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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



Ambulatory esophageal pH monitoring.  


Extraesophageal manifestations of gastroesophageal reflux may be best diagnosed using ambulatory esophageal pH monitoring. This test involves the placemenmt of a thin pH probe in the esophagus, which is connected to a small box on a waistbelt. Studies are done in an ambulatory state in the patient's home and work environment. Data collected assesses acid exposure time over the circadian cycle and the relationship of symptoms to pH drops. Studies in adult asthmatics demonstrate abnormal amounts of acid reflux by 24-hour esophageal pH monitoring in >50% of patients. Likewise, large studies in patients with chronic ENT complaints find abnormal acid reflux values in 50-80% of patients. Several problems and issues with ambulatory pH monitoring still need addressing, including (1) the need for dual pH monitoring, (2) artifact and reproducibility, (3) normal values, (4) role in the initial diagnosis, and (5) role in the follow-up of poorly responding patients. PMID:9422638

Richter, J E



Comparison of esophageal manometry, provocative testing, and ambulatory monitoring in patients with unexplained chest pain  

Microsoft Academic Search

Prolonged ambulatory esophageal pH and pressure monitors are being developed to evaluate noncardiac chest pain. This new technology needs comparison with conventional esophageal tests before determining which studies are most useful in diagnosing and treating esophageal chest pain. Therefore, we studied 45 patients with esophageal manometry, acid perfusion and edrophonium tests, and 24 hr pH and pressure monitoring. Manometry was

Edward G. Hewson; Christine B. Dalton; Joel E. Richter



Clinical Value of Esophageal Motility Testing  

Microsoft Academic Search

Esophageal motility testing is the method of choice in evaluating esophageal motor disorders. Some physicians, however, question the clinical utility of esophageal motility testing, since the results are often normal in symptomatic patients. The clinical utility of esophageal motility testing is reviewed for patients with a complaint of noncardiac chest pain, dysphagia or symptoms of gastroesophageal reflux disease. Esophageal motility

Melvin L. Allen; Richard B. Lynn; Saeed Zamani



ACG Practice Guidelines: Esophageal Reflux Testing  

Microsoft Academic Search

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

Ikuo Hirano; Joel E. Richter



The pathogenesis of the low pleural fluid pH in esophageal rupture.  


To determine the possible mechanisms responsible for the low pH pleural effusion associated with esophageal rupture we evaluated the following possibilities: (1) gastric acid reflux, (2) bacterial metabolism, and (3) leukocyte metabolism. Neither elimination of gastric hydrogen ion contribution by distal esophageal ligation nor elimination of bacteria with antibiotics prevented the progressive fall in pleural fluid pH after esophageal rupture. Only elimination of polymorphonuclear leukocytes from the pleural space by rendering animals leukopenic with nitrogen mustard, prevented a low pH effusion after esophageal rupture. It appears that pleural fluid leukocyte metabolism is primarily responsible for the low pH effusion associated with esophageal rupture. PMID:6859653

Good, J T; Antony, V B; Reller, L B; Maulitz, R M; Sahn, S A



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



Diagnosis of supra-esophageal gastric reflux: Correlation of oropharyngeal pH with esophageal impedance monitoring for gastroesophageal reflux  

PubMed Central

Background Oropharyngeal (OP) pH monitoring has been developed as a new way to diagnose supraesophageal gastric reflux (SEGR), but has not been well-validated. Our aim was to determine the correlation between OP pH and gastroesophageal (GER) events detected by multichannel intraluminal impedance-pH (MII-pH). Methods Fifteen patients (11 Males, median age 10.8 yrs) with suspected GER were prospectively evaluated with ambulatory 24-h OP pH monitoring (positioned at the level of the uvula) and concomitant esophageal MII-pH monitoring. Potential OP events were identified by the conventional pH threshold of <4, and by the following alternative criteria: 1) relative pH drop >10% from 15-min baseline and 2) absolute pH drop below thresholds of <5.5, 5.0, and 4.5. The 2-min window preceding each OP event was analyzed for correlation with an episode of GER detected by MII-pH. Key Results A total of 926 GER events were detected by MII-pH. Application of alternative pH criteria increased the identification of potential OP pH events; however, a higher proportion of oropharyngeal events had no temporal correlation with GER (45-81%), compared to the conventional definition of pH<4 (40%). A total of 306 full-column acid reflux episodes were dectected by MII-pH, of which 10(3.3%) were also identified by OP pH monitoring. Conclusions & Inferences Use of extended pH criteria increased the detection of potential SEGR events, but the majority of decreases in OP pH were not temporally correlated with GER. Oropharyngeal pH monitoring without concurrent esophageal measurements may over-estimate the presence of SEGR in children.

Chiou, Eric; Rosen, Rachel; Jiang, Hongyu; Nurko, Samuel



Comparison of the Bravo™ Wireless and Digitrapper™ Catheter-Based pH Monitoring Systems for Measuring Esophageal Acid Exposure  

Microsoft Academic Search

INTRODUCTION:We compared esophageal acid exposure data obtained during simultaneous esophageal pH studies using the Bravo™ wireless and the Slimline™ catheter-Mark III Digitrapper™ pH systems.METHODS:Twenty-five asymptomatic subjects underwent endoscopy with endoclip placement at the squamocolumnar junction (SCJ) and manometry to localize the lower esophageal sphincter (LES). A Bravo™ capsule was placed 6 cm above the SCJ and a Slimline™ catheter 5

John E. Pandolfino; Mitchal A. Schreiner; Thomas J. Lee; Qing Zhang; Christopher Boniquit; Peter J. Kahrilas



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


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

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





... resulting in a chemical burn of the esophagus. Eating disorders - Similar to acid reflux, frequent vomiting can cause ... esophagus. Esophagitis sometimes is seen in people with eating disorders such as bulimia. Medications - Some common medications also ...


