± 1.9 wk postmenstrual age. Ninety-five midesophageal and 31 sham stimuli were given in sleep during concurrent manometry and videopolysomnography. With stimulus onset as reference point, we scored the response latency, frequency occurrence and duration of arousals, peristaltic reflex, and upper esophageal sphincter contractile reflex (UESCR). Changes in polysomnography-respiratory patterns and esophageal sensory-motor parameters were scored by blinded observers. Significantly (for each characteristic listed, P < 0.05), swallow sequences were associated with arousals and sleep state changes, and arousals were associated with incomplete peristalsis, response delays to lower esophageal sphincter relaxation, and prolonged esophageal clearance. GER events (73.5%) provoked arousals, and arousals were associated with response delays to peristaltic reflexes or clearance, sleep state modification, and prolonged respiratory arousal. Midesophageal stimuli (54%) provoked arousals and were associated with increased frequency, prolonged latency, prolonged response duration of peristaltic reflexes and UESCR, and increased frequency of sleep state changes and respiratory arousals. In human neonates, ECAs are provoked upon esophageal stimulation; the sensory-motor characteristics of esophageal reflexes are distinct when accompanied by arousals. Aerodigestive homeostasis is defended by multiple tiers of aerodigestive safety mechanisms, and when esophageal reflexes are delayed, cortical hypervigilance (ECAs) occurs. PMID:21852361

Jadcherla, Sudarshan R; Parks, Vanessa N; Peng, Juan; Dzodzomenyo, Samuel; Fernandez, Soledad; Shaker, Reza; Splaingard, Mark

2012-01-01

124

Esophageal carcinoma cuniculatum: report of 9 cases.  

PubMed

Carcinoma cuniculatum, a unique variant of well-differentiated squamous cell carcinoma, has been only rarely reported in the esophagus. We report 9 cases of esophageal carcinoma cuniculatum diagnosed on esophagectomy specimens in 7 men and 2 women during a 20-year period. All but 1 of the patients presented with persistent or progressive dysphagia. All patients had an esophageal mass or lesion on endoscopic examination. In 8 cases (88.8%), the tumor was located in the distal esophagus. Burrowing was noted on the tumor surface in 2 recent cases on macroscopic examination. All carcinomas were invasive either at the mucosa (n=2), submucosa (n=1), muscularis propria (n=4), adventitia (n=3), or adventitia and lung (n=1). All carcinomas demonstrated a common histologic pattern characterized by hyperkeratosis, acanthosis, dyskeratosis, abnormal keratinization, keratin-filled cyst/furrows, koilocyte-like cells, intraepithelial neutrophils, and focal cytologic atypia. In situ hybridization for human papillomavirus subtypes was negative in all 10 tumors tested. None of the cases showed lymph node metastasis. Two patients died postoperatively due to complications. The remaining patients were followed up for a median duration of 84 months (48 to 214 mo). During the follow-up period, 3 patients died 49, 66, and 214 months after esophagectomy at the ages of 66, 68, and 91 years, respectively; death in these 3 cases was not related to recurrence/metastases of esophageal cancer. Four patients were alive without disease at 48, 49, 84, and 87 months after curative resection. Our report identifies a common histomorphologic pattern of esophageal carcinoma cuniculatum and supports the fact that surgical resection of the tumor by esophagectomy provides long-term survival even in patients with T3 tumor. PMID:22020041

Landau, Michael; Goldblum, John R; DeRoche, Tom; Dumot, John; Downs-Kelly, Erinn; Rice, Thomas W; Xiao, Shu-Yuan; Liu, Xiuli

2012-01-01

125

Acid corrosive esophagitis: radiographic findings.  

PubMed

Thirty-nine esophagograms of 24 patients after ingestion of muriatic acid (27% HCI) in suicide attempts were reviewed. All esophagograms were obtained in the acute, subacute, and chronic phases. In the acute and subacute phases, the radiographic findings consisted of mucosal edema, submucosal edema or hemorrhage, ulcerations, sloughing of the mucosa, atony, and dilatation. Strictures of the esophagus were present in the chronic phase. These radiographic findings were not different from those found in alkaline corrosive esophagitis. The severity of the corrosive esophagitis is considered related to the concentration, amount, viscosity, and duration of contact between the caustic agent and the esophageal mucosa. PMID:6770621

Muhletaler, C A; Gerlock, A J; de Soto, L; Halter, S A

1980-06-01

126

Functional evaluation of gastric transplants used in esophageal reconstruction  

Microsoft Academic Search

Gastric transplants using the Akiyama method were used to treat esophageal carcinoma in 12 patients. Endoscopic examination,\\u000a prolonged manometry (>30 min), and 24 h pH monitoring were performed postoperatively to evaluate functional results. All patients\\u000a could swallow without difficulty at the time of examination and had no dysphagia, regurgitation, heartburn, or sensation of\\u000a abdominal fullness.\\u000a \\u000a Histologic examinations of residual esophagus

M. Bouchoucha; P.-H. Cugnenc; C. Drevillon; A. Faye; B. Boboc; P. Arhan; J.-Ph. Barbier

1989-01-01

127

Esophageal function, radiography, and dysphagia in Sjögren's syndrome  

Microsoft Academic Search

Esophageal function and anatomy were investigated with manometry, acid perfusion test, acid clearing test, and x-ray in 11 patients with primary Sjögren's syndrom (SS) and in 11 with secondary SS. The manometric investigation revealed minor motor differences in the SS patients as compared to 16 controls, ie, shorter peristaltic contraction time of the whole esophagus, and faster peristaltic velocity preferably

G. Kjellén; S. G. Fransson; F. Lindström; H. Sökjer; L. Tibbling

1986-01-01

128

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

SciTech Connect

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.

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

1987-03-01

129

Environmental Causes of Esophageal Cancer  

PubMed Central

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.

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

2009-01-01

130

Recent experience with esophageal atresia.  

PubMed Central

A nine-year experience with esophageal atresia of all types is described with current diagnostic and therapeutic approaches and long-term results. During this time, 53 neonates with esophageal atresia and tracheoesophageal fistula had a 93% survival, with four deaths in risk group C. Temporary postoperative morbidity related to the anastomosis occurred in ten patients. All patients had some disturbance in esophageal motility. While all have been studied for gastroesophageal reflux, only five had significant reflux, and four required fundoplication. Five patients with isolated esophageal atresia survived staged repair, and an additional five patients with H-type fistulae survived primary repair, including one with a long tracheoesophageal cleft. Despite the fact that 45% of the 63 patients had significant associated anomalies, initial survival was 93.5% and late survival 91%. Long-term functional results were generally satisfactory.

O'Neill, J A; Holcomb, G W; Neblett, W W

1982-01-01

131

Esophageal Cancer - Featured Clinical Trials  

Cancer.gov

Esophageal Cancer - Featured Clinical Trials The following list shows Featured Clinical Trials for a specific type of cancer. You may also want to view: Multiple Cancer Types - Featured Clinical Trials Supportive Care - Featured Clinical Trials Related

132

Human Esophageal Epithelial Cell Lines.  

National Technical Information Service (NTIS)

Human esophageal epithelial cells having replicative capacity in cell culture that is enhanced compared to normal cells and are unable to produce tumors is disclosed. Normal human esophagus tissue from two autopsy specimens was explanted in serum-free med...

G. D. Stoner R. R. Reddel C. C. Harris R. Roger

1989-01-01

133

Steroids in pediatric eosinophilic esophagitis.  

PubMed

Swallowed fluticasone and oral viscous budesonide are effective first-line therapies for eosinophilic esophagitis in children. Side effects are minimal without evidence of Cushing syndrome, as seen in treatment with systemic corticosteroids. New studies on alternative delivery systems and different corticosteroids (eg, ciclesonide) are encouraging. As knowledge of corticosteroids in eosinophilic esophagitis expands, newer questions continue to arise concerning dose, delivery, and choice of corticosteroids; long-term adverse effects; and maintenance therapies. PMID:24813520

Contreras, Emily M; Gupta, Sandeep K

2014-06-01

134

Giant asymptomatic primary esophageal schwannoma.  

PubMed

Primary esophageal schwannomas are uncommon. We describe a case of a large asymptomatic primary esophageal schwannoma in a 65-year-old patient. Computed tomography and positron emission tomography revealed an (18)F-fluorodeoxyglucose-avid 11-cm mass arising from the esophagus. A preoperative diagnosis was made via endoscopic ultrasound. The patient underwent a three-field esophagogastrectomy with cervical esophagogastric anastomosis. He remains well and free of recurrence 10 months after treatment. PMID:22450109

Kassis, Edmund S; Bansal, Shelly; Perrino, Carmen; Walker, Jon P; Hitchcock, Charles; Ross, Patrick; Daniel, Vincent C

2012-04-01

135

Hypopharyngeal pH Monitoring Artifact in Detection of Laryngopharyngeal Reflux  

Microsoft Academic Search

Hypopharyngeal pH artifacts have been a concern in the detection of laryngopharyngeal reflux. Our purpose was to analyze and quantify artifacts from dual-sensor hypopharyngeal pH monitoring. In all, 42 hypopharyngeal and 58 esophageal pH studies were reviewed. Type 1 (out of range), type 2 (pH drift), and type 3 (isolated pH drop) artifacts were identified. The proportion of proximal-sensor pH

John M. Wo; Abdul Jabbar; Welby Winstead; Steve Goudy; Robert Cacchione; Jeff W. Allen

2002-01-01

136

Hyperthermochemoradiotherapy and esophageal carcinoma  

SciTech Connect

Cancer of the esophagus still poses considerable treatment problems, with a poor 5-year survival rate after surgery, an even worse outlook after radiation and surgery, and a not very satisfactory response to chemotherapy. After several years of continued research, in 1983 we developed a Radio Frequency System with endotract electrode and thermosensors for administering hyperthermochemoradiotherapy to patients with carcinoma of the esophagus. Results in 129 patients are discussed. Immediate improvement of subjective complaints and decrease or elimination of the cancer lesion are so distinct that this treatment, by means of an endotract antenna, shows promise as a modality for esophageal lesions and may find application in diseases such as colorectal cancer or carcinoma of the uterine cervix.

Sugimachi, K.; Inokuchi, K.

1986-01-01

137

Role of peripheral reflexes in the initiation of the esophageal phase of swallowing.  

PubMed

The aim of this study was to determine the role of peripheral reflexes in initiation of the esophageal phase of swallowing. In 10 decerebrate cats, we recorded electromyographic responses from the pharynx, larynx, and esophagus and manometric data from the esophagus. Water (1-5 ml) was injected into the nasopharynx to stimulate swallowing, and the timing of the pharyngeal and esophageal phases of swallowing was quantified. The effects of transection or stimulation of nerves innervating the esophagus on swallowing and esophageal motility were tested. We found that the percent occurrence of the esophageal phase was significantly related to the bolus size. While the time delays between the pharyngeal and esophageal phases of swallowing were not related to the bolus size, they were significantly more variable than the time delays between activation of muscles within the pharyngeal phase. Transection of the sensory innervation of the proximal cervical esophagus blocked or significantly inhibited activation of the esophageal phase in the proximal cervical esophagus. Peripheral electrical stimulation of the pharyngoesophageal nerve activated the proximal cervical esophagus, peripheral electrical stimulation of the vagus nerve activated the distal cervical esophagus, and peripheral electrical stimulation the superior laryngeal nerve (SLN) had no effect on the esophagus. Centripetal electrical stimulation of the SLN activated the cervical component of the esophageal phase of swallowing before initiation of the pharyngeal phase. Therefore, we concluded that initiation of the esophageal phase of swallowing depends on feedback from peripheral reflexes acting through the SLN, rather than a central program. PMID:24557762

Lang, Ivan M; Medda, Bidyut K; Babaei, Arash; Shaker, Reza

2014-04-01

138

Symptomatic diffuse esophageal spasm as a major ictal manifestation of post-traumatic epilepsy: a case report.  

PubMed

Post-traumatic epilepsy (PTE) can create diagnostic confusion when typical epileptic seizures are not manifest. Abdominal symptoms as a manifestation of PTE are rare in this setting. We present a 43-year-old female with paroxysmal chest and abdominal pain, nausea, salivation, and intermittent dysphagia. Esophageal testing demonstrated diffuse esophageal spasm, but smooth muscle relaxants provided no relief. Finally, after history revealed that a motor vehicle accident temporally preceded symptom onset, video electroencephalography confirmed PTE. Therapy with anti-epileptic drug completely resolved symptoms, and the esophageal motor pattern normalized. We speculate that abnormal epileptiform discharges from the seizure focus altered cerebral input to intrinsic esophageal innervation, resulting in inhibitory dysfunction and a picture resembling diffuse esophageal spasm. This is the first report of symptomatic esophageal spasm as a major ictal manifestation of PTE. PMID:23121455

He, Y-Q; Sheng, J-Q; Wang, J-H; An, H-J; Wang, X; Li, A-Q; Wang, X-W; Gyawali, C P

2013-04-01

139

Esophageal Atresia and Tracheo-Esophageal Fistula -- 25 Years' Experience and Current Management  

PubMed Central

A review of the experience with esophageal atresia and tracheoesophageal fistula over a 25-year period appears to lead to the advisability of the following procedures in surgical management: • Emergency gastrostomy under local anesthesia in all patients. • Extrapleural interruption of tracheo-esophageal fistula and end-to-end esophago-esophagostomy in patients who have the common type of upper esophageal atresia with distal tracheo-esophageal fistula. • Upper esophageal stretching and eventual esophago-esophagostomy in patients with proximal and distal esophageal atresia with or without proximal tracheo-esophageal fistula. ImagesFigure 1.Figure 2.

Krishinger, G. L.; Woolley, Morton M.

1969-01-01

140

Esophageal surgery in newborns, infants and children.  

PubMed

The most common surgery on the esophagus by pediatric surgeons the world over is performed in the newborn period in babies with congenital esophageal atresia with tracheo-esophageal fistula. Post-operative complications like recurrent fistula, anastomotic stricture and some patients with gastroesophageal reflux would also require surgical intervention. Apart from esophageal dilatation, gastrostomy and feeding jejunostomy, children with strictures secondary to caustic ingestion, reflux or previous esophageal anastomosis may require esophageal substitution. This operation may also be required in babies with pure esophageal atresia as well as those with a long gap esophageal atresia with fistula. The entire stomach, stomach tubes, colon or jejunum are often used but techniques preserving as much of the original esophagus as possible are preferable and more physiological. Surgery is also required in children with congenital esophageal stenosis and duplication cyst. PMID:19011807

Menon, Prema; Rao, K L N

2008-09-01

141

21 CFR 878.3610 - Esophageal prosthesis.  

Code of Federal Regulations, 2013 CFR

... 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...

2013-04-01

142

Nissen fundoplication for reflux esophagitis. Long-term clinical and endoscopic results in 109 of 127 consecutive patients.  

PubMed Central

OBJECTIVE: This study evaluates the clinical and endoscopic long-term results of Nissen fundoplication in reflux esophagitis. SUMMARY BACKGROUND DATA: Nissen fundoplication has been reported to give good results in the treatment of gastroesophageal reflux with success rates up to 78-97%. Most of the previous studies on long-term results of fundoplication have, however, been based on interviews with only sporadic endoscopic examinations. METHODS: Of 127 patients consecutively treated with Nissen fundoplication for reflux esophagitis, 109 were available for follow-up after a median of 77 months. Upper gastrointestinal endoscopy was done in 105 cases, and all the patients with reflux symptoms or abnormal endoscopic observations were referred to esophageal 24-hour pH monitoring and manometry. RESULTS: No symptoms of gastroesophageal reflux were reported by 73 of the 109 patients, but dysphagia was present in 47. Endoscopy showed defective fundic wrap in 24 patients. Objective evidence of reflux was found in 24 patients (endoscopic esophagitis in 18 and pathologic 24-hour pH score without esophagitis in 6). Esophagitis was found in 14 of the 24 patients with defective wrap, but in only 4 of the 81 with infact wrap. CONCLUSIONS: Nissen fundoplication alleviated symptoms of gastroesophageal reflux and cured esophagitis in great majority of cases. The main determinant of outcome was the state of the fundic wrap.

Luostarinen, M

1993-01-01

143

A Comprehensive Review of Esophageal Stents  

PubMed Central

Esophageal stents are important tools for palliative treatment of inoperable esophageal malignancies. With the development of multiple self-expandable stents, there are now several therapeutic options for managing benign and malignant esophageal diseases. This paper discusses the various types of esophageal stents currently available, indications for their placement, challenges and complications that gastroenterologists face when placing these stents, and some of the innovations that will become available in the near future.

Hong, Jinwha; Lam-Tsai, Yvette; Gress, Frank

2012-01-01

144

Gallium-67 imaging in candidal esophagitis  

SciTech Connect

Ga-67 scanning has been used to evaluate esophageal carcinoma. It has demonstrated candidal infection in other body sites and, in one previous case, in the esophagus. The authors present a case of diffuse esophageal uptake of Ga-67 in esophageal candidiasis.

Rundback, J.H.; Goldfarb, C.R.; Ongseng, F. (Beth Israel Medical Center, New York, NY (USA))

1990-01-01

145

Esophageal Carcinoma: Ex Vivo Evaluation with Diffusion-Tensor MR Imaging and Tractography at 7 T.  

PubMed

Purpose To determine the feasibility of diffusion-tensor magnetic resonance (MR) imaging and tractography as a means of evaluating the depth of mural invasion by esophageal carcinomas. Materials and Methods This study was approved by the institutional review board, and written informed consent was obtained from each patient. Twenty esophageal specimens, each containing a carcinoma, were studied with a 7.0-T MR imaging system equipped with a four-channel phased-array surface coil. Diffusion-tensor MR images were obtained with a field of view of 50-60 mm × 25-30 mm, matrix of 256 × 128, section thickness of 1 mm, b value of 1000 sec/mm(2), and motion-probing gradient in seven noncollinear directions. The MR images were compared with the histopathologic findings as the reference standard. The differences in diffusion-tensor MR imaging parameters between the carcinoma and the layers of the esophageal wall were statistically analyzed by using the Dunnett test. Results In all 20 carcinomas (100%), the diffusion-weighted images, apparent diffusion coefficient (ADC) maps, fractional anisotropy (FA) maps, ?1 maps, and direction-encoded color FA maps made it possible to determine the depth of tumor invasion of the esophageal wall that was observed during histopathologic examination. The ?1 maps showed the best contrast between the carcinomas and the layers of the esophageal wall. The carcinomas had both lower ADC values and lower FA values than the normal esophageal wall; thus, the carcinomas were clearly demarcated from the normal esophageal wall. Diffusion-tensor tractography images were also useful for determining the depth of tumor invasion of the esophageal wall. Conclusion Diffusion-tensor MR imaging and tractography are feasible in esophageal specimens and provide excellent morphologic data for the evaluation of mural invasion by esophageal carcinomas. © RSNA, 2014 Online supplemental material is available for this article. PMID:24654973

Yamada, Ichiro; Hikishima, Keigo; Miyasaka, Naoyuki; Kawano, Tatsuyuki; Tokairin, Yutaka; Ito, Eisaku; Kobayashi, Daisuke; Eishi, Yoshinobu; Okano, Hideyuki

2014-07-01

146

The Pathophysiology of Eosinophilic Esophagitis  

PubMed Central

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.

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

2014-01-01

147

Relationships Between Sleep Quality and pH Monitoring Findings in Persons with Gastroesophageal Reflux Disease  

PubMed Central

Background: Nighttime reflux has been shown to be associated with esophageal mucosal injury, complications, and extra-esophageal manifestations. However, few studies have assessed the impact of gastroesophageal reflux on reported quality of sleep and quality of sleep on gastroesophageal reflux. Aims: The aims of this study were (1) to determine the correlation between the severity of gastroesophageal reflux disease (GERD) symptoms and esophageal acid contact time and subjects' perceived quality of sleep; (2) to investigate the correlation between reported quality of sleep of the night prior and severity of GERD symptoms and esophageal acid contact time the following day; and (3) to define in a sleep laboratory the correlation between acid reflux events and sleep architecture. Methods: Subjects with typical GERD symptoms ?3 times a week underwent upper endoscopy and pH monitoring. These subjects subsequently completed the GERD Symptom Assessment Score (GSAS), and the Sleep Heart Health Study Sleep Habits (SHHS) Questionnaire to assess baseline sleep symptoms and GERD symptoms, including an index of GERD symptom severity (GERD symptom index). Before and after the pH test, the patients completed a different instrument, the Sleep Quality Questionnaire, utilized specifically to assess the quality of each subject's sleep before and after pH testing. Fifteen randomly selected subjects also underwent a polysomnographic study during the pH test. Results: Forty-eight (33 males/15 females, mean age 48.8 ± 17.1 y) subjects were prospectively recruited. Using data from the GSAS and SHHS questionnaires, disorders of initiating and maintaining sleep were found to be positively associated with greater severity of the GERD symptom index (r = 0.33, p <0.05). More frequent awakenings also correlated with a higher GERD symptom index (r = 0.4, p <0.01). Correlations between the Sleep Quality Questionnaire on the night before sleep testing and pH monitoring data showed that subjects with poorer sleep quality had longer acid reflux events (r=?0.34, p<0.05). More perceived awakenings also were correlated with the number of supine acid reflux events > 5 min (r=0.31, p<0.05) and the duration of the longest supine acid reflux event (r = 0.28, p = 0.05). Inverse correlations were observed between overall sleep quality on the pH testing night and a higher percentage of time spent with pH<4 supine (r=?0.432, p 0.002), and the duration of the longest acid reflux event during the entire night (r = ?0.38, p <0.01) and supine (r=?0.37, p<0.02). Conclusions: Persons with worse GERD symptoms report poorer subject sleep quality. Poor sleep quality on the night prior to pH testing was associated with more acid exposure the following day. Greater acid exposure at night was related to a worse perception of sleep quality the next day. These findings suggest important interactions between GERD and sleep quality. Citation: Dickman R; Green C; Fass SS; Quan SF; Dekel R; Risner-Adler S; Fass R. Relationships between sleep quality and ph monitoring findings in persons with gastroesophageal reflux disease. J Clin Sleep Med 2007;3(5):505-513.

Dickman, Ram; Green, Colleen; Fass, Shira S.; Quan, Stuart F.; Dekel, Roy; Risner-Adler, Sara; Fass, Ronnie

2007-01-01

148

Isothiocyanates and plant polyphenols as inhibitors of lung and esophageal cancer  

Microsoft Academic Search

A group of arylalkyl isothiocyanates were tested for their abilities to inhibit tumorigenicity and DNA methylation induced by both the tobacco-specific nitrosamine, NNK, in A\\/J mouse lung and the esophageal-specific carcinogen, NMBA, in F344 rat esophagus. In addition, ellagic acid was tested for its ability to inhibit NMBA-induced esophageal tumorigenesis. In the strain A lung tumor model, PEITC effectively inhibited

Gary D. Stoner; Mark A. Morse

1997-01-01

149

Understanding pH  

NSDL National Science Digital Library

The first site related to pH is from the Horiba corporate Web site entitled the Story of pH (1). Visitors can learn what pH is and how it's measured, explore various facts about pH, and read several anecdotes such as "Is the Rain in Our Cities Acidic." The site contains simple text, attractive graphics, and a well-designed layout making it fun and easy for anyone to explore. The second site from the Miami Museum of Science is called the pH Factor (2) kids activity page. This interactive and extensive site contains lessons on testing items for pH, tasting acids and bases, an interactive meter to find the pH of common household items, and much more. Next, is the pH and Water Quality (3) page, which is part of the State of Kentucky Division of Water Web site. The site provides a table of the effects of pH on fish and aquatic life and gives a short description of the most significant environmental impacts of pH. Trout for example, can tolerate a pH range between 4.1 and 9.5 while Mosquito larvae can survive within the 3.3 and 4.7 range. The fourth site from Gardengate Magazine.com is entitled More Soil Stuff: Soil pH (4). Described is the pH range of most soil types, requirements of certain plants, how to test soil for pH, and how to adjust it using sulfur and limestone. Seaworld.org maintains the Understanding the pH Cycle within the Aquarium (5) lesson plan site. The stated objective of the activity is to have students define pH, explain how it affects a tank's water quality, and test the pH level in a classroom aquarium. Although an aquarium is obviously needed, the activity offers a unique and fun way for kids to learn about this basic chemistry concept. About.com offers the next site, which is an interactive pH calculator called pH (6). Users simply enter a pH to get the concentration of Hydrogen ions or, conversely, the Hydrogen ion concentration to get the pH. Another tool to learn about pH and Hydrogen ions is called Acids and Alkalis--the pH Scale (7). Provided by Purchon.com, the interactive pH scale illustrates how the ion concentration changes with pH, common acids associated with each, and whether it is a weak or strong acid or alkali. The last site maintained by the National Park Service is called Acid Rain Lesson Plan: Activity 1 The pH Scale (8). Kids will be able to describe the pH scale and its components, explain why a pH measurement must be accurate, and explain why small changes in pH are important. Everything needed to complete the activity is provided, including a materials list, complete instructions, thinking questions, as well as links for further information.

Brieske, Joel A.

150

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

PubMed

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

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

2013-03-01

151

Airway responses to esophageal acidification.  

PubMed

The effects of esophageal acidification on airway function are unclear. Some have found that the esophageal acidification causes a small increase in airway resistance, but this change is too small to cause significant symptoms. The aims of this study were to investigate the effects of esophageal acidification on multiple measures of airway function in chloralose-anesthetized cats. The esophagus was cannulated and perfused with either 0.1 M PBS or 0.1 N HCl at 1 ml/min as the following parameters were quantified in separate experiments: diameter of bronchi (n = 5), tracheal mucociliary transport rate (n = 4), tracheobronchial mucus secretion (n = 7), and lung function (n = 6). We found that esophageal acidification for 10-30 min decreased bronchial diameters primarily of the smaller low-resistance airways (10-22%, P < 0.05), decreased tracheal mucociliary transport (53%, 8.7 +/- 2.4 vs. 4.1 +/- 1.3 mm/min, P < 0.05), increased tracheobronchial mucus secretion (147%, 3.4 +/- 0.7 vs. 8.4 +/- 2.6 mg/10 min, P < 0.05), and caused no change in total lung resistance or dynamic compliance (P > 0.05). Considering that tracheal mucociliary transport rate is governed in part by mucus secretion, we concluded that the primary airway response to esophageal acidification observed is increased mucus secretion. Airway constriction may act to assist in rapid secretion of mucus and to increase the effectiveness of coughing while not affecting lung resistance or compliance. Given the buffering capabilities of mucus, esophageal acidification activates appropriate physiological responses that may act to neutralize gastroesophageal reflux that reaches the larynx, pharynx, or lower airways. PMID:17928508

Lang, Ivan M; Haworth, Steven T; Medda, Bidyut K; Roerig, David L; Forster, Hubert V; Shaker, Reza

2008-01-01

152

Microstructural Evolution and Response to Double-Loop Reactivation Testing of Heat-Treated pH 13-8 Mo Martensitic Stainless Steel.  

National Technical Information Service (NTIS)

The double loop electrochemical potentiokinetic reactivation (DL-EPR) test was used to investigate the intergranular and interlath corrosion susceptibility of pH 13-8 Mo as a function of heat treatment. Degree of sensitization was measured to the ratio of...

W. R. Cieslak M. J. Cieslak C. R. Hills

1987-01-01

153

Alteration of the upper esophageal sphincter belch reflex in patients with achalasia.  

PubMed

Some patients with achalasia have been reported to develop airway obstruction from a massively air-distended esophagus, which may represent an abnormality in the upper esophageal sphincter belch reflex. When questioned carefully, 95% of our achalasia patients reported difficulty with belching. The upper esophageal belch reflex in 23 consecutive achalasia patients and 12 healthy controls was studied using an upper esophageal sphincter sleeve manometry catheter and rapid injection of 20-50 mL of air into the midesophagus. Compared with normal subjects, achalasia patients were significantly less likely to have an esophageal belch for all volumes tested and were more likely to have an increase rather than a decrease in upper esophageal sphincter pressure in response to air injection. This study systematically documents that many achalasia patients have an alteration in the upper esophageal sphincter belch reflex that may be a contributory mechanism for some of the chest and upper airway symptoms reported by some patients during acute esophageal distension. PMID:1426877

Massey, B T; Hogan, W J; Dodds, W J; Dantas, R O

1992-11-01

154

Use of the double-loop reactivation test to measure sensitization in aged and welded pH 13-8 Mo martensitic stainless steel  

Microsoft Academic Search

Electrochemical potentiokinetic reactivation (EPR) testing provides quantitative detection of small degrees of sensitization. We have used double-loop (DL-EPR) testing, a method which has been characterized for use on austenitic stainless steels, to measure sensitization resulting from aging or from welding of PH 13-8 Mo martensitic stainless steel. Aging at either 500°C or 620°C results in an increase of the reactivation

W. R. Cieslak; M. J. Cieslak; C. R. Hills

1987-01-01

155

Esophageal dilations in eosinophilic esophagitis: A single center experience  

PubMed Central

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.

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

2014-01-01

156

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

ClinicalTrials.gov

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

2014-06-23

157

Prenatal diagnosis of esophageal atresia  

Microsoft Academic Search

The prenatal sonographic detection of esophageal atresia (EA) has been possible for more than a decade and relies on the finding of a small or absent fetal stomach bubble associated with maternal polyhydramnios. The aims of this study were to assess the accuracy of this technique and to determine whether the outcome of prenatally diagnosed EA differs from its postnatal

Mark D Stringer; Kathleen M McKenna; Ruth B Goldstein; Roy A Filly; N. Scott Adzick; Michael R Harrison

1995-01-01

158

Esophageal motility in the elderly  

Microsoft Academic Search

The effect of age on motor function of the esophagus was studied manometrically by comparing 49 asymptomatic subjects over 60 years of age with 43 similar subjects under 40 years of age. The resting pressures and the responses to deglutition were recorded in the esophagus, lower esophageal sphincter (LES), and the stomach. Significant differences in motility patterns were seen between

T. Ali Khan; B. W. Shragge; J. S. Crispin; J. F. Lind

1977-01-01

159

Genetic variations in microRNA-related genes are novel susceptibility loci for esophageal cancer risk.  

PubMed

MicroRNAs (miRNA) can act as oncogenes or tumor suppressors and modulate the expression of approximately one third of all human genes. To test the hypothesis that adverse alleles in miRNA-related genes may increase the risk for esophageal cancer, we assessed the associations between esophageal cancer risk and 41 potentially functional single nucleotide polymorphisms (SNP) in 26 miRNA-related genes in a case-control study of 346 Caucasian esophageal cancer patients (85.5% with esophageal adenocarcinoma) and 346 frequency-matched (age, gender, and ethnicity) controls. Seven SNPs were significantly associated with esophageal cancer risk. The most notable finding was that the SNP rs6505162, which is located in the pre-mir423 region, was associated with a per-allele odds ratio of 0.64 [95% confidence interval (95% CI), 0.51-0.80; P for trend < 0.0001]. This association remained significant after we corrected for multiple comparisons. A common haplotype of the GEMIN4 gene was associated with a significantly reduced risk of esophageal cancer (odds ratio, 0.65; 95% CI, 0.42-0.99). We did a combined unfavorable genotype analysis to further evaluate the cumulative effects of the promising (risk associated) SNPs. In comparison with the low-risk group (fewer than three unfavorable genotypes), the medium-risk group (three unfavorable genotypes) had a 2.00-fold (95% CI, 1.31-3.08) increased risk and the high-risk group (more than three unfavorable genotypes) had a 3.14-fold (95% CI, 2.03-4.85) increased risk (P for trend < 0.0001). Results for the risk of esophageal adenocarcinoma were similar to the overall risk results. The present study provides the first evidence that miRNAs may affect esophageal cancer risk in general and that specific genetic variants in miRNA-related genes may affect esophageal cancer risk individually and jointly. PMID:19138993

Ye, Yuanqing; Wang, Kenneth K; Gu, Jian; Yang, Hushan; Lin, Jie; Ajani, Jaffer A; Wu, Xifeng

2008-11-01

160

Genetic Variations in microRNA-related Genes Are Novel Susceptibility Loci for Esophageal Cancer Risk  

PubMed Central

MicroRNAs (miRNAs) can act as oncogenes or tumor suppressors and modulate the expression of approximately one-third of all human genes. To test the hypothesis that adverse alleles in miRNA-related genes may increase the risk for esophageal cancer, we assessed the associations between esophageal cancer risk and 41 potentially functional single-nucleotide polymorphisms (SNPs) in 26 miRNA-related genes in a case-control study of 346 Caucasian esophageal-cancer patients (85.5% with esophageal adenocarcinoma) and 346 frequencymatched (age, gender, and ethnicity) controls. Seven SNPs were significantly associated with esophageal cancer risk. The most notable finding was that the SNP rs6505162, which is located in the pre-mir423 region, was associated with a per-allele odds ratio of 0.64 (95% confidence interval [CI], 0.51-0.80; P for trend < 0.0001). This association remained significant after we corrected for multiple comparisons. A common haplotype of the GEMIN4 gene was associated with a significantly reduced risk of esophageal cancer (odds ratio = 0.65; 95% CI, 0.42-0.99). We performed a combined unfavorable genotype analysis to further evaluate the cumulative effects of the promising (risk-associated) SNPs. In comparison with the low-risk group (fewer than three unfavorable genotypes), the medium-risk group (three unfavorable genotypes) had a 2.00-fold (95% CI=1.31-3.08) increased risk and the high-risk group (more than three unfavorable genotypes) had a 3.14-fold (95% CI=2.03-4.85) increased risk (P for trend < 0.0001). Results for the risk of esophageal adenocarcinoma were similar to the overall risk results. The present study provides the first evidence that miRNAs may affect esophageal cancer risk in general and that specific genetic variants in miRNA-related genes may affect esophageal cancer risk individually and jointly.

Ye, Yuanqing; Wang, Kenneth K.; Gu, Jian; Yang, Hushan; Lin, Jie; Ajani, Jaffer A.

2009-01-01

161

Effect of esophageal acid exposure on the cortical swallowing network in healthy human subjects  

PubMed Central

Recent studies have demonstrated common cortical activity regions associated with esophageal acidification and swallowing. The effect of sensory signals imparted on these regions by esophageal acidification on swallow-related brain activity has physiological and clinical ramifications. Our aim in this study was to determine the effect of prior, unperceived esophageal acid exposure on cortical activity associated with swallowing. Functional magnetic resonance imaging (fMRI) techniques monitored brain activity associated with volitional swallowing before and after subliminal esophageal acid stimulation. Studies were carried out in two phases. In phase I (15 healthy, right-handed subjects, age 21–49 yr, 7 female) using whole brain imaging, we documented the potentiating effects of esophageal acidification alone on swallow-related cortical activity. In phase II (10 healthy, right-handed subjects, age 20–54 yr, 5 female) using high-resolution fMRI, we measured swallow-induced regional brain activity within the cortical swallowing network before and after esophageal acidification. Unlike the phase I studies, we also tested the effect of saline perfusion alone on the cortical swallowing network in the phase II studies. Because of constraints imposed by high-resolution MRI for region-of-interest (ROI) analysis, we studied only the left hemisphere in this phase. None of the subjects developed heartburn during acid perfusion. In phase I, the number of swallow-induced activated voxels increased by 43% following esophageal acid stimulation (preacid, 44 ± 3 voxels; postacid, 63 ± 6 voxels; means ± SE, P < 0.05) In phase II, contrary to saline perfusion, ROI analysis showed significantly increased regional swallow-related fMRI activity volumes as well as percent maximum signal change after esophageal acid perfusion in cingulate, prefrontal, insula, and sensory/motor regions (P < 0.05). The precuneus showed no significant change. We concluded that subliminal esophageal acid stimulation has a potentiating effect on the cortical swallowing network in healthy individuals.

Kern, Mark; Chai, Krisna; Lawal, Adeyemi; Shaker, Reza

2009-01-01

162

Effect of esophageal acid exposure on the cortical swallowing network in healthy human subjects.  

PubMed

Recent studies have demonstrated common cortical activity regions associated with esophageal acidification and swallowing. The effect of sensory signals imparted on these regions by esophageal acidification on swallow-related brain activity has physiological and clinical ramifications. Our aim in this study was to determine the effect of prior, unperceived esophageal acid exposure on cortical activity associated with swallowing. Functional magnetic resonance imaging (fMRI) techniques monitored brain activity associated with volitional swallowing before and after subliminal esophageal acid stimulation. Studies were carried out in two phases. In phase I (15 healthy, right-handed subjects, age 21-49 yr, 7 female) using whole brain imaging, we documented the potentiating effects of esophageal acidification alone on swallow-related cortical activity. In phase II (10 healthy, right-handed subjects, age 20-54 yr, 5 female) using high-resolution fMRI, we measured swallow-induced regional brain activity within the cortical swallowing network before and after esophageal acidification. Unlike the phase I studies, we also tested the effect of saline perfusion alone on the cortical swallowing network in the phase II studies. Because of constraints imposed by high-resolution MRI for region-of-interest (ROI) analysis, we studied only the left hemisphere in this phase. None of the subjects developed heartburn during acid perfusion. In phase I, the number of swallow-induced activated voxels increased by 43% following esophageal acid stimulation (preacid, 44 +/- 3 voxels; postacid, 63 +/- 6 voxels; means +/- SE, P < 0.05) In phase II, contrary to saline perfusion, ROI analysis showed significantly increased regional swallow-related fMRI activity volumes as well as percent maximum signal change after esophageal acid perfusion in cingulate, prefrontal, insula, and sensory/motor regions (P < 0.05). The precuneus showed no significant change. We concluded that subliminal esophageal acid stimulation has a potentiating effect on the cortical swallowing network in healthy individuals. PMID:19407219

Kern, Mark; Chai, Krisna; Lawal, Adeyemi; Shaker, Reza

2009-07-01

163

[Gastric emptying in reflux esophagitis. Effect of metoclopramide and cinitapride].  

PubMed

The gastric emptying of solids was evaluated with radionuclide techniques in 16 patients with reflux esophagitis, demonstrated by two of the following methods: endoscopy, pathology, and/or pH measurement. The percentage of radionuclide remaining within the stomach was 80.8 +/- 17% after 45 minutes, 63.3 +/- 10% after 75 minutes, and 48.8 +/- 19% after 105 minutes, with a half time (T1/2) of gastric emptying of 103.4 +/- 6 minutes. These results showed significant differences in T1/2 with those from a control group of healthy individuals, the gastric emptying being slower in patients with esophagitis (103.4 min vs 85.3 min; p less than 0.01). Subsequently, a double blind study to assess the effect of metoclopramide and cinitapride on gastric emptying in patients with reflux esophagitis was carried out. Cinitapride accelerated the gastric emptying of solids with statistically significant differences when compared with placebo (84 min vs 104 min, p less than 0.05). In this study, metoclopramide showed a tendency to accelerate gastric emptying, although it did not achieve a significant difference with placebo. PMID:2691780

Monés, J; Espinós, J C; Carrió, I; Calabuig, R; Vilardell, F

1989-09-30

164

Effect of monotherapy and combination therapy of pantoprazole and aprepitant in gastric esophageal reflux disease in albino rats.  

PubMed

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

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

2014-01-01

165

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

PubMed Central

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.

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

2014-01-01

166

Long-term outcome of esophageal anastomosis.  

PubMed

After repair of esophageal atresia (EA) in a newborn, esophageal dysmotility presenting as dysphagia and symptomatic gastroesophageal reflux are common. Significant esophageal morbidity associated with EA extends into adulthood. In adulthood approximately one-fifth of the patients have developed epithelial metaplastic changes, one-third of these have intestinal metaplasia (Barrett esophagus). Surgical complications, increasing age, and impaired esophageal motility predict the development of epithelial metaplasia after repair of EA. To date, worldwide, eight cases of esophageal cancer have been reported in young adults treated for EA. Incidence of esophageal cancer after EA repair is very much likely to increase in the future. Life-long endoscopic follow-up is warranted in patients with EA. PMID:23737132

Rintala, R J; Pakarinen, M P

2013-06-01

167

Human Esophageal Cancer Is Distinguished from Adjacent Esophageal Tissue by Tissue Cysteine Concentrations  

Microsoft Academic Search

Recent studies have suggested that cysteine, in addition to glutathione, may play a role in the genesis, pathobiology, and treatment response of rodent and human cancers. We examined the relative concentrations of cysteine and glutathione in human esophageal cancer and adjacent, minimally involved esophageal tissue. Small biopsies from tumors and adjacent esophageal tissues were placed into cold acid to allow

S. M. Evans; R. Lew; M. L. Kochman; E. P. Wileyto; E. Baum; K. M. Safford; C. J. Koch

2002-01-01

168

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

SciTech Connect

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.

Um, Wooyong; Papelis, Charalambos

2003-11-01

169

Clinical application of iodine-eluting stent in patients with advanced esophageal cancer  

PubMed Central

The aim of the present study was to compare the clinical effectiveness of an iodine-eluting stent with a conventional stent in patients with advanced esophageal cancer. Patients with malignant esophageal cancer were randomly assigned to receive a conventional stent (group A) or an iodine-eluting stent (group B). Following implantation, the relief from dysphagia, survival time, routine blood tests, thyroid function examination and complications were compared in the two groups. Groups A and B consisted of 36 and 31 patients, respectively. The mean value that the dysphagia score decreased by was significantly lower in group A (0.83) compared with group B (1.65). The median survival time was longer in group B compared with group A (P=0.0022). No significant differences were observed in the severe complications between the two groups (P=0.084). The iodine-eluting esophageal stent is a relatively safe, feasible and effective treatment for malignant esophageal strictures.

DAI, ZHENBO; ZHOU, DEJUN; HU, JIANZHANG; ZHANG, LEI; LIN, YUNSHOU; ZHANG, JING; LI, FENGLING; LIU, PENG; LI, HUA; CAO, FULIANG

2013-01-01

170

Adenosine-induced activation of esophageal nociceptors  

PubMed Central

Clinical studies implicate adenosine acting on esophageal nociceptive pathways in the pathogenesis of noncardiac chest pain originating from the esophagus. However, the effect of adenosine on esophageal afferent nerve subtypes is incompletely understood. We addressed the hypothesis that adenosine selectively activates esophageal nociceptors. Whole cell perforated patch-clamp recordings and single-cell RT-PCR analysis were performed on the primary afferent neurons retrogradely labeled from the esophagus in the guinea pig. Extracellular recordings were made from the isolated innervated esophagus. In patch-clamp studies, adenosine evoked activation (inward current) in a majority of putative nociceptive (capsaicin-sensitive) vagal nodose, vagal jugular, and spinal dorsal root ganglia (DRG) neurons innervating the esophagus. Single-cell RT-PCR analysis indicated that the majority of the putative nociceptive (transient receptor potential V1-positive) neurons innervating the esophagus express the adenosine receptors. The neural crest-derived (spinal DRG and vagal jugular) esophageal nociceptors expressed predominantly the adenosine A1 receptor while the placodes-derived vagal nodose nociceptors expressed the adenosine A1 and/or A2A receptors. Consistent with the studies in the cell bodies, adenosine evoked activation (overt action potential discharge) in esophageal nociceptive nerve terminals. Furthermore, the neural crest-derived jugular nociceptors were activated by the selective A1 receptor agonist CCPA, and the placodes-derived nodose nociceptors were activated by CCPA and/or the selective adenosine A2A receptor CGS-21680. In contrast to esophageal nociceptors, adenosine failed to stimulate the vagal esophageal low-threshold (tension) mechanosensors. We conclude that adenosine selectively activates esophageal nociceptors. Our data indicate that the esophageal neural crest-derived nociceptors can be activated via the adenosine A1 receptor while the placodes-derived esophageal nociceptors can be activated via A1 and/or A2A receptors. Direct activation of esophageal nociceptors via adenosine receptors may contribute to the symptoms in esophageal diseases.

Ru, F.; Surdenikova, L.; Brozmanova, M.

2011-01-01

171

Surgical treatment of superficial esophageal cancer  

Microsoft Academic Search

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

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

2006-01-01

172

Physiology of esophageal sensorimotor malfunctions in neonatal neurological illness  

PubMed Central

We aimed to define the sensorimotor characteristics of aero-digestive reflexes evoked upon midesophageal provocations in neuropathology infants. Provocative esophageal motility testing was performed in 20 neuropathology infants and 10 controls at 42.3 ± 0.6 and 38.9 ± 0.9 wk postmenstrual age. Data from 1,073 infusions were examined for the sensory thresholds, response frequencies, response magnitude of upper esophageal sphincter (UES) contractile reflexes, lower esophageal sphincter (LES) relaxation reflexes, and peristaltic reflexes using mixed statistical models. Threshold volumes for air and liquid in neuropathology and control infants were similar for all reflexes. Graded air- and liquid volume-dependent UES contractile reflex, LES relaxation reflex, and peristaltic reflex frequency recruitment were present in neuropathology and control subjects for the media (P < 0.0001) and the reflexes (P < 0.0001). In neuropathology infants (vs. controls), UES contractile magnitude is higher (P < 0.0001); LES relaxation reflex occurred earlier (P = 0.008); LES nadir duration lasted longer (P = 0.006); secondary peristalsis is the chief method of esophageal clearance (P < 0.0001); pharyngeal swallows and deglutition apneas are less frequent (P = 0.001); proximal, midesophageal waveform magnitudes and duration are exaggerated (P < 0.008). UES contractile reflex was longer with liquid than air in both groups (P = 0.03). We concluded that 1) perception to midesophageal provocation remains preserved in neuropathology neonates; 2) sustained and exaggerated myogenic response from afferent activation is evident by increased excitatory efferent outputs to the UES and esophageal body and increased inhibitory efferent outputs to the LES; 3) dysfunctional regulation of pharyngeal swallowing and infrequent deglutition responses indicate the possibility of impaired descending modulation and central malfunctions of brainstem and vagal nuclei.

Chan, Chin Yee; Moore, Rebecca; Fernandez, Soledad; Shaker, Reza

2013-01-01

173

Physiology of esophageal sensorimotor malfunctions in neonatal neurological illness.  

PubMed

We aimed to define the sensorimotor characteristics of aero-digestive reflexes evoked upon midesophageal provocations in neuropathology infants. Provocative esophageal motility testing was performed in 20 neuropathology infants and 10 controls at 42.3 ± 0.6 and 38.9 ± 0.9 wk postmenstrual age. Data from 1,073 infusions were examined for the sensory thresholds, response frequencies, response magnitude of upper esophageal sphincter (UES) contractile reflexes, lower esophageal sphincter (LES) relaxation reflexes, and peristaltic reflexes using mixed statistical models. Threshold volumes for air and liquid in neuropathology and control infants were similar for all reflexes. Graded air- and liquid volume-dependent UES contractile reflex, LES relaxation reflex, and peristaltic reflex frequency recruitment were present in neuropathology and control subjects for the media (P < 0.0001) and the reflexes (P < 0.0001). In neuropathology infants (vs. controls), UES contractile magnitude is higher (P < 0.0001); LES relaxation reflex occurred earlier (P = 0.008); LES nadir duration lasted longer (P = 0.006); secondary peristalsis is the chief method of esophageal clearance (P < 0.0001); pharyngeal swallows and deglutition apneas are less frequent (P = 0.001); proximal, midesophageal waveform magnitudes and duration are exaggerated (P < 0.008). UES contractile reflex was longer with liquid than air in both groups (P = 0.03). We concluded that 1) perception to midesophageal provocation remains preserved in neuropathology neonates; 2) sustained and exaggerated myogenic response from afferent activation is evident by increased excitatory efferent outputs to the UES and esophageal body and increased inhibitory efferent outputs to the LES; 3) dysfunctional regulation of pharyngeal swallowing and infrequent deglutition responses indicate the possibility of impaired descending modulation and central malfunctions of brainstem and vagal nuclei. PMID:23328206

Jadcherla, Sudarshan R; Chan, Chin Yee; Moore, Rebecca; Fernandez, Soledad; Shaker, Reza

2013-03-15

174

Esophageal mesenchymal tumors: Endoscopy, pathology and immunohistochemistry  

PubMed Central

AIM: To study the endoscopic, pathological and immuno-histochemical features of esophageal mesenchymal tumors. METHODS: Twenty-nine patients diagnosed as esophageal mysenchymal tumors by electronic endoscopy and endoscopic ultrasound (EUS) were observed under light microscopes, and all tissues were stained by the immunohistochemical method. The expression of CD117, CD34, SMA and desmin were measured by staining intensity of cells and positive cell ratios. RESULTS: Endoscopically, esophageal gastrointestinal stromal tumors (GISTs) and leiomyomas (LMs) had similar appearances, showing submucosal protuberant lesions. They all showed low echo images originated from the muscularis propria or muscularis mucosa on EUS. Endoscopy and EUS could not exactly differentiate esophageal GISTs from LMs. Microscopically, there were two kinds of cells: spindle cell type and epitheloid cell type in esophageal GISTs. Leiomyomas and leiomyosarcomas were only of spindle cell type. One malignancy was found in five cases of esophageal GISTs, and one malignancy in 24 cases of leiomyomas and leiomyosarcomas. Using Fisher’s exact method, the differences of malignant lesion proportion were not significant between esophageal LMs and GISTs, 1/5 vs 1/24 (P > 0.05). All cases of esophageal GISTs were positive for CD117, and 3 cases were also positive for CD34. The 24 cases of leiomyomas and leiomyosarcomas were all negative for CD117 and CD34. The differences of positive rates of CD117 and CD34 were significant between esophageal GISTs and LMs, 5/5 vs 0/24, 3/5 vs 0/24 (P < 0.005). All leiomyomas and leiomyosarcomas were positive for SMA, and desmin. Among 5 cases of esophageal GISTs, 2 cases were SMA positive, and 1 case was desmin positive. The differences in positive rates and expression intensity of SMA and desmin were significant between esophageal LMs and GISTs, 24/24 vs 2/5, 24/24 vs 1/5 (P < 0.005). CONCLUSION: The most common esophageal mesenchymal tumors are leiomyomas, and esophageal GISTs are less common. Most of esophageal LMs and GISTs are benign. Endoscopy and EUS are the effective methods to diagnose esophageal mesenchymal tumors and they can provide useful information for the treatment of these tumors. However, they cannot exactly differentiate esophageal GISTs from LMs. Pathological, especially immunohistochemical features are useful to differentiate GISTs from leiomyomas.

Zhu, Xuan; Zhang, Xiao-Qian; Li, Bi-Min; Xu, Ping; Zhang, Kun-He; Chen, Jiang

2007-01-01

175

Anatomy and physiology of the esophageal body.  

PubMed

The primary role of the esophagus is to propel swallowed food or fluid into the stomach and to prevent or clear gastroesophageal reflux. This function is achieved by an organized pattern that involves a sensory pathway, neural reflexes, and a motor response that includes esophageal tone, peristalsis, and shortening. The motor function of the esophagus is controlled by highly complex voluntary and involuntary mechanisms. There are three different functional areas in the esophagus: the upper esophageal sphincter, the esophageal body, and the LES. This article focused on anatomy and physiology of the esophageal body. PMID:21385283

Yazaki, E; Sifrim, D

2012-05-01

176

The esophageal coin: is it a penny?  

PubMed

Because of their high zinc content modern U.S. pennies that become lodged in the esophagus may react with stomach acid thereby damaging the esophageal mucosa. Management of esophageal pennies may therefore differ from that of other esophageal coins making differentiation of pennies from other coins important. We reviewed the records of 111 children who underwent endoscopic esophageal coin removal over a 19-year period to determine the ability of history and size of esophageal coin images on posterior-anterior and lateral chest radiographs alone and in combination to differentiate esophageal pennies from other esophageal coins. History alone accurately identified 83 per cent of esophageal coins. Ranges of two standard deviations around mean image sizes were determined for each coin denominations. We determined the probability of an esophageal coin being a penny based on combinations of historical data and whether or not image sizes fell within the calculated range for a penny. When all data agree that a coin is or is not a penny they are nearly always correct. When there is disagreement among historical and image size data the probability that is a coin is a penny is strongly influenced by the size of the radiographic images. PMID:12013283

Cantu, Santos; Conners, Gregory P

2002-05-01

177

Microstructural evolution and response to double-loop reactivation testing of heat-treated pH 13-8 Mo martensitic stainless steel  

Microsoft Academic Search

The double loop electrochemical potentiokinetic reactivation (DL-EPR) test was used to investigate the intergranular and interlath corrosion susceptibility of pH 13-8 Mo as a function of heat treatment. Degree of sensitization was measured to the ratio of the peak current on a reverse (reactivation) scan to that on the forward anodic scan. Corrosion morphology was characterized by SEM, and microstructure

W. R. Cieslak; M. J. Cieslak; C. R. Hills

1987-01-01

178

Meat consumption and risk of esophageal and gastric cancer in a large prospective study  

PubMed Central

Background Red and processed meats could increase cancer risk via several potential mechanisms involving iron, heterocyclic amines, polycyclic aromatic hydrocarbons and N-nitroso compounds. Although there have been multiple studies of meat and colorectal cancer, other gastrointestinal malignancies are understudied. Methods We estimated hazards ratios (HR) and 95% confidence intervals (CI) for the association between meat, meat components, and meat cooking by-products and risk of esophageal or gastric cancer in a large cohort study. During approximately 10 years of follow-up, we accrued 215 esophageal squamous cell carcinomas, 630 esophageal adenocarcinomas, 454 gastric cardia adenocarcinomas and 501 gastric non-cardia adenocarcinomas. Results Red meat intake was positively associated with esophageal squamous cell carcinoma (HR for the top versus bottom quintile = 1.79, 95% CI: 1.07–3.01, P for trend = 0.019). Individuals in the highest intake quintile of 2-amino-3,4,8-trimethylimidazo[4,5-f]quinoxaline (DiMeIQx) had an increased risk for gastric cardia cancer (HR = 1.44, 95% CI: 1.01–2.07, P for trend = 0.104). Furthermore, those in the highest quintile of 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline (MeIQx), 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) or heme iron intake had a suggestive increased risk for esophageal adenocarcinoma (HR = 1.35, 95% CI: 0.97–1.89, P for trend = 0.022; HR = 1.45, 95% CI: 0.99–2.12, P for trend = 0.463; HR = 1.47, 95% CI: 0.99-2.20, P for trend = 0.063, respectively). Benzo[a]pyrene, nitrate and nitrite were not associated with esophageal or gastric cancer. Conclusions We found positive associations between red meat intake and esophageal squamous cell carcinoma, and between DiMeIQx intake and gastric cardia cancer.

Cross, Amanda J.; Freedman, Neal D.; Ren, Jiansong; Ward, Mary H.; Hollenbeck, Albert R.; Schatzkin, Arthur; Sinha, Rashmi; Abnet, Christian C.

2010-01-01

179

Recurrence risk model for esophageal cancer after radical surgery  

PubMed Central

Objective The aim of the present study was to construct a risk assessment model which was tested by disease-free survival (DFS) of esophageal cancer after radical surgery. Methods A total of 164 consecutive esophageal cancer patients who had undergone radical surgery between January 2005 and December 2006 were retrospectively analyzed. The cutpoint of value at risk (VaR) was inferred by stem-and-leaf plot, as well as by independent-samples t-test for recurrence-free time, further confirmed by crosstab chi-square test, univariate analysis and Cox regression analysis for DFS. Results The cutpoint of VaR was 0.3 on the basis of our model. The rate of recurrence was 30.3% (30/99) and 52.3% (34/65) in VaR <0.3 and VaR ?0.3 (chi-square test, ?2 =7.984, P=0.005), respectively. The 1-, 3-, and 5-year DFS of esophageal cancer after radical surgery was 70.4%, 48.7%, and 45.3%, respectively in VaR ?0.3, whereas 91.5%, 75.8%, and 67.3%, respectively in VaR <0.3 (Log-rank test, ?2 =9.59, P=0.0020), and further confirmed by Cox regression analysis [hazard ratio =2.10, 95% confidence interval (CI): 1.2649-3.4751; P=0.0041]. Conclusions The model could be applied for integrated assessment of recurrence risk after radical surgery for esophageal cancer.

Tao, Hua; Song, Dan; Chen, Cheng

2013-01-01

180

Risk factors for eosinophilic esophagitis.  

PubMed

Eosinophilic esophagitis (EoE) is a chronic antigen driven disease, whereby food and/or aeroallergens result in inflammation and luminal narrowing, and the clinical symptoms of dysphagia and food bolus obstruction events (FBOE). Established risk factors are male gender, Caucasian race and atopy. Increased risk amongst family members, and a single nucleotide polymorphism (SNP) in a gene coding thymic stromal lymphopoietin (TSLP) on the pseudoautosomal region of the X and Y chromosomes supports a genetic predisposition. Environmental factors including the timing and nature of food and aeroallergen exposure to the developing immune system may be important, whilst esophageal barrier function integrity and the influence of microbiota are worthy of future research. PMID:24990069

Philpott, H; Nandurkar, S; Royce, S G; Thien, F; Gibson, P R

2014-08-01

181

Management of Barrett's esophageal carcinoma.  

PubMed

Barrett's esophagus (BE) is the premalignant lesion from which esophageal adenocarcinoma near the esophagogastric junction arises. The management of BE and the treatment of Barrett's esophageal adenocarcinoma (BEA) are important clinical issues in Europe and the United States. As the Helicobacter pylori infection rate in Japan is decreasing in the younger population, the incidence of BE and adenocarcinoma arising from BE may start increasing. Thus, we review the current status of BEA and its management. Magnifying endoscopy with narrow-band imaging is important for diagnosing dysplasia arising from BE. In Japan, adenocarcinoma arising from BE is managed the same way as squamous cell carcinoma in the same location. Strategies to prevent BEA may include medication such as non-steroidal anti-inflammatory drugs and proton pump inhibitors, and anti-reflux surgery. Understanding the pathophysiology of BE will help to reduce the incidence of BEA. PMID:23283352

Miyazaki, Tatsuya; Inose, Takanori; Tanaka, Naritaka; Yokobori, Takehiko; Suzuki, Shigemasa; Ozawa, Daigo; Sohda, Makoto; Nakajima, Masanobu; Fukuchi, Minoru; Kato, Hiroyuki; Kuwano, Hiroyuki

2013-04-01

182

Endoscopic Detection of Esophageal Neoplasia  

Microsoft Academic Search

Endoscopic visualization of the esophagus has been practiced since the 19th century; the first illuminated views were obtained\\u000a by Mikulicz in 1880 (1). Esophagogastroduodenoscopy (EGD) or “upper endoscopy” is one of the most frequently performed semi-invasive procedures,\\u000a currently accounting for approx 25% of all endoscopies conducted annually. Use of endoscopy to detect esophageal dysplasia\\u000a in the United States is primarily

Brian C. Jacobson; Jacques Van Dam

183

Rapid cervical phIGFBP-1 test in asymptomatic twin pregnancies: role in mid-pregnancy prediction of spontaneous preterm delivery.  

PubMed

Objective This study aimed to assess the accuracy of a second-trimester rapid cervical phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) test to predict spontaneous preterm delivery in asymptomatic twin pregnancies. Method During the second trimester, a rapid test to detect phIGFBP-1 in cervical secretions was performed on consecutive twin pregnancies between 2009 and 2011, to evaluate its predictive value for spontaneous preterm delivery at <28, <30, <32 and <34?weeks' gestation. Excluded were patients with cerclage, pessary or undergoing indicated preterm delivery. Results A total of 197 pregnancies fulfilled the study criteria and were tested at a median gestational age of 20.3?weeks (interquartile range: 20-20.6). Median gestational age at delivery was 36.4?weeks. Spontaneous preterm delivery at <34?weeks occurred in 21 (10.7%) cases, at <32?weeks in 9 (4.5%), at <30?weeks in 6 (3%) and at <28?weeks in 4 (2%). Seventeen patients (8.7%) were test positive: In this group, three patients delivered before 34?weeks' gestation, whereas none delivered at <32?weeks. The sensitivity, specificity, positive and negative predictive value of the test for spontaneous preterm delivery <34?weeks were 14% (95% confidence interval, 3-37%), 92% (86-95%), 17% (4-44%) and 90% (84-93%), respectively, with a positive and negative likelihood ratio of 1.79 (0.56-5.74) and 0.93 (0.78-1.10). Conclusions In the second trimester, rapid cervical phIGFBP-1 testing in asymptomatic twin pregnancies has a poor performance in predicting spontaneous preterm delivery. © 2014 John Wiley & Sons, Ltd. PMID:24436153

Fichera, Anna; Prefumo, Federico; Zanardini, Cristina; Stagnati, Valentina; Frusca, Tiziana

2014-05-01

184

Glycomic Expression in Esophageal Disease  

PubMed Central

Glycosylation is among the most common post translation modifications of proteins in humans. Decades of research have demonstrated that aberrant glycosylation can lead to malignant degeneration. Glycoproteomic studies in the past several years have identified techniques that can successfully characterize a glycan or glycan profile associated with a high-grade dysplastic or malignant state. This review summarizes the current glycomic and glycoproteomic literature with specific reference to esophageal cancer. Esophageal adenocarcinoma represents a highly morbid and mortal cancer with a defined progression from metaplasia (Barrett's esophagus) to dysplasia to neoplasia. This disease is highlighted because (1) differences in glycan profiles between the stages of disease progression have been described in the glycoproteomic literature; (2) a glycan biomarker that identifies a given stage may be used as a predictor of disease progression and thus may have significant influence over clinical management; and (3) the differences in glycan profiles between disease and disease-free states in esophageal cancer are more dramatic than in other cancers.

Mohanty, Sanjay; Tsiouris, Athanasios; Hammoud, Zane

2012-01-01

185

Esophageal schwannoma: a case report.  

PubMed

Most tumorous lesions of the esophagus are esophageal cancers. Benign primary tumors of the esophagus are uncommon, and account for approximately 2% of all esophageal tumors. More than 80% of benign esophageal tumors are leiomyomas, with schwannomas being rare. A 55-year-old woman visited our internal medicine department with complaints of palpitations and discomfort during swallowing. A chest computed tomography scan showed a lobulated tumor (75 × 57 × 80 mm) in the upper to middle mediastinum, with homogenous inner opacity, compressing the esophagus. Upper gastrointestinal endoscopy revealed a smooth-surfaced elevated lesion covered with normal mucosa, and a schwannoma was diagnosed based on the biopsy result. The tumor was large. It was thus considered to be difficult to repair the esophagus by direct anastomosis after tumor resection. Therefore, subtotal esophagectomy and esophagogastrostomy in the right thorax were performed. Histopathological examination revealed spindle-shaped cells in a fasciculated and disarrayed architecture and nuclei in a palisading pattern. Immunohistochemical studies revealed S100 protein positivity and the absence of staining for ? smooth muscle actin (?SMA), CD34 and CD117, thereby establishing the diagnosis of benign schwannoma. Her postoperative course was uneventful and there has been no evidence of recurrence to date. PMID:24088647

Kitada, Masahiro; Matsuda, Yoshinari; Hayashi, Satoshi; Ishibashi, Kei; Oikawa, Kensuke; Miyokawa, Naoyuki

2013-01-01

186

Darier's disease with esophageal carcinoma.  

PubMed

We report a patient with longstanding Darier's disease (DD) involving the mucous membrane of the esophagus who developed esophageal carcinoma. A number of small white plaques were observed around the carcinoma in the postoperative specimens of the esophageal mucosal epithelium. Histopathological findings of the specimens near the carcinoma showed suprabasal clefts and villi formation, features consistent with DD, with no evidence of malignancy. There was some speculation on the pathogenic relationship between esophageal carcinoma and DD in this patient, but nothing was confirmed. Immunohistochemistry of lesional skin examined with antibody against desmogleins (Dsgs) 1 + 2 showed a diffuse pattern throughout the cytoplasm in most of the suprabasal acantholytic cells, whereas some of the spherical acantholytic cells showed a ring pattern surrounding the nucleus. In electron microscopy, these areas stained with Dsgs corresponded to dispersed tonofibrils in the suprabasal acantholytic cells and perinuclear aggregation of tonofibrils in the spherical acantholytic cells. This implies that in DD patients, some affinity remains after acantholysis between Dsgs and intermediate filaments, possibly through other desmosomal components. PMID:10980472

Shimizu, H; Tan Kinoshita, M T; Suzuki, H

2000-08-01

187

Current knowledge on esophageal atresia  

PubMed Central

Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is the most common congenital anomaly of the esophagus. The improvement of survival observed over the previous two decades is multifactorial and largely attributable to advances in neonatal intensive care, neonatal anesthesia, ventilatory and nutritional support, antibiotics, early surgical intervention, surgical materials and techniques. Indeed, mortality is currently limited to those cases with coexisting severe life-threatening anomalies. The diagnosis of EA is most commonly made during the first 24 h of life but may occur either antenatally or may be delayed. The primary surgical correction for EA and TEF is the best option in the absence of severe malformations. There is no ideal replacement for the esophagus and the optimal surgical treatment for patients with long-gap EA is still controversial. The primary complications during the postoperative period are leak and stenosis of the anastomosis, gastro-esophageal reflux, esophageal dysmotility, fistula recurrence, respiratory disorders and deformities of the thoracic wall. Data regarding long-term outcomes and follow-ups are limited for patients following EA/TEF repair. The determination of the risk factors for the complicated evolution following EA/TEF repair may positively impact long-term prognoses. Much remains to be studied regarding this condition. This manuscript provides a literature review of the current knowledge regarding EA.

Pinheiro, Paulo Fernando Martins; Simoes e Silva, Ana Cristina; Pereira, Regina Maria

2012-01-01

188

Thallium cardiac stressing by esophageal pacing  

SciTech Connect

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.

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

189

Esophageal replacement using cryopreserved tracheal graft.  

PubMed

Esophageal replacement using artificial material is not a new concept. Prior experiences with prostheses, allografts and composite grafts have not proved particularly successful. The aim of this study is to investigate whether cryopreserved animal trachea is suitable for the replacement of the esophagus. In 12 beagle dogs a 6-cm-long segment of the cervical esophagus was removed, and was replaced with cryopreserved trachea, which had been stored for 21 days on -86 degrees C. The proximal and distal ends of the esophagus were joined together with the graft by simple continuous suture (Biosyn 3/0) and covered with the sternohyoid flap. Postoperatively 16 hematological parameters were measured. The dogs were planned to be euthanized at random on days 28, 42 and 56 after the operation. Tests for air leak were performed and the inner diameter of the graft was measured to detect shrinkage. The microscopic structure of the graft was analyzed using haematoxylin and eosin staining. There was no indication of insufficiency. Based on the air leak test the sutures withheld properly. The inner diameter of the graft narrowed from an average 19 mm (+/- 1 mm) to 15.8 mm (+/- 0.6 mm). In length, the graft shortened from an average 60 mm to 47 mm (+/- 3 mm). No feeding difficulty was observed. In two cases wound suppuration was found involving only the cutaneous and subcutaneous layers. Concerning the laboratory parameters, only the fibrinogen level and white blood cell count showed temporary although significant changes. Histology findings on the 56th day showed absolute integration of the trachea with the esophagus, with disintegration of the tracheal cartilages. Cryopreserved trachea seems to be suitable for the replacement of a 5-6-cm-long esophageal segment. PMID:19125802

Juhász, A; Szilágyi, A; Mikó, I; Altorjay, I; Kecskés, G; Altorjay, A

2008-01-01

190

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

NASA Technical Reports Server (NTRS)

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.