Effects of refluxate pH values on duodenogastroesophageal reflux-induced esophageal adenocarcinoma  

PubMed Central

AIM: To determine the effects of duodenogastric juice pH on the development of esophageal adenocarcinoma (EAC). METHODS: An animal model of duodenogastroesophageal reflux was established using Sprague-Dawley (SD) rats undergoing esophagoduodenostomy (ED). The development of EAC was investigated in rats exposed to duodenogastric juice of different pH. The rats were divided into three groups: low-pH group (group A), high-pH group (group B) and a sham-operated group as a control (group C) (n = 30 rats in each group). The incidence of esophagitis, Barrett’s esophagus (BE), intestinal metaplasia with dysplasia and EAC was observed 40 wk after the treatment. RESULTS: The incidence rate of esophagitis, BE, intestinal metaplasia with dysplasia and EAC was higher in groups A and B compared with the control group after 40 wk (P < 0.01), being 96% and 100% (P > 0.05), 88% and 82.4% (P > 0.05), 20% and 52.1% (P < 0.05), and 8% and 39% (P < 0.05), respectively. CONCLUSION: Non-acidic refluxate increases the occurrence of intestinal metaplasia with dysplasia and EAC while the low-pH gastric juice exerts a protective effect in the presence of duodenal juice. The non-acid reflux is particularly important in the progression from BE to cancer. Therefore, control of duodenal reflux may be an important prophylaxis for EAC.

Cheng, Peng; Li, Jian-Sheng; Gong, Jun; Zhang, Lian-Feng; Chen, Rong-Zhong



Radionuclide transit: a sensitive screening test for esophageal dysfunction  

SciTech Connect

The purpose of this study was to extend existing nuclear medicine techniques for the diagnosis of esophageal motor disorders. A standard homogeneous bolus of 99mtechnetium sulfur colloid in water was swallowed in the supine position under the collimator of a gamma camera linked to a microprocessor. Bolus transit was recorded at 0.4-s intervals, and the movie obtained was used to analyze transit in an objective manner. Ten normal volunteers and 30 subjects with dysphagia not related to mechanical obstruction were studied with this technique. Radionuclide transit studies detected a higher incidence of esophageal motor abnormality than manometry or radiology in the dysphagia group. In addition a definitive description of the functional problem was possible in most cases. Radionuclide transit is a safe noninvasive test and suitable as a screening test for esophageal motor disorders.

Russell, C.O.; Hill, L.D.; Holmes, E.R. III; Hull, D.A.; Gannon, R.; Pope, C.E. II



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



[Esophageal tuberculosis].  


Primary esophageal tuberculosis is virtually non-existent and there are few cases described of secondary esophageal tuberculosis. Esophageal tuberculosis should be suspected in patients with dysphagia, positive test results for tuberculin, active pulmonary disease or mediastinal adenopathies. Endoscopic or x-ray images could be indistinguishable from esophageal carcinomas, hence a diagnosis can prevent wrong treatments. Confirming the diagnosis requires isolation of tuberculosis bacillus. Treatment for a patient with esophageal tuberculosis is standard therapy. Key words: Tuberculosis, esophagus. PMID:16865167

Baños, Ramón; Serrano, Andrés; Alberca, Fernando; Alajarín, María; Albaladejo, Aquilino; Vargas, Angel; Molina, Joaquín


Functional esophageal disorders  

PubMed Central

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

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



Friction-Assisted Magnetic Holding of an Ingestible Capsule for Esophageal pH and Impedance Monitoring  

Microsoft Academic Search

24-hour catheter-based ambulatory pH and impedance monitoring is an essential tool for diagnosing esophageal disorders. However, catheter-based monitoring systems are uncomfortable and interfere with normal activities of the patient. To overcome these disadvantages, different wireless monitoring systems have been proposed. However, efficient ways to position and hold wireless capsules are lacking. Currently there is a need to develop safe and

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



Wireless Capsules for Esophageal pH Monitoring: Are We Placing Them Correctly?  

Microsoft Academic Search

Background: Recommended Bravo™ capsule placement is 6 cm proximal to the squamocolumnar junction. This is because the junction resides 1 cm distal to the lower esophageal sphincter. Aim: To determine the positional accuracy of capsule placement compared with the ideal location in symptomatic patients. Methods: Retrospective analysis of consecutive symptomatic outpatients undergoing both capsule placement and esophageal manometry on the

Siva Doma; Susmita Paladugu; Henry P. Parkman; Frank K. Friedenberg



Technological insights: Combined impedance manometry for esophageal motility testing-current results and further implications  

Microsoft Academic Search

This review focuses on current aspects of the novel technology of combined impedance manometry for esophageal motility testing. It presents methodological features, summarizes current results and discusses implications for further research. The combined technique assesses simultaneously bolus transport and associated peristalsis, thus allowing detailed analysis of the relationships between bolus transit and esophageal motility. Recent studies demonstrate that combined impedance

Huan Nam Nguyen; Gerson Ricardo; Souza Domingues; Frank Lammert; Medizinische Klinik; Elisabeth-Krankenhaus Rheydt



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



Unsedated peroral wireless pH capsule placement vs. standard pH testing: A randomized study and cost analysis  

PubMed Central

Background Wireless capsule pH-metry (WC) is better tolerated than standard nasal pH catheter (SC), but endoscopic placement is expensive. Aims: to confirm that non-endoscopic peroral manometric placement of WC is as effective and better tolerated than SC and to perform a cost analysis of the available esophageal pH-metry methods. Methods Randomized trial at 2 centers. Patients referred for esophageal pH testing were randomly assigned to WC with unsedated peroral placement or SC after esophageal manometry (ESM). Primary outcome was overall discomfort with pH-metry. Costs of 3 different pH-metry strategies were analyzed: 1) ESM?+?SC, 2) ESM?+?WC and 3) endoscopically placed WC (EGD?+?WC) using publicly funded health care system perspective. Results 86 patients (mean age 51?±?2?years, 71% female) were enrolled. Overall discomfort score was less in WC than in SC patients (26?±?4?mm vs 39?±?4?mm VAS, respectively, p?=?0.012) but there were no significant group differences in throat, chest, or overall discomfort during placement. Overall failure rate was 7% in the SC group vs 12% in the WC group (p?=?0.71). Per patient costs ($Canadian) were $1475 for EGD?+?WC, $1014 for ESM?+?WC, and $906 for ESM?+?SC. Decreasing the failure rate of ESM?+?WC from 12% to 5% decreased the cost of ESM?+?WC to $991. The ESM?+?SC and ESM?+?WC strategies became equivalent when the cost of the WC device was dropped from $292 to $193. Conclusions Unsedated peroral WC insertion is better tolerated than SC pH-metry both overall and during placement. Although WC is more costly, the extra expense is partially offset when the higher patient and caregiver time costs of SC are considered. Trial registration Identifier NCT01364610



Combined esophageal multichannel intraluminal impedance and pH monitoring (MII -pH) in the diagnostics and treatment of gastroesophageal reflux disease and its complications.  


The technique of 24-hour esophageal multichannel intraluminal impedance monitoring combined with pH-metry (MII-pH) is currently considered to be the golden standard in the diagnostics of gastroesophageal reflux disease (GERD). The technique allows for differentiation of gas and liquid reflux as well as detection of non-acid reflux, which cannot be detected with other techniques that are based only on measuring the pH of gastric contents.THE AIM OF THE STUDY was to assess the usefulness of MII-pH in the diagnostics and treatment of GERD and its complications. MATERIAL AND METHODS. A group of 213 patients referred to II Katedra i Klinika Chirurgii Ogólnej, Gastroenterologicznej i Nowotworów Uk?adu Pokarmowego Uniwersytetu Medycznego w Lublinie [the Second Faculty and Clinic of General and Gastrointestinal Surgery and Gastrointestinal Oncology at Medical University of Lublin] due to persistent symptoms of GERD and 21 volunteers without any clinical evidence of GERD underwent esophageal monitoring via MII-pH. The results were correlated with those of upper gastrointestinal tract endoscopy. The data gathered during MII-pH and endoscopy as well as information from questionnaires were entered into an MS Excel spreadsheet and subsequently analyzed with STATISTICA PL software. RESULTS AND CONCLUSIONS. MII-pH proved to be considerably more useful than conventional pHmetry in recording acid reflux. The sensitivity of pH-metry based on the MII-pH technique was established at 74%. GERD-induced changes in the esophageal mucosa result in decreased impedance baseline. The presence and severity of inflammatory esophageal lesions was proven to be associated with acid reflux episodes and proximal reflux episodes. No direct relationship between the grade of GERD and the occurrence of non-acid reflux episodes was confirmed. Non-acid reflux episodes were shown to predispose to non-erosive reflux disease (NERD). The results of this study confirm that MIIpH is an essential technique in the diagnostics, as well as in assessment of the course of treatment and the severity of GERD. PMID:22166737

Masiak, Wioletta; Wallner, Grzegorz; Wallner, Jan; Pedowski, Tomasz; Solecki, Micha?



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'Incà; Rita Polo; Remo Naccarato; Ermanno Ancona



A MCh test pre-post esophageal acidification in detecting GER-related asthma.  


The direct effect of gastro-esophageal reflux (GER) on lung function is still debated. Objective. To investigate the role of esophageal acidification in affecting airway response to MCh in GER-related versus atopic asthmatics and to assess specificity and sensitivity of events. Subjects. A total of 56 never-smoking, mild asthmatics: 27 non-atopic asthmatics and acid GER (GER+ve) and 29 atopic asthmatics without any GER (GER-ve). Methods. Each subject performed an MCh challenge in baseline (MCh(b)), and 30 minutes after an acid drink (125 mL at pH = 2; MCh(ac)), one day apart. PD(20)FEV(1) MCh(b) and MCh(ac) were compared by estimating the area under the ROC curve (AU-ROC). Results. GER+ve and GER-ve subjects (well matched in baseline) had a different duration of esophageal acid contact (24-hour monitoring; pH-24h AU(4)), and PD(20)FEV(1) MCh(ac) (both p < 0.001). AU-ROC was 86.3% (76% to 97%, 95%CI). Sensitivity and specificity of changes were 82.8% (72.9% to 92.7%, 95%CI) and 85.2% (75.9% to 94.5%, 95%CI), respectively. The difference in MCh threshold that maximized both the sensitivity and specificity level was 100 mu g. Conclusions. The esophageal acidification identified GER-related asthma with a good level of both sensitivity and specificity by enhancing the MCh response only in the presence of acid GER. Data are supporting the effectiveness of this procedure for clinical purposes. PMID:19484668

Dal Negro, Roberto Walter; Tognella, Silvia; Micheletto, Claudio; Sandri, Marco; Guerriero, Massimo



Clinical Application of Impedance-Manometry for Motility Testing and Impedance-pH for Reflux Monitoring  

Microsoft Academic Search

Esophageal function testing and monitoring are important clinical tests in patients presenting with esophageal symptoms. Many clinicians and investigators consider esophageal manometry the gold standard to evaluate the motor function of the esophagus, and esophageal pH monitoring the gold standard to diagnose gastroesophageal reflux. As these techniques offer only indirect information about intraesophageal bolus movement and presence, videofluoroscopic or radioisotopic

Radu Tutuian; Donald O Castell


Interlaboratory Test of pH Measurements in Rainwater.  

National Technical Information Service (NTIS)

An interlaboratory test of pH measurements in rainwater has been conducted. Various types of electrodes and junction materials were used in the test. The results of the exercise verify that there are significant differences in the pH values of low ionic s...

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



Interlaboratory test of pH measurements in rainwater  

SciTech Connect

An interlaboratory test of pH measurements in rainwater was conducted. Various types of electrodes and junction materials were used in the test. The results of the exercise verify that there are significant differences in the pH values of low-ionic-strength solutions reported by various laboratories.

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



Achalasia and Esophageal Motility Disorders  


... tests to evaluate for achalasia and other esophageal motility disorders is manometry. This test is performed on an outpatient basis. A small ... coordination of contractions of the esophageal muscles. Some motility disorders, including ... TREATMENTS ARE AVAILABLE FOR ACHALASIA? Endoscopic Treatment ...


Diffuse Esophageal Spasm: Not Diffuse but Distal Esophageal Spasm (DES)  

Microsoft Academic Search

Diffuse esophageal spasm is an uncommon motility disorder that is found in less than 5% of patients undergoing esophageal motility testing for dysphagia. It is defined manometrically by the presence of 20% or more simultaneous contractions in the distal esophageal body with normal peristalsis. This motility abnormality has been traditionally identified as occurring primarily in the smooth muscle portion of

Monicca Sperandio; Radu Tutuian; R. Matthew Gideon; Philip O. Katz; Donald O. Castell



Esophageal Cancer  


... brachytherapy). Radiation therapy is most often combined with chemotherapy in people with esophageal cancer. It can be used before or after surgery. Radiation therapy is also used to relieve complications of advanced esophageal cancer, such as when a ...