2005-01-01

191

Scintigraphic methods to evaluate alterations of gastric and esophageal functions in female obesity.  

PubMed

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/m(2) (range:32-39 kg/m(2)). 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 (t˝) 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

Omür, Ozgür; Erdo?an, Mehmet; Ozk?l?ç, Hayal; Y?lmaz, Cande?er

2014-02-01

192

Estimation of influence of myofascial release techniques on esophageal pressure in patients after total laryngectomy.  

PubMed

In patients after total laryngectomy, increased tension in myofascial neck and arm areas might be observed. Via fascial continuity it has an adverse impact on the superior esophageal constrictor forming the "mouth of the oesophagus", which hinders learning of esophageal speech. The aim is to assess the effect of manual myofascial release techniques on esophageal pressure in patients after total laryngectomy. Forty patients (12 F, 28 M), aged 43-75 (mean 56.8 years), 9 months to 13 years (average 3 years) after total laryngectomy, 35 patients (87.5%) after neck lymph node resection, 38 patients (95%) after radiotherapy. Esophageal pressure was assessed using modified Seeman's method. Manual myofascial release techniques were applied within head, neck, arms, upper trunk and upper limb areas. Wilcoxon and Shapiro-Wilk's test was used for the purpose of statistical analysis. Statistically significant decrease of the mean esophageal pressure was observed after the physiotherapy treatment. The average pressure among the examined patients decreased from 37.9 to 26.6 mmHg. The application of myofascial manual techniques decreases esophageal pressure, thus allowing patients to learn esophagus speech at a faster pace. PMID:19023585

Marsza?ek, S?awomir; Zebryk-Stopa, Anna; Kra?ny, Jacek; Obrebowski, Andrzej; Golusi?ski, Wojciech

2009-08-01

193

Aerofoil testing in a self-streamlining flexible walled wind tunnel. Ph.D. Thesis - Jul. 1987  

NASA Technical Reports Server (NTRS)

Two-dimensional self-streamlining flexible walled test sections eliminate, as far as experimentally possible, the top and bottom wall interference effects in transonic airfoil testing. The test section sidewalls are rigid, while the impervious top and bottom walls are flexible and contoured to streamline shapes by a system of jacks, without reference to the airfoil model. The concept of wall contouring to eliminate or minimize test section boundary interference in 2-D testing was first demonstrated by NPL in England during the early 40's. The transonic streamlining strategy proposed, developed and used by NPL has been compared with several modern strategies. The NPL strategy has proved to be surprisingly good at providing a wall interference-free test environment, giving model performance indistinguishable from that obtained using the modern strategies over a wide range of test conditions. In all previous investigations the achievement of wall streamlining in flexible walled test sections has been limited to test sections up to those resulting in the model's shock just extending to a streamlined wall. This work however, has also successfully demonstrated the feasibility of 2-D wall streamlining at test conditions where both model shocks have reached and penetrated through their respective flexible walls. Appropriate streamlining procedures have been established and are uncomplicated, enabling flexible walled test sections to cope easily with these high transonic flows.

Lewis, Mark Charles

1988-01-01

194

Esophageal aspergillosis after bone marrow transplant  

Microsoft Academic Search

The prolonged immune suppression associated with bone marrow transplants predisposes to fungal infections including Aspergillus. Disseminated aspergillosis occurs in up to 60% of patients with invasive pulmonary aspergillosis; sites of involvement include the brain, gastrointestinal tract, kidney, liver, thyroid, heart, and spleen. There is only one report of isolated esophageal aspergillosis. A recent acute myelogenous leukemia patient had isolated esophageal

JH Choi; JH Yoo; IJ Chung; DW Kim; CW Han; WS Shin; WS Min; CC Kim; DJ Kim

1997-01-01

195

CT appearance of implanted esophageal stents.  

PubMed

Three different types of esophageal stents, the Z-stent, Ultraflex, and Wall-stent, exhibit different shapes on CT, which may suggest a difference in the radial forces applied by each of the stents. CT is useful for displaying the relationship between an esophageal stent and adjacent structures and complications. PMID:10667652

Iwasaki, Y; Nakajima, Y; Ishikawa, T; Wakabayashi, M; Ashida, H

2000-01-01

196

Toll-Like Receptors in Esophageal Cancer  

PubMed Central

Esophageal squamous cell carcinoma and esophageal adenocarcinoma are cancers of high mortality. EAC develops through Barrett’s esophagus (BE) and columnar dysplasia, preceded by gastro-esophageal reflux disease. The risk of esophageal squamous cell carcinoma is increased by smoking and alcohol consumption. New treatment options for esophageal cancer are desperately needed. Toll-like receptors (TLRs) play a central role in mammalian immunity and cancer. TLRs are activated by microbial components, such as lipopolysaccharide, flagellin, DNA, and RNA, as well as endogenous ligands, including heat-shock proteins and endogenous DNA. This review summarizes the studies on TLRs in esophageal squamous cell carcinoma and EAC. It has been shown that TLRs 1–10 are expressed in the normal esophagus. In esophageal squamous cell carcinoma, TLRs3, 4, 7, and 9 have been studied, showing associations to aggressive disease properties. In BE and EAC, only TLRs4, 5, and 9 have been studied. In the review, we discuss the implications of TLRs in esophageal cancer.

Kauppila, Joonas H.; Selander, Katri S.

2014-01-01

197

[Prenatal MRI diagnosis of esophageal atresia].  

PubMed

The diagnosis of esophageal atresia may be suspected on prenatal ultrasonography in fetuses with absent or small stomach, upper esophageal dilatation and unexplained polyhydramnios. However, the diagnostic value of these findings is relatively poor. Two cases are reported where MRI appeared to be accurate for establishing the diagnosis of this congenital anomaly. PMID:15692414

Chaumoître, K; Amous, Z; Bretelle, F; Merrot, T; D'Ercole, C; Panuel, M

2004-12-01

198

Radionuclide esophageal transit of a liquid bolus: A reappraisal  

SciTech Connect

Measurement of radionuclide esophageal transit (RT) using a liquid bolus has been suggested as a screening test for esophageal motor disorders (EMD). The authors prospectively evaluated RT in 49 patients referred for esophageal manometry. Ten subjects with normal manometry served as controls. RT was performed using two 10 ml boluses of water labeled with 250 ..mu..Ci /sup 99m/Tc-sulfur colloid. Patients were studied supine and the swallow sequences framed in 1 second intervals. Transit time was measured from the time of entry to the time of exit from the esophagus. Mean transit time in normal subjects was 9.1 +- 2.1 (SD) sec. The test was abnormal if the transit time was prolonged (> 15 sec) in at least 1 of 2 swallows. RT agreed with manometry in 36/49 patients (75%), including 9/9 achalasics, 3/3 diffuse esophageal spasm, 3/7 'nutcracker esophagus' and 7/8 non-specific motor disorders (NSMD). 4/18 patients with normal manometry had abnormal RT. 9/31 patients with abnormal manometry had normal RT, including 4/7 nutcracker esophagus, 3/3 hypertrensive LES, 1/1 scleroderma and 1/8 NSMD. Sensitivity of RT was 70% and specificity 77%. The false positive rate was 15% and the false negative rate 39%. The authors conclude the following: 1) RT identifies patients with absent or impaired peristalsis; 2) There is substantial incidence of false negatives among patients with manometric disorders but normal peristalsis; and 3) Abnormal RT did occur in some patients with normal menometry. RT using a liquid bolus may not be sensitive enough as a screening test for EMD, but it may be an important adjunct to manometry.

Holloway, R.H.; Lange, R.C.; Magyar, L.; Greene, R.; McCallum, R.W.

1984-01-01

199

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

Microsoft Academic Search

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

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

2003-01-01

200

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

PubMed

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

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

2013-10-01

201

Association of esophageal candidiasis and squamous cell carcinoma  

PubMed Central

Chronic esophageal candidiasis is an infection that is mostly seen in immunocompromised conditions, among which is chronic mucocutaneous candidiasis (CMC). Recently an association between CMC and esophageal carcinoma has been reported. Here we present two patients with chronic esophageal candidiasis who developed esophageal squamous cell carcinoma and we discuss the etiologic role of Candida-induced nitrosamine production, the loss of STAT1 function and impaired tumor surveillance and T-lymphocyte function in the development of esophageal carcinoma.

Delsing, C.E.; Bleeker-Rovers, C.P.; van de Veerdonk, F.L.; Tol, J.; van der Meer, J.W.M.; Kullberg, B.J.; Netea, M.G.

2012-01-01

202

Nitrate-contaminated groundwater remediation by combined autotrophic and heterotrophic denitrification for sulfate and pH control: batch tests.  

PubMed

Groundwater remediation was evaluated for combined autotrophic and heterotrophic denitrification under high (154 mg/L as CaCO3) and low (95 mg/L as CaCO3) alkaline conditions. Two levels of acetate (47 and 94 mg/L) and ethanol (24 and 48 mg/L) were added to the reactors. Obtained denitrification rates were 2.89, 2.58, 3.55, 1.96, and 2.0 mg-N/L?·?h for high alkaline conditions, whereas under low alkaline conditions has given 2.36, 1.94, 2.47, 2.74, and 2.29 mg-N/L?·?h for control, 47 and 94 mg/L acetate, and 24 and 48 mg/L ethanol, respectively. Nitrite was accumulated for controls but reactors with acetate and ethanol did not accumulate nitrite. Acetate and ethanol addition decreased sulfate to nitrate ratios in the range of 4.5-7.58 for high alkaline conditions (12.77 for control) and 4.43-6.78 for low alkaline conditions (7.90 for control). Acetate was more efficient compared with ethanol in controlling sulfate production and pH maintenance. PMID:23529400

Qambrani, Naveed Ahmed; Jung, Sokhee; Jung, Suk Hee; Ok, Yong Sik; Kim, Yong Seong; Oh, Sang-Eun

2013-12-01

203

The design and operational development of self-streamlining 2-dimensional flexible walled test sections. Ph.D. Thesis  

NASA Technical Reports Server (NTRS)

Self streamlining two dimensional flexible walled test sections eliminate the uncertainties found in data from conventional test sections particularly at transonic speeds. The test section sidewalls are rigid, while the floor and ceiling are flexible and are positioned to streamline shapes by a system of jacks, without reference to the model. The walls are therefore self streamlining. Data are taken from the model when the walls are good streamlines such that the inevitable residual wall induced interference is acceptably small and correctable. Successful two dimensional validation testing at low speeds has led to the development of a new transonic flexible walled test section. Tunnel setting times are minimized by the development of a rapid wall setting strategy coupled with on line computer control of wall shapes using motorized jacks. Two dimensional validation testing using symmetric and cambered aerofoils in the Mach number range up to about 0.85 where the walls are just supercritical, shows good agreement with reference data using small height-chord ratios between 1.5 and unity.

Wolf, S. W. D.

1984-01-01

204

Nonsynonymous polymorphisms in FAT4 gene are associated with the risk of esophageal cancer in an Eastern Chinese population.  

PubMed

FAT4 plays a crucial role in carcinogenesis as a key component of the Hippo signaling pathway. We hypothesized that potential functional polymorphisms in the FAT4 gene may modify the risk of esophageal cancer. To test this hypothesis, we evaluated the association between four nonsynonymous polymorphisms (rs1039808, rs12508222, rs1567047 and rs1014867) in FAT4 and esophageal cancer risk in a case-control study of 2,139 esophageal cancer cases and 2,273 controls in a Chinese population. We found that the T allele of rs1014867 (Pro4972Ser) was significantly associated with a decreased risk of esophageal cancer (odds ratio [OR]=0.77, 95% confidence interval [95% CI]=0.66-0.90; p=1.42 × 10(-3)). We also observed a borderline significant association between rs1039808 (Ala807Val) and esophageal cancer risk (OR=0.90, 95% CI=0.82-1.00; p=0.050), which was more prominent in non-drinkers (OR=0.82, 95% CI=0.71-0.94; p=6.53 × 10(-3)). Furthermore, we detected a significant interaction between rs1039808 genotypes and alcohol drinking on esophageal cancer risk (p=0.013). These findings indicate that the nonsynonymous variants rs1014867 (Pro4972Ser) and rs1039808 (Ala807Val) of FAT4 may contribute to esophageal cancer susceptibility. PMID:23319386

Du, Jiangbo; Ji, Jian; Gao, Yong; Xu, Lin; Xu, Jing; Zhu, Chen; Gu, Haiyong; Jiang, Jie; Li, Huizhang; Ma, Hongxia; Hu, Zhibin; Jin, Guangfu; Guo, Wei; Chen, Xiaofei; Shen, Hongbing

2013-07-15

205

Animal Model of Acid-Reflux Esophagitis: Pathogenic Roles of Acid/Pepsin, Prostaglandins, and Amino Acids  

PubMed Central

Esophagitis was induced in rats within 3?h by ligating both the pylorus and transitional region between the forestomach and glandular portion under ether anesthesia. This esophageal injury was prevented by the administration of acid suppressants and antipepsin drug and aggravated by exogenous pepsin. Damage was also aggravated by pretreatment with indomethacin and the selective COX-1 but not COX-2 inhibitor, whereas PGE2 showed a biphasic effect depending on the dose; a protection at low doses, and an aggravation at high doses, with both being mediated by EP1 receptors. Various amino acids also affected this esophagitis in different ways; L-alanine and L-glutamine had a deleterious effect, while L-arginine and glycine were highly protective, both due to yet unidentified mechanisms. It is assumed that acid/pepsin plays a major pathogenic role in this model of esophagitis; PGs derived from COX-1 are involved in mucosal defense of the esophagus; and some amino acids are protective against esophagitis. These findings also suggest a novel therapeutic approach in the treatment of esophagitis, in addition to acid suppressant therapy. The model introduced may be useful to test the protective effects of drugs on esophagitis and investigate the mucosal defense mechanism in the esophagus.

2014-01-01

206

High Resolution Microendoscopy for Quantitative Diagnosis of Esophageal Neoplasia  

NASA Astrophysics Data System (ADS)

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.

Shin, Dongsuk

207

Current management of esophageal cancer  

PubMed Central

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.

Thomas, Pascal Alexandre

2014-01-01

208

Epidemiologic risk factors for esophageal cancer development.  

PubMed

In retrospective studies of esophageal cancer (EC), cigarettes and hookah smoking, nass use (a chewing tobacco product), opium consumption, hot tea drinking, 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 EC, and dysplasia remains the only factor useful for identifying patients at increased risk, for the development of esophageal adenocarcinoma in clinical practice. Here, we review the epidemiologic studies that have investigated the epidemiologic patterns and causes of EC. PMID:22320939

Mao, Wei-Min; Zheng, Wei-Hui; Ling, Zhi-Qiang

2011-01-01

209

[Oral blastomycosis, laryngeal papillomatosis and esophageal tuberculosis].  

PubMed

Esophageal involvement is an extremely rare complication of tuberculosis even in countries with high prevalence of infection. We report the case of a 57 year-old hiv-seronegative patient with simultaneous diagnoses of oral blastomycosis and laryngeal papillomatosis. Both were confirmed by anatomopathological analysis. The esophageal biopsy revealed granulomatous esophagitis with necrosis and ziehl-neelsen stain showed acid-fast alcohol resistant bacilli suggestive of tuberculosis. The patient's history included pulmonary tuberculosis twice and previous abandonment of therapy. Thus, it was necessary to use oral itraconazole combined with second-line anti-tuberculosis drugs administered through a gastrostomy tube. The clinical development was favorable. PMID:22858774

Montoya, Manuel; Chumbiraico, Robert; Ricalde, Melvin; Cazorla, Ernesto; Hernández-Córdova, Gustavo

2012-06-01

210

Esophageal melanocytosis in oral opium consumption.  

PubMed

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

Geramizadeh, Bita; Asadian, Fatemeh; Taghavi, Alireza

2014-01-01

211

Esophageal Melanocytosis in Oral Opium Consumption  

PubMed Central

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.

Geramizadeh, Bita; Asadian, Fatemeh; Taghavi, Alireza

2014-01-01

212

Correlation of esophageal manometry and radionuclide esophageal transit in normal subjects.  

PubMed

What was the correlation of esophageal manometry and scintigraphy in Chinese was studied. Thirty-two volunteers (M/F: 18/14, age: 20-57) without evident esophageal motor disturbance and chest deformity underwent manometric measurement in the spine position using a low compliance pneumohydraulic infusion system. These measurements included the location of both upper and lower esophageal sphincter from nostril, and dry or wet swallow elicited peristaltic speed in the lower esophageal segment. Within one week after manometry, they swallowed a technetium-99m colloid bolus to measure radionuclide manifested esophageal transit time in the supine position beneath a gamma-camera. Body heights of enrolled subjects exhibited a significant positive correlation (r = 0.458, p < 0.01) with manometry measured esophageal lengths. Mean radionuclide esophageal transit time was 7.61 +/- 2.51 sec (3.1-13.57 sec). These transit times exhibited a positive correlation with esophageal lengths (r = 0.6, p < 0.001). Radionuclide transit speed was actually slower than either dry swallow or wet swallow elicited speed (p < 0.05). In conclusion, either manometry or scintigraphy manifests their specific benefits to diagnose esophageal motility disorders. Some correlations of measured variables can be obtained if they are simultaneously employed. PMID:8549235

Chang, F Y; Lee, C T; Yeh, C L; Lee, S D; Chu, L S

1995-01-01

213

Wireless pH capsule--yield in clinical practice.  

PubMed

Wireless pH monitoring is one of the recent technologies that focus on improving the diagnosis of gastroesophageal reflux disease (GERD). The capsule, which is fixed within the esophagus, transmits data via telemetry to an external receiver. The capsule is usually inserted 6 cm above the squamocolumnar junction during an upper endoscopy. The standard recording duration is 48 hours but this can be extended to 96 hours. The wireless capsule has been shown to be at least as accurate as the conventional catheter for the monitoring of esophageal pH. Normal pH values have been established in three different series. The use of a wireless capsule provides an increased diagnostic yield for GERD compared with the conventional catheter. The increased yield is the result of higher sensitivity to detect both abnormal acid esophageal exposure and positive symptom-reflux association. This may be related both to the prolonged recording duration and to fewer dietary modifications and restrictions on activities. Several studies have shown that the pH capsule was better tolerated by patients than the conventional pH catheter. Mild-to-moderate chest pain represents the main side effect of the pH capsule: severe chest pain requiring endoscopic removal of the capsule is rare. The main indication for wireless capsule application is monitoring of distal esophageal pH for diagnostic purpose, particularly in patients with a normal endoscopic examination. The capsule technique has some limitations: costs are higher than conventional pH monitoring, misplacement may occur, and the sampling rate is lower. Finally, compared with pH-impedance monitoring, only acid reflux events can be evaluated. PMID:22275050

Roman, S; Mion, F; Zerbib, F; Benamouzig, R; Letard, J C; Bruley des Varannes, S

2012-03-01

214

Temporal evolution in caveolin 1 methylation levels during human esophageal carcinogenesis  

PubMed Central

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.

2014-01-01

215

Esophageal ulceration induced by intracavitary irradiation for esophageal carcinoma  

SciTech Connect

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.

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

1984-08-01

216

Roentgenologic Diagnosis of Sliding Esophageal Hiatus Hernia.  

National Technical Information Service (NTIS)

On the basis of the study of 210 cases of sliding esophageal hiatus hernia (SEHH) and normal esophagogastric regions in 40 subjects, 4 roentgenologic diagnostic features have been suggested: supraphrenic hernial sac, the gastric mucosa appears supradiaphr...

C. Xingrong

1980-01-01

217

The ultraflex stents for malignant esophageal obstruction.  

PubMed

Ultraflex esophageal stents have contributed to the tremendous success of self-expanding metal stents (SEMS) in the treatment of esophageal cancer because they are easy and safe to insert. With an eye to improving clinical outcome, the Ultraflex stent design has been in a state of constant evolution since its introduction. However, as with other SEMS, a high reintervention rate remains a challenging problem. PMID:10388856

Mokhashi, M S; Hawes, R H

1999-07-01

218

Extrapleural suction buttress of primary esophageal repair.  

PubMed Central

Buttress reinforcement of a primary esophageal repair after perforation may diminish the potential for breakdown or leakage of the approximation. We describe a method of reinforcing a primary esophageal repair by using pleural tissue that is secured in place with an extrapleural, soft T-tube attached to a suction device. This technique is simple to apply and may maximize recovery of respiratory function by permitting timely removal of chest tubes.

Takach, T J; Gregoric, I; Campbell, J D

1997-01-01

219

Proton Pump Inhibitor Impact on Esophageal Eosinophilia  

PubMed Central

Objective Differentiation between the common etiologies of dense esophageal eosinophilia such as gastroesophageal reflux disease (GERD) and eosinophilic esophagitis (EoE), can be difficult. We hypothesized that histologic features may provide diagnostic clues concerning the etiology of esophageal eosinophilia. Methods We performed a retrospective chart review of 204 children with the diagnosis of esophagitis characterized by ? 15 eos/ HPF in at least one biopsy. We then restricted our analysis to subjects who had received at least 8 weeks of only proton pump inhibitors (PPIs) followed by endoscopy and who had a clinicopathologic response to this treatment. Symptoms, endoscopic findings, and pathologic descriptions were reviewed and an eosinophil peroxidase (EPX) index was determined to assess for degranulation/eosinophil activation. Results Of the 204 identified charts, 7 subjects identified met the inclusion criteria. Five of these 7 patients showed a clinicopathologic response to PPIs after their follow up endoscopy, (mean peak eosinophil count- 92 vs 5 eos/ HPF, and EPX index-39.2 vs 14.6, pre- and post-treatment respectively). Two patients experienced initial resolution of symptoms and esophageal eosinophilia with PPI therapy however; within 17–23 months redeveloped symptoms and esophageal eosinophilia while on PPI therapy at the time of a third endoscopy (mean peak eosinophil count- 40 vs 11 vs 36 eos / HPF, and EPX index- 44 vs 21 vs 36.5, pre-, post- and post-treatment respectively). No clinicopathologic features or degranulation patterns differentiated subjects with GERD / PPI responsive esophageal eosinophilia (PPIREE) from those who had transient response to PPI treatment. Conclusions No clinicopathologic features differentiated subjects who responded to PPI treatment. PPI treatment can be helpful to exclude GERD and PPIREE but long-term follow up is critical in the management of esophagitis.

Schroeder, Shauna; Capocelli, Kelley E; Masterson, Joanne C; Harris, Rachel; Protheroe, Cheryl; Lee, James J; Furuta, Glenn T

2012-01-01

220

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.

221

THE AMBULATORY pH STUDY IS NORMAL, BUT THE PATIENT IS NOT—THE IMPORTANCE OF THE SYMPTOMS INDEX  

Microsoft Academic Search

ABSTRACTThe authors conducted a double blind, crossover, placebo controlled trial of Omeprazole 20 mg twice daily versus placebo in patients with heartburn and regurgitation with normal esophagoscopy and esophageal acid exposure during ambulatory pH monitoring of less than 5% of the total monitoring time who had at least one symptom episode during the pH monitoring period. The authors calculated a

Philip Katz

1998-01-01

222

The ambulatory pH study is normal, but the patient is not—the importance of the symptoms index  

Microsoft Academic Search

The authors conducted a double blind, crossover, placebo controlled trial of Omeprazole 20 mg twice daily versus placebo in patients with heartburn and regurgitation with normal esophagoscopy and esophageal acid exposure during ambulatory pH monitoring of less than 5% of the total monitoring time who had at least one symptom episode during the pH monitoring period. The authors calculated a

Philip Katz

1998-01-01

223

Laryngopharyngeal reflux in patients with reflux esophagitis  

PubMed Central

AIM: To assess the prevalence of laryngopharyngeal reflux (LPR) in patients with reflux esophagitis and disclose factors contributing to the development of LPR. METHODS: A total of 167 patients who proved to have reflux esophagitis by endoscopy were enrolled. They received laryngoscopy to grade the reflux findings for the diagnosis of LPR. We used validated questionnaires to identify the presence of laryngopharyngeal symptoms, and stringent criteria of inclusion to increase the specificity of laryngoscopic findings. The data of patients were analyzed statistically to find out factors related to LPR. RESULTS: The prevalence rate of LPR in studied subjects with reflux esophagitis was 23.9%. Age, hoarseness and hiatus hernia were factors significantly associated with LPR. In 23 patients with a hiatus hernia, the group with LPR was found to have a lower trend of esophagitis grading. CONCLUSION: Laryngopharyngeal reflux is present in patients with reflux esophagitis, and three predicting factors were identified. However, the development of LPR might be different from that of reflux esophagitis. The importance of hiatus hernia deserves further study.

Lai, Yung-Chih; Wang, Pa-Chun; Lin, Jun-Chen

2008-01-01

224

[Clinicopathological study of acute esophageal mucosal lesion].  

PubMed

Acute esophageal mucosal lesion (AEML) is a comprehensive disease that includes necrotizing esophagitis and acute erosive esophagitis, which result in upper gastrointestinal bleeding. However, little is known about AEML. We examined the clinicopathological features of 57 AEML cases. AEML presented as acute diffuse esophagitis showing an endoscopically erosive mucosa. The disease did not include corrosive injury, radiation-induced damage, infectious esophagitis, or acute exacerbation of chronic gastroesophageal reflux disease. AEML predominantly affected elderly men, and upper gastrointestinal bleeding was the frequent presenting symptom. Severe underlying diseases such as cranial nerve disease or pneumonia were observed in 98% of the patients. Esophageal sliding hernia and gastroduodenal ulcers were endoscopically observed in 67% and 63% of the patients, respectively. Deaths due to exacerbation of the underlying diseases accounted for 16%. Most cases rapidly improved with conservative management using a proton pump inhibitor or an H2 blocker. Therefore, AEML should be considered a disease having characteristics different from those of common gastroesophageal reflux disease. PMID:23831655

Kawauchi, Hirohito; Ohta, Tomoyuki; Matsubara, Yu; Yoshizaki, Koji; Sakamoto, Jun; Amitsuka, Hisato; Kimura, Keisuke; Maemoto, Atsuo; Orii, Fumika; Ashida, Toshifumi

2013-07-01

225

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

SciTech Connect

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.

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

1991-03-15

226

Effects of transdermal nicotine on lower esophageal sphincter and esophageal motility  

Microsoft Academic Search

Cigarette smoking has been shown to decrease lower esophageal sphincter pressure (LESP) by 19–42%. This decrease in LESP may be due to nicotine in the cigarette smoke or substances other than nicotine. The aim of this study was to evaluate the effects of a nicotine patch on esophageal motility since nicotine patches are devoid of all toxins present in the

Shailesh C. Kadakia; Henry Renom De la Baume; Richard T. Shaffer

1996-01-01

227

IgG4-Related Esophageal Disease Presenting as Esophagitis Dissecans Superficialis With Chronic Strictures  

PubMed Central

IgG4-related disease is a recently recognized autoimmune systemic disorder that has been described in various organs. The disease is characterized histologically by a dense lymphoplasmocytic infiltrate of IgG4-positive cells, storiform fibrosis and can be associated with tumefactive lesions. IgG4-related disease involving the upper gastrointestinal tract is rare and only two previous case reports have reported IgG4-related esophageal disease. We report the case of a 63-year-old female patient with a long-standing history of severe dysphagia and odynophagia with an initial diagnosis of reflux esophagitis. Symptoms persisted despite anti-acid therapy and control esophagogastroduodenoscopy (EGD) revealed endoscopic images consistent with esophagitis dissecans superficialis (sloughing esophagitis). An underlying autoimmune process was suspected and immunosuppressant agents were tried to control her disease. The patient eventually developed disabling dysphagia secondary to multiple chronic esophageal strictures. A diagnosis of IgG4-related disease was eventually made after reviewing esophageal biopsies and performing an immunohistochemical study with an anti-IgG4 antibody. Treatment attempts with corticosteroids and rituximab was not associated with a significant improvement of the symptoms of dysphagia and odynophagia, possibly because of the chronic nature of the disease associated with a high fibrotic component. Our case report describes this unique case of IgG4-related esophageal disease presenting as chronic esophagitis dissecans with strictures. We also briefly review the main histopathological features and treatment options in IgG4-related disease.

Dumas-Campagna, Myriam; Bouchard, Simon; Soucy, Genevieve; Bouin, Mickael

2014-01-01

228

[Changes in mechanical and functional processes of the lower esophageal sphincter in patients with reflux esophagitis].  

PubMed

The present study was performed to establish eventual inferences of functional and mechanical alterations of the lower esophageal sphincter (LES) in determining reflux esophagitis. The LES basal pressure, the percentual incidence of the incoordinate LES relaxations swallowing-induced, the LES overall and abdominal length, with gastroesophageal reflux disease (GERD), with and without endoscopic evidence of esophagitis, were manometrically evaluated in 117 consecutive patients. In patients with symptomatic GERD, a significant LES pressure reduction, which is inversely related to the severity of the endoscopic mucosal damage, an increased prevalence of the incoordinate LES relaxations swallowing-induced and, only in patients with esophagitis, a significant reduction of the LES overall and abdominal length of the LES, were showed. Two or three alterations of the LES antireflux devices can occur in the same patient, thus increasing the risk of esophagitis. PMID:2251450

Pustorino, S; Migliorato, D; Ianni, G; Martinez, P; Guerrisi, O; Federico, G; Luzza, G

1990-06-01

229

Critical Analysis of Esophageal Multichannel Intraluminal Impedance Monitoring 20 Years Later  

PubMed Central

Multichannel intraluminal impedance (MII) for the evaluation of esophageal diseases was created in 1991 trying to solve previous limitations of esophageal function test. MII-pH is able to determine the physical characteristics of the refluxate (liquid, gas, or mixed) and nonacidic GER. MII-manometry can determine the presence of bolus and its relation with peristalsis. This paper makes a critical analysis of the clinical applications of MII 20 years after its creation. Literature review shows that MII made great contributions for the understanding of esophageal physiology; however, direct clinical applications are few. MII-pH was expected to identify patients with normal acid reflux and abnormal nonacidic reflux. These patients are rarely found off therapy, that is, nonacidic reflux parallels acid reflux. Furthermore, the significance of isolated nonacidic reflux is unclear. Contradictory MII-manometry and conventional manometry findings lack better understanding and clinical implication as well as the real significance of bolus transit.

Herbella, Fernando A. M.

2012-01-01

230

InterSCOPE Study: Associations Between Esophageal Squamous Cell Carcinoma and Human Papillomavirus Serological Markers  

PubMed Central

Background The role of human papillomavirus (HPV) in the causation of esophageal squamous cell carcinoma is unclear. We examined the associations between esophageal squamous cell carcinoma and 28 centrally measured HPV serological markers in serum from six existing case–control studies conducted in regions with differing background risks of esophageal cancer. Methods We used centralized multiplex serology to test serum samples from 1561 case subjects and 2502 control subjects from six case–control studies for antibodies to the major HPV capsid protein (L1) and/or the early proteins E6 and/or E7 of eight high-risk, two low-risk, and four cutaneous HPV types. Study-specific odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated using conditional logistic regression with adjustment for smoking, alcohol consumption, and other potential confounders. Pooled odds ratios and 95% confidence intervals were calculated using either a linear mixed-effects approach or a joint fixed-effects approach. All statistical tests were two-sided. Results We found statistically significant associations between esophageal squamous cell carcinoma and antibodies to E6 for HPV16 (OR = 1.89, 95% CI = 1.09 to 3.29, P = .023) and HPV6 (OR = 2.53, 95% CI = 1.51 to 4.25, P < .001) but not for other tested HPV types. There were no statistically significant associations between esophageal squamous cell carcinoma and antibodies to E7 for any of the tested HPV types. Simultaneous seropositivity for HPV16 E6 and E7 was rare (four case subjects, two control subjects; OR = 5.57, 95% CI = 0.90 to 34.35; P = .064). We also found statistically significant associations between esophageal squamous cell carcinoma and capsid antibodies for the high-risk mucosal type HPV33 L1 (OR = 1.30, 95% CI = 1.00 to 1.69; P = .047) and the low-risk mucosal types HPV6 (OR = 1.22, 95% CI = 1.05 to 1.42; P = .010) and HPV11 (OR = 1.30, 95% CI = 1.09 to 1.56, P = .0036). Conclusions We found limited serological evidence of an association between esophageal squamous cell carcinoma and HPV in the populations studied. Although HPV does not appear to be an important risk factor for esophageal squamous cell carcinoma, we cannot exclude the possibility that certain HPV types may be involved in a small subset of cancers.

Egger, Sam; Urban, Margaret I.; Taylor, Philip R.; Abnet, Christian C.; Boffetta, Paolo; O'Connell, Dianne L.; Whiteman, David C.; Brennan, Paul; Malekzadeh, Reza; Pawlita, Michael; Dawsey, Sanford M.; Waterboer, Tim; Webb, Penelope M.; Green, Adele C.; Hayward, Nicholas K.; Zaridze, David; Holcatova, Ivana; Mates, Dana; Szeszenia-Dabrowska, Neonila; Ferro, Gilles; Janout, Vladimir; Curado, Maria Paula; Menezes, Ana Maria; Koifman, Sergio; Islami, Farhad; Nasrollahzadeh, Dariush; Hu, Nan; Goldstein, Alisa M.; Gao, Ying; Ding, Ti; Kamangar, Farin

2012-01-01

231

Improved Esophageal Fistula Closure Devices for Cattle and Sheep.  

National Technical Information Service (NTIS)

This publication describes a redesigned esophageal fistula plug and an esophageal cannula. These closure devices set forth state-of-the-art structural design, are more rugged, require minimal time to construct, and are relatively light when compared with ...

D. M. Anderson D. L. Mertz W. E. Franklin P. J. Manz

1985-01-01

232

Genetics Home Reference: Esophageal atresia/tracheoesophageal fistula  

MedlinePLUS

... OMIM Genetic disorder catalog Conditions > Esophageal atresia/tracheoesophageal fistula (often shortened to EA/TEF ) On this page: ... 2012 What is EA/TEF? Esophageal atresia/tracheoesophageal fistula (EA/TEF) is a condition resulting from abnormal ...

233

Smoking, Drinking Combo Raises Odds for Esophageal Cancer  

MedlinePLUS

... sharing features on this page, please enable JavaScript. Smoking, Drinking Combo Raises Odds for Esophageal Cancer Study ... 25, 2014 Related MedlinePlus Pages Alcohol Esophageal Cancer Smoking FRIDAY, April 25, 2014 (HealthDay News) -- People who ...

234

Chemoprevention of esophageal squamous cell carcinoma  

SciTech Connect

Esophageal squamous cell carcinoma (SCC) is responsible for approximately one-sixth of all cancer-related mortality worldwide. This malignancy has a multifactorial etiology involving several environmental, dietary and genetic factors. Since esophageal cancer has often metastasized at the time of diagnosis, current treatment modalities offer poor survival and cure rates. Chemoprevention offers a viable alternative that could well be effective against the disease. Clinical investigations have shown that primary chemoprevention of this disease is feasible if potent inhibitory agents are identified. The Fischer 344 (F-344) rat model of esophageal SCC has been used extensively to investigate the biology of the disease, and to identify chemopreventive agents that could be useful in human trials. Multiple compounds that inhibit tumor initiation by esophageal carcinogens have been identified using this model. These include several isothiocyanates, diallyl sulfide and polyphenolic compounds. These compounds influence the metabolic activation of esophageal carcinogens resulting in reduced genetic (DNA) damage. Recently, a few agents have been shown to inhibit the progression of preneoplastic lesions in the rat esophagus into tumors. These agents include inhibitors of inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), vascular endothelial growth factor (VEGF) and c-Jun [a component of activator protein-1 (AP-1)]. Using a food-based approach to cancer prevention, we have shown that freeze-dried berry preparations inhibit both the initiation and promotion/progression stages of esophageal SCC in F-344 rats. These observations have led to a clinical trial in China to evaluate the ability of freeze-dried strawberries to influence the progression of esophageal dysplasia to SCC.

Stoner, Gary D. [Division of Hematology and Oncology, Department of Internal Medicine, Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, OH 43210 (United States)], E-mail: gary.stoner@osumc.edu; Wang Lishu; Chen Tong [Division of Hematology and Oncology, Department of Internal Medicine, Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, OH 43210 (United States)

2007-11-01

235

[Primary herpetic esophageal infection in an immunocompetent patient].  

PubMed

Herpetic esophageal primary infection is not a common event in immunocompetent patients. The case of a 27-year-old immunocompetent woman who developed herpetic esophagitis involving the whole esophagus as a manifestation of primary herpetic infection is presented. The endoscopic appearance initially suggested esophageal candidiasis, which is not an exceptional event. PMID:9044750

Montalvo, I I; Yuste, R; Rodríguez, F; Gil, I; Castiella, A; Alzate, L F; Arenas, J I

1996-12-01

236

Oropharyngeal and esophageal interrelationships in patients with nonobstructive dysphagia.  

PubMed

Normal swallowing requires the close functional coordination of the mouth, pharynx, and esophagus, and if one of these components becomes functionally impaired, it is likely that the others may be affected. Using videofluoroscopy and manometry in this study, we examined the esophageal phase of swallowing in 12 patients with oropharyngeal dysphagia (group A) and the oropharyngeal components of swallowing in 29 patients with esophageal motor dysfunction and nonobstructive dysphagia (group B). A wide range of esophageal function abnormalities was seen in the first group, including delayed esophageal body peristalsis, spontaneous or simultaneous (tertiary) contractions, esophageal body dilation, proximal bolus redirection, and poor lower esophageal sphincter relaxation. Manometrically, 92% of group A patients were classified as having nonspecific esophageal motility disorder (NSEMD). In a similar fashion, group B patients exhibited many oropharyngeal function abnormalities on videofluorography including disturbed lingual peristalsis, slowed pharyngeal transit time with poor constriction of pharyngeal muscles, and laryngeal vestibular and tracheal bolus penetration. Manometrically, group B patients were classified as having NSEMD, achalasia, diffuse esophageal spasm, nutcracker esophagus, scleroderma, and chronic intestinal pseudoobstruction. In conclusion, oropharyngeal function is significantly altered in patients with esophageal motility disorders and dysphagia, and esophageal motor dysfunction occurs in patients with oropharyngeal dysphagia. These changes may represent either a compensatory mechanism or concomitant involvement of the oropharynx or the esophagus by the underlying neuromotor disorder. We suggest that assessment by esophageal motility and videofluoroscopy of both the oropharyngeal and esophageal phases of swallowing may improve diagnosis and therapy in patients with nonobstructive dysphagia. PMID:1551345

Triadafilopoulos, G; Hallstone, A; Nelson-Abbott, H; Bedinger, K

1992-04-01

237

Caustic esophageal strictures in children: 30 years’ experience  

Microsoft Academic Search

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

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

2003-01-01

238

pH Protocol  

NSDL National Science Digital Library

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.

The GLOBE Program, UCAR (University Corporation for Atmospheric Research)

2005-06-02

239

Differential Effects of TRPV1 Antagonists in Acid-induced Excitation of Esophageal Vagal Afferent Fibers of Rats  

PubMed Central

Gastro-esophageal acid reflux can stimulate esophageal vagal sensory afferents by activating proton-sensitive ion channel transient receptor vanilloid one (TRPV1). The objective of this study was to investigate the response characteristics of vagal afferent fibers of rats to acid (0.1N HCl) and capsaicin (CAP) following esophagitis and differential effects of two classes of TRPV1 antagonists on responses of vagal afferent fibers. The chronic reflux was induced by ligating the fundus of the stomach and partial constriction of pylorus. Extracellular single fiber recordings were made from the cervical vagal afferent fibers from naďve control and fundus-ligated (FL) esophagitis rats. Innervations of fibers were identified to esophageal distension (ED) and subsequently tested to CAP and acid before and after injection of TRPV1 antagonist JYL1421 or AMG9810 (10?mol/kg, i.v.). Seventy-five vagal afferent fibers from 70 rats were identified to ED. Intra-esophageal CAP (0.1ml of 1mg/ml) excited 39.5% (17/43, 5/22 from naďve and 12/21 from FL rats) fibers. In contrast, intravenous (i.v.) injection of CAP (0.03–0.3 ?mol/kg) dose-dependently excited 72% (42/58) fibers. Responses to CAP were significantly greater for fibers from FL rats (n=32) than naďve rats (n=25). TRPV1 antagonists JYL1421 and AMG9810 (10 ?mol/kg) significantly blocked response to CAP. Intra-esophageal acid infusion stimulated 5/17 (29.4%) fibers from naďve rats and 12/28 (42%) from FL rats. Effect of acid was significantly blocked by AMG9810, but not by JYL1421. Results indicate that following esophagitis the number of fibers responsive to CAP and acid is greater than non-inflamed esophagus, which may contribute to esophageal hypersensitivity. Acid-induced excitation of vagal sensory afferents can be differentially attenuated by different classes of TRPV1 antagonists. Therefore, TRPV1 antagonists play a key role in attenuation of hypersensitivity following reflux-induced esophagitis. The use of TRPV1 antagonists could be an alternative to the traditional symptoms based treatment of chronic acid reflux and esophageal hypersensitivity.

Peles, S.; Medda, B. K.; Zhang, Zhihong; Banerjee, B.; Lehmann, A.; Shaker, R.; Sengupta, J.N.

2009-01-01

240

Pathomorphology of esophageal and gastric varices.  

PubMed

In this article, the gross pathology of varices and supplying veins are described comparing esophageal varices and varices of the cardia and fundus of the stomach. The angioarchitecture of the lower esophagus is such that normally very thin parallel veins in the lamina propria mucosae in the palisade zone become enlarged in portal hypertension and join the few larger submucosal veins to form esophageal varices. Enlarged parallel veins come to pile up and join the submucosal veins at an acute angle, rendering this area vulnerable to rupture. Most ruptures occur in this critical area. The basic differences between esophageal and gastric varices are the layers in which the varicose veins form: the lamina propria mucosae and submucosa in the esophageal varices and the submucosa in gastric varices. While cardiac veins and varices are continuous with esophageal varices, fundic varices develop independently as part of a splenogastrorenal shunt that runs through the stomach wall, having rare communications with other veins. The fundic varix is so large in caliber that when it ruptures, the muscularis mucosae and lamina propria are penetrated with massive bleeding. The treatment of varices calls for complete thrombosis of all varicose veins, and merits and demerits of available treatment modalities are discussed based on autopsies from the pathologic point of view. Because of the large size, the management of fundic varices is difficult, and the new technique called balloon-occluded retrograde transvenous obliteration for occluding fundic varices is discussed. PMID:11928080

Arakawa, Masahiro; Masuzaki, Takao; Okuda, Kunio

2002-02-01

241

FOLFOX-6 Induction Chemotherapy Followed by Esophagectomy and Post-operative Chemoradiotherapy in Patients With Esophageal Adenocarcinoma  

ClinicalTrials.gov

Adenocarcinoma of the Esophagus; Adenocarcinoma of the Gastroesophageal Junction; Adenocarcinoma of the Gastric Cardia; Stage IIIA Esophageal Cancer; Stage IIIB Esophageal Cancer; Stage IIIC Esophageal Cancer

2014-01-20

242

Evolution of a physiological pH 6.8 bicarbonate buffer system: Application to the dissolution testing of enteric coated products  

Microsoft Academic Search

The use of compendial pH6.8 phosphate buffer to assess dissolution of enteric coated products gives rise to poor in vitro–in vivo correlations because of the inadequacy of the buffer to resemble small intestinal fluids. A more representative and physiological medium, pH6.8 bicarbonate buffer, was developed to evaluate the dissolution behaviour of enteric coatings. The bicarbonate system was evolved from pH7.4

Fang Liu; Hamid A. Merchant; Rucha P. Kulkarni; Maram Alkademi; Abdul W. Basit

2011-01-01

243

Airway and Esophageal Stenting in Patients with Advanced Esophageal Cancer and Pulmonary Involvement  

PubMed Central

Background Most inoperable patients with esophageal-advanced cancer (EGC) have a poor prognosis. Esophageal stenting, as part of a palliative therapy management has dramatically improved the quality of live of EGC patients. Airway stenting is generally proposed in case of esophageal stent complication, with a high failure rate. The study was conducted to assess the efficacy and safety of scheduled and non-scheduled airway stenting in case of indicated esophageal stenting for EGC. Methods and Findings The study is an observational study conducted in pulmonary and gastroenterology endoscopy units. Consecutive patients with EGC were referred to endoscopy units. We analyzed the outcome of airway stenting in patients with esophageal stent indication admitted in emergency or with a scheduled intervention. Forty-four patients (58±\\?8 years of age) with esophageal stenting indication were investigated. Seven patients (group 1) were admitted in emergency due to esophageal stent complication in the airway (4 fistulas, 3 cases with malignant infiltration and compression). Airway stenting failed for 5 patients. Thirty-seven remaining patients had a scheduled stenting procedure (group 2): stent was inserted for 13 patients with tracheal or bronchial malignant infiltration, 12 patients with fistulas, and 12 patients with airway extrinsic compression (preventive indication). Stenting the airway was well tolerated. Life-threatening complications were related to group 1. Overall mean survival was 26+/?10 weeks and was significantly shorter in group 1 (6+/?7.6 weeks) than in group 2 (28+/?11 weeks), p<0.001). Scheduled double stenting significantly improved symptoms (95% at day 7) with a low complication rate (13%), and achieved a specific cancer treatment (84%) in most cases. Conclusion Stenting the airway should always be considered in case of esophageal stent indication. A multidisciplinary approach with initial airway evaluation improved prognosis and decreased airways complications related to esophageal stent. Emergency procedures were rarely efficient in our experience.

Paganin, Fabrice; Schouler, Laurent; Cuissard, Laurent; Noel, Jean Baptiste; Becquart, Jean-Philippe; Besnard, Mathieu; Verdier, Laurent; Rousseau, Denis; Arvin-Berod, Claude; Bourdin, Arnaud

2008-01-01

244

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

PubMed Central

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.

Dobrucali, Ahmet; Caglar, Erkan

2010-01-01

245

TRANSIENT LOWER ESOPHAGEAL SPHINCTER RELAXATION IN ACHALASIA: EVERYTHING BUT LES RELAXATION  

PubMed Central

Background: In conducting clinical high resolution esophageal pressure topography (HREPT) studies we observed that after subjects sat upright between series of supine and upright test swallows, they frequently had a transient lower esophageal sphincter relaxation (tLESR). When achalasia patients were studied in the same protocol, they exhibited a similar HREPT event leading to the hypothesis that achalasics had incomplete tLESRs. Methods: We reviewed clinical HREPT studies of 94 consecutive non-achalasics and 25 achalasics. Studies were analyzed for a tLESR-like event during the study and, when observed, that tLESR-like event was characterized for the degree and duration of distal esophageal shortening, the degree of LES relaxation, associated crural diaphragm (CD) inhibition, esophageal pressurization, and upper esophageal sphincter (UES) relaxation. Results: 64/94 (68%) non-achalasics and 15/24 (63%) of achalasics had a pressure topography event after the posture change characterized by a prolonged period of distal esophageal shortening and/or LES relaxation. Events among the non-achalasics and achalasics were similar in terms of magnitude and duration of shortening and all were associated with CD inhibition. Similar proportions had associated non-deglutitive UES relaxations. The only consistent differences were the absence of associated LES relaxation and the absence of HREPT evidence of reflux among the achalasics leading us to conclude that their events were incomplete tLESRs. Conclusions: Achalasic patients exhibit a selective defect in the tLESR response suggesting preservation of all sensory, central, and efferent aspects of the requisite neural substrate with the notable exception of LES relaxation, a function of inhibitory (nitrergic) myenteric plexus neurons.

KWIATEK, Monika A.; POST, Jennifer; PANDOLFINO, John E.; KAHRILAS, Peter J.

2009-01-01

246

O-6-methylguanine-deoxyribonucleic acid methyltransferase methylation enhances response to temozolomide treatment in esophageal cancer  

PubMed Central

Background: World-wide, esophageal cancer is a growing epidemic and patients frequently present with advanced disease that is surgically inoperable. Hence, chemotherapy is the predominate treatment. Cytotoxic platinum compounds are mostly used, but their efficacy is only moderate. Newer alkylating agents have shown promise in other tumor types, but little is known about their utility in esophageal cancer. Methods: We utilized archived human esophageal cancer samples and esophageal cancer cell lines to evaluate O-6-methylguanine-deoxyribonucleic acid methyltransferase (MGMT) hypermethylation status and determined sensitivity to the alkylating drug temozolomide (TMZ). Immunoblot analysis was performed to determine MGMT protein expression in cell lines. To assess and confirm the effect of TMZ treatment in a methylated esophageal cancer cell line in vivo, a mouse flank xenograft tumor model was utilized. Results: Nearly 71% (12/17) of adenocarcinoma and 38% (3/8) of squamous cell carcinoma (SCC) patient samples were MGMT hypermethylated. Out of four adenocarcinoma and nine SCC cell lines tested, one of each histology was hypermethylated. Immunoblot analyses confirmed that hypermethylated cell lines did not express the MGMT protein. In vitro cell viability assays showed the methylated Kyse-140 and FLO cells to be sensitive to TMZ at an IC50 of 52-420 ?M, whereas unmethylated cells Kyse-410 and SKGT-4 did not respond. In an in vivo xenograft tumor model with Kyse-140 cells, which are MGMT hypermethylated, TMZ treatment abrogated tumor growth by more than 60%. Conclusion: MGMT methylation may be an important biomarker in subsets of esophageal cancers and targeting by TMZ may be utilized to successfully treat these patients.

Hasina, Rifat; Surati, Mosmi; Kawada, Ichiro; Arif, Qudsia; Carey, George B.; Kanteti, Rajani; Husain, Aliya N.; Ferguson, Mark K.; Vokes, Everett E.; Villaflor, Victoria M.; Salgia, Ravi

2013-01-01

247

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

PubMed

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

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

2014-05-01

248

Surgical treatment of intractable esophagitis.  

PubMed Central

An operative technique combining a 360-degree fundoplication which is stabilized by anchoring the gastroesophageal junction to the middle arcuate ligament was used in a series of 140 patients since 1973. The patients were evaluated 1 year or more after surgery with clinical and radiographic assessment, regardless of complaints. Clinical results have been good in 91%. There has been no operative mortality and minor transient morbidity. X-rays done at least 1 year after surgery were compared with results obtained in 88 patients who had a modification of Hill's posterior gastropexy performed during the earlier years of this experience. The incidence of x-ray abnormalities with the posterior gastropexy was reduced from 23.5% to 5% when fundoplication was used in combination with a posterior gastropexy. The anchorage of the esophagogastric junction to the middle arcuate ligament allows a relatively loose fundoplication and thereby has reduced the incidence of disabling gas-bloat. Stabilizing the fundoplication prevents the occurrence of other complications related to fundoplication such as disruption, migration, and obstruction. This technique avoids the use of sutures in the esophageal wall, thus reducing the potential for perforation, fistula, or injury to the vagus nerves.

Gregorie, H B; Cathcart, R S; Gregorie, R J

1984-01-01

249

Recent developments in esophageal adenocarcinoma.  

PubMed

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

Lagergren, Jesper; Lagergren, Pernilla

2013-01-01

250

2011 update on esophageal achalasia  

PubMed Central

There have been some breakthroughs in the diagnosis and treatment of esophageal achalasia in the past few years. First, the introduction of high-resolution manometry with pressure topography plotting as a new diagnostic tool has made it possible to classify achalasia into three subtypes. The most favorable outcome is predicted for patients receiving treatment for type II achalasia (achalasia with compression). Patients with typeI(classic achalasia) and type III achalasia (spastic achalasia) experience a less favorable outcome. Second, the first multicenter randomized controlled trial published by the European Achalasia Trial group reported 2-year follow-up results indicating that laparoscopic Heller myotomy was not superior to endoscopic pneumatic dilation (PD). Although the follow-up period was not long enough to reach a convincing conclusion, it merits the continued use of PD as a generally available technique in gastroenterology. Third, the novel endoscopic technique peroral endoscopic myotomy is a promising option for treating achalasia, but it requires increased experience and cautious evaluation. Despite all this good news, the bottom line is a real breakthrough from the basic studies to identify the actual cause of achalasia that may impede treatment success is still anticipated.

Chuah, Seng-Kee; Hsu, Pin-I; Wu, Keng-Liang; Wu, Deng-Chyang; Tai, Wei-Chen; Changchien, Chi-Sin

2012-01-01

251

Pharyngeal pump and esophageal transit.  

PubMed

In deglutition the pharynx appears to act as a pump to "inject" boluses into the esophagus. A new method for measuring the velocity profile of the leading edge of a radionuclide bolus has been developed and applied to boluses of different viscosity--water and treacle--in nine normal volunteers. The results show that the more viscous bolus (treacle) acquires a slower initial "injection" velocity (152 mm/sec vs 236 mm/sec) that only propels it over the proximal half of the esophagus. Peristaltic action must drive the bolus over the distal half. With water boluses, however, the higher initial velocity is sufficient to propel a part of the bolus at least to the gastroesophageal junction leaving minimal "work" to be performed by esophageal peristalsis. This confirms the important role of the pharyngeal pump in deglutition. The pump may be the major mechanism for ingestion of nonviscous liquids (water), peristalsis merely being required to "sweep up" what remains in the esophagus. PMID:3665679

Buthpitiya, A G; Stroud, D; Russell, C O

1987-11-01

252

Early esophageal carcinoma treated with intracavitary irradiation  

SciTech Connect

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.

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

1985-08-01

253

Herpetic Esophagitis in Immunocompetent Medical Student  

PubMed Central

Esophagitis caused by herpes simplex virus (HSV) is often documented during periods of immunosuppression in patients infected with human immunodeficiency virus (HIV); it is rare in immunocompetent diagnosed patients. Case reports of herpetic esophagitis in students of health sciences are extremely rare. The disease presents with a clinical picture characterized by acute odynophagia and retrosternal pain without obvious causes and ulcers, evidenced endoscopically in the middistal esophagus. Diagnosis depends on endoscopy, biopsies for pathology studies, and immunohistochemistry techniques. The disease course is often benign; however, treatment with acyclovir speeds the disappearance of symptoms and limits the severity of infection. In this report, we present a case of herpetic esophagitis in an immunocompetent medical student, with reference to its clinical features, diagnosis, and treatment. The disease may have manifested as a result of emotional stress experienced by the patient.

Marinho, Andreia Vidica; Bonfim, Vinicius Mendes; de Alencar, Luciana Rodrigues; Pinto, Sebastiao Alves; de Araujo Filho, Joao Alves

2014-01-01

254

Bidirectional esophageal dilatation in pharyngoesophageal stenosis postradiotherapy.  

PubMed

Severely stenosed radiation-induced benign strictures around the level of cricopharyngeus post-radical chemoradiation for head and neck or upper esophageal cancers pose significant management problems. We report our technique of bidirectional assessment and dilatation of pharyngoesophageal strictures in patients with an in situ percutaneous endoscopic gastrostomy (PEG) tube. The upper gastrointestinal surgeon approached the area of stenosis in a retrograde manner through the PEG tube to guide the otolaryngeal surgeon who performed anterograde dilatation via a rigid laryngoscope. Between 2005 and 2009, bidirectional esophageal dilatation was performed on 5 patients at our institution. Video fluoroscopy confirmed improved patency of stenosed esophagus in all cases and good improvement in swallowing ability in 4 patients. The ability to accurately assess pharyngoesophageal strictures using bidirectional visualization and transillumination is the key modification of our technique. We suggest using bidirectional esophageal dilatation on difficult cases with severe pharyngoesophageal stenoses although extreme care is required. PMID:22473569

Gavriel, Haim; Duong, Cuong; Spillane, John; Sizeland, Andrew

2013-05-01

255

Proton Beam Therapy and Concurrent Chemotherapy for Esophageal Cancer  

SciTech Connect

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.

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

256

MicroRNAs and esophageal cancer  

PubMed Central

Cancer of the esophagus is a highly aggressive disease associated with an overall poor prognosis. There is an insistent need for improving our understanding of the molecular basis of this disease. The recent emergence of observations on the role of microRNAs in cancer and their potential as biomarkers has prompted many investigations to examine their relevance to esophageal cancer. This article provides an introduction to microRNA biology and the techniques involved in studying them, and summates what is now known about their role and utility in regard to neoplastic esophageal diseases.

Patnaik, Santosh Kumar; Mallick, Reema

2010-01-01

257

Steroid treatment of eosinophilic esophagitis in adults.  

PubMed

Topical steroid therapy has been used to treat eosinophilic esophagitis (EoE) for more than 15 years. We review the treatment trials of topical steroid therapy in adult patients with EoE. Currently, there is no commercially available preparation designed to deliver the steroid to the esophagus. Current regimens consist of swallowing steroid preparations designed for inhalation treatment for asthma. In the short term, steroids are associated with an approximately 15% to 25% incidence of asymptomatic esophageal candidiasis, but otherwise appear to be well tolerated. PMID:24813521

Alexander, Jeffrey A

2014-06-01

258

Eosinophilic esophagitis: interactions with gastroesophageal reflux disease.  

PubMed

Gastroesophageal reflux disease (GERD) and eosinophilic esophagitis (EoE) are not mutually exclusive. The notion that GERD and EoE can be distinguished by the response to proton pump inhibitor (PPI) treatment is based on the mistaken assumption that gastric acid suppression is the only important therapeutic effect of PPIs, and therefore only GERD can respond to PPIs. We believe that a clinical or histologic response to PPIs does not rule in GERD or rule out EoE. We recommend a trial of PPI therapy for patients with symptomatic esophageal eosinophilia, even if the diagnosis of EoE seems clear-cut. PMID:24813513

Cheng, Edaire; Souza, Rhonda F; Spechler, Stuart Jon

2014-06-01

259

Technological advances in radiotherapy for esophageal cancer  

PubMed Central

Radiotherapy with concurrent chemotherapy and surgery represent the main treatment modalities in esophageal cancer. The goal of modern radiotherapy approaches, based on recent technological advances, is to minimize post-treatment complications by improving the gross tumor volume definition (positron emission tomography-based planning), reducing interfraction motion (image-guided radiotherapy) and intrafraction motion (respiratory-gated radiotherapy), and by better dose delivery to the precisely defined planning target volume (intensity-modulated radiotherapy and proton therapy). Reduction of radiotherapy-related toxicity is fundamental to the improvement of clinical results in esophageal cancer, although the dose escalation concept is controversial.

Vosmik, Milan; Petera, Jiri; Sirak, Igor; Hodek, Miroslav; Paluska, Petr; Dolezal, Jiri; Kopacova, Marcela

2010-01-01

260

Etiology, diagnosis and treatment of infectious esophagitis  

PubMed Central

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.

Kierzkiewicz, Maciej

2013-01-01

261

Duodenal reflux produces hyperproliferative epithelial esophagitis—A possible precursor to esophageal adenocarcinoma in the rat  

Microsoft Academic Search

Esophageal reflux of duodenal contents converts a rat nitrosamine esophageal cancer model from squamous cell carcinoma to\\u000a adenocarcinoma. Further, there was a tendency for male rats to have a higher incidence of cancer than female rats. However,\\u000a chemical castration with the gonadotropin-releasing hormone analog leuprolide did not protect male or female animals from\\u000a developing cancer. We have identified an early

Colman K. Byrnes; Anil Bahadursingh; Nabeel Akhter; Narasimham L. Parinandi; Viswanathan Natarajan; Elizabeth Montgomery; Tarik Tihan; Mark D. Duncan; Petra H. Nass; John W. Harmon

2003-01-01

262

IgG4-Related Esophageal Disease Presenting as Esophagitis Dissecans Superficialis With Chronic Strictures.  

PubMed

IgG4-related disease is a recently recognized autoimmune systemic disorder that has been described in various organs. The disease is characterized histologically by a dense lymphoplasmocytic infiltrate of IgG4-positive cells, storiform fibrosis and can be associated with tumefactive lesions. IgG4-related disease involving the upper gastrointestinal tract is rare and only two previous case reports have reported IgG4-related esophageal disease. We report the case of a 63-year-old female patient with a long-standing history of severe dysphagia and odynophagia with an initial diagnosis of reflux esophagitis. Symptoms persisted despite anti-acid therapy and control esophagogastroduodenoscopy (EGD) revealed endoscopic images consistent with esophagitis dissecans superficialis (sloughing esophagitis). An underlying autoimmune process was suspected and immunosuppressant agents were tried to control her disease. The patient eventually developed disabling dysphagia secondary to multiple chronic esophageal strictures. A diagnosis of IgG4-related disease was eventually made after reviewing esophageal biopsies and performing an immunohistochemical study with an anti-IgG4 antibody. Treatment attempts with corticosteroids and rituximab was not associated with a significant improvement of the symptoms of dysphagia and odynophagia, possibly because of the chronic nature of the disease associated with a high fibrotic component. Our case report describes this unique case of IgG4-related esophageal disease presenting as chronic esophagitis dissecans with strictures. We also briefly review the main histopathological features and treatment options in IgG4-related disease. PMID:24883156

Dumas-Campagna, Myriam; Bouchard, Simon; Soucy, Genevieve; Bouin, Mickael

2014-08-01

263

Evolution of a physiological pH 6.8 bicarbonate buffer system: application to the dissolution testing of enteric coated products.  

PubMed

The use of compendial pH 6.8 phosphate buffer to assess dissolution of enteric coated products gives rise to poor in vitro-in vivo correlations because of the inadequacy of the buffer to resemble small intestinal fluids. A more representative and physiological medium, pH 6.8 bicarbonate buffer, was developed to evaluate the dissolution behaviour of enteric coatings. The bicarbonate system was evolved from pH7.4 Hanks balanced salt solution to produce a pH 6.8 bicarbonate buffer (modified Hanks buffer, mHanks), which resembles the ionic composition and buffer capacity of intestinal milieu. Prednisolone tablets were coated with a range of enteric polymers: hypromellose phthalate (HP-50 and HP-55), cellulose acetate phthalate (CAP), hypromellose acetate succinate (HPMCAS-LF and HPMCAS-MF), methacrylic acid copolymers (EUDRAGIT® L100-55, EUDRAGIT® L30D-55 and EUDRAGIT® L100) and polyvinyl acetate phthalate (PVAP). Dissolution of coated tablets was carried out using USP-II apparatus in 0.1M HCl for 2h followed by pH 6.8 phosphate buffer or pH 6.8 mHanks bicarbonate buffer. In pH 6.8 phosphate buffer, the various enteric polymer coated products displayed rapid and comparable dissolution profiles. In pH 6.8 mHanks buffer, drug release was delayed and marked differences were observed between the various coated tablets, which is comparable to the delayed disintegration times reported in the literature for enteric coated products in the human small intestine. In summary, the use of pH 6.8 physiological bicarbonate buffer (mHanks) provides more realistic and discriminative in vitro release assessment of enteric coated formulations compared to compendial phosphate buffer. PMID:21255647

Liu, Fang; Merchant, Hamid A; Kulkarni, Rucha P; Alkademi, Maram; Basit, Abdul W

2011-05-01

264

Perception of Syllable Stress in Esophageal Speech.  

ERIC Educational Resources Information Center

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…

Walker, Christopher Niles; Morris, Hughlett L.

1988-01-01

265

21 CFR 876.5365 - Esophageal dilator.  

Code of Federal Regulations, 2010 CFR

...hollow and weighted with mercury or a metal olive-shaped weight that slides on a guide, such as a string or wire and is used to dilate a stricture of the esophagus. This generic type of device includes esophageal or gastrointestinal bougies and the...

2009-04-01

266

The ultraflex esophageal and diamond biliary stents.  

PubMed

This article begins with an overview of the history and development of stents. The material properties unique to the Ultraflex esophageal stent and the Diamond biliary stent along with their clinical benefits are presented in detail. The author also provides detailed product information, recommendations, and contraindications for the use of both stents. PMID:10388853

Hoffman, D

1999-07-01

267

Endoscopic Laser Therapies For Obstructing Esophageal Tumors  

Microsoft Academic Search

Photodynamic Therapy (PDT) of obstructing esophageal tumors relieves dysphagia and improves quality of life. Low laser light doses are effective, with a high correlation between the tissue dose and the depth of tumor necrosis. Compared to NdYAG laser therapy, PDT is better tolerated and results in greater palliation of longer duration. Few complications are associated with either therapy.

Stephen K. Heier; Kathleen Rothman; Lawrence M. Heier; William S. Rosenthal

1990-01-01

268

Tracheal Trifurcation Associated With Esophageal Atresia  

PubMed Central

We report a newborn with esophageal atresia (EA) in whom right tracheal bronchus (TB) and a tracheal diverticulum were identified intra-operatively. The right TB was further confirmed on MRI scan performed post-operatively. Such a tracheal trifurcation associated with EA has not been reported hitherto from Indian subcontinent.

2010-01-01

269

Thoracoscopic treatment of benign esophageal tumors  

PubMed Central

Introduction Gastrointestinal stromal tumors are among the most frequent mesenchymal tumors of the gastrointestinal tract; the incidence of these tumors in the esophagus is less than 5%. Prognosis depends on localization, size, mitotic activity and possible invasion of surrounding structures. Minimally invasive surgery may be maximally utilized for removal of these tumors from the esophageal wall. This operation is usually performed thoracoscopically or laparoscopically and using the “rendez-vous” method – with endoscopic navigation. Aim To evaluate a set of patients with benign tumor of the esophagus who were operated on at the First Department of Surgery from 2006 to 2011. Material and methods In the years 2006-2011 a total of 11 patients with benign tumors of the esophagus underwent operation. Results Of the 11 patients with esophageal tumor, 5 were diagnosed with gastrointestinal stromal tumor, 5 with leiomyoma and in one patient the lesion was described as heterotopy of the pancreas. We used the minimally invasive rendez-vous method with endoscopic navigation in 9 cases. All patients healed primarily and were released from hospital on the 4th-7th day. These patients are being followed up as outpatients and recurrence of the tumor has not been observed in any of them. Conclusions Minimally invasive treatment of benign tumors of the esophageal wall is considered to the method of choice. Due to possible complications and the need for subsequent therapy in some patients, these procedures should be centralized to departments with experience in esophageal, thoracic and minimally invasive surgery.