Recommended Soil pH and Lime Requirement Tests  

Microsoft Academic Search

Soil pH is defined as the negative logarithm (base 10) of the H+ activity (moles per liter) in the soil solution. As the activity of H+ in the soil solution increases, the soil pH value decreases. Soils with pH values below pH 7 are referred to as \\

Donald Eckert; J. Thomas Sims


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

Code of Federal Regulations, 2010 CFR

...2010-04-01 2010-04-01 false Urinary pH (nonquantitative) test system. 862...Chemistry Test Systems § 862.1550 Urinary pH (nonquantitative) test system. (a) Identification. A urinary pH (nonquantitative) test system is a...



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

Code of Federal Regulations, 2013 CFR

...2013-04-01 2013-04-01 false Urinary pH (nonquantitative) test system. 862...Chemistry Test Systems § 862.1550 Urinary pH (nonquantitative) test system. (a) Identification. A urinary pH (nonquantitative) test system is a...



Solid bolus transit by esophageal scintigraphy in patients with dysphagia and normal manometry and radiography  

Microsoft Academic Search

Scintigraphic technique was used to study esophageal transport of a solid bolus in 16 patients with dysphagia but with normal manometry, and negative acid perfusion tests, acid clearing tests, and pH reflux tests. Radiology performed on 14 of the 16 patients showed no evidence of organic lesions. Half the patients had abnormal findings at scintigraphy, with either bolus retention in

Gerhard Kjellén; John B. Svedberg; Lita Tibbling



Pathogenesis of esophageal rings in eosinophilic esophagitis.  


Eosinophilic esophagitis and eosinophilic gastroenteritis is being recognized more frequently among the adult patients. The disease is characterized by massive infiltration of the wall of gastrointestinal tract by sheets of eosinophils. The clinical features depend upon the site of involvement. They include dyspepsia, dysphagia, nausea, vomiting, chest pain, diarrhea and protein-losing enteropathy. Eosinophilic esophagitis may present as chest pain, dysphagia or dyspepsia. The characteristic endoscopic feature of eosinophilic esophagitis is the formation of fine concentric mucosal rings (corrugated esophagus). Regarding the pathogenesis of these mucosal rings our hypothesis is that mast cells in the esophageal wall in response to allergens release histamine, eosinophilic chemotactic factor and platelet activating factor, etc. which activate eosinophils to release toxic cationic proteins. Activation of acetyl choline by histamine may cause contraction of the muscle fibers in the muscularis mucosae resulting in the formation of esophageal rings. This hypothesis can be tested by demonstrating the contraction of muscle layers of muscularis mucosae with the use of high frequency endoscopic ultrasonic probe introduced via the biopsy channel of an endoscope. PMID:15617859

Mann, N S; Leung, J W



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.



Esophageal wall blood perfusion during contraction and transient lower esophageal sphincter relaxation in humans  

PubMed Central

We recently reported that esophageal contraction reduces esophageal wall perfusion in an animal study. Our aim was to determine esophageal wall blood perfusion (EWBP) during esophageal contraction and transient lower esophageal sphincter relaxations (TLESRs) in humans. We studied 12 healthy volunteers. A custom-designed laser Doppler probe was anchored to the esophageal wall, 4–6 cm above the LES, by use of the Bravo pH system so that the laser light beam stay directed toward the esophageal mucosa. A high-resolution manometry equipped with impedance electrodes recorded esophageal pressures and reflux events. Synchronized pressure, impedance, pH, and EWBP recordings were obtained during dry and wet swallows and following a meal. Stable recordings of laser Doppler EWBP were only recorded when the laser Doppler probe was firmly anchored to the esophageal wall. Esophageal contractions induced by dry and wet swallows resulted in 46 ± 9% and 60 ± 10% reduction in the EWBP, respectively (compared to baseline). Reduction in EWBP was directly related to the amplitude (curvilinear fit) and duration of esophageal contraction. Atropine reduced the esophageal contraction amplitude and decreased the EWBP reduction associated with esophageal contraction. TLESRs were also associated with reduction in the EWBP, albeit of smaller amplitude (29 ± 3%) but longer duration (19 ± 2 s) compared with swallow-induced esophageal contractions. We report 1) an innovative technique to record EWBP for extended time periods in humans and 2) contraction of circular and longitudinal muscle during peristalsis and selective longitudinal muscle contraction during TLESR causes reduction in the EWBP; 3) using our innovative technique, future studies may determine whether esophageal wall ischemia is the cause of esophageal pain/heartburn.

Jiang, Yanfen; Bhargava, Valmik; Kim, Young Sun




Microsoft Academic Search

Twelve patients with known esophageal varices and willingness to cooperate were included in the study. Medications administered were placebo, 2 mg of glucagon, and 30 mg of propantheline bromide. All medications were given double-blind and crossover. On the basis of this study the authors believe that for optimal visualization of esophageal varices the following is the procedure of choice: (I)



Esophageal Rings and Webs  


... 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, ...


Esophageal Cancer  


... the abdomen and connects the mouth to the stomach. Cancer, or a malignant tumor, is the result of ... stomach join should be considered esophageal cancer or stomach cancer. Interestingly, it's this region which gives rise to ...


Esophageal cancer  

SciTech Connect

This book contains the proceedings on esophageal cancer. Topics covered include: Scope of the problem, Diagnostic considerations: Methods of early diagnosis, Staging criteria, Elective surgical management, and Postoperative complications.

Delarue, N.C. (Univ. of Toronto, Toronto (CA)); Wilkins, E.W. Jr. (Harvard Medical School, MA (US)); Wong, J. (Dept. of Surgery, Univ. of Hong Kong (HK))



Eosinophilic Esophagitis  

Microsoft Academic Search

Eosinophilic esophagitis is a chronic inflammatory disorder characterized by dense eosinophilic infiltration of the esophageal\\u000a mucosa. The pathogenesis is incompletely understood and food allergies and aeroallergens have been implicated. The most common\\u000a clinical presentation in adults is dysphagia to solids. Its associated endoscopic findings are distinct and include concentric\\u000a rings and longitudinal furrows, although endoscopy may be unremarkable in a

Fouad J. Moawad; Ganesh R. Veerappan; Roy K. Wong



[Esophageal injuries].  


Despite progress in the management of esophageal perforations by early diagnosis, antibiotics, monitoring, and respiratory and nutritional support, it still remains as a disasterous condition. The most common cause of esophageal perforation is iatrogenic disruption. The result in the management of esophageal perforation is influenced by several factors: localization and size of the rupture, length of delay in diagnosis, age, extent of mediastinal and pleural contamination, the presence of underlying esophageal diseases, and inflammation or tumor at the perforation localization. In this study, 7 cases of esophageal perforations in the last six years have been analysed retrospectively. In study group, there were 5 males and 2 females, and the mean age was 36 (12-75). The most common cause of perforation was gunshot injury (3 cases), and stab wound (1 case), foreign body (1 case), iatrogenic distruption (2 cases). Three patients died and four patients were discharged from hospital with recovery. Esophageal perforation is a life-threatening condition. Early diagnosis and repair reduces the morbidity and mortality. PMID:11705168

Ertekin, C; Yanar, H T; Gülo?lu, R; Tavilo?lu, K; Dilege, S



Vaginal pH: Home-Use Tests  


... type of test is this? This is a quantitative test -- you find out how acidic your vaginal ... Government For Press Combination Products Advisory Committees Science & Research Regulatory Information Safety Emergency Preparedness International Programs News & ...


Patients with Helicobacter pylori infection have less severe gastroesophageal reflux disease: a study using endoscopy, 24-hour gastric and esophageal pH metry  

Microsoft Academic Search

Background and aim  The relationship between gastroesophageal reflux disease (GERD) and Helicobacter pylori is controversial. We evaluated endoscopic, 24-h gastric and esophageal acid profile among patients with GERD in relation\\u000a to H. pylori, as the latter might alter gastric acid secretion.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Patients with GERD (n?=?123), who were not on acid-suppressive drugs, and had not received anti-H. pylori therapy, underwent gastroduodenoscopy and

Dipti Chourasia; Asha Misra; Shweta Tripathi; Narendra Krishnani; Uday C. Ghoshal



Sustained esophageal contraction: A marker of esophageal chest pain identified by intraluminal ultrasonography  

Microsoft Academic Search

Background & Aims: Intraluminal pressure recording systems have not demonstrated predictable esophageal motor correlates of unexplained chest pain. This study used continuous high-frequency intraluminal ultrasonography to characterize esophageal contraction at the time of spontaneous and provoked chest pain. Methods: Intraluminal pressure, pH, and ultrasound images of the esophagus were recorded for a maximum of 24 hours in 10 subjects with

David H. Balaban; Yoshihiro Yamamoto; Jianmin Liu; Nonko Pehlivanov; Ralph Wisniewski; Dennis DeSilvey; Ravinder K. Mittal



[Esophageal cancer].  


Esophageal cancers are highly malignant tumours with often a poor prognostic, except for minimal lesions treated with surgery. Radiation therapy, or combined radiation and chemotherapy is the most used therapeutic modality, alone or before oesophagectomy. The delineation of target volumes is now more accurate owing the possibility to use routinely the new imaging techniques (mainly PET). The aim of this work is to precise the radio-anatomical particularities, the pattern of spread of esophageal cancer and the principles of 3D conformal radiotherapy illustrated with a clinical case. PMID:21129673

Dupuis, O; Ganem, G; Béra, G; Pointreau, Y; Pradier, O; Martin, P; Mirabel, X; Denis, F



Eosinophilic esophagitis.  


Eosinophilic esophagitis is a chronic inflammatory disorder characterized by dense eosinophilic infiltration of the esophageal mucosa. The pathogenesis is incompletely understood and food allergies and aeroallergens have been implicated. The most common clinical presentation in adults is dysphagia to solids. Its associated endoscopic findings are distinct and include concentric rings and longitudinal furrows, although endoscopy may be unremarkable in a minority of patients. A number of management strategies exist; however, data are limited in adults, and only a few are based on randomized controlled trials. Management options include dietary modifications, pharmacological therapy, and endoscopic dilation. PMID:19554448

Moawad, Fouad J; Veerappan, Ganesh R; Wong, Roy K



Comparison of the California Mastitis Test, Catalase Test, and pH Readings on Quarter Milk Samples  

Microsoft Academic Search

Three representative groups from 611 quarter samples of aseptically collected milk were compared for catalase, pH, and California mastitis test readings. Statistical analysis (determination of correlation coefficient) was applied to 102 of the 611 quarter samples. It was found that the correlation coefficient for catalase and pH reading was more significant than the correlation coefficient of the catalase and CMT

C. T. Raby; P. L. Hubbard; R. H. Cobbins



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



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



Evaluation of esophageal motor function in clinical practice.  


Esophageal motor function is highly coordinated between central and enteric nervous systems and the esophageal musculature, which consists of proximal skeletal and distal smooth muscle in three functional regions, the upper and lower esophageal sphincters, and the esophageal body. While upper endoscopy is useful in evaluating for structural disorders of the esophagus, barium esophagography, radionuclide transit studies, and esophageal intraluminal impedance evaluate esophageal transit and partially assess motor function. However, esophageal manometry is the test of choice for the evaluation of esophageal motor function. In recent years, high-resolution manometry (HRM) has streamlined the process of acquisition and display of esophageal pressure data, while uncovering hitherto unrecognized esophageal physiologic mechanisms and pathophysiologic patterns. New algorithms have been devised for analysis and reporting of esophageal pressure topography from HRM. The clinical value of HRM extends to the pediatric population, and complements preoperative evaluation prior to foregut surgery. Provocative maneuvers during HRM may add to the assessment of esophageal motor function. The addition of impedance to HRM provides bolus transit data, but impact on clinical management remains unclear. Emerging techniques such as 3-D HRM and impedance planimetry show promise in the assessment of esophageal sphincter function and esophageal biomechanics. PMID:23336590

Gyawali, C P; Bredenoord, A J; Conklin, J L; Fox, M; Pandolfino, J E; Peters, J H; Roman, S; Staiano, A; Vaezi, M F



Caustic ingestion and esophageal function  

SciTech Connect

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

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



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

Microsoft Academic Search

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

Xu Wang Yin; Cui Juan Niu



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.



Complications of gastroesophageal reflux disease. Role of the lower esophageal sphincter, esophageal acid and acid/alkaline exposure, and duodenogastric reflux.  