Neoral, Cestmir; Aujesky, Rene; Skarda, Jozef; Vrba, Radek; Chudacek, Josef; Vomackova, Katherine

2012-01-01

270

Diet and esophageal cancer in calvados (France)  

Microsoft Academic Search

The role of nutrients and food factors in relation to esophageal cancer was observed in a large case?control study in a region having a high incidence of the disease. Several factors that increased or decreased the risk were identified. After adjusting for other covariates, we found that animal proteins and polyunsaturated fats had a significant protective effect. Separating the effects

Albert J. Tuyns; Elio Riboli; Gerda Doornbos; Georges Péquignot

1987-01-01

271

Esophagobronchial fistula caused by traction esophageal diverticulum  

Microsoft Academic Search

Fistulization is a rare and not often described complication of esophageal diverticula. We present the case of a patient treated surgically in our service who had a history of diverticulum of the third distal of the esophagus, and was diagnosed for irritative post-ingestive cough with associated regurgitation and vomiting of undigested food.

Angel López; Pedro Rodr??guez; Norberto Santana; Jorge Freixinet

2003-01-01

272

Effect of pH on the anaerobic acidogenesis of agroindustrial wastewaters for maximization of bio-hydrogen production: A lab-scale evaluation using batch tests.  

PubMed

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 (0.642molH2/mol equivalent glucose consumed), whereas the maximum VFAs concentration (i.e. 13.43g/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 11g/L) before its further bioconversion to butyric acid and hydrogen. PMID:24759638

Dareioti, Margarita Andreas; Vavouraki, Aikaterini Ioannis; Kornaros, Michael

2014-06-01

273

Elimination diets in the management of eosinophilic esophagitis  

PubMed Central

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.

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

2014-01-01

274

Influence of endoscopic submucosal dissection on esophageal motility  

PubMed Central

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.

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

2013-01-01

275

Should patients with esophageal atresia be submitted to esophageal substitution before they start walking?  

PubMed

Esophagocoloplasty and gastric transposition are two major methods for esophageal substitution in children with esophageal atresia, and there is broad agreement that these operations should not be performed before the children start walking. However, there are some reported advantages of performing such operations in the first months of life or in the neonatal period. In this study, we compared our experience with esophageal substitution procedures performed in walking children with esophageal atresia, with the outcomes of children who had the operation before the third month of life reported in the literature. The purpose of this study was to establish if we have to wait until the children start walking before indicating the esophageal replacement procedure. From February 1978 to October 2009, 129 children with esophageal atresia underwent esophageal replacement in our hospital (99 colonic interpositions and 30 gastric transpositions). The records of these patients were reviewed for data regarding demographics, complications (leaks, graft failures, strictures, and graft torsion), and mortality and compared with those reported in the two main articles on esophageal replacement in the neonatal period or in patients less than 3 months of age. The main complication of our casuistic was cervical anastomosis leakage, which sealed spontaneously in all except in four patients. One patient of the esophagocoloplasty group developed graft necrosis and three patients in the gastric transposition group had gastric outlet obstruction, secondary to axial torsion of the stomach placed in the retrosternal space. The long-term outcome of the patients in both groups was considered good to excellent in terms of normal weight gain, absence of dysphagia, and other gastrointestinal symptoms. The comparisons of the main complications and mortality rates in walking children with esophageal substitutions performed in the first months of life showed that the incidences of cervical anastomotic leaks and graft failures were similar, but mortality rate in the first few months of life was significantly greater than that observed in our group of patients (P= 0.001). Based on the comparison of our results with those of published series, we conclude that the recommendation of performing esophagocoloplasty or total gastric transposition in children with esophageal atresia after they start walking is still valid. PMID:20545969

Tannuri, U; Tannuri, A C A

2011-01-01

276

Effects of neutralizing agents on esophageal burns caused by disc batteries.  

PubMed

The sequelae associated with ingested disc batteries that lodge in the esophagus may include tracheoesophageal fistula, esophageal perforation, stricture formation, or death. The focus of the current investigation is on whether medical therapy can arrest or lessen the severity of the injury during the time required to transport the patient to a center for treatment. A case of esophageal damage from the ingestion of a 1.5-V manganese dioxide disc battery in a 3-year-old boy is reported also. A two-phase study was completed in which the initial phase was an in vitro experiment to identify potable solutions that might neutralize the alkali contained in disc batteries. An in vivo study in 24 cats was undertaken to determine if bolus administration of these solutions would arrest or lessen the severity of the esophageal injury. None of the solutions tested demonstrated a significant difference in the degree of gross or histologic esophageal damage when compared to controls. PMID:3619278

Rivera, E A; Maves, M D

1987-01-01

277

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

PubMed Central

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.

2012-01-01

278

Esophageal acid contact time and heartburn in acute treatment with ranitidine and metoclopramide.  

PubMed

Ranitidine and metoclopramide were compared for their ability to reduce esophageal acid contact time and heartburn. Twelve patients with histories of heartburn received ranitidine 150 mg bid, metoclopramide 10 mg qid, and placebo (ranitidine-matched) bid in a randomized, open-label, crossover fashion. Esophageal pH was monitored with an antimony electrode and portable recording unit for 24 h under strictly controlled laboratory conditions. Ranitidine significantly (p less than or equal to 0.05) reduced 24-h acid contact time from 11.6% to 6.4%. Reflux episode frequency was also significantly (p less than or equal to 0.05) reduced from 82 to 45 episodes per day and from 12 to 2 episodes at night. In contrast, metoclopramide did not reduce 24-h acid contact time or daytime reflux episode frequency, although nighttime episode frequency was significantly (p less than or equal to 0.05) decreased. Only ranitidine significantly reduced heartburn frequency and severity. We conclude that acute treatment with ranitidine, but not metoclopramide, significantly reduces esophageal acid contact time, reflux episode frequency, and heartburn frequency and severity in patients with gastroesophageal reflux. PMID:2191595

Orr, W C; Finn, A; Wilson, T; Russell, J

1990-06-01

279

Esophageal perforation post pneumatic dilatation for achalasia managed by esophageal stenting  

PubMed Central

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.

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

2013-01-01

280

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

PubMed Central

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.

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

2011-01-01

281

Detection of esophageal ulcerations with technetium-99m albumin sucralfate  

SciTech Connect

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.

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

1986-07-01

282

Primary esophageal sclerosing mucoepidermoid carcinoma with "tissue eosinophilia"  

PubMed Central

Mucoepidermoid carcinoma (MEC) is a rare primary esophageal malignancy. It is characterized by poor clinical recognition, pre-operative diagnostic challenges and a lack of standardized therapeutic guidelines. We report the clinicopathological features of a hitherto unreported variant of esophageal MEC, sclerosing MEC with “tissue eosinophilia”, in a mid-esophageal location in a 51-year-old female. The diagnosis of the initial biopsy was challenging, because of the small size, poor orientation and inadequate representation of the MEC components. Recognition of the resectability of the tumor prompted surgical resection and enabled a demonstration of the low grade foci containing intermediate cells, mucin pools and the hitherto undescribed presence of stromal sclerosis and tissue eosinophils in esophageal MEC. Heightened clinicopathological awareness of esophageal MEC facilitated a definitive diagnosis and patient management. Increased recognition and global documentation of esophageal sclerosing MEC with “tissue eosinophilia” is necessary to improve the understanding and diagnosis of this malignancy in this location and to improve management guidelines.

Mewa Kinoo, Suman; Maharaj, Kapil; Singh, Bhugwan; Govender, Michelle; Ramdial, Pratistadevi Kanaye

2014-01-01

283

[Diagnosis of esophageal neoplasms by sponge biopsy (I)].  

PubMed

Fifty-one (51) patients with carcinoma of the esophagus, 27 with cancer of the gastric fundus invading gastroesophageal junction, and 28 controls with non-tumoral esophageal problems were studied by the sponge biopsy technique, an effective procedure for cytologyc diagnosis of esophageal tumors. Various advantages of this technique over esophageal washings are described and results with the sponge biopsy technique are favorably compared with them. PMID:829078

Poleo, J R; Vegas, H J

1975-01-01

284

Esophageal Impairment in Adult Celiac Disease With Steatorrhea  

Microsoft Academic Search

Objective:A high prevalence of reflux esophagitis in celiac children and gut motor disorders in adult patients have been described. The aim of this study is to investigate the prevalence of esophageal symptoms and the esophageal motility pattern in adult celiac patients before and after gluten-free diet.Methods:In 22 consecutive adult celiac patients, before and after gluten-free diet, and in controls we

Paola Iovino; Carolina Ciacci; Francesco Sabbatini; Dinete Mota Acioli; Giuseppe D'Argenio; Gabriele Mazzacca

1998-01-01

285

Eosinophilic esophagitis and food impaction: an instructive case.  

PubMed

Although the key features of eosinophilic esophagitis have been increasingly described over recent years, this entity is still often not considered and consequently diagnosis is often either not made or delayed. Typical endoscopic findings may be present. The diagnosis of eosinophilic esophagitis, however, relies on the histological assessment of mucosal biopsies. This case report highlights a common pattern of presentation of eosinophilic esophagitis and demonstrates the importance of considering this diagnosis. PMID:22798122

Tilakaratne, Samantha; Day, Andrew; Lemberg, Daniel

2012-06-01

286

Black esophagus (acute esophageal necrosis) after spinal anesthesia.  

PubMed

Acute esophagic necrosis or black esophagus is an uncommon clinical entity that owes its name to the endoscopic view of the necrotic esophageal mucosa. It is always related with a critical medical condition and usually has an ischemic etiology. We report the first case of acute esophageal necrosis after a spinal anesthetic for partial hip joint arthroplasty. We discuss the underlying pathophysiological mechanisms. PMID:24054057

Román Fernández, A; López Álvarez, A; Fossati Puertas, S; Areán González, I; Varela García, O; Viańo López, P M

2014-01-01

287

Use of a continuing medical education course to improve fellows' knowledge and skills in esophageal disorders.  

PubMed

Advanced esophageal endoscopic procedures such as stricture dilation, hemostasis tools, and stent placement as well as high-resolution manometry (HRM) interpretation are necessary skills for gastroenterology fellows to obtain during their training. Becoming proficient in these skills may be challenging in light of higher complication rates compared with diagnostic procedures and infrequent opportunities to practice these skills. Our aim was to determine if intensive training during a continuing medical education (CME) course boosts the knowledge and skills of gastroenterology fellows in esophageal diagnostic test interpretation and performance of therapeutic procedures. This was a pretest-posttest design without a control group of a simulation-based, educational intervention in esophageal stricture balloon dilation and HRM interpretation. The participants were 24 gastroenterology fellows from 21 accredited US training programs. This was an intensive CME course held in Las Vegas, Nevada from August 7 to August 9, 2009. The research procedure had two phases. First, the subjects were measured at baseline (pretest) for their knowledge and procedural skill. Second, the fellows received 6 hours of education sessions featuring didactic content, instruction in HRM indications and interpretation, and deliberate practice using an esophageal stricture dilation model. After the intervention, all of the fellows were retested (posttest). A 17-item checklist was developed for the esophageal balloon dilation procedure using relevant sources, expert opinion, and rigorous step-by-step procedures. Nineteen representative HRM swallow studies were obtained from Northwestern's motility lab and formed the pretest and posttest in HRM interpretation. Mean scores on the dilation checklist improved 81% from 39.4% (standard deviation [SD]= 33.4%) at pretest to 71.3% (SD = 29.5%) after simulation training (P < 0.001). HRM mean examination scores increased from 27.2% (SD = 16.4%) to 46.5% (SD = 15.8%), representing a 71% improvement (P < 0.001). Pearson's correlations indicated there was no correlation between pretest performance, medical knowledge measured by United States Medical Licensing Examination examinations, prior clinical experience, or procedural self-confidence and posttest performance of esophageal dilation or HRM interpretation. The education program was rated highly. This study demonstrated that a CME course significantly enhanced the technical skills and knowledge of gastroenterology fellows in esophageal balloon dilation and HRM interpretation. CME courses such as this may be a valuable adjunct to standard fellowship training in gastroenterology. PMID:21309911

Kim, H C; Pandolfino, J E; Komanduri, S; Hirano, I; Cohen, E R; Wayne, D B

2011-08-01

288

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

NASA Astrophysics Data System (ADS)

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.

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

289

Desmoglein-1 regulates esophageal epithelial barrier function and immune responses in eosinophilic esophagitis.  

PubMed

The desmosomal cadherin desmoglein-1 (DSG1) is an essential intercellular adhesion molecule that is altered in various human cutaneous disorders; however, its regulation and function in allergic disease remains unexplored. Herein, we demonstrate a specific reduction in DSG1 in esophageal biopsies from patients with eosinophilic esophagitis (EoE), an emerging allergic disorder characterized by chronic inflammation within the esophageal mucosa. Further, we show that DSG1 gene silencing weakens esophageal epithelial integrity, and induces cell separation and impaired barrier function (IBF) despite high levels of desmoglein-3. Moreover, DSG1 deficiency induces transcriptional changes that partially overlap with the transcriptome of inflamed esophageal mucosa; notably, periostin (POSTN), a multipotent pro-inflammatory extracellular matrix molecule, is the top induced overlapping gene. We further demonstrate that IBF is a pathological feature in EoE, which can be partially induced through the downregulation of DSG1 by interleukin-13 (IL-13). Taken together, these data identify a functional role for DSG1 and its dysregulation by IL-13 in the pathophysiology of EoE and suggest that the loss of DSG1 may potentiate allergic inflammation through the induction of pro-inflammatory mediators such as POSTN. PMID:24220297

Sherrill, J D; Kc, K; Wu, D; Djukic, Z; Caldwell, J M; Stucke, E M; Kemme, K A; Costello, M S; Mingler, M K; Blanchard, C; Collins, M H; Abonia, J P; Putnam, P E; Dellon, E S; Orlando, R C; Hogan, S P; Rothenberg, M E

2014-05-01

290

The evaluation of esophageal stenting complications in palliative treatment of dysphagia related to esophageal cancer  

PubMed Central

Summary Background Esophageal cancer is the seventh-most frequent cause of cancer-related deaths and it is usually diagnosed at an inoperable stage. In palliative treatment, endoscopic and non-endoscopic methods are applied to reduce dysphagia in patients with neoplastic esophageal obstruction. Because of severe complications, non-endoscopic treatment (surgery, radiotherapy, brachytherapy and chemotherapy) is applied rarely. Within the endoscopic methods, only the use of endoprostheses yields long-term effects. The aim of this study was to evaluate the safety and efficacy of implantation of self-expandable esophageal stents in palliative treatment of dysphagia related to esophageal cancer. Material/Methods A total number of 46 patients (41 males and 5 females) were qualified to palliative implantation of coated self-expandable stent. The mean age of the patients was 67 years (from 51 to 78 years). In all patients, Evolution-type coated self-expandable stents were used. In all cases, 24 hours after the implantation, radiological examination was performed to assess the stent location. Results Severe, possibly life-threatening, complications constituted 28% of all the complications and occurred in 9% of the patients. Less severe complications occurred in 17% of the observed patients and were not life-threatening. Conclusions In patients with neoplastic esophageal stenosis, stenting with coated, self-expandable nitinol prostheses is a safe, effective and fast method of palliative dysphagia treatment.

Kujawski, Krzysztof; Stasiak, Magdalena; Rysz, Jacek

2012-01-01

291

Evaluation and treatment of esophageal varices in the cirrhotic patient.  

PubMed

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

Ashkenazi, Eyal; Kovalev, Yulia; Zuckerman, Eli

2013-02-01

292

A sequence variant in the phospholipase C epsilon C2 domain is associated with esophageal carcinoma and esophagitis.  

PubMed

A single-nucleotide polymorphism (rs2274223: A5780G:His1927Arg) in the phospholipase C epsilon gene (PLC?) was recently identified as a susceptibility locus for esophageal cancer in Chinese subjects. To determine the underlying mechanisms of PLC? and this SNP in esophageal carcinogenesis, we analyzed PLC? genotypes, expression, and their correlation in esophageal cancer cell lines, non-transformed esophageal cells, 58 esophageal squamous cell carcinomas and 10,614 non-cancer subjects from China. We found that the G allele (AG or GG) was associated with increased PLC? mRNA and protein expression in esophageal cancer tissues and in esophageal cancer cell lines. G allele was also associated with higher enzyme activity, which might be associated with increased protein expression. Quantitative analysis of the C2 domain sequences revealed that A:G allelic imbalance was strongly linked to esophageal malignancy. Moreover, the analysis of 10,614 non-cancer subjects demonstrated that the G allele was strongly associated with moderate to severe esophagitis in the subjects from the high-incidence areas of China (OR 6.03, 95% CI 1.59-22.9 in high-incidence area vs. OR 0.74, 95% CI 0.33-1.64 in low-incidence area; P?=?0.008). In conclusion, the PLC? gene, particularly the 5780G allele, might play a pivotal role in esophageal carcinogenesis via upregulating PLC? mRNA, protein, and enzyme activity, and augmenting inflammatory process in esophageal epithelium. Thus, 5780G allele may constitute a promising biomarker for esophageal squamous cell carcinoma risk stratification, early detection, and progression prediction. PMID:23390063

Wang, Li-Dong; Bi, Xiuli; Song, Xin; Pohl, Nicole M; Cheng, Yulan; Zhou, Yixing; Shears, Stephen; Ansong, Emmanuel; Xing, Mengtao; Wang, Shaomeng; Xu, Xiao-Chun; Huang, Peng; Xu, Liyan; Wang, Liang; Fan, Zongmin; Zhao, Xueke; Dong, Huali; Meltzer, Stephen J; Ding, Ivan; Yang, Wancai

2013-11-01

293

Acquired Tracheoesophageal Fistula through Esophageal Diverticulum in Patient Who Had a Prolonged Tracheostomy Tube - A Case Report -  

PubMed Central

Acquired tracheoesophageal fistula through esophageal diverticulum is infrequent. We report tracheoesophageal fistula through esophageal diverticulum in a 55-year-old male who had a prolonged tracheostomy tube during 6 months, and a NG tube during 18 months. He suffered from recurrent pneumonia. He complained of a cough associated with eating, and production of sputum mixed with food. To help evaluate the aspiration to the lung and the cause of aspiration, he was tested using gastrointestinal scintigraphy (gastric emptying study), a chest CT scan (pre & post contrast), and esophagoduodenoscopy. The chest CT scan revealed an acquired tracheoesophageal fistula through esophageal diverticulum, and esophagoduodenoscopy revealed a 3 mm sized fistula that was located -33 cm from the upper incisor. We treated the tracheoesophageal fistula by clipping under esophagoduodenoscopy. The symptoms of fever, cough, and aspiration were no long observed after the clipping was completed.

Jung, Jae Hwan; Kim, Ji Sung

2011-01-01

294

Current strategies in chemoradiation for esophageal cancer  

PubMed Central

Chemoradiotherapy (CRT) has an important role in the treatment of esophageal cancer in both the inoperable and the pre-operative settings. Pre-operative chemoradiation therapy is generally given to 41.4-50.4 Gy with platinum or paclitaxel based chemotherapy. The most common definitive dose in the U.S. is 50-50.4 Gy. New advances in CRT for esophageal cancer have come from looking for ways to minimize toxicity and maximize efficacy. Recent investigations for minimizing toxicity have focused advanced radiation techniques such as IMRT and proton therapy, have sought to further define normal tissue tolerances, and have examined the use of tighter fields with less elective clinical target volume coverage. Efforts to maximize efficacy have included the use of early positron emission tomography (PET) response directed therapy, molecularly targeted therapies, and the use of tumor markers that predict response.

Lloyd, Shane

2014-01-01

295

Neoadjuvant treatment for esophageal squamous cell carcinoma  

PubMed Central

Squamous cell carcinoma and adenocarcinoma are types of esophageal cancer, one of the most aggressive malignant diseases. Since both histological types present entirely different diseases with different epidemiology, pathogenesis and tumor biology, separate therapeutic strategies should be developed against each type. While surgical resection remains the dominant therapeutic intervention for patients with operable esophageal squamous cell carcinoma (ESCC), alternative strategies are actively sought to reduce the frequency of post-operative local or distant disease recurrence. Such strategies are particularly sought in the preoperative setting. Currently, the optimal management of resectable ESCC differs widely between Western and Asian countries (such as Japan). While Western countries focus on neoadjuvant or definitive chemoradiotherapy, neoadjuvant chemotherapy followed by surgery is the standard treatment in Japan. Importantly, each country and region has established its own therapeutic strategy from the results of local randomized control trials. This review discusses the current knowledge, available data and information regarding neoadjuvant treatment for operable ESCC.

Baba, Yoshifumi; Watanabe, Masayuki; Yoshida, Naoya; Baba, Hideo

2014-01-01

296

Determination of regional esophageal transit in children by means of krypton-8 1m  

SciTech Connect

Radionuclide methods using Tc-99m have been developed in the last few years for the assessment of the esophageal transit. The method is physiologic, easy to perform and giving thus interesting informations concerning the severity of the disease as well as the effect of the applied treatment. In children, however, one is limited by radiation protection considerations, and the results are often of poor quality due to the low count rate. Furthermore, the risk of external contamination and the impossibility of repeating the test constitute significant disadvantages, particularly in young children. These problems are completely avoided by using Krypton-8lm diluted in a glucose solution. For each swallowing about 8 mCi of Kr-8 lm are administered. Sixty one-second frames are recorded and several parameters of regional transit can be extracted in a few minutes, using time activity curves and parametric images. The test is very sensitive in detecting minor regional transit alterations. The reproducibility of the test is good and phenomenons like intercurrent gastro-esophageal reflux or asynergic peristaltic waves can easily be detected. The test has been applied to 52 children, aged 1 week to 19 years, and provided helpful information concerning the localization and the importance of transit abnormalities in caustic and peptic esophagitis, postoperative cases (atresia or antireflux plasty) and in patients with neuromuscular disorders.

Piepsz, A.; Ham, H.R.; Georges, B.; Delaet, M.H.; Cadranel, S.

1984-01-01

297

Diagnosis and Recognition of Early Esophageal Neoplasia  

Microsoft Academic Search

Barrett’s esophagus (BE) is the precursor lesion of esophageal adenocarcinoma, a malignancy with increasing incidence in Western countries. Malignant transformation of Barrett’s metaplasia is a multistep process in which intestinal metaplasia progresses through low-grade and high-grade dysplasia into eventually invasive cancer. Several risk factors for the development of BE have been identified. The degree of dysplasia is currently used as

László Herszényi; István Pregun; Zsolt Tulassay

2009-01-01

298

Effect of Postnatal Maturation on the Mechanisms of Esophageal Propulsion in Preterm Human Neonates: Primary and Secondary Peristalsis  

PubMed Central

OBJECTIVES The changes in esophageal propulsive characteristics during maturation are not known. Our aim was to define the effects of postnatal maturation on esophageal peristaltic characteristics in preterm human neonates. We tested the hypotheses that: (i) maturation modifies esophageal bolus propulsion characteristics, and (ii) the mechanistic characteristics differ between primary and secondary peristalsis. METHODS Esophageal motility in 10 premature neonates (mean 27.5 weeks gestational age) was evaluated twice at 33.8 weeks (time 1, earlier study) and 39.2 weeks (time 2, later study) mean postmenstrual age. Esophageal manometry waveform characteristics (amplitude and duration, peristaltic velocity, and intrabolus pressure domains) were analyzed during spontaneous primary peristalsis and infusion-induced secondary peristalsis. Repeated-measures and unstructured variance–covariance or compound symmetry matrixes were used for statistical comparison. Values stated as least squares means±s.e.m. or percent. RESULTS A total of 200 primary peristalsis and 227 secondary peristalsis events were evaluated. Between time 1 and time 2: (i) proximal esophageal waveform amplitude increased (P < 0.02), with primary peristalsis (38±6 vs. 48±7 mm Hg) and with secondary peristalsis (34±6 vs. 46±5 mm Hg); (ii) distal esophageal waveform amplitude was similar (P = NS), with primary peristalsis (42±4 vs. 43±4 mm Hg) and secondary peristalsis (29±3 vs. 32±4 mm Hg); (iii) proximal esophageal waveform onset to peak duration decreased (P = 0.02) with primary (2.6±0.3 vs. 1.9±0.1 s, P < 0.003) and with secondary peristalsis (2.2±0.2 vs. 1.8±0.1 s); (iv) distal esophageal waveform onset to peak duration decreased (P = 0.01) with primary (2.4±0.3 vs. 1.8±0.1 s) and with secondary peristalsis (1.9±0.2 vs. 1.5±0.1 s); (v) effects of identical stimulus volume on intrabolus pressure were similar (P = NS); however, greater infusion volumes (2 vs. 1 ml) generated higher intrabolus pressure at both time 1 and time 2 (both Ps < 0.05). Between primary and secondary peristalsis (mechanistic variable): (i) no differences were noted at either period, with proximal esophageal waveform amplitudes (P = NS); (ii) differences were noted with distal esophageal waveform amplitudes at each time period (P = 0.0002); (iii) no differences were noted with both esophageal waveforms duration at either period (P = NS); (iv) peristaltic velocity was faster with secondary peristalsis than with primary peristalsis at either period (at earlier study, 7.9±1.4 vs. 2.5±1.4 cm/s and at later study 6.2±1.6 vs. 1.2±1.5 cm/s, both Ps < 0.01). CONCLUSIONS In preterm neonates, longitudinal maturation modulates the characteristics of primary and secondary peristalsis. Differences in proximal striated muscle and distal smooth muscle activity during peristalsis are evident. Peristaltic velocity is faster with secondary peristalsis. These findings may represent maturation of central and peripheral neuromotor properties of esophageal bolus propulsion in healthy preterm human neonates.

Gupta, Alankar; Gulati, Parul; Kim, Walter; Fernandez, Soledad; Shaker, Reza; Jadcherla, Sudarshan R.

2013-01-01

299

Lymphocytic Esophagitis: A Diagnosis of Increasing Frequency  

PubMed Central

Background Despite being found with increasing frequency on esophageal biopsies, the clinical significance of lymphocytic esophagitis (LE) remains poorly understood. Goals The primary aim of our study was to characterize the clinical presentation and natural history of LE among adult patients. Study We retrospectively reviewed records for all 81 adult patients at the University of Michigan Medical Center who had a histopathological diagnosis of LE between January 1998 and November 2009. Patient demographics, clinical history, laboratory data, and imaging results from the time of diagnosis were obtained through review of computerized medical records. A telephone survey was conducted to collect natural history data. Results The number of LE diagnoses increased over time, with 81.5% (n=66) of patients being diagnosed in the last three years. The most frequent symptoms at the time of presentation were dysphagia (n=54), chest/abdominal pain (n=36), and heartburn (n=38). The majority (58.6%) of patients reported improvement in their initial gastrointestinal symptoms – most commonly associated with initiation of a proton pump inhibitor. Upon follow-up, most patients reported a good quality of life and satisfaction with their current health status. Conclusions Lymphocytic esophagitis is a new clinical entity with an increasing incidence. LE appears to have a benign natural history, with most patients reporting an improvement in symptoms and satisfaction with their health-related quality of life. Prospective studies are needed to better characterize the natural history and potential treatments for this clinical entity.

Cohen, Shirley; Saxena, Aditi; Waljee, Akbar; Piraka, Cyrus; Purdy, Julianne; Appelman, Henry; McKenna, Barbara; Elmunzer, B. Joseph; Singal, Amit G.

2012-01-01

300

Esophageal perforation: a rare complication of transesophageal echocardiography in a patient with asymptomatic esophagitis.  

PubMed

Transesophageal echocardiography (TEE) is a commonly used procedure in patients with suspected endocarditis. A rare but dreadful complication of this procedure is perforation of the esophagus. We report the case of an elderly female with multiple comorbidities, who presented with polyarticular septic arthritis. TEE was performed to rule out endocarditis. Though the standard procedure protocol was followed, she developed esophageal perforation. It was managed with esophageal stenting but she developed multiorgan failure and did not survive. This case highlights the potential of severe morbidity and mortality associated with TEE. Appropriate screening must be done and high-risk individuals must be identified before such procedures are attempted. PMID:23341798

Ahmed, Kabir; Lal, Yasir; Condron, Steven

2012-09-01

301

Esophageal Varices in Chronic Intestinal Insufficiency in Absence of Portal Hypertension or Liver Cirrhosis: Case Report  

Microsoft Academic Search

We report the case of a 62-year-old man with short-bowel syndrome, referred for intestinal transplantation, who had esophageal varices (EV) due to superior vena cava (SVC) thrombosis. Pretransplantation work-up revealed protein S deficiency. Results of liver function tests were normal. Upper endoscopy showed grade II to III EV in the upper and middle segments of the esophagus. Computed tomography demonstrated

T. Yandza; S. M. Schneider; S. Novellas; L. Badan; M. C. Saint-Paul; P. A. Bounin; A. Rahili; G. Zeanandin; D. Benchimol; J. Gugenheim; X. Hébuterne

2010-01-01

302

Ion transport mechanisms linked to bicarbonate secretion in the esophageal submucosal glands  

PubMed Central

The esophageal submucosal glands (SMG) secrete HCO3? and mucus into the esophageal lumen, where they contribute to acid clearance and epithelial protection. This study characterized the ion transport mechanisms linked to HCO3? secretion in SMG. We localized ion transporters using immunofluorescence, and we examined their expression by RT-PCR and in situ hybridization. We measured HCO3? secretion by using pH stat and the isolated perfused esophagus. Using double labeling with Na+-K+-ATPase as a marker, we localized Na+-coupled bicarbonate transporter (NBCe1) and Cl?-HCO3? exchanger (SLC4A2/AE2) to the basolateral membrane of duct cells. Expression of cystic fibrosis transmembrane regulator channel (CFTR) was confirmed by immunofluorescence, RT-PCR, and in situ hybridization. We identified anion exchanger SLC26A6 at the ducts' luminal membrane and Na+-K+-2Cl? (NKCC1) at the basolateral membrane of mucous and duct cells. pH stat experiments showed that elevations in cAMP induced by forskolin or IBMX increased HCO3? secretion. Genistein, an activator of CFTR, which does not increase intracellular cAMP, also stimulated HCO3? secretion, whereas glibenclamide, a Cl? channel blocker, and bumetanide, a Na+-K+-2Cl? blocker, decreased it. CFTRinh-172, a specific CFTR channel blocker, inhibited basal HCO3? secretion as well as stimulation of HCO3? secretion by IBMX. This is the first report on the presence of CFTR channels in the esophagus. The role of CFTR in manifestations of esophageal disease in cystic fibrosis patients remains to be determined.

Nakhoul, Hani N.; Kalliny, Medhat I.; Gyftopoulos, Alex; Rabon, Edd; Doetjes, Rienk; Brown, Karen; Nakhoul, Nazih L.

2011-01-01

303

Influence of hardness on the wear resistance of 17-4 PH stainless steel evaluated by the pin-on-disc testing  

Microsoft Academic Search

Present work aimed at investigating the wear resistance of AISI 630 (UNS S17400) or 17-4 PH stainless steel hardened by precipitation hardening or aging at various hardness levels. The PHs steels are an interesting family of steels for applying in highly stressed parts for its corrosion resistance and relative high hardness, attaining up to 49 HRC by low-temperature aging heat

J. D. Bressan; D. P. Daros; A. Sokolowski; R. A. Mesquita; C. A. Barbosa

2008-01-01

304

Foreign body impaction as presentation of eosinophilic esophagitis.  

PubMed

Esophageal foreign body is a frequent pediatric presentation, and eosinophilic esophagitis (EoE) is an important underlying disease. To determine characteristics common in the presentation of esophageal foreign body indicative of underlying EoE and reach a recommendation for the appropriate scenario in which to obtain esophageal mucosal biopsy, 312 pediatric esophageal foreign bodies requiring operative removal were reviewed. Patients older than 18 years or with a known history of esophageal surgery or pathology were excluded. Eligibility criteria were met in 271 cases. Twenty-seven patients were biopsied, and 18 were diagnosed with EoE. The following factors were identified in the EoE population: food impaction (89%), older age (average 12.2 years), male sex (78%), atopic disease (61%), previous esophageal foreign body or frequent dysphagia (83%), and endoscopic abnormalities (100%). These factors are all associated with an underlying diagnosis of EoE, and patients meeting these criteria should be strongly considered for intraoperative esophageal mucosal biopsy. PMID:23959816

Hudson, Scott; Sampson, Chris; Muntz, Harlan R; Jackson, W Daniel; Smith, Marshall E

2013-11-01

305

Photodynamic Therapy for Barrett's Esophagus and Esophageal Carcinoma  

PubMed Central

This paper reviews the use of photodynamic therapy (PDT) in patients with Barrett's esophagus and esophageal carcinoma. We describe the history of PDT, mechanics, photosensitizers for PDT in patients with esophageal disease. Finally, we discuss its utility and limitations in this setting.

Qumseya, Bashar J.; David, Waseem

2013-01-01

306

Esophagocutaneous drainage to treat late and complicated esophageal perforation  

Microsoft Academic Search

Five patients with complicated esophageal perforation - three with spontaneous rupture, one with dehiscence after resection of a diverticulum, and one with an iatrogenic lesion - were successfully treated by esophagocutaneous drainage of the esophageal perforation. At thoracotomy, after careful debridement and cleaning of the mediastinum and pleura, a T-tube drain was placed in the esophagus through the perforation in

S. Larsson; G. Pettersson; V. Lepore

2009-01-01

307

Delayed release dexlansoprazole in the treatment of GERD and erosive esophagitis  

PubMed Central

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.

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

2009-01-01

308

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

PubMed

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

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

2009-01-01

309

Making pH Tangible.  