PubMed Central

The factors contributing to the development of esophageal mucosal injury in gastroesophageal reflux disease (GERD) are unclear. The lower esophageal sphincter, esophageal acid and acid/alkaline exposure, and the presence of excessive duodenogastric reflux (DGR) was evaluated in 205 consecutive patients with GERD and various degrees of mucosal injury (no mucosal injury, n = 92; esophagitis, n = 66; stricture, n = 19; Barrett's esophagus, n = 28). Manometry and 24-hour esophageal pH monitoring showed that the prevalence and severity of esophageal mucosal injury was higher in patients with a mechanically defective lower esophageal sphincter (p less than 0.01) or increased esophageal acid/alkaline exposure (p less than 0.01) as compared with those with a normal sphincter or only increased esophageal acid exposure. Complications of GERD were particularly frequent and severe in patients who had a combination of a defective sphincter and increased esophageal acid/alkaline exposure (p less than 0.01). Combined esophageal and gastric pH monitoring showed that esophageal alkaline exposure was increased only in GERD patients with DGR (p less than 0.05) and that DGR was more frequent in GERD patients with a stricture or Barrett's esophagus. A mechanically defective lower esophageal sphincter and reflux of acid gastric juice contaminated with duodenal contents therefore appear to be the most important determinants for the development of mucosal injury in GERD. This explains why some patients fail medical therapy and supports the surgical reconstruction of the defective sphincter as the most effective therapy.

Stein, H J; Barlow, A P; DeMeester, T R; Hinder, R A



Esophageal Cancer  

Microsoft Academic Search

\\u000a Purpose:  To present the results of a prospective phase II study in esophageal carcinoma.\\u000a \\u000a \\u000a \\u000a Patients and Methods:  Patients received single doses of 1.8 Gy up to 27 Gy, then concomitant boost to a total of 50.4 Gy (PTV2 [planning target\\u000a volume], single dose 1.8 Gy) and 64.8 Gy (PTV1, single dose 1.2 Gy in the morning and 1.8 Gy in the afternoon)

Thomas B. Brunner; Andreas Rupp; Winfrid Melzner; Gerhard G. Grabenbauer; Rolf Sauer



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

Code of Federal Regulations, 2013 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...



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

Code of Federal Regulations, 2010 CFR

... 2, PO 2) and blood pH test system is a device...blood, serum, plasma or pH of blood, serum, and plasma... 2, PO 2) and blood pH are used in the diagnosis...treatment of life-threatening acid-base disturbances. (b)...



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

Code of Federal Regulations, 2010 CFR

... 2, PO 2) and blood pH test system is a device...blood, serum, plasma or pH of blood, serum, and plasma... 2, PO 2) and blood pH are used in the diagnosis...treatment of life-threatening acid-base disturbances. (b)...



[Reflux esophagitis (esophageal hiatus hernia)].  


Recently, the guidelines for the treatment of gastroesophageal reflux disease (GERD) by the Japanese Society of Gastroenterology. There are many statements including recommended grade (from A to D) and evidence level (from I to VI) for the epidemiology, pathogenesis, diagnosis, medical treatments, surgical treatment of GERD, reflux esophagitis after gastrectomy, and non-typical symptoms of GERD. In this manuscript, we showed the latest date and current status of GERD in Japan used this guidelines. In summary, the prevalence of GERD has been increasing since the end of 1990s, the 1st choice of medical treatment is proton pump inhibitors, endoscopic treatments for GERD are not available in Japan, laparoscopic Toupet fundoplication is superior to laparoscopic Nissen fundoplication as postoperative dysphagia with similar reflux control, and complications of surgical treatment are pneumothorax, splenic injury, aortic injury, gastric ulcer, sever dysphagia, gastric perforation etc., but complication rate is low. PMID:21916192

Omura, Nobuo; Kashiwagi, Hideyuki



pH testing of feeding-tube aspirates to determine placement.  


Although radiologic confirmation of tube placement remains the "gold standard," there is growing evidence that pH testing of feeding-tube aspirates can reduce (although not totally eliminate) reliance on x-rays used for this purpose. This article describes that evidence and tells how it was obtained. Reducing the number of x-rays needed to confirm tube position can have far-reaching financial benefits. PMID:7476791

Metheny, N A; Clouse, R E; Clark, J M; Reed, L; Wehrle, M A; Wiersema, L



Rapid antibiotic susceptibility testing in a microfluidic pH sensor.  


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



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


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


Ergonovine-provoked esophageal spasm during coronary angiography  

SciTech Connect

In many patients with chest pain of esophageal origin, findings are normal on routine esophageal manometry and dysmotility develops only upon provocation with ergonovine maleate. Unfortunately, ergonovine may induce myocardial ischemia in patients in whom coronary artery spasm did not occur during previous provocative testing in a cardiac laboratory - limiting its clinical usefulness. Esophageal pressure has been recorded simultaneously with ergonovine infusion during angiography in ten patients without significant arterial stenoses. In two patients their usual chest pain developed associated with esophageal spasm and without changes in coronary vessels. Simultaneous performance of angiography and manometry enhanced the diagnostic yield of provocative testing by showing esophageal motility changes. This method may detect significant changes in the esophageal motility, is easy to carry out and does not interfere with angiography. It maximizes the information gained from a single provocative test and avoids the risk of ergonovine infusion outside of a cardiac laboratory.

Lieberman, D.A.; Jendrzejewski, J.W.; McAnulty, J.H.



Does surgery correct esophageal motor dysfunction in gastroesophageal reflux  

SciTech Connect

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.



Esophageal dilation \\/ dilators  

Microsoft Academic Search

Opinion statement  Esophageal dilation is the treatment of choice for most patients with esophageal dysphagia (functional and mechanical). Multiple\\u000a forms of esophageal dilators are available. Mechanical dilators (guidewire\\/nonguidewire assisted) are the major forms of dilators\\u000a used. Balloon dilator use has increased but they offer only a marginal advantage over traditional mechanical dilators at a\\u000a greatly increased cost (2° to single use).

Timothy T. Nostrant



When is esophagitis healed?  

Microsoft Academic Search

In order to asses whether in reflux esophagitis morphological and functional disorders persist after macroscopic healing, cimetidine was given for 6–12 weeks at a dose of 1.6 g\\/day to 30 patients with acid gastroesophageal reflux and esophagitis. The mucosal defects healed in 6 patients, improved in 14 patients, and remained unchanged in 10 patients. Lower esophageal sphincter pressure, acid clearance,

Amnon Sonnenberg; Gerd Lepsien; STEFAN A. MISILLER-LISSNER; Hans R. Koelz; J. Rüdiger Siewert; André L. Blum



Esophageal Cancer: Initial Staging  

Microsoft Academic Search

The incidence of esophageal cancer is increasing. Worldwide it is the ninth most common malignancy and is endemic in many\\u000a parts of the world, particularly in the developing countries. There were 14,550 new cases and 13,770 deaths from esophageal\\u000a cancer in the United States in 2006. Esophageal cancer has two pathological subtypes: squamous cell carcinoma and adenocarcinoma.\\u000a Squamous cell carcinoma

Lana Y. Schumacher; Nicole B. Baril; Sherry M. Wren


Lower esophageal sphincter pressure in histologic esophagitis.  


The fasting lower esophageal sphincter pressure of 18 normal volunteers was compared to 22 patients with symptoms and objective evidence of gastroesophageal reflux. Lower esophageal sphincter pressure was measured by rapid pull-through using an 8-lumen radially perfused catheter that sampled pressure every45 degrees around the circumference of the sphincter. The 22 reflux patients were subdivided for analysis into two groups, those with an acute inflammatory infiltrate on biopsy and those without inflammation. Those patients without inflammatory esophagitis had normal sphincter pressures. Those with a definite inflammatory infiltrate had pressures significantly less than normal. The least reliable separation between normals and those with inflammatory esophagitis occurred in the anterior orientations. We conclude that while basal lower esophageal sphincter pressure measurement may identify patients with reflux and inflammatory esophagitis, it is of no help in identifying those patients with reflux unassociated with inflammation. Decreased basal fasting LESP does not appear to be the most important primary determinant of gastroesophageal reflux. PMID:7379675

Welch, R W; Luckmann, K; Ricks, P; Drake, S T; Bannayan, G; Owensby, L



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))



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



Bleeding esophageal varices  


... they can bleed severely. Any type of chronic liver disease can cause esophageal varices. Varices can also occur ... People with chronic liver disease and esophageal varices may have no symptoms. If there is only a small amount of bleeding, the only symptom ...


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

PubMed Central

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.

Fornari, Fernando; Wagner, Rafaela



Effect of bolus taste on the esophageal transit of patients with stroke.  


Stroke is a frequent cause of oropharyngeal dysphagia but may also cause alterations in esophageal motility. The aim of this investigation was to evaluate the effect of bolus taste on the esophageal transit of patients with stroke and controls. Esophageal transit and clearance were evaluated by scintigraphy in 36 patients in the chronic phase of stroke (44-82 years, mean: 63 years) and in 30 controls (33-85 years, mean: 59 years). The patients had a stroke 1-84 months (median: 5.5 months) before the evaluation of esophageal transit. Eight had dysphagia. Each subject swallowed in random order and in the sitting position 5 mL of liquid boluses with bitter (pH=6.0), sour (pH=3.0), sweet (pH=6.9), and neutral (pH=6.8) taste. Transit and clearance duration and the amount of residues were measured in the proximal, middle, and distal esophageal body. There was no difference between patients and controls in esophageal transit or clearance duration. In the distal esophagus, the transit and clearance durations were longer with the sour bolus than with the other boluses in both patients and controls. The amount of residues in the esophageal body was greater in patients than in controls after swallows of the neutral bolus. In control subjects, after swallows of a sour bolus, there was an increase in the amount of residues in the middle and distal esophagus compared with the other boluses. In conclusion, a sour bolus with low pH causes a longer transit and clearance duration in the distal esophageal body. There was no effect of bolus taste or pH on the esophageal transit of patients in the chronic phase of stroke compared with normal volunteers. The longer transit and clearance duration in the distal esophageal body with the sour bolus appears to be a consequence of the low pH of the bolus. PMID:22642501

Alves, L M T; Fabio, S R C; Dantas, R O



Effects of pH in the in vitro chromosomal aberration test.  


The relation between the pH of the medium and clastogenic activity was studied in Chinese hamster ovary (CHO) K1 cells in vitro. The pH was adjusted with NaOH, KOH, HCl or H2SO4. No clastogenic activity was observed over the initial pH range of 7.3-10.9 without S9 mix, but a few chromosomal aberrations were induced at pH 10.4 with S9 mix. The frequency of aberrations increased with the increase in amount of S9. At acidic pH, many chromatid breaks were induced at initiatial pH 5.5 or below without S9 mix, and aberrations such as chromatid breaks and chromatid exchanges were induced at initial pH 6.2 or below with S9 mix. Using MES and Bis-Tris as buffers instead of sodium bicarbonate, we observed that aberrations of the chromatid break type were inducible at pH 6.2 or below. These results show that the combination of strong alkalinity and S9 is clastogenic to CHO-K1 cells, and also that weakly acidic media are genetically active. The results indicate that incubations at non-physiological pH might give false-positive responses. PMID:2913491

Morita, T; Watanabe, Y; Takeda, K; Okumura, K


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



Esophageal Cancer (PDQ): Prevention  


... 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 ...


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



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



Staging of Esophageal Cancer  

Microsoft Academic Search

Esophageal carcinoma is the fifth most common gastrointestinal cancer, and the recent data suggests that it is rising in incidence\\u000a faster than any other malignancy. Although esophageal carcinoma is generally felt to have a poor prognosis, this is largely\\u000a owing to the heterogeneity of patients. As with any malignancy, the stage of the tumor predicts prognosis and determines treatment\\u000a options.

Jason Vollweiler; Gregory Zuccaro


Esophageal eosinophilia with dysphagia  

Microsoft Academic Search

Small numbers of intraepithelial esophageal eosinophils (IEE) may be seen in 50% of patients with gastroesophageal reflux disease and occasionally in normal volunteers. High concentrations of IEE are rarely seen in either setting. During a two-year period we idetified 12 adult patients with very dense eosinophil infiltrates in esophageal biopsies (defined as >20 IEE\\/high-power field). Dysphagia was the presenting complaint

Stephen E. A. Attwood; Thomas C. Smyrk; Tom R. Demeester; James B. Jones



A lime requirement test for maritime Canada, and response time and effect of liming source on soil ph  

Microsoft Academic Search

An experiment was conducted to determine which of the two lime requirement tests (LRT) used in Maritime Canada (Adams?Evans, SMP) are most appropriate, and to evaluate the effect of two sources of limestone (calcitic and dolomitic) on soil pH during a four month incubation period. Four soils, varying in texture from loamy sand to silty loam, and three rates of

P. R. Warman; B. Harnish; T. Muizelaar



Esophagitis and Barrett esophagus after correction of esophageal atresia  

Microsoft Academic Search

BackgroundGastroesophageal reflux is a frequent problem after esophageal atresia (EA) repair. Our aim was to determine the prevalence of esophagitis and Barrett esophagus more than 10 years after repair of EA.