ERIC Educational Resources Information Center

Presents a laboratory exercise in which students test the pH of different substances, study the effect of a buffer on acidic solutions by comparing the behavior of buffered and unbuffered solutions upon the addition of acid, and compare common over-the-counter antacid remedies. (MKR)

McIntosh, Elizabeth; Moss, Robert

1995-01-01

310

Cyclin E involved in early stage carcinogenesis of esophageal adenocarcinoma by SNP DNA microarray and immunohistochemical studies  

PubMed Central

Background Cyclin E is a cell cycle regulator which is critical for driving G1/S transition. Abnormal levels of cyclin E have been found in many cancers. However, the level changes of cyclin E in esophageal adenocarcinoma and its precancerous lesion have not been well studied. Here, we focus on the gene amplification and expression of cyclin E in these lesions, and aim to ascertain the relationship with clinicopathological characteristics. Methods Genomic DNA was analyzed from 116 esophageal adenocarcinoma and 26 precancerous lesion patients using Affymetrix SNP 6.0 arrays. The protein overexpression of cyclin E was also detected using immunohistochemistry from tissue microarrays containing esophageal adenocarcinoma and precancerous lesions. Patient survival and other clinical data were collected and analyzed. The intensity and percentage of the cyclin E expressing cells in tissue microarrays were scored by two pathologists. Fisher exact tests and Kaplan-Meier methods were used to analyze data. Results By genomic analysis, cyclin E was amplified in 19.0% of the EAC samples. By immunohistochemistry, high expression of cyclin E was observed in 2.3% of squamous mucosa tissues, 3.7% in columnar cell metaplasia, 5.8% in Barrett’s esophagus, 19.0% in low grade dysplasia, 35.7% in high grade dysplasia, and 16.7% in esophageal adenocarcinoma. The differences in cyclin E high expression between neoplastic groups and non-dysplasia groups are statistically significant (p?esophageal lesion to low and high grade dysplasia, suggesting that cyclin E plays an important role in the early stage of carcinogenesis. Importantly, cyclin E is also amplified and highly expressed in a subset of esophageal adenocarcinoma patients, but this increase is not associated with worse prognosis.

2014-01-01

311

Depleting ABCE1 expression induces apoptosis and inhibits the ability of proliferation and migration of human esophageal carcinoma cells  

PubMed Central

Objective: This study aims to explore the clinical characteristics of ABCE1 in esophageal cancers and its roles in the proliferation, invasiveness, migration and apoptosis of the esophageal carcinoma Eca109 cell line. Methods: The expression of ABCE1 and its target protein-RNase L, were first studied in tumor tissues of esophageal carcinoma and adjacent non-tumor tissues. The siRNA green fluorescent protein (GFP) expression vector of ABCE1 was prepared and transfected into the esophageal carcinoma Eca109 cells, then the fluorescence microscope was used to study the transfection efficiency. The MTT assay, cell invasion, the transwell and scratch assay were used to study cell proliferation and migration activity; the apoptosis rate was tested by flow cytometry. Western blot and RT-PCR assay were adopted to measure their silencing efficacy. Results: ABCE1 expression is low in the adjacent non-tumor tissues while the expression is high in the esophageal carcinoma; the expression is reversely proportional to the differentiation degrees. The expression of RNase L was in contrary to ABCE1. After transfected with ABCE1-siRNA, the proliferation, invasiveness and migration capabilities of cells decreased significantly whilst the apoptosis rate enhanced greatly (P<0.01). Meanwhile, the expression of ABCE1 in Eca109 cells was blocked (P<0.01) while the expression of RNase L increased significantly (P<0.01). Conclusion: ABCE1 is closely connected with the pathogenesis and development of esophageal carcinoma, which act through the cellular pathways of 2-5A/RNase L.

Huang, Bo; Gong, Xiangnan; Zhou, Hongli; Xiong, Fei; Wang, Siwang

2014-01-01

312

Mediastinal abscess and esophageal stricture following voice prosthesis insertion.  

PubMed

The use of a tracheo-esophageal voice prosthesis is a well-established procedure to restore the voice in total laryngectomees. The insertion of the prosthesis is not a risk-free procedure, various complications having been reported especially in irradiated patients. Here described is a case of an esophageal rupture after secondary tracheo-esophageal puncture with mediastinal abscess in a patient previously treated with pharyngo-laryngectomy and subsequent radiotherapy for a left pyriform sinus carcinoma, which required immediate surgical drainage through a left cervical approach. Few weeks after surgical drainage an esophageal stricture at the site of the rupture developed, which was only temporarily resolved after the insertion of biodegradable esophageal stents, followed by re-stenosis once the reabsorption of the stent took place. PMID:24210965

Bozzo, Corrado; Meloni, Francesco; Trignano, Mario; Profili, Stefano

2014-04-01

313

Stromal cells participate in the murine esophageal mucosal injury response  

PubMed Central

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.

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

2013-01-01

314

Two Fatal Complications after Parallel Tracheal-Esophageal Stenting  

SciTech Connect

Two patients with malignant obstructions of both the trachea and esophagus underwent parallel stent placement with Gianturco-Roesch Z (GRZ) stents for palliation of symptoms. Fatal hemorrhage occurred in both patients 2 and 3 weeks after stent placement respectively. An autopsy performed on one of these patients demonstrated esophageal tissue necrosis and erosion with perforation of both the tracheal and esophageal walls at sites where the stent struts were in direct opposition, leading to bleeding from the esophageal venous plexus. GRZ stents have been successful in the treatment of both solitary tracheal and esophageal stenoses. However, parallel tracheal-esophageal stenting with GRZ stents places patients at high risk for complications due to the high radial force exerted by this particular stent and the minimal amount of intervening tissue between the two structures.

Binkert, Christoph A.; Petersen, Bryan D. [Dotter Interventional Institute, Oregon HealthSciences University, 3181 SW Sam Jackson Park Road, Portland, OR97201-3098 (United States)

2002-03-15

315

Alendronate-induced Esophagitis in an Elderly Woman  

PubMed Central

Ingestion of alendronate sodium (Fosamax) had been reported to sometimes cause erosive or ulcerative esophagitis. Despite its widespread use and several case reports describing the clinical and endoscopic presentation, there has been limited discussion on the histologic appearances of the esophagitis caused by the medication. Here we describe one case of an elderly woman who presented with alendronate-induced esophagitis. The histopathologic changes that make this case unique are the large, “bizarre” squamous epithelial cells and scattered dyskaratotic cells, two findings not well described in previous reports. These unique features add to the histologic spectrum of alendronate-induced esophageal injury, and shall help differentiating this type of esophagitis from those with other etiologies.

Gomez, Victoria; Xiao, Shu-Yuan

2009-01-01

316

pH, healing rate, and symptom relief in patients with GERD.  

PubMed Central

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.

Huang, J. Q.; Hunt, R. H.

1999-01-01

317

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

ClinicalTrials.gov

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

2014-03-17

318

Chicago Classification Criteria of Esophageal Motility Disorders Defined in High Resolution Esophageal Pressure Topography (EPT)†  

PubMed Central

Background The Chicago Classification of esophageal motility was developed to facilitate the interpretation of clinical high resolution esophageal pressure topography (EPT) studies, concurrent with the widespread adoption of this technology into clinical practice. The Chicago Classification has been, and will continue to be, an evolutionary process, molded first by published evidence pertinent to the clinical interpretation of high resolution manometry (HRM) studies and secondarily by group experience when suitable evidence is lacking. Methods This publication summarizes the state of our knowledge as of the most recent meeting of the International High Resolution Manometry Working Group in Ascona, Switzerland in April 2011. The prior iteration of the Chicago Classification was updated through a process of literature analysis and discussion. Key Results The major changes in this document from the prior iteration are largely attributable to research studies published since the prior iteration, in many cases research conducted in response to prior deliberations of the International High Resolution Manometry Working Group. The classification now includes criteria for subtyping achalasia, EGJ outflow obstruction, motility disorders not observed in normal subjects (Distal esophageal spasm, Hypercontractile esophagus, and Absent peristalsis), and statistically defined peristaltic abnormalities (Weak peristalsis, Frequent failed peristalsis, Rapid contractions with normal latency, and Hypertensive peristalsis). Conclusions & Inferences The Chicago Classification is an algorithmic scheme for diagnosis of esophageal motility disorders from clinical EPT studies. Moving forward, we anticipate continuing this process with increased emphasis placed on natural history studies and outcome data based on the classification.

Bredenoord, Albert J; Fox, Mark; Kahrilas, Peter J; Pandolfino, John E; Schwizer, Werner; Smout, AJPM; Conklin, Jeffrey L; Cook, Ian J; Gyawali, Prakash; Hebbard, Geoffrey; Holloway, Richard H; Ke, Meiyun; Keller, Jutta; Mittal, Ravinder K; Peters, Jeff; Richter, Joel; Roman, Sabine; Rommel, Nathalie; Sifrim, Daniel; Tutuian, Radu; Valdovinos, Miguel; Vela, Marcelo F; Zerbib, Frank

2011-01-01

319

Chylothorax after Primary Repair of Esophageal Atresia with Tracheo-esophageal Fistula: Successful Management by Biological Fibrin Glue.  

PubMed

A neonate, who had undergone primary repair of esophageal atresia with tracheo-esophageal fistula, developed right pleural effusion in the postoperative period. It was initially misdiagnosed as an anastomotic leak, but later confirmed to be chylothorax. Conservative treatment failed. Application of biological fibrin glue (sealant) on the mediastinum through a thoracotomy was curative. PMID:23061032

Dhua, Anjan Kumar; Ratan, Simmi K; Aggarwal, Satish K

2012-09-01

320

Chylothorax after Primary Repair of Esophageal Atresia with Tracheo-esophageal Fistula: Successful Management by Biological Fibrin Glue  

PubMed Central

A neonate, who had undergone primary repair of esophageal atresia with tracheo-esophageal fistula, developed right pleural effusion in the postoperative period. It was initially misdiagnosed as an anastomotic leak, but later confirmed to be chylothorax. Conservative treatment failed. Application of biological fibrin glue (sealant) on the mediastinum through a thoracotomy was curative.

Dhua, Anjan kumar; Ratan, Simmi K

2012-01-01

321

Per rectal portal scintigraphy as a useful tool for predicting esophageal variceal bleeding in cirrhotic patients  

PubMed Central

AIM: To investigate potential roles of per rectal portal scintigraphy in diagnosis of esophageal varices and predicting the risk of bleeding. METHODS: Fifteen normal subjects and fifty cirrhotic patients with endoscopically confirmed esophageal varices were included. Patients were categorized into bleeder and non-bleeder groups according to history of variceal bleeding. All had completed per rectal portal scintigraphy using 99mTechnetium pertechnetate. The shunt index was calculated from the ratio of 99mTechnetium pertechnetate in the heart and the liver. Data were analyzed using Student’s t-test and receiver operating characteristics. RESULTS: Cirrhotic patients showed a higher shunt index than normal subjects (63.80 ± 25.21 vs 13.54 ± 6.46, P < 0.01). Patients with variceal bleeding showed a higher shunt index than those without bleeding (78.45 ± 9.40 vs 49.35 ± 27.72, P < 0.01). A shunt index of over 20% indicated the presence of varices and that of over 60% indicated the risk of variceal bleeding. CONCLUSION: In cirrhotic patients, per rectal portal scintigraphy is a clinically useful test for identifying esophageal varices and risk of variceal bleeding.

Chitapanarux, Taned; Praisontarangkul, Ong-ard; Thongsawat, Satawat; Pisespongsa, Pises; Leerapun, Apinya

2007-01-01

322

Relationship between HER-2 overexpression and brain metastasis in esophageal cancer patients  

PubMed Central

AIM: To study if HER-2 overexpression by locally advanced esophageal cancers increase the chance of brain metastasis following esophagectomy. METHODS: We retrospectively reviewed the medical records of esophageal cancer patients who underwent esophagectomy at University of Iowa Hospitals and Clinics between 2000 and 2010. Data analyzed consisted of demographic and clinical variables. The brain metastasis tissue was assayed for HER-2 overexpression utilizing the FDA approved DAKO Hercept Test®. RESULTS: One hundred and forty two patients were reviewed. Median age was 64 years (36-86 years). Eighty eight patients (62%) received neoadjuvant chemoradiotherapy. Pathological complete and partial responses were achieved in 17 (19%) and 71 (81%) patients. Cancer relapsed in 43/142 (30%) patients. The brain was the first site of relapse in 9/43 patients (21%, 95% CI: 10%-36%). HER-2 immunohistochemistry testing of the brain metastasis tissue showed that 5/9 (56%) cases overexpressed HER-2 (3+ staining). CONCLUSION: HER-2 overexpression might be associated with increased risk of brain metastasis in esophageal cancer patients following esophagectomy. Further studies will be required to validate this observation.

Abu Hejleh, Taher; DeYoung, Barry R; Engelman, Eric; Deutsch, Jeremy M; Zimmerman, Bridget; Halfdanarson, Thorvardur R; Berg, Daniel J; Parekh, Kalpaj R; Lynch, William R; Iannettoni, Mark D; Bhatia, Sudershan; Clamon, Gerald

2012-01-01

323

The value of multiple rapid swallows during preoperative esophageal manometry before laparoscopic antireflux surgery  

PubMed Central

Background When multiple swallows are rapidly administered, esophageal peristalsis is inhibited, and pronounced lower esophageal sphincter relaxation ensues. After the last swallow of the series, a robust contraction sequence results. The authors hypothesize that multiple rapid swallows (MRS) may have value in predicting esophageal transit symptoms in patients undergoing laparoscopic antireflux surgery (LARS). Methods Records of patients undergoing esophageal high-resolution manometry (HRM) before LARS were evaluated. The evaluation of MRS included adequate inhibitory response during swallows and the contraction pattern after MRS. Dysphagia was scored based on a product of symptom frequency and severity using 5-point Likert scales. A composite dysphagia score comprised the sum of scores for solid and liquid dysphagia, and a score of 4 or higher was considered clinically significant. The normal and abnormal MRS responses of patients with preoperative, early, and late postoperative dysphagia were compared with those of patients with no dysphagia. Results In this study, 63 patients (mean age, 60.3 ± 1.7 years, 48 women) undergoing HRM before LARS successfully performed MRS (median, 5 swallows; longest interval between swallows, 3.2 ± 0.1 s). After MRS, 14 patients (22.2 %) had an intact peristaltic sequence. Complete failure of peristalsis was seen in 21 (33.3 %), and incomplete esophageal inhibition in 25 (39.7 %) of the remaining patients. When stratified by presence or absence of dysphagia, 58.3 % of the subjects without dysphagia had a normal MRS response, whereas 83.3 % had formation of peristaltic segments after MRS. In contrast, only 14 % of the subjects with dysphagia had a normal MRS response (p ? 0.003 vs. the subjects with no dysphagia). Abnormal MRS responses were more prevalent in the patients with any preoperative and late postoperative dysphagia (p = 0.04 across groups) and in those with clinically significant dysphagia (p = 0.08 across groups). Conclusions High-resolution manometry with MRS helps to predict dysphagia in subjects undergoing preoperative esophageal function testing before LARS.

Stoikes, Nathaniel; Drapekin, Jesse; Kushnir, Vladimir; Shaker, Anisa; Brunt, L. Michael

2014-01-01

324

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

PubMed Central

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.

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

2012-01-01

325

Unilateral Cervical Nodal Metastasis Is an Independent Prognostic Factor for Esophageal Squamous Cell Carcinoma Patients Undergoing Chemoradiotherapy: A Retrospective Study  

PubMed Central

Purpose To determine the prognostic significance of unilateral cervical lymph nodal metastasis (CLNM) in patients with inoperable thoracic esophageal squamous cell carcinoma (SCC) and to identify significant prognostic factors in these patients. Patients and methods This retrospective study involved 395 patients with inoperable esophageal SCC treated with concurrent chemoradiotherapy. The patients were classified into three groups according to their cervical lymph node status: group A, no evidence of CLNM; group B, unilateral CLNM; group C, other distant metastases. Overall survival (OS) and progression-free survival (PFS) were calculated. Significant prognostic factors were identified using univariate and multivariate analyses. Results The 3-year OS rates in groups A, B and C were 46.7%, 33.5% and 8.3%, respectively (p<0.001, log-rank test). The corresponding PFS rates were 40.7%, 26.4% and 4.7% (p<0.001, log-rank test). Group B had a similar prognosis to that of group A and better 3-year OS (p?=?0.009) and PFS (p?=?0.006) rates than those of group C. Multivariate analysis demonstrated that T stage, chemotherapy regimen and cervical lymph node involvement were independent prognostic factors affecting OS and PFS. Conclusions Compared to other distant metastases, unilateral CLNM is associated with longer OS in esophageal SCC and should be regarded as a regional disease. Sex, T stage, concurrent chemotherapy modality and cervical lymph node involvement are independent predictors of survival in esophageal SCC.

Zhao, Lei; Li, Qiao-Qiao; He, Liru; Liu, Shiliang; Shen, Jingxian; Liu, Meng-Zhong

2014-01-01

326

Emerging Therapeutic Options for Eosinophilic Esophagitis  

PubMed Central

Eosinophilic esophagitis (EoE) is a chronic inflammatory condition of the esophagus that often occurs in atopic persons. Management strategies include pharmacotherapy, dietary modification, and endoscopic therapy, although patients will often have a relapsing and remitting course. Currently, the primary pharmacotherapy for EoE consists of corticosteroids. Immuno-modulators, leukotriene antagonists, biologies, and monoclonal antibodies are currently under study for treatment of EoE. The role of immunoglobulin E-mediated allergic reactions has been well documented and may provide insight into the etiology and effective therapy of EoE.

Dougherty, Timothy; Stephen, Sindu; Borum, Marie L.

2014-01-01

327

Strategies to improve outcomes in esophageal adenocarcinoma.  

PubMed

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

Cowie, Andrew; Noble, Fergus; Underwood, Timothy

2014-06-01

328

An optimized lead system for long-term esophageal electrocardiography.  

PubMed

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

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

2014-04-01

329

Endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms  

PubMed Central

Endoscopic resection is an effective treatment for non-invasive esophageal squamous cell neoplasms (ESCNs). Endoscopic mucosal resection (EMR) has been developed for small localized ESCNs as an alternative to surgical therapy because it shows similar effectiveness and is less invasive than esophagectomy. However, EMR is limited in resection size and therefore piecemeal resection is performed for large lesions, resulting in an imprecise histological evaluation and a high frequency of local recurrence. Endoscopic submucosal dissection (ESD) has been developed in Japan as one of the standard endoscopic resection techniques for ESCNs. ESD enables esophageal lesions, regardless of their size, to be removed en bloc and thus has a lower local recurrence rate than EMR. The development of new devices and the establishment of optimal strategies for esophageal ESD have resulted in fewer complications such as perforation than expected. However, esophageal stricture after ESD may occur when the resected area is larger than three-quarters of the esophageal lumen or particularly when it encompasses the entire circumference; such a stricture requires multiple sessions of endoscopic balloon dilatation. Recently, oral prednisolone has been reported to be useful in preventing post-ESD stricture. In addition, a combination of chemoradiotherapy (CRT) and ESD might be an alternative therapy for submucosal esophageal cancer that has a risk of lymph node metastasis because esophagectomy is extremely invasive; CRT has a higher local recurrence rate than esophagectomy but is less invasive. ESD is likely to play a central role in the treatment of superficial esophageal squamous cell neoplasms in the future.

Honda, Kuniomi; Akiho, Hirotada

2012-01-01

330

Reliability-based econometrics of aerospace structural systems: Design criteria and test options. Ph.D. Thesis - Georgia Inst. of Tech.  

NASA Technical Reports Server (NTRS)

The design criteria and test options for aerospace structural reliability were investigated. A decision methodology was developed for selecting a combination of structural tests and structural design factors. The decision method involves the use of Bayesian statistics and statistical decision theory. Procedures are discussed for obtaining and updating data-based probabilistic strength distributions for aerospace structures when test information is available and for obtaining subjective distributions when data are not available. The techniques used in developing the distributions are explained.

Thomas, J. M.; Hanagud, S.

1974-01-01

331

Esophageal assessments of left ventricular filling pressures: A proof-of-concept study  

PubMed Central

Objective: We sought to evaluate if left ventricular filling pressures can be assessed from the esophagus. Background: The invasive assessment of left ventricular filling pressures is of importance in the evaluation and monitoring of critically ill patients. The left atrium is in very close proximity to the esophagus. We hypothesized that the temporal pressure decay characteristics of an esophageal fluid volume positioned at the level ofthe left atrium should depend on the atrial and left ventricular filling pressure. Materials and Methods: In five pigs an esophageal balloon was placed at the level ofthe left atrium. The balloon was then pressurized to 50 mmHg followed by an automated release that allowed us to directly record the pressure decay, while simultaneously recording left atrial pressures. An algorithm was developed to estimate atrial pressures. We also tested if invasive transesophageal atrial pressures can be recorded via an ultrasound guided left atrial puncture. Results: Noninvasive transesophageal assessments of left atrial pressures are feasible. The left atrial pressure directly affects the esophageal pressure decay and correlates with the transition point from an exponential pressure decay to a more linear decay (r = 0.949). This approach also allows for the assessment of atrial waveforms. We could also demonstrate that invasive transesophageal pressure measurements are feasible and safe. Conclusions: The esophagus allows for reproducible less invasive assessments of left ventricular filling pressures and atrial pressure waveforms. This close spatial relationship provides an alternative access site for diagnostic and therapeutic cardiac procedures.

Meyer, Markus; Bell, Stephen P; Sardana, Neeraj; Zubarik, Richard; LeWinter, Martin M; Dauerman, Harold L

2014-01-01

332

Adenoviral-based immunotherapy provides local disease control in an orthotopic murine model of esophageal cancer.  

PubMed

Despite recent advances in the development of novel therapies, esophageal carcinoma remains an aggressive cancer associated with a poor prognosis. The lack of a high throughput, reproducible syngeneic animal model that replicates human disease is partly responsible for the paucity of novel therapeutic approaches. In this report, we present the first successful syngeneic, orthotopic model for esophageal cancer. This model was used to test an established adenoviral-based tumor vaccine. We utilized a murine esophageal cancer cell line established from the ED-L2-cyclin D1;p53 mouse that was transduced to express a viral tumor antigen, the Human Papilloma Virus (HPV) E7 protein. The tumor was established in its natural microenvironment at the gastroesophageal junction. Tumor growth was consistent and reproducible. An adenoviral vaccine to E7 (Ad.E7) induced an E7-specific population of functionally active CD8 T cells that trafficked into the tumors and retained cytotoxicity. Ad.E7 vaccination reduced local tumor growth and prolonged overall survival. These findings suggest that orthotopic tumor growth is a reasonable preclinical model to validate novel therapies. PMID:24810640

Quatromoni, Jon G; Predina, Jarrod D; Bhojnagarwala, Pratik; Judy, Ryan P; Jiang, Jack; De Jesus, Elizabeth M; Kapoor, Veena; Cheng, Guanjun; Okusanya, Olugbenga T; Eruslanov, Evgeniy; Singhal, Sunil

2014-06-01

333

[Recurrent tracheoesophageal fistula in type III esophageal atresia: Diagnosis and treatment are not easy].  

PubMed

Recurrent tracheoesophageal fistula (TEF) is possible after repair of congenital esophageal atresia. The frequency of recurrent TEF is observed in about 10% of the cases. Within a cohort of 67 children with type III esophageal atresia repaired between 1998 and 2009, we aimed to identify the number of children with recurrent TEF, the risk factors for this condition, and the treatment proposed. The sex ratio was 1.7. Surgery was performed between 4 and 36hours of life. Five children (7.5%) had a recurrent TEF, usually during the first 3months, revealed by respiratory symptoms related to feeding in some cases. We noted that recurrent TEF was more frequent with anastomotic leakage (P=0.09) or postsurgical pneumothorax (P<0.01). The diagnosis was made in four cases out of five by a methylene blue test performed during a tracheobronchial endoscopy. Surgical treatment was noted in four children, with three postsurgical secondary effects. One child was treated by endoscopy and an esophageal clip. With a median follow-up of 52months, no recurrence was noted. The recurrence of TEF may be linked to postsurgical events. Diagnosis is not easy and treatment is not clearly codified. Endoscopic treatment may be an advantageous option to surgery, likely with less morbidity. PMID:24856368

Lepeytre, C; Roquelaure, B; de Lagausie, P; Merrot, T; Dubus, J-C

2014-07-01

334

Relation of different grades of esophageal varices with Child-Pugh classes in cirrhosis of liver.  

PubMed

This cross-sectional observational study was conducted in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh over a period of 6 months from October 2011 to April 2012 and was carried out to evaluate the relation of different grades of esophageal varices with Child-Pugh classes of cirrhosis of liver patients. A total 37 patients were included. Child-Pugh score and esophageal varices of each patient were noted. Relation was carried out using the Chi-square test through determining the association of different variables. P value <0.05 was considered significant. Among 37 patients, 27(73%) were male and 10(27%) were female and their frequency of age were found, 7(18.9%) from 18-38 years, 18(48.7%) from 39-59 years and 12(32.4%) from 60 years of age and above. The etiology of liver cirrhosis revealed 18(48.7%) hepatitis B virus, 3(8.1%) hepatitis C virus and 16(43.2%) others causes. Child-Pugh classes were observed 3(8.2%) Class A, 17(45.9%) Class B and 17(45.9%) Class C and grades of esophageal varies were 13(35.1%) F1, 20(54.1%) F2 and 4(10.8%) F3 patients among total. A statistically significant positive relation was found that higher grade of esophageal varices was seen in the more advanced class of Child-Pugh classes with a p value 0.001. PMID:23416806

Sumon, S M; Sutradhar, S R; Chowdhury, M; Khan, N A; Uddin, M Z; Hasan, M I; Rozana, F K; Haque, M F; Barman, T K; Ferdous, J

2013-01-01

335

Esophageal Stenting in the Setting of Malignancy  

PubMed Central

Esophageal cancer is often diagnosed at an advanced stage, with many patients found to have locoregional or metastatic disease at time of diagnosis. Because of this, cure may be unlikely, leading treatment efforts to focus more on symptom palliation and improving patient quality of life. The majority of patients with advanced disease suffer from some degree of dysphagia. Palliative efforts are therefore directed at relieving dysphagia, allowing patients to manage their oropharyngeal secretions, reduce aspiration risk, and maintain caloric intake orally. A variety of endoscopic treatment modalities have been utilized with these objectives in mind, with options determined by the location and size of the tumor, as well as the patient's expected prognosis. In this article, we review the use of endoscopically-placed stents for palliation in patients with advanced esophageal cancer. We discuss the history of stent use in such cases, as well as more recent developments in stent technology. We give an overview of some of the more commonly used stents in practice, discuss the technique of insertion, and survey the short- and long-term outcomes of stent placement.

Martinez, Juan Carlos; Puc, Matthew M.; Quiros, Roderick M.

2011-01-01

336

Hiccups as a Presenting Symptom of Eosinophilic Esophagitis  

PubMed Central

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.

Levy, Alexander N.; Rahaman, Soroya M.; Bonis, Peter A.; Javid, Golrokh; Leung, John

2012-01-01

337

Esophageal Gastrointestinal Stromal Tumor: Diagnostic Complexity and Management Pitfalls  

PubMed Central

Introduction. Gastrointestinal stromal tumors of the esophagus are rare. Case Presentation. This is a case of a 50-year-old male patient who was referred to our department complaining of atypical chest pain. A chest computed tomographic scan and endoscopic ultrasound revealed a submucosal esophageal tumor measuring 5 cm in its largest diameter. Suspecting a leiomyoma, we performed enucleation via right thoracotomy. The pathology report yielded a diagnosis of an esophageal gastrointestinal stromal tumor. The patient has shown no evidence of recurrence one year postoperatively. Conclusions. This report illustrates the complexity and dilemmas inherent in diagnosing and treating esophageal GISTs.

Markakis, Charalampos G.; Spartalis, Eleftherios D.; Liarmakopoulos, Emmanouil; Kavoura, Evangelia G.; Tomos, Periklis

2013-01-01

338

Successful Endoscopic Mucosal Resection of a Low Esophageal Carcinoid Tumor  

PubMed Central

Esophageal carcinoid tumors remain some of the rarest of all carcinoid tumors, with only several cases previously reported in the literature. The endoscopic mucosal resection of selected carcinoid tumors has been shown to be a valid, safe, and effective method of treatment. Endoscopic ultrasonography is the technique of choice to select patients eligible for endoscopic resection. Here, we report successful endoscopic mucosal resection of a low esophageal carcinoid tumor and review the relevant literature. The present case is the first reported case of esophageal carcinoid tumor in Korea.

Lim, Chang Sup; Park, Moo In; Moon, Won; Kim, Hyung Hun; Lee, Jun Sik; Kim, Bong Jin; Ku, Dong Young

2013-01-01

339

An Update on Modern Approaches to Localized Esophageal Cancer  

PubMed Central

Esophageal cancer treatment continues to be a topic of wide debate. Based on improvements in chemotherapy drugs, surgical techniques, and radiotherapy advances, esophageal cancer treatment approaches are becoming more specific to the stage of the tumor and the overall performance status of the patient. While surgery continues to be the standard treatment option for localized disease, the current direction favors multimodality treatment including both radiation and chemotherapy with surgery. In the next few years, we will continue to see improvements in radiation techniques and proton treatment, with more minimally invasive surgical approaches minimizing postoperative side effects, and the discovery of molecular biomarkers to help deliver more specifically targeted medication to treat esophageal cancers.

Welsh, James; Amini, Arya; Likhacheva, Anna; Erasmus, Jeremy; Gomez, Daniel; Davila, Marta; Mehran, Reza J; Komaki, Ritsuko; Liao, Zhongxing; Hofstetter, Wayne L; Bhutani, Manoop; Ajani, Jaffer A

2014-01-01

340

Thoracoscopic enucleation of esophageal leiomyomas: a feasible and safe procedure.  

PubMed

In recent years, minimally invasive approaches have been introduced, providing thoracoscopic/laparoscopic techniques in the treatment of esophageal leiomyomas. We determined the technical feasibility and patient safety of thoracoscopic enucleation of esophageal leiomyomas by evaluation of 10 consecutive patients undergoing this procedure. For the surgical approach, a four-trocar access via the right pleural cavity in single-lung ventilation was chosen. All minimally invasive procedures were successfully completed without conversion to open surgery. Every tumor was completely resected without opening of the mucosa. No relevant intra- or postoperative complications were detected. These data suggest that thoracoscopic enucleation is a feasible and safe procedure for esophageal leiomyomas. PMID:18072062

Vallböhmer, D; Hölscher, A H; Brabender, J; Bollschweiler, E; Gutschow, C

2007-12-01

341

pH Game  

NSDL National Science Digital Library

The purpose of this resource is to teach students about the acidity levels of liquids and other substances around their school so they understand what pH levels tell us about the environment. Students will create mixtures of water samples, soil samples, plants and other natural materials to better understand the importance of pH levels.

The GLOBE Program, UCAR (University Corporation for Atmospheric Research)

2003-08-01

342

Exercise and Pulmonary Hypertension (PH)  

MedlinePLUS

... International PH News and Projects Let Me Breathe Music Video PATIENTS Patients Newly Diagnosed Request an Envelope ... International PH News and Projects Let Me Breathe Music Video Help spread PH awareness and share PH ...

343

Limiting esophageal temperature in radiofrequency ablation of left atrial tachyarrhythmias results in low incidence of thermal esophageal lesions  

PubMed Central

Background Atrio-esophageal fistula formation following radiofrequency ablation of left atrial tachyarrhythmias is a rare but devastating complication. Esophageal injuries are believed to be precursors of fistula formation and reported to occur in up to 47% of patients. This study investigates the incidence of esophageal lesions when real time esophageal temperature monitoring and temperature limitation is used. Methods 184 consecutive patients underwent open irrigated radiofrequency ablation of left atrial tachyarrhythmias. An esophageal temperature probe consisting of three independent thermocouples was used for temperature monitoring. A temperature limit of 40°C was defined to interrupt energy delivery. All patients underwent esophageal endoscopy the next day. Results Endoscopy revealed ulcer formation in 3/184 patients (1.6%). No patient developed atrio-esophageal fistula. Patient and disease characteristics had no influence on ulcer formation. The temperature threshold of 40°C was reached in 157/184 patients. A temperature overshoot after cessation of energy delivery was observed frequently. The mean maximal temperature was 40.8°C. Using a multiple regression analysis creating a box lesion that implies superior- and inferior lines at the posterior wall connecting the right and left encircling was an independent predictor of temperature. Six month follow-up showed an overall success rate of 78% documented as sinus rhythm in seven-day holter ECG. Conclusion Limitation of esophageal temperature to 40°C is associated with the lowest incidence of esophageal lesion formation published so far. This approach may contribute to increase the safety profile of radiofrequency ablation in the left atrium.

2010-01-01

344

Response of the Upper Esophageal Sphincter to Esophageal Distension is Affected by Posture, Velocity, Volume, and Composition of the Infusate  

PubMed Central

Background & Aims Studies of the pressure response of the upper esophageal sphincter (UES) to simulated or spontaneous gastroesophageal reflux have shown conflicting results. These discrepancies could result from uncontrolled influence of variables such as posture, volume, and velocity of distension. We characterized in humans the effects of these variables on UES pressure response to esophageal distension. Methods We studied 12 healthy volunteers (average 27±5 years old, 6 male) using concurrent esophageal infusion and high-resolution manometry to determine UES, lower esophageal sphincter, and intraesophageal pressure values. Reflux events were simulated by distal esophageal injections of room-temperature air and water (5, 10, 20, and 50 ml) in individuals in 3 positions (upright, supine and semi-supine). Frequencies of various UES responses were compared using ?2 analysis. Multinomial logistical regression analysis was used to identify factors that determine the UES response. Results UES contraction and relaxation were the overriding responses to esophageal water and air distension, respectively, in a volume-dependent fashion (P<.001). Water-induced UES contraction and air-induced UES relaxation were the predominant responses among individuals in supine and upright positions, respectively (P<.001). The prevalence of their respective predominant response significantly decreased in the opposite position. Proximal esophageal dp/dt significantly and independently differentiated the UES response to infusion with water or air. Conclusions The UES response to esophageal distension is affected by combined effects of posture (spatial orientation of the esophagus), physical properties, and volume of refluxate, as well as the magnitude and rate of increase in intraesophageal pressure. The UES response to esophageal distension can be predicted using a model that incorporates these factors.

Babaei, Arash; Dua, Kulwinder; Naini, Sohrab Rahimi; Lee, Justin; Katib, Omar; Yan, Ke; Hoffmann, Raymond; Shaker, Reza

2012-01-01

345

Notch receptor inhibition reveals the importance of cyclin D1 and Wnt signaling in invasive esophageal squamous cell carcinoma  

PubMed Central

Esophageal squamous cell carcinoma (ESCC) is one of the most aggressive forms of squamous cell carcinomas. Common genetic lesions in ESCC include p53 mutations and EGFR overexpression, both of which have been implicated in negative regulation of Notch signaling. In addition, cyclin D1 is overexpressed in ESCC and can be activated via EGFR, Notch and Wnt signaling. To elucidate how these genetic lesions may interact during the development and progression of ESCC, we tested a panel of genetically engineered human esophageal cells (keratinocytes) in organotypic 3D culture (OTC), a form of human tissue engineering. Notch signaling was suppressed in culture and mice by dominant negative Mastermind-like1 (DNMAML1), a genetic pan-Notch inhibitor. DNMAML1 mice were subjected to 4-Nitroquinoline 1-oxide-induced oral-esophageal carcinogenesis. Highly invasive characteristics of primary human ESCC were recapitulated in OTC as well as DNMAML1 mice. In OTC, cyclin D1 overexpression induced squamous hyperplasia. Concurrent EGFR overexpression and mutant p53 resulted in transformation and invasive growth. Interestingly, cell proliferation appeared to be regulated differentially between those committed to squamous-cell differentiation and those invading into the stroma. Invasive cells exhibited Notch-independent activation of cyclin D1 and Wnt signaling. Within the oral-esophageal squamous epithelia, Notch signaling regulated squamous-cell differentiation to maintain epithelial integrity, and thus may act as a tumor suppressor by preventing the development of a tumor-promoting inflammatory microenvironment.

Naganuma, Seiji; Whelan, Kelly A; Natsuizaka, Mitsuteru; Kagawa, Shingo; Kinugasa, Hideaki; Chang, Sanders; Subramanian, Harry; Rhoades, Ben; Ohashi, Shinya; Itoh, Hiroshi; Herlyn, Meenhard; Diehl, J Alan; Gimotty, Phyllis A; Klein-Szanto, Andres J; Nakagawa, Hiroshi

2012-01-01

346

Detection of HPV DNA in esophageal cancer specimens from different regions and ethnic groups: a descriptive study  

PubMed Central

Background HPV has been found repeatedly in esophageal carcinoma tissues. However, reported detection rates of HPV DNA in these tumors have varied markedly. Differences in detection methods, sample types, and geographic regions of sample origin have been suggested as potential causes of this discrepancy. Methods HPV L1 DNA and HPV genotypes were evaluated in 435 esophageal carcinoma specimens collected from four geographic regions with different ethnicities including Anyang in north China, Shantou in south China, Xinjiang in west China, and the United States. The HPV L1 fragment was detected using SPF1/GP6+ primers. HPV genotyping was performed using genotype specific PCR. Results Two hundred and forty four of 435 samples (56.1%) tested positive for HPV L1. Significant differences in detection rate were observed neither among the three areas of China nor between China and the US. HPV6, 16, 18, 26, 45, 56, 57, and 58 were identified in L1 positive samples. HPV16 and 57 were the most common types in all regions, followed by HPV26 and HPV18. Conclusions HPV infection is common in esophageal carcinoma independent of region and ethnic group of origin. Findings in this study raise the possibility that HPV is involved in esophageal carcinogenesis. Further investigation with a larger sample size over broader geographic areas may be warranted.

2010-01-01

347

Fish oil-supplemented parenteral nutrition in patients following esophageal cancer surgery: effect on inflammation and immune function.  

PubMed

Our aim was to investigate whether adding ?-3 polyunsaturated fatty acids (PUFAs) to parenteral nutrition (PN) could reduce inflammation and improve immune function in patients following esophageal cancer surgery. In this pilot study, 60 patients with esophageal cancer were divided into 2 groups (30 patients in each group). All patients had total scores of more than or equal to 3 on the nutritional risk screening (NRS2002) test recommended by the European Society of Parenteral Enteral Nutrition, which showed that all patients had nutritional risk and should receive nutritional support. Both groups received isocaloric and isonitrogenous PN. One group received a ?-3 PUFAs supplement. Key indicators of inflammation [serum procalcitonin (PCT) level and the ratio of CD4(+) to CD8(+) (CD4(+)/CD8(+) ratio)] were determined intraoperatively and 24, 72, and 144 h postoperatively. PCT level was notably lower and CD4(+)/CD8(+) ratio was markedly higher in the ?-3 PUFAs group (P = 0.007 for PCT level and P = 0.012 for CD4(+)/CD8(+) ratio) on postoperative day 6 but not on postoperative days 1 and 3. ?-3 PUFAs supplemented PN can reduce inflammation and improve immune function in patients following esophageal cancer surgery. A larger trial is required to see whether ?-3 PUFAs supplementation of PN improves the clinical outcomes of patients following esophageal cancer surgery. PMID:23368915

Long, Hao; Yang, Han; Lin, Yongbin; Situ, Dongrong; Liu, Wanli

2013-01-01

348

The prognostic effect of ethnicity for gastric and esophageal cancer: the population-based experience in British Columbia, Canada  

PubMed Central

Background Gastric and esophageal cancers are among the most lethal human malignancies. Their epidemiology is geographically diverse. This study compares the survival of gastric and esophageal cancer patients among several ethnic groups including Chinese, South Asians, Iranians and Others in British Columbia (BC), Canada. Methods Data were obtained from the population-based BC Cancer Registry for patients diagnosed with invasive esophageal and gastric cancer between 1984 and 2006. The ethnicity of patients was estimated according to their names and categorized as Chinese, South Asian, Iranian or Other. Cox proportional hazards regression analysis was used to estimate the effect of ethnicity adjusted for patient sex and age, disease histology, tumor location, disease stage and treatment. Results The survival of gastric cancer patients was significantly different among ethnic groups. Chinese patients showed better survival compared to others in univariate and multivariate analysis. The survival of esophageal cancer patients was significantly different among ethnic groups when the data was analyzed by a univariate test (p = 0.029), but not in the Cox multivariate model adjusted for other patient and prognostic factors. Conclusions Ethnicity may represent underlying genetic factors. Such factors could influence host-tumor interactions by altering the tumor's etiology and therefore its chance of spreading. Alternatively, genetic factors may determine response to treatments. Finally, ethnicity may represent non-genetic factors that affect survival. Differences in survival by ethnicity support the importance of ethnicity as a prognostic factor, and may provide clues for the future identification of genetic or lifestyle factors that underlie these observations.

2011-01-01

349

A shape memory stent of poly(?-caprolactone-co-DL-lactide) copolymer for potential treatment of esophageal stenosis.  

PubMed

Biodegradable polymer stent with shape memory effect is expected to be developed in the treatment of esophageal stenosis, most likely due to traditional stents having such shortages as considerable rigidity and nondegradation. A tubular stent with the inner and outer diameters of 28 and 30 mm was manufactured from biodegradable poly(?-caprolactone-co-DL-lactide) (PCLA) copolymer consisting of ?-caprolactone and DL-lactide at a weight ratio of 10/90. A series of tests were accomplished to investigate its properties including shape memory effects (SMEs), compression property and influence of in vitro degradation of polymer matrix on its shape recovery and dilation force. Significantly, an implantation of the stent into a dog model was performed to evaluate its function for the treatment of esophageal stenosis. The deformed stent needs about 36 s to recover its initial shape in vitro in 37°C warm water. The primary animal experiment in vivo has revealed that the implanted deformed stent could be triggered by body temperature and expectedly returned to a nearly-round shape to support esophageal wall. Therefore, the biodegradable intelligent polymer stent may be great potential to displace the conventional metallic stents for the esophageal stenosis therapy. PMID:22057969

Yu, Xiongjun; Wang, Lin; Huang, Maotao; Gong, Tao; Li, Wenbing; Cao, Yaling; Ji, Daijin; Wang, Ping; Wang, Jing; Zhou, Shaobing

2012-02-01

350

Overexpression of interleukin-8 receptor 2 (IL-8R2) indicates better prognosis in esophageal adenocarcinoma and squamous cell carcinoma procession.  

PubMed

Researches have showed that interleukin family or receptors play a role in many human tumor progressions including esophageal carcinoma. In this study, we examined the expression of interleukin-8 receptor 2 (IL-8R2) and analyze the relationship between it and esophageal carcinoma clinical characteristics. IL-8R2 protein expression was confirmed by immunohistochemistry and immunofluorescence arrays and was analyzed further via Western blot and qRT-PCR analysis in frozen tissues. The correlation between their expression levels and clinical characteristics were evaluated by Mann-Whitney and Kruskal-Wallis test. Via Kaplan-Meier plots and Cox proportional hazard models, overall survival (OS) was analyzed. Compared with normal esophageal tissue, IL-8R2 protein was overexpressed significantly in esophageal cancer (p < 0.05) and was observed both in cytoplasm and nuclear. The lower expression of IL-8R2 protein was observed with higher p staging of esophageal cancer, and the significant association between them was confirmed (p = 0.000), and in advanced p T stage, the similar result was obtained (p = 0.015); however, compared with lymph node metastasis-negative group, it is no significant difference in positive group (p = 0.152). In a Kaplan-Meier analysis, compared with IL-8R2 low expression, IL-8R2 high expression identified a group of patients with the longest OS. Cox proportional hazard models revealed that IL-8R2 predicted long time to OS. The higher expression of IL-8R2 was found in early esophageal carcinoma, which may indicate that IL-8R2 plays an important role and is better prognostic factor in esophageal cancer development. PMID:24972913

Liang, Bing; Zhao, Hui; Che, Jian-Bo; Wang, Hao-Jie; Shi, Gong-Ning

2014-08-01

351

Esophageal Capsule Endoscopy for Screening Esophageal Varices among Japanese Patients with Liver Cirrhosis  

PubMed Central

Purpose. Although esophageal capsule endoscopy (ECE) is reportedly useful in the diagnosis of esophageal varices (EV), few reports have described the benefits of this technique in Asian countries. The present paper evaluates the usefulness of ECE for diagnosing EV in Japanese patients with cirrhosis. Methods. We examined 29 patients with cirrhosis (20 males and 9 females; mean age 60 years; Child-Pugh classification A/B/C; 14/14/1) using ECE followed by esophagogastroduodenoscopy (EGD). High-risk EV were defined as F2 and/or RC2 and above. Results. The sensitivity and specificity of ECE for the diagnosis of high-risk EV were 92% and 80%, respectively. Conclusions. The findings showed that ECE is a highly sensitive method of diagnosing high-risk EV that requires endoscopic or pharmacological therapy. Thus, ECE might be a useful method for the screening and followup of EV in patients with cirrhosis.

Ishiguro, Haruya; Saito, Shoichi; Imazu, Hiroo; Aihara, Hiroyuki; Kato, Tomohiro; Tajiri, Hisao

2012-01-01

352

Esophageal involvement in epidermolysis bullosa dystrophica: clinical and roentgenographic manifestations.  

PubMed

Epidermolysis bullosa is a rare hereditary mechanobullous skin disorder. Four patients with esophageal involvement are reported. These cases and review of reported cases of epidermolysis bullosa dystrophica-recessive (EBD-R) showed distinct clinical and roentgenographie features of esophageal involvement: diffuse inflammatory changes, motility disorders, small blisters or bullae seen as constant nodular-filling defects, esophageal ulcers, scars, pseudodiverticula, transverse and circumferential webs, various size strictures, shortening of the esophagus with development of traction hiatal hernia and gastroesophageal reflux, perforation, and complete obstruction of the esophageal lumen. Dysphagia is reversible when caused by bullae or webs and permanent when due to cicatrizing strictures. The strictures may remain unchanged in size for many years despite variations in dysphagic symptoms. PMID:6852425

Agha, F P; Francis, I R; Ellis, C N

1983-01-01

353

Synchronous squamous esophageal carcinoma and urothelial renal cancer.  

PubMed

Synchronous development of a second primary cancer in patients with esophageal squamous cell carcinoma was reported in 2.73%-11% of the cases. Although the synchronous association between esophageal and renal cancer is very rare, an increasingly number of cases is reported in medical literature. This study's aim is to report a case of synchronous esophageal squamous cell carcinoma and an urothelial carcinoma of the right kidney. Patient G.D. was admitted in our clinic with esophageal cancer diagnosis; during the preoperative work-up protocol, an asymptomatic right renal mass was discovered. A nephroureteroscopy with biopsy was performed and the urothelial renal cancer diagnosis was established. The patient is proposed for seriate surgery: nephroureterectomy on the first stage, then esophagectomy with gastric reconstruction was performed. Postoperative evolution was unfavourable, patient being finally discharged, on his request, with severely altered status. PMID:21351703

Vilcea, I D; Vasile, I; Tomescu, P; Mirea, C; Vilcea, A M; Stoica, L; Mesina, C; Dumitrescu, T; Cheie, M; Enache, M A

2010-01-01

354

Cetuximab and Chemoradiotherapy for Locally Advanced Esophageal Cancer  

Cancer.gov

In this trial, patients with locally advanced esophageal cancer will undergo chemoradiotherapy using the drugs cisplatin and paclitaxel, and half of them will be randomly assigned to also receive the biologic agent cetuximab.

355

Squamous dysplasia - the precursor lesion for esophageal squamous cell carcinoma  

PubMed Central

Esophageal squamous cell carcinoma (ESCC) accounts for 80% of all esophageal cancers worldwide, and esophageal squamous dysplasia (ESD) is the only histopathology that predicts the development of ESCC. The prevalence of ESD parallels rates of invasive ESCC, and is typically found in 25% or more of adults above the age of 35 years in populations in north central China, where risk for ESCC is among the highest in the world. Results of chemoprevention and early detection studies to prevent progression of ESD suggest that these approaches, coupled with emerging endoscopic therapies, offer promise for the prevention of esophageal cancer mortality in high-risk populations. Future research on ESD and ESCC should focus on finding additional modifiable risk factors and on identifying biomarkers to incorporate into early detection strategies.

Taylor, Philip R; Abnet, Christian C; Dawsey, Sanford M

2013-01-01

356

Drug-induced acute esophageal lesions and use of ciprofloxacin.  

PubMed

We report the case of a 95-year-old woman who had acute esophageal lesions while being treated with oral ciprofloxacin for an acute cystitis. On day 2 of treatment, she reported retroesternal pain with a globus sensation, and presented hematemesis and melena. There was no history of gastric or esophageal disturbances. An upper digestive endoscopy showed bleeding lesions on the middle third of the esophagus. Ciprofloxacin was discontinued and a proton pump inhibitor was administered. One week later, the endoscopic aspect of the esophagus was normal. Only two cases of ciprofloxacin-induced esophageal lesions have been reported previously. A short review of this kind of esophageal injuries is presented, focusing on the main risk factors and preventive measures. PMID:22552134

Santos, V M; Carneiro, M V; Cruz, L R; Paixao, G T G

2012-01-01

357

Metastases of esophageal carcinoma to skeletal muscle: Single center experience  

PubMed Central

Metastases of esophageal carcinoma to the skeletal muscle are rare, but the incidence may be increasing because of better diagnosis resulting from widespread use of positron emission tomography/computed tomography (PET/CT). A cohort of 205 patients with esophageal carcinoma treated at our center who had PET/CT between 2006 and 2010 was retrospectively evaluated for the presence of skeletal muscle metastases. Four patients had skeletal muscle metastases of esophageal carcinoma, including two patients with squamous cell carcinoma. In another patient with squamous cell carcinoma of the esophagus and synchronous skeletal muscle metastases, muscle metastases were subsequently shown to be related to second primary pancreatic adenocarcinoma. In all cases, skeletal muscle metastases were the first manifestation of systemic disease. In three patients palliation was obtained with the combination of external beam radiation therapy, systemic chemotherapy or surgical resection. Skeletal muscle metastases are a rare complication of esophageal carcinoma.

Cincibuch, Jan; Myslivecek, Miroslav; Melichar, Bohuslav; Neoral, Cestmir; Metelkova, Iva; Zezulova, Michaela; Prochazkova-Studentova, Hana; Flodr, Patrik; Zlevorova, Miloslava; Aujesky, Rene; Cwiertka, Karel

2012-01-01

358

Neoadjuvant chemoradiotherapy for esophageal/gastroesophageal carcinoma  

PubMed Central

Background Esophageal/gastroesophageal junction (GEJ) adenocarcinoma is increasingly treated with trimodality therapy. We present our experience using carboplatin/paclitaxel and radiotherapy followed by surgery. Methods Consecutive patients with distal esophageal/GEJ adenocarcinoma (?T2 or N+) treated from July 2010 to October 2011 were identified. Treatment included neoadjuvant carboplatin/paclitaxel with concurrent radiotherapy (CRT) to 50.4 Gy using an IMRT technique and then Ivor Lewis esophagogastrectomy (ILE). PET/CT was performed prior to and after CRT. Patient/treatment characteristics and tumor response were analyzed. Results Over this timeframe, 16 patients completed trimodality therapy. All were male, median age of 60 years (45-72 years). All tumors were grade 2-3 with mean tumor length of 4.4 cm (1-9 cm). A median of 6 cycles (5-9 cycles) neoadjuvant carboplatin/paclitaxel were administered. Average time from diagnosis to CRT completion was 76 days (44-141 days) and 60 days (35-92 days) from CRT end to surgery. Neoadjuvant CRT was well tolerated with mean weight loss of 3.9 kg. All pts had R0 resections. No anastomotic leaks or perioperative mortality occurred. Mean hospital stay was 13 days (8-28 days). Pathologic complete response (pCR) was seen in 38% of patients, microscopic residual disease (isolated tumor cells or <2 mm) in 31%, and macroscopic residual disease remained in 31%. Mean SUV reduction was 41% (0-100%). Of 11 patients with ?35% SUV decrease, 45% had pCR and 27% had microscopic residual disease. Three patients had signet ring features. Of these, 2 had no SUV reduction and all had gross residual disease, including the only patient with positive nodal disease. Conclusions Trimodality therapy utilizing concurrent carboplatin/paclitaxel and radiotherapy to 50.4 Gy followed by surgery was well tolerated and resulted in significant pathologic complete response or minimal residual disease. Further investigation of predictive factors for response is needed to best tailor therapy in the management of esophageal/GEJ adenocarcinoma.

Nurkin, Steven J.; Fong, Mei Ka; Groman, Adrienne; Flaherty, Leayn; Malhotra, Usha; LeVea, Charles M.; Yendamuri, Sai; Warren, Graham W.; Nava, Hector R.; May, Kilian S.

2013-01-01

359

Esophageal cancer: staging system and guidelines for staging and treatment  

PubMed Central

Survival of esophageal cancer is improving but remains poor. Esophageal cancer stage is based on depth of tumor invasion, involvement of regional lymph nodes, and the presence or absence of metastatic disease. Appropriate work-up is critical to identify accurate pre-treatment staging so that both under-treatment and unnecessary treatment is avoided. Treatment strategy should follow guideline recommendations, and generally should be developed after multidisciplinary evaluation.

2014-01-01

360

Inhibiting Interleukin-19 Activity Ameliorates Esophageal Squamous Cell Carcinoma Progression  

PubMed Central

Background IL-19 is expressed in esophageal squamous cell carcinoma (SCC), but its biological effect on esophageal cancer remains unclear. We determined the correlation between IL-19 expression levels and clinicopathological variables and explored the effects of IL-19 on the esophageal SCC in vivo and in vitro. Methodology/Principal Findings We determined the expression levels of esophageal SCC tissues from 60 patients using immunohistochemistry. We examined the effects of IL-19 on intracellular signaling, cytokines production as well as proliferation, colonization, and migration in the human esophageal SCC cell line CE81T. Monoclonal antibodies (mAbs) against IL-19 (1BB1) and its receptor IL-20R1 (51D) were used to antagonize the effects of IL-19. We injected SCID mice with CE81T cells and then treated them with anti-IL-19 mAb or control IgG every 3 days and determined tumor growth for 32 days. Of the 60 esophageal SCC patients, 36 patients (60%) were IL-19 strongly stained, which was associated with advanced tumor stage. CE81T cells expressed IL-19 and its receptors. IL-19 induced phosphorylation of STAT3, P38, JNK, ERK1/2, Akt, and NF-?B in CE81T cells. IL-19 promoted the proliferation, colonization, and migration of CE81T cells, which were antagonized by 1BB1 and 51D. IL-19 also induced expression of the transcripts of TGF-?, cyclin B1, CXCR4, and MMP-1 in CE81T cells. In CE81T tumor-bearing mice, 1BB1 reduced tumor growth and downregulated TGF-?, cyclin B1, MMP-1, and CXCR4 expression in tumors. Conclusions/Significance IL-19 affects the pathogenesis of esophageal cancer. IL-19 mAb (1BB1) is potentially a potent drug for esophageal cancer therapy.

Cheng, Hung-Chi; Li, Chien-Feng; Chang, Ming-Shi

2013-01-01

361

Drug-induced esophagitis detected by double-contrast radiography  

SciTech Connect

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.

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

362

Darier disease with oral and esophageal involvement: a case report.  

PubMed

A 58-year-old man presented with itchy papular eruptions all over the body since 15 years. Intraoral examination revealed raised papular lesions on the labial mucosa, hard palate, and tongue. The histopathology of the oral and skin lesions was confirmative of Darier disease (DD). This patient also showed esophageal involvement, which was confirmed histopathologically. Such a presentation of DD, with oral and esophageal involvement, is rare. PMID:22484882

Thiagarajan, Magesh Karuppur; Narasimhan, Malathi; Sankarasubramanian, Anandan

2011-01-01

363

MicroRNAs and Esophageal Squamous Cell Carcinoma  

Microsoft Academic Search

Esophageal cancer is a common cause of cancer death worldwide. Esophageal squamous cell carcinoma (ESCC) is the most predominant type. Certain microRNAs (miRNAs) function in tumorgenesis involved in important biological and pathologic processes. To reveal miRNAs’ signatures of ESCC, we analyzed miRNAs extracted from ESCC cell lines with the microRNA microarray. The significant alterations were confirmed by quantitative real-time PCR

Kayoko Matsushima; Hajime Isomoto; Shigeru Kohno; Kazuhiko Nakao

2010-01-01

364

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

PubMed Central

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.

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

365

1913: Annus mirabilis of esophageal surgery.  

PubMed

Although Sir Ronald Belsey once called the year 1904 "annus mirabilis," it is actually the year 1913 that stands out as the true milestone in esophageal surgery. Within a year, Torek performed the first transpleural resection for cancer in the thoracic esophagus, Zaaijer successfully resected the distal esophagus through the transpleural route, Heller performed the first myotomy for achalasia, and it was also the year of Ach's pioneering transmediastinal esophagectomy. Previously, in 1912, after a series of animal experiments by Beck and Jianu, Roepke successfully used the greater curvature of the stomach as a presternal conduit. Other previous approaches included reconstruction with jejunum (Roux-1907), colon (Kelling-1911), and skin tube (Bircher-1907). Several technical advances made these operations possible, most of all were the giant leaps in the perioperative medicine. PMID:23344774

Kun, Levente; Herbella, Fernando A; Dubecz, Attila

2013-09-01

366

In Vivo Cancer Biomarkers of Esophageal Neoplasia  

PubMed Central

Summary The emergence of in vivo cancer biomarkers is promising tool for early detection, risk stratification, and therapeutic intervention in the esophagus, where adenocarcinoma is increasing at a rate that is faster than any other in industrialized nations. Exciting advances in target identification, probe development, and optical instrumentation are creating tremendous new opportunities for advancing techniques of molecular imaging. Progress in these areas is being made with small animal models of esophageal cancer using surgical approaches to induce reflux of acid and bile, and these findings are beginning to be evaluated in the clinic. Further identification of relevant targets, characterization of specific probes, and development of endoscopic imaging technologies are needed to further this direction in the field of molecular medicine. In the future, new methods that use in vivo cancer biomarkers for the early detection of neoplastic changes in the setting of Barrett's esophagus will become available.

Lu, Shaoying; Wang, Thomas D

2011-01-01

367

The development of the DAST I remotely piloted research vehicle for flight testing an active flutter suppression control system. Ph.D. Thesis. Final Report  

NASA Technical Reports Server (NTRS)

The development of the DAST I (drones for aerodynamic and structural testing) remotely piloted research vehicle is described. The DAST I is a highly modified BQM-34E/F Firebee II Supersonic Aerial Target incorporating a swept supercritical wing designed to flutter within the vehicle's flight envelope. The predicted flutter and rigid body characteristics are presented. A description of the analysis and design of an active flutter suppression control system (FSS) designed to increase the flutter boundary of the DAST wing (ARW-1) by a factor of 20% is given. The design and development of the digital remotely augmented primary flight control system and on-board analog backup control system is presented. An evaluation of the near real-time flight flutter testing methods is made by comparing results of five flutter testing techniques on simulated DAST I flutter data. The development of the DAST ARW-1 state variable model used to generate time histories of simulated accelerometer responses is presented. This model uses control surface commands and a Dryden model gust as inputs. The feasibility of the concept of extracting open loop flutter characteristics from closed loop FSS responses was examined. It was shown that open loop characteristics can be determined very well from closed loop subcritical responses.

Grose, D. L.

1979-01-01

368

Multidisciplinary Modalities Achieve Encouraging Long-Term Survival in Resectable Limited-Disease Esophageal Small Cell Carcinoma  

PubMed Central

Background The management of limited-disease esophageal small cell carcinoma is not well defined, and the role of surgery is still controversial. We aim to determine the optimal treatment strategy in limited-disease of esophageal small cell carcinoma. Methods and Findings We conducted a retrospective review of 141 patients with limited-disease esophageal small cell carcinoma from 3 institutions in China who underwent treatment between July 1994 and September 2008, July 1994 and July 2011, and June 2004 and December 2010, respectively. The survival rate was calculated by the Kaplan-Meier method, and the log-rank test was used to assess the survival differences between the groups. Cox proportional hazards model were used to further determine the independent factors impacting overall survival. The median survival time was 16.1 months for the entire cohort of patients, with a 5-year survival rate of 6.7%. The median survival times for surgery alone, surgery combined with chemotherapy, surgery combined with radiotherapy, surgery combined with chemotherapy and radiotherapy, chemotherapy plus radiotherapy, and chemotherapy alone were 18.0 months, 15.0 months, 23.0 months, 25.0 months, 17.1 months, and 6.1 months, respectively; the corresponding 5-year survival rates were 0%, 15.4%, 0%, 38.9%, 0%, and 0%, respectively. For the 105 patients who underwent R0 resection, the median disease-free survival time was 12.0 months, with a 95% confidence interval of 9.5 months to 14.5 months. The multivariate Cox regression analysis demonstrated that advanced pathological staging (p?=?0.003), and pure esophageal small cell carcinoma (p?=?0.035) were independent factors decreasing overall survival. Conclusions Our data suggested that multidisciplinary modalities achieved encouraging long-term survival in patients with resectable limited-disease of esophageal small cell carcinoma.

Wu, Jing-Xun; Wang, Xin; Fu, Jian-Hua; Lin, Peng; Yang, Hao-Xian

2013-01-01

369

Beneficial effects of Ankaferd Blood Stopper on caustic esophageal injuries: an experimental model.  

PubMed

Ankaferd Blood Stopper (ABS) is an herbal extract that enhances mucosal healing. The aim of this study was to investigate the efficacy of ABS on the healing of the esophagus and prevention of stricture development after esophageal caustic injuries in rats. The study included 50 rats. Rats were divided into five groups: group 1 (no injury, sham surgery), group 2 (injury + no ABS + study after 2 weeks of injury), group 3 (injury + ABS + study after 2 weeks of injury), group 4 (injury + no ABS + study after 4 weeks of injury), and group 5 (injury + ABS + study after 4 weeks of injury). Standard esophageal burn injury was created by applying 50% NaOH solution to distal esophagus of about 1.5?cm. To rats in the sham group, isotonic solution was given instead of NaOH. ABS (2?mL/day) was given via oral route to group 3 and 5 rats. Fourteen days (group 2 and 3) and 28 days (group 4 and 5) later, all the live rats were killed. The distal esophageal segments of all rats were removed and divided into two equal parts for biochemical and histopathological examination. Mortality rate, weight changes, inflammation, stenosis index (SI), and biochemical measurements were evaluated. The SI was found as 0.31 ± 0.03 in group 1, 0.533 ± 0.240 in group 2, 0.568 ± 0.371 in group 3, 0.523 ± 0.164 in group 4, and 0.28 ± 0.03 in group 5. The SI and inflammation in ABS-treatment group 5 was significantly lower than that in non-treatment group 4 (P= 0.005). There were no significant differences between inflammation and SI among other groups. The mortality rate was 14.2% in group 1, 37.5% in untreated group 2, 14.2% in ABS-treated group 3, 80% in untreated group 4, and 33.3% in ABS-treated group 5. The mortality rate in group 4 was significantly higher than other groups (P= 0.025). Decrease rates in mean body weights of the groups were as follows: group 1, 1%; group 2, 15%; group 3, 14%; group 4, 46%; and group 5, 15%. Biochemical tests other than albumin and creatinine were comparable among the groups. Treatment with ABS prevents inflammation, scar formation, weight loss, and mortality in esophageal caustic injuries. Additional studies to evaluate the clinical benefits of ABS in esophageal caustic injury are recommended. PMID:21819483

Akbal, E; Köklü, S; Karaca, G; Astarci, H M; Koçak, E; Ta?, A; Beyazit, Y; Topcu, G; Haznedaro?lu, I C

2012-04-01

370

Esophageal stent improves ventilation in a child with a broncho-esophageal fistula caused by Mycobacterium tuberculosis.  

PubMed

The deployment of an esophageal stent to aid in the ventilation of a child who had developed an acquired broncho-esophageal fistula caused by Mycobacterium tuberculosis (MTB) is described. The 12-month-old boy presented with respiratory failure requiring ventilation. The air leak via the fistula led to inadequate mechanical ventilation. The deployment of the stent resulted in successful ventilation, closure of the fistula, and eventual successful treatment. PMID:17133521

Goussard, P; Sidler, D; Kling, S; Andronikou, S; Rossouw, G F; Gie, R P

2007-01-01

371

Esophagogastroduodenoscopy with conscious sedation does not interfere with catheter-based 24-h pH monitoring  

PubMed Central

AIM: To investigate the impact of esophagogastroduodenoscopy with conscious sedation on the subsequent 24-h catheter-based pH monitoring. METHODS: Fifty patients with extra-esophageal symptoms of gastroesophageal reflux disease undergoing ambulatory dual-probe 24-h pH monitoring were enrolled from March 2010 to August 2011. All of the data were collected prospectively and analyzed retrospectively. Thirty-six patients (72%, group A) underwent pH monitoring shortly after esophagogastroduodenoscopy (EGD) with conscious sedation, and 14 patients (28%, group B) underwent pH monitoring without conscious sedation. The 24-h pH data from two time periods were analyzed: the first 4 h (Period?I) and the remaining time of the study (Period II). RESULTS: The mean age of the patients was 49.6 ± 12.5 years; 20 patients (40%) were men. The baseline data, including age, sex, body mass index, reflux esophagitis, the Reflux Symptom Index, and the Reflux Findings Score, were comparable between the two groups. The percentage of total time with a pH < 4 and the frequency of acid reflux during Period?I?were not significantly different between the two groups, as measured using both pharyngeal (0.03% ± 0.10% vs 0.07% ± 0.16%, P = 0.32; and 0.07 ± 0.23 episodes/h vs 0.18 ± 0.47 episodes/h, P = 0.33, respectively) and esophageal probes (0.96% ± 1.89% vs 0.42% ± 0.81%, P = 0.59; and 0.74 ± 1.51 episodes/h vs 0.63 ± 0.97 episodes/h, P = 0.49, respectively). The percentage of total time with a pH < 4 and the frequency of acid reflux were also not significantly different between Periods I and II in group A patients, as measured using both pharyngeal (0.03% ± 0.10% vs 0.23% ± 0.85%, P = 0.21; and 0.07 ± 0.23 episodes/h vs 0.29 ± 0.98 episodes/h, P = 0.22, respectively) and esophageal probes (0.96% ± 1.89% vs 1.11% ± 2.57%, P = 0.55; and 0.74 ± 1.51 episodes/h vs 0.81 ± 1.76 episodes/h, P = 0.55, respectively). CONCLUSION: EGD with conscious sedation does not interfere with the results of subsequent 24-h pH monitoring in patients with extra-esophageal symptoms of gastroesophageal reflux disease.

Tsou, Yung-Kuan; Lien, Jau-Min; Chen, Chin-Kuo; Lin, Cheng-Hui; Chen, Hsing-Yu; Lee, Mu-Shien

2013-01-01

372

Breast cancer resistance protein (BCRP) and excision repair cross complement-1 (ERCC1) expression in esophageal cancers and response to cisplatin and irinotecan based chemotherapy  

PubMed Central

Background Esophageal cancer patients face a dismal outcome despite tri-modality management and median survival remains 15-18 months. Breast cancer resistance protein (BCRP) is an ATP-dependent efflux protein associated with chemotherapy resistance. The role of BCRP expression in esophageal cancer and normal esophageal cells is not known. Excision repair cross complement-1 (ERCC1) overexpression has been correlated with poorer response to cisplatin based chemotherapy. We examined the expression of BCRP and ERCC1 in patients with esophageal cancer and correlated it with survival in patients receiving irinotecan and cisplatin based chemotherapy. Methods With IRB approval, 40 cases of esophageal cancer diagnosed from 2004-2008, were stained for BCRP and ERCC1 expression by immunohistochemistry and scored by a pathologist blinded to clinical data. Baseline demographics, therapy given and survival data were collected and correlated with BCRP and ERCC1 expression. Fisher’s exact test was used to determine association between BCRP and ERCC1 expression and demographics. Cox proportional hazards model was used for association of BCRP and ERCC1 with survival. Results On immunohistochemistry, 30/40 cancers (75%) expressed BCRP. Interestingly, down-regulation of BCRP expression in tumor compared with normal cells was seen in 40% of patients. ERCC1 positivity was seen in 15/30 cases (50%). Median overall survival (OS) was 19 months with no difference in survival between BCRP positive and negative patients (P=0.13) or ERCC1 positive and negative patients (P=0.85). Estimated hazard ratio (HR) of death for BRCP positive patients was 2.29 (95% CI: 0.79-6.64) and for ERCC1 positive patients was 1.09 (95% CI: 0.46-2.56). There was no association of BCRP and ERCC1 expression with disease stage, age, gender or histology. For patients who received cisplatin and irinotecan as first line chemotherapy, there was no difference in survival based on BCRP or ERCC1 status. Conclusions BCRP expression is seen in a majority of esophageal cancers and normal esophageal mucosa. ERCC1 expression is seen in about half of the patients with esophageal cancer. Irinotecan based studies with esophageal and gastric cancer suggest response rates of 14-65%. Whether the 40% of tumors in our study found with down regulation of BCRP expression, constitute a majority of these responders needs to be prospectively validated in a larger data set. It should include markers such as ERCC1 predicting response to 5-fluorouracil and platinum based chemotherapy, to enable individualizing therapy for this cancer.

Bharthuar, Anubha; Black, Jennifer D.; Levea, Charles; Malhotra, Usha; Mashtare, Terry L.; Iyer, Renuka

2014-01-01

373

[Use of esophageal cytology. Comparative study on the value of various methods (III)].  

PubMed

Several esophageal cytologic tecniques (sponge biopsy, sponge smear, and espohageal washings) were assessed and compared with endoscopy and biopsy of esophageal tumors. Esophageal cytology rendered better results than esophagoscopy or biopsy, with a 97% positivity in cases of esophageal carcinoma, when using sponge biopsy and sponge smear techniques, and of 91.4% for esophageal and gastric carcinoma of the fundus invading gastroesophageal junction, when considered together. The combination of sponge techniques was better for diagnosisng esophageal carcinoma than the application of esophageal washings, a more difficult, time consuming, and sometimes unfeasible method. However, the utilization of three mehtods enhanced the overall diagnostic possibilities in all cases of esophageal tumors when considered together. PMID:829080

Poleo, J R; Vegas, H J; Acevedo, F

1975-01-01

374

Water contamination and esophageal cancer at Gassim Region, Saudi Arabia  

SciTech Connect

Between January 1980 and December 1982, 183 patients with histologically confirmed carcinoma of the esophagus who were referred to a tertiary referral hospital were studied. Thirty-two (17%) patients were referred from Gassim Region at the north central part of Saudi Arabia. In contrast, only 5% of total cancer patient referrals were from this area. A case-control study showed a significant regional difference within Saudi Arabia and the most referrals from Gassim area. A prospective case-control study showed persistently high numbers of referrals from that region during 1983-1987. When patients from Gassim Region were compared with those referred from other locations, no statistical differences were noted between the two groups except for the source of drinking water. Water analysis from Gassim area showed a high solid content with elevated levels of calcium, magnesium, and to a lesser extent, chromium iron, cadmium, and cobalt. Traces of petroleum oil were found in five of six water samples from Gassim during 1983, compared with 3 of 49 samples from other areas. Mutagenicity tests on water specimens form Gassim Region indicated the presence of possible carcinogens. It is being suggested that the high prevalence of esophageal cancer in this region may be related to contamination of water by impurities such as petroleum oils. Malnutrition, particularly vitamin A deficiency, as well as other factors may have promoted such malignancies.

Amer, M.H.; El-Yazigi, A.; Hannan, M.A.; Mohamed, M.E. (King Faisal Specialist Hospital, Riyadh (Saudi Arabia))

1990-05-01

375

Fluoroscopic balloon dilation of esophageal atresia anastomotic strictures in children and young adults: single-center study of 103 consecutive patients from 1999 to 2011.  

PubMed

Purpose To determine whether fluoroscopic balloon dilation (FBD) is a safe and effective method of treating esophageal anastomotic stricture after surgical repair in an unselected patient population. Materials and Methods With ethics committee approval, records for 103 consecutive patients who underwent FBD with our interventional radiology service (1999-2011) were reviewed retrospectively. Patients underwent diagnostic contrast material-enhanced study prior to the first dilation. Dilations were performed by using general anesthesia. Outcomes were number and/or frequency of dilations, clinical effectiveness and response to dilations, esophageal perforation, requirement for surgery, and mortality. Data were expressed as mean ± standard deviation (with range). Comparisons were conducted by using the Fisher exact test and log-rank test. The significance level was set at P < .05. Results One hundred three patients (61 male patients, 59%) underwent 378 FBD sessions (median, two dilations per patient; range, 1-40 dilations). The median age at first FBD was 2.2 years (range, 0.1-19.5 years). The balloon catheter diameters ranged from 4 to 20 mm. FBD was successful in 93 patients (90%): 44 (47%) after single dilation and 49 (53%) after multiple dilations. There was no difference in the proportion of patients who required one dilation and were younger than 1 year versus those who were 1 year of age and older (P > .99; odds ratio, 1.07 [range, 0.43-2.66]). Ten patients (10%) required further procedures: Three underwent stent placement, three underwent esophageal stricture resection, and four underwent esophageal reconstruction. Four esophageal perforations (1%) developed after FBD. Antireflux surgery was performed in 18 patients (17%). There were no deaths. Conclusion FBD for anastomotic strictures after esophageal atresia repair is feasible and acceptably safe and provides relief of symptoms in most patients (90%); however, about half require more than one dilation, and surgery is best predicted if more than 10 dilations are required. © RSNA, 2013. PMID:24475793

Thyoka, Mandela; Barnacle, Alex; Chippington, Samantha; Eaton, Simon; Drake, David P; Cross, Kate M K; De Coppi, Paolo; Kiely, Edward M; Pierro, Agostino; Curry, Joseph I; Roebuck, Derek J

2014-05-01

376

The Function and Interaction of Genes Related to Esophageal Squamous Cell Cancer  

Microsoft Academic Search

Objective: To study the function and interaction of genes related to esophageal squamous cell cancer and discuss esophageal cancer molecular mechanism.Methods: The gene microarray date set of esophageal was downloaded from the GEO BRB-ArrayTools and online tool was used to analysis the difference expression genes between esophageal squamous cell cancer and normal tissue, and analysis the functional and interaction of

Yu Long Chen; Su Gai Yin; Yao Song Wu

2011-01-01

377

Esophageal Complications Following Aluminium Phosphide Ingestion: An Emerging Issue Among Survivors of Poisoning  

Microsoft Academic Search

Aluminium phosphide ingestion is the most common agricultural poisoning in suburban and rural India and with a high mortality\\u000a rate. Among survivors of acute poisoning there are recent sporadic reports of esophageal complications such as esophageal\\u000a strictures and tracheo-esophageal fistula. The present study was carried out to determine the incidence, natural history,\\u000a and treatment outcome of local esophageal complications in

Rajendra K. Jain; Narendra B. Gouda; Virendra K. Sharma; Tribhuvan N. Dubey; Atul Shende; Rajesh Malik; Gurudutt Tiwari

2010-01-01

378

The Role of P53 and MDM2 Polymorphisms in the Risk of Esophageal Squamous Cell Carcinoma  

Microsoft Academic Search

The tumor suppressor P53 pathway plays a crucial role in preventing carcinogenesis and genetic variations of this pathway may be associated with cancer susceptibility. We tested this hypothesis by examining the contribution of functional polymorphisms in P53 and MDM2 to risk of esophageal squamous cell carcinoma (ESCC). DNA from 758 ESCC patients and 1,420 controls were genotyped for P53 codon

Yuan Hong; Xiaoping Miao; Xuemei Zhang; Aiping Luo; Yongli Guo; Zhihua Liu; Dongxin Lin

2005-01-01

379

Alterations in N-methyl-d-aspartate receptor subunits in primary sensory neurons following acid-induced esophagitis in cats  

PubMed Central

The excitatory amino acid glutamate plays an important role in the development of neuronal sensitization and the ionotropic N-methyl-d-aspartate receptor (NMDAR) is one of the major receptors involved. The objective of this study was to use a cat model of gastroesophageal reflux disease (GERD) to investigate the expression of the NR1 and NR2A subunits of NMDAR in the vagal and spinal afferent fibers innervating the esophagus. Two groups of cats (Acid-7D and PBS-7D) received 0.1 N HCl (pH 1.2) or 0.1 M PBS (pH 7.4) infusion in the esophagus (1 ml/min for 30 min/day for 7 days), respectively. NR1 splice variants (both NH2 and COOH terminals) and NR2A in the thoracic dorsal root ganglia (DRGs), nodose ganglia (NGs), and esophagus were evaluated by RT-PCR, Western blot, and immunohistochemistry. Acid produced marked inflammation and a significant increase in eosinophil peroxidase and myeloperoxidase contents compared with PBS-infused esophagus. The NR1-4 splice variant gene exhibited a significant upregulation in DRGs and esophagus after acid infusion. In DRGs, NGs, and esophagus, acid infusion resulted in significant upregulation of NR1 and downregulation of NR2A subunit gene expression. A significant increase in NR1 polypeptide expression was observed in DRGs and NGs from Acid-7D compared with control. In conclusion, long-term acid infusion in the cat esophagus resulted in ulcerative esophagitis and differential expressions of NR1 and NR2A subunits. It is possible that these changes may in part contribute to esophageal hypersensitivity observed in reflux esophagitis.

Banerjee, Banani; Medda, Bidyut K.; Zheng, Yue; Miller, Heather; Miranda, Adrian; Sengupta, Jyoti N.; Shaker, Reza

2009-01-01

380

Alterations in N-methyl-D-aspartate receptor subunits in primary sensory neurons following acid-induced esophagitis in cats.  

PubMed

The excitatory amino acid glutamate plays an important role in the development of neuronal sensitization and the ionotropic N-methyl-d-aspartate receptor (NMDAR) is one of the major receptors involved. The objective of this study was to use a cat model of gastroesophageal reflux disease (GERD) to investigate the expression of the NR1 and NR2A subunits of NMDAR in the vagal and spinal afferent fibers innervating the esophagus. Two groups of cats (Acid-7D and PBS-7D) received 0.1 N HCl (pH 1.2) or 0.1 M PBS (pH 7.4) infusion in the esophagus (1 ml/min for 30 min/day for 7 days), respectively. NR1 splice variants (both NH(2) and COOH terminals) and NR2A in the thoracic dorsal root ganglia (DRGs), nodose ganglia (NGs), and esophagus were evaluated by RT-PCR, Western blot, and immunohistochemistry. Acid produced marked inflammation and a significant increase in eosinophil peroxidase and myeloperoxidase contents compared with PBS-infused esophagus. The NR1-4 splice variant gene exhibited a significant upregulation in DRGs and esophagus after acid infusion. In DRGs, NGs, and esophagus, acid infusion resulted in significant upregulation of NR1 and downregulation of NR2A subunit gene expression. A significant increase in NR1 polypeptide expression was observed in DRGs and NGs from Acid-7D compared with control. In conclusion, long-term acid infusion in the cat esophagus resulted in ulcerative esophagitis and differential expressions of NR1 and NR2A subunits. It is possible that these changes may in part contribute to esophageal hypersensitivity observed in reflux esophagitis. PMID:18974310

Banerjee, Banani; Medda, Bidyut K; Zheng, Yue; Miller, Heather; Miranda, Adrian; Sengupta, Jyoti N; Shaker, Reza

2009-01-01

381

Cytogenetic studies of esophageal squamous cell carcinomas in the northern Chinese population by comparative genomic hybridization  

Microsoft Academic Search

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.

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

382

Bone marrow involvement in esophageal cancer patients who underwent surgical resection  

Microsoft Academic Search

Objective: Behaviors of esophageal cancer are different according to the geographic distribution. The prevalence of bone marrow involvement in patients with esophageal cancer has been shown to be between 40% and 90%, but clinical correlation is unknown. The aim of this study is to determine the rate of bone marrow involvement in patients with esophageal cancer in the northeast of

Reza Bagheri; Ghodratollah Maddah; Hamid Saeidi Saedi; Mohammad Hadi Sadeghian; Setareh Roodbari

2011-01-01

383

The endoscopic assessment of esophagitis: A progress report on observer agreement  

Microsoft Academic Search

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

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

384

Treatment response and prognosis of patients after recurrence of esophageal cancer  

Microsoft Academic Search

Background. Although radical operation and adjuvant chemoradiotherapy improve survival in patients with advanced esophageal cancer, more than half of these patients have recurrence. The aim of this study was to explore treatment responses and prognostic factors in patients with recurrent esophageal cancer. Methods. The operative specimens from 258 patients undergoing radical esophagectomy with extended lymphadenectomy for esophageal squamous cell carcinoma

Hideaki Shimada; Hiroyuki Kitabayashi; Yoshihiro Nabeya; Shin-ichi Okazumi; Hisahiro Matsubara; Yutaka Funami; Yukimasa Miyazawa; Tooru Shiratori; Takashi Uno; Hisao Itoh; Takenori Ochiai

2003-01-01

385

Identification of human brain loci processing esophageal sensation using positron emission tomography  

Microsoft Academic Search

BACKGROUND & AIMS: Brain loci that process human esophageal sensation remain unidentified. The aim of this study was to identify the brain loci that process nonpainful and painful human esophageal sensation. METHODS: In 8 healthy subjects (7 men; age range, 24-47 years), distal esophageal stimulation was performed by repeatedly inflating a balloon at volumes that produced either no sensation, definite

Q Aziz; JL Andersson; S Valind; A Sundin; S Hamdy; AK Jones; ER Foster; B Langstrom; DG Thompson

1997-01-01

386

Prospective multicenter trial of esophageal Z-stent placement for malignant dysphagia and tracheoesophageal fistula  

Microsoft Academic Search

Background: Conventional esophageal prosthesis placement has been associated with a 6% to 8% perforation rate and numerous postplacement complications. Expandable esophageal stents have been developed to preclude the above but there are few studies that have prospectively defined clinical results and subsequent stent-related complications. Methods: All patients who underwent esophageal Z-stent placement at nine university or referral hospitals were prospectively

Richard A. Kozarek; Shirley Raltz; William R. Brugge; Robert H. Schapiro; Irving Waxman; H. Worth Boyce; John Baillie; Stanley Branch; Paul Stevens; Charles J. Lightdale; Glen A. Lehman; Stanley Benjamin; David E. Fleischer; Andrew Axelrad; Paul Kortan; Norman Marcon

1996-01-01

387

Physical activity is associated with reduced risk of esophageal cancer, particularly esophageal adenocarcinoma: a systematic review and meta-analysis  

PubMed Central

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.

2014-01-01

388

4-Aminobutyrate Aminotransferase (ABAT): Genetic and Pharmacological Evidence for an Involvement in Gastro Esophageal Reflux Disease  

PubMed Central

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.

Hammond, Paul; Davidson, Geoffrey; Knutsson, Mikael; Walentinsson, Anna; Jensen, Jorgen M.; Lehmann, Anders; Agreus, Lars; Lagerstrom-Fermer, Maria

2011-01-01

389

Heart sounds analysis via esophageal stethoscope system in beagles.  

PubMed

Esophageal stethoscope is less invasive and easy to handling. And it gives a lot of information. The purpose of this study is to investigate the correlation of blood pressure and heart sound as measured by esophageal stethoscope. Four male beagles weighing 10 to 12 kg were selected as experimental subjects. After general anesthesia, the esophageal stethoscope was inserted. After connecting the microphone, the heart sounds were visualized and recorded through a self-developed equipment and program. The amplitudes of S1 and S2 were monitored real-time to examine changes as the blood pressure increased and decreased. The relationship between the ratios of S1 to S2 (S1/S2) and changes in blood pressure due to ephedrine was evaluated. The same experiment was performed with different concentration of isoflurane. From S1 and S2 in the inotropics experiment, a high correlation appeared with change in blood pressure in S1. The relationship between S1/S2 and change in blood pressure showed a positive correlation in each experimental subject. In the volatile anesthetics experiment, the heart sounds decreased as MAC increased. Heart sounds were analyzed successfully with the esophageal stethoscope through the self-developed program and equipment. A proportional change in heart sounds was confirmed when blood pressure was changed using inotropics or volatile anesthetics. The esophageal stethoscope can achieve the closest proximity to the heart to hear sounds in a non-invasive manner. PMID:23529343

Park, Sang Hi; Shin, Young Duck; Bae, Jin Ho; Kwon, Eun Jung; Lee, Tae-Soo; Shin, Ji-Yun; Kim, Yeong-Cheol; Min, Gyeong-Deuk; Kim, Myoung hwan

2013-10-01

390

Predicting response to neoadjuvant therapy in esophageal cancer.  

PubMed

Despite improvements in preoperative staging, surgical techniques and postoperative care, the 5-year survival rate of patients with locally advanced esophageal cancer remains only approximately 15-40%. Therefore, multimodality treatment options have been widely promoted in the therapy of this malignant disease. However, recent meta-analyses evaluating randomized trials of neoadjuvant therapy protocols prior to surgery for patients with advanced esophageal cancer showed only modest improvement of survival for the whole treatment group. Among these patients, those with excellent histopathologic response seem to benefit greatly from neoadjuvant regimens. Therefore, predictive markers to allow individualization of multimodality therapy in locally advanced esophageal cancer are needed to identify those who will benefit the most. Unfortunately, there is still a great lack of markers for response assessment in patients with esophageal cancer undergoing multimodality therapy. Endoscopy, endoscopic biopsies, computed tomography and endoscopic ultrasound do not seem to provide reliable information for assessing the response to neoadjuvant therapy. Whether (18)F-fluorodeoxyglucose-PET can effectively characterize responders in neoadjuvant therapy protocols remains controversial. Finally, although results of mostly retrospective studies on molecular factors for response assessment in esophageal cancer patients are promising, these markers do not yet provide a reliable and cost-effective molecular tool for utilization in clinical practice. PMID:21929318

Vallböhmer, Daniel; Brabender, Jan; Grimminger, Peter; Schröder, Wolfgang; Hölscher, Arnulf H

2011-09-01

391

Ph.D. shortage  

NASA Astrophysics Data System (ADS)

The late 1990s will see a shortage of Ph.D. graduates, according to the Association of American Universities, Washington, D.C. AAU's new comprehensive study, “The Ph.D. Shortage: The Federal Role,” reports that competition for new Ph.D.s is already intense and can only intensify because demand is greater than supply in both academic and nonacademic markets.Doctoral education plays an increasingly important role in U.S. research and development programs. Students have a pivotal part in doing research and enriching it with new ideas. The AAU report says that graduate students are “major determinants of the creativity and productivity of U.S. academic research, the source of more than 50% of the nation's basic research.’ The market for doctoral education extends beyond the university. In 1985, about 43% of all Ph.D.s employed in this country were working outside higher education; the demand for doctorate recipients in nonacademic sectors continues to grow.

392

HCl-induced and ATP-dependent upregulation of TRPV1 receptor expression and cytokine production by human esophageal epithelial cells  

PubMed Central

The pathogenesis of gastroesophageal reflux disease (GERD) remains elusive, but recent evidence suggests that early secretion of inflammatory cytokines and chemokines by the mucosa leads to influx of immune cells followed by tissue damage. We previously showed that exposure of esophageal mucosa to HCl causes ATP release, resulting in activation of acetyl-CoA:1-O-alkyl-sn-glycero-3-phosphocholine acetyltransferase (lyso-PAF AT), the enzyme responsible for the production of platelet-activating factor (PAF). In addition, HCl causes release of IL-8 from the esophageal mucosa. We demonstrate that esophageal epithelial cells secrete proinflammatory mediators in response to HCl and that this response is mediated by ATP. Monolayers of the human esophageal epithelial cell line HET-1A were exposed to acidified cell culture medium (pH 5) for 12 min, a total of seven times over 48 h, to simulate the recurrent acid exposure clinically occurring in GERD. HCl upregulated mRNA and protein expression for the acid-sensing transient receptor potential cation channel, subfamily vanilloid member 1 (TRPV1), lyso-PAF AT, IL-8, eotaxin-1, -2, and -3, macrophage inflammatory protein-1?, and monocyte chemoattractant protein-1. The chemokine profile secreted by HET-1A cells in response to repeated HCl exposure parallels similar findings in erosive esophagitis patients. In HET-1A cells, the TRPV1 agonist capsaicin reproduced these findings for mRNA of the inflammatory mediators lyso-PAF AT, IL-8, and eotaxin-1. These effects were blocked by the TRPV1 antagonists iodoresiniferatoxin and JNJ-17203212. These effects were imitated by direct application of ATP and blocked by the nonselective ATP antagonist suramin. We conclude that HCl/TRPV-induced ATP release upregulated secretion of various chemoattractants by esophageal epithelial cells. These chemoattractants are selective for leukocyte subsets involved in acute inflammatory responses and allergic inflammation. The data support the validity of HET-1A cells as a model of the response of the human esophageal mucosa in GERD.

Ma, Jie; Altomare, Annamaria; Guarino, Michele; Cicala, Michele; Rieder, Florian; Fiocchi, Claudio; Li, Dan; Cao, Weibiao; Behar, Jose; Biancani, Piero

2012-01-01

393

Operative and nonoperative management of esophageal perforations.  

PubMed Central

During a 21-year period, 72 patients were treated for esophageal perforations; the diagnosis was made only at postmortem examination in 13 other patients. Fifty-eight of 85 patients (68%) sustained iatrogenic perforations, 11 patients (13%) had "spontaneous" perforation, nine patients (11%) had foreign body related perforation, and seven patients (8%) had perforation caused by external trauma. Eleven cervical perforations, contained between the cervical paravertebral structures, plus eight thoracic perforations, contained in the mediastinum, were treated with antibiotics, intravenous hydration, and nasogastric drainage. The mortality rate after this nonoperative approach was 16% (3/19 patients). Indications for operative treatment in 53 patients were hydropneumothorax with mediastinal emphysema, sepsis, shock and respiratory failure. The operative mortality rate in these instances was 17% (9/53 patients). Six of the nine patients who died had been operated on more than 24 hours after the onset of symptoms. For cervical perforations the best results were obtained by drainage plus repair of the perforation (mortality rate: 0%; 0/10 patients) and for thoracic perforations by suturing supported by a pedicled pleural flap (mortality rate: 11%; 1/9 patients). Simple drainage of thoracic perforation was followed by a mortality rate of 43% (3/7 patients).

Michel, L; Grillo, H C; Malt, R A

1981-01-01

394

Esophageal Achalasia: An Uncommon Complication during Pregnancy Treated Conservatively  

PubMed Central

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.

Spiliopoulos, Dimitrios; Spiliopoulos, Michail; Awala, Alero

2013-01-01

395

Hiccups as a presenting symptom of eosinophilic esophagitis.  

PubMed

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 H(2) 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

Levy, Alexander N; Rahaman, Soroya M; Bonis, Peter A; Javid, Golrokh; Leung, John

2012-05-01

396

Gastro-esophageal studies in relationship to respiratory problems.  

PubMed

Gastroesophageal reflux represents a physiological phenomenon in the first year of life. The reflux associated with clinical complications is defined as "gastroesophageal reflux disease" (GERD), that may be esophageal or extra-esophageal, as is for respiratory problems. Nuclear medicine investigations have given an important contribution to the diagnostic assessment and therapeutical management of GERD in children, by means of the following procedures: scintigraphy of the gastroduodenal transit and reflux detection, scintigraphic quantification of gastric emptying, scintigraphy of the esophageal transit, radioisotopic salivagram, scintigraphy of lung perfusion, ventilation and of mucociliary clearance. All of these investigations are among the less irradiating nuclear medicine procedures, therefore particularly adapted to paediatrics. The main clinical advantages of this body of information include: improvements in the management of many asthmatic children, surgical anti-reflux intervention success-rate increase, prompt regional lung alterations detection for preventing stable tissue damage, and many others. PMID:20823805

Ciofetta, G

2010-08-01

397

Esophageal stent migration can lead to intestinal obstruction  

PubMed Central

Background: Self-expanding metallic stents are the devices of choice in the treatment of malign or benign strictures of the esophagus. Stent migration is a well-known complication of this procedure. Aims: We report a case of intestinal obstruction caused by esophageal stent migration, in which surgical intervention was used. Methods: A 65-year-old woman, who had a medical history of gastric cancer operations and esophageal stent applications, was admitted to our emergency department with a 48-hour history of abdominal pain, nausea and vomiting. An emergency laparotomy was performed and the migrated stent causing intestinal obstruction was removed. Results: The patient recovered without incident and was discharged on postoperative day 3. Conclusion: This case illustrates that esophageal stent migration has to be considered as a potential life-threatening complication.

Karatepe, Oguzhan; Acet, Ersin; Altiok, Merih; Battal, Muharrem; Adas, Gokhan; Karahan, Servet

2009-01-01

398

Milk temperature influences esophageal motility in the newborn lamb.  

PubMed

Esophageal dysmotility is common in infants. We aimed to evaluate the influence of milk temperature on esophageal motility using multichannel intraluminal impedance-pH monitoring (MII-pH). Five healthy lambs, ages 2 to 3 days, underwent a MII-pH whereas bottle-fed randomly with 50 mL of ewe milk at 26 °C, 38.5 °C, and 41.5 °C. Impedance motility parameters were studied on 5 swallows at each temperature. At 38.5 °C we noted a higher total propagation velocity and a shorter total bolus transit time (TBTT) (P < 0.05). These unique results suggest a potential role of milk temperature alterations in improving oral feeding in infants with esophageal dysmotility. PMID:22710998

Djeddi, Djamal; Samson, Nathalie; Praud, Jean-Paul

2013-01-01

399

[Esophageal toxicity of radiation therapy: clinical risk factors and management].  

PubMed

Acute radiation-induced esophagitis includes all clinical symptoms (odynophagia, dysphagia) occurring within 90 days after thoracic irradiation start. Its severity can be graded using RTOG and CTCAE scales. The clinical risk factors are: age, female gender, initial performance status, pre-therapeutic body mass index, pre-therapeutic dysphagia, tumoral and nodal stage, delivered dose, accelerated hyperfractionned radiotherapy, concomitant association of chemotherapy to radiotherapy and response to the treatment. The dosimetric parameters predictive of esophagitis are: mean dose, V(20Gy), V(30Gy), V(40Gy), V(45Gy) and V(50Gy). Amifostine is the only drug to have a proven radioprotective efficacy (evidence level C, ESMO recommendation grade III). The medical management of esophagitis associates a diet excluding irritant food, medication against gastroesophageal reflux, analgesic treatment according to the WHO scale and management of dehydration and denutrition by enteral feeding. PMID:22925486

Challand, T; Thureau, S; Dubray, B; Giraud, P

2012-09-01

400

Type II congenital pulmonary airway malformation in an esophageal lung  

PubMed Central

A seven-month-old girl, born prematurely (birth weight 1000 g) from a twin pregnancy, was admitted to hospital due to recurrent pneumonia and atelectasis. She experienced cough and respiratory distress during feeding. The right hemithorax was smaller than the left, with diminished breath sounds and dullness. Chest x-rays revealed decreased lung volume and multiple radiolucent images in the right lung, as well as overdistention of the left lung. An esophagogram revealed three bronchial branches arising from the lower one-third of the esophagus, corresponding to the right lung and ending in a cul-de-sac. A diagnosis of esophageal lung was established. On bronchography, the right lung was absent and the trachea only continued into the left main bronchus. Echocardiography and angiotomography revealed agenesis of the pulmonary artery right branch. The surgical finding was an esophageal right lung, which was removed; the histopathological diagnosis was type II congenital pulmonary airway malformation in an esophageal lung.

Martinez-Martinez, Blanca Estela; Furuya, Maria Elena Yuriko; Martinez-Muniz, Irma; Vargas, Mario H; Flores-Salgado, Rosalinda

2013-01-01

401

Type II congenital cystic pulmonary malformation in an esophageal lung.  

PubMed

A seven-month-old girl, born prematurely (birth weight 1000 g) from a twin pregnancy, was admitted to hospital due to recurrent pneumonia and atelectasis. She experienced cough and respiratory distress during feeding. The right hemithorax was smaller than the left, with diminished breath sounds and dullness. Chest x-rays revealed decreased lung volume and multiple radiolucent images in the right lung, as well as overdistention of the left lung. An esophagogram revealed three bronchial branches arising from the lower one-third of the esophagus, corresponding to the right lung and ending in a cul-de-sac. A diagnosis of esophageal lung was established. On bronchography, the right lung was absent and the trachea only continued into the left main bronchus. Echocardiography and angiotomography revealed agenesis of the pulmonary artery right branch. The surgical finding was an esophageal right lung, which was removed; the histopathological diagnosis was type II congenital pulmonary airway malformation in an esophageal lung. PMID:23762890

Martínez-Martínez, Blanca E; Furuya, María Elena Yuriko; Martínez-Muńiz, Irma; Vargas, Mario H; Flores-Salgado, Rosalinda

2013-01-01

402

Significance of tumor length as prognostic factor for esophageal cancer.  

PubMed

Abstract Our study indicated the relationship between tumor length and clinicopathologic characteristics as well as long-term survival in esophageal cancer. A total of 116 patients who underwent curative surgery for thoracic esophageal cancer with standard lymphadenectomy in 2 fields between 2000 and 2010 were included in the study. The medical records of these patients were retrospectively reviewed. The patients with tumor length ?3 cm had a highly significant difference in the involvement of adventitia and lymph node stations. The patients with tumor length ?3 cm had significantly lower rates of involvement of the adventitia and lymph node stations. Tumor length could have a significant impact on both the overall survival and disease-free survival of patients with resected esophageal carcinomas and may provide additional prognostic value to the current tumor, node, and metastasis staging system before patients receive any cancer-specific treatment. PMID:23971777

Zeybek, Arife; Erdo?an, Abdullah; Gülkesen, Kemal Hakan; Ergin, Makbule; Sarper, Alpay; Dertsiz, Levent; Demircan, Abid

2013-01-01

403

[Rubber-band ligation of esophageal and cardiac varices].  

PubMed

Esophageal sclerotherapy was the treatment of choice for bleeding esophageal varices in the past decade. It is effective for treating acute variceal bleeding, as well as eradicating esophageal varices for secondary prevention of bleeding. However, in more than 20% of patients sclerotherapy involves complications, some of which are serious. The high complication rate suggested the development of a new method that should be at least as effective and as easy to perform as sclerotherapy, but with fewer complications and side-effects. Endoscopic variceal ligation was developed at the University of Colorado and described in 1986. It is reported to control active variceal bleeding in about 90% of patients, and to eradicate varices in about 80% of surviving patients. Complications are rare. We have adapted the method in our unit and here describe out preliminary experience in 11 patients. PMID:8436323

Arnon, R; Zimmerman, J; Keret, D; Lysy, J; Wengrower, D; Fich, A; Goldin, E

1993-01-15

404

A case of infectious esophagitis caused by human papilloma virus.  

PubMed

Esophageal infections may be caused by diverse pathogens that alter the mucosal lining and produce mild symptoms or sometimes critical clinical diseases with a high risk of mortality, particularly among the immunocompromised. The most common causes of infectious esophagitis are: herpes virus, candida, cytomegalovirus (CMV), and human immunodeficiency virus (HIV); human papilloma virus (HPV) infections are rare in Western countries. Endoscopic features of infectious esophagitis are specific for different agents; nonetheless, differential diagnosis is difficult and requires biopsy, cultures and brushing. We present the clinical case of a young woman admitted to the Department of General Surgery of A.O.U. Federico II, Naples, for a large, deep ulcerative lesion of the esophagus caused by HPV infection. PMID:18614980

Quarto, G; Sivero, L; Somma, P; De Rosa, G; Mosella, F; Nunziata, G; Solimeno, G; Benassai, G

2008-09-01

405

Hyperfractionated Concomitant Boost Proton Beam Therapy for Esophageal Carcinoma  

SciTech Connect

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.

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

406

Rapidly Growing Esophageal Carcinosarcoma Reduced by Neoadjuvant Radiotherapy Alone  

PubMed Central

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.

Ogasawara, Naotaka; Tamura, Yasuhiro; Funaki, Yasushi; Yamaguchi, Yoshiharu; Shimozato, Akihiro; Yanamoto, Kenichiro; Takahashi, Emiko; Miyachi, Masahiko; Sasaki, Makoto; Kasugai, Kunio