Jacqueline A. Deurloo; Seine Ekkelkamp; Jan A. J. M. Taminiau; C. M. Frank Kneepkens; Fibo W. J. ten Kate; Joep F. W. M. Bartelsman; Dink A. Legemate; Daniel C. Aronson



Esophageal blood flow in the cat. Normal distribution and effects of acid perfusion  

SciTech Connect

The radioactive microsphere technique was used to estimate blood flow to different regions of the esophagus and to adjacent regions of the stomach before and after perfusion of the esophagus with hydrochloric acid (pH 1.5) for 5 min. Under resting conditions total blood flow, as well as blood flow to the mucosal-submucosal layer and the muscular layer, to both sphincters was significantly higher than to the esophageal body. Blood flow to the adjacent regions of the stomach was significantly higher than esophageal blood flow. Acid perfusion resulted in a large increase in total blood flow in both sphincters and the lower esophageal body. Gastric blood flow was not altered by acid perfusion. The esophageal hyperemia resulted primarily from an increase in blood flow to the muscular layer; mucosal-submucosal blood flow was increased only in the lower esophageal sphincter. The present study indicates that short periods (5 min) of gastroesophageal reflux may increase esophageal blood flow.

Hollwarth, M.E.; Smith, M.; Kvietys, P.R.; Granger, D.N.



Esophageal Impedance: Role in the Evaluation of Esophageal Motility  

Microsoft Academic Search

The esophagus is a hollow muscular tube with ends closed proximally and distally by muscular sphincters. The upper esophageal sphincter and proximal one third of the esophageal body are composed of striated muscle. There is then a transition zone where striated and smooth muscle mix together. The lower esophageal sphincter and the distal one half to two thirds of the

Chien-Lin Chen



Esophageal duplication cyst with esophageal web and tracheoesophageal fistula  

Microsoft Academic Search

The authors report the case of lower carvical\\/ upper thoracic esophageal duplication associated with an obstructing esophageal web. This presented in the newborn period as an esophageal atresia. Initial resection of the web and closure of the fistula were performed. The duplication was excised electively at 2 months of age. Persistent symptomatic tracheomalacia required aortopexy, after which the child recovered

Charles L Snyder; Steven W Bickler; George K Gittes; V Ramachandran; Keith W Ashcraft



Multidisciplinary management of esophageal cancer.  


This article reviews the current management of esophageal cancer, including staging and treatment options, as well as providing support for using multidisciplinary teams to better manage esophageal cancer patients. PMID:23453332

Mulligan, Charles R



Esophageal Atresia and Tracheoesophageal Fistula  


MENU Return to Web version Esophageal Atresia and Tracheoesophageal Fistula Overview What is esophageal atresia? In babies who ... swallows gets into the stomach. What is a tracheoesophageal fistula? A fistula (say “fist-you-lah”) is a ...


QuickTox™ Drug\\/Adulteration Test COC\\/MOR\\/MET\\/THC\\/PCP with Nitrite, Creatinine, pH and Oxidizing Agent Adulteration Test Pads  

Microsoft Academic Search

Additionally QuickTox™ can assess the validity of the urine sample simultaneous to drug-of-abuse testing. The adulteration pads of the QuickTox™ Test are chemical indicator assays that provide visual qualitative results for nitrite, creatinine, pH and oxidizing agents. The QuickTox™ Drug\\/Adulteration Test is intended for the professionals in vitro diagnostic use only, and is not intended for over-the-counter sale. The QuickTox™

COC Benzoylecgonine



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 (...


pH Testing. Youth Training Scheme. Core Exemplar Work Based Project.  

ERIC Educational Resources Information Center

|This trainer's guide is intended to assist supervisors of work-based career training projects in teaching students how to sample and analyze soil to determine its pH value. The guide is one in a series of core curriculum modules that is intended for use in combination on- and off-the-job programs to familiarize youth with the skills, knowledge,…

Further Education Staff Coll., Blagdon (England).



EPA Science Inventory

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


Technical note: development and testing of a radio transmission pH measurement system for continuous monitoring of ruminal pH in cows.  


An indwelling ruminal pH system has been used for the continuous recording of ruminal pH to evaluate subacute ruminal acidosis (SARA) in dairy cows. However this system does not allow the field application. The objective of this study was to develop a new radio transmission pH measurement system, and to assess its performance and usefulness in a continuous evaluation of ruminal pH for use on commercial dairy farms. The radio transmission pH measurement system consists of a wireless pH sensor, a data measurement receiver, a relay unit, and a personal computer installed special software. The pH sensor is housed in a bullet shaped bolus, which also encloses a pH amplifier circuit, a central processing unit (CPU) circuit, a radio frequency (RF) circuit, and a battery. The mean variations of the measurements by the glass pH electrode were +0.20 (n=10) after 2 months of continuous recording, compared to the values confirmed by standard pH solutions for pH 4 and pH 7 at the start of the recording. The mean lifetime of the internal battery was 2.5 months (n=10) when measurements were continuously transmitted every 10 min. Ruminal pH recorded by our new system was compared to that of the spot sampling of ruminal fluid. The mean pH for spot sampling was 6.36 ± 0.55 (n=96), and the mean pH of continuous recording was 6.22 ± 0.54 (n=96). There was a good correlation between continuous recording and spot sampling (r=0.986, P<0.01). We also examined whether our new pH system was able to detect experimentally induced ruminal acidosis in cows and to record long-term changes in ruminal pH. In the cows fed acidosis-inducing diets, the ruminal pH dropped markedly during the first 2h following the morning feeding, and decreased moreover following the evening feeding, with many pulse-like pH changes. The pH of the cows showed the lowest values of 5.3-5.2 in the midnight time period and it recovered to the normal value by the next morning feeding. In one healthy periparturient cow, the circadian changes in ruminal pH were observed as a constant pattern in the pre-parturient period, however that pattern became variable in the post-partum period. The frequency of the ruminal pH lower than 5.5 increased markedly 3 and 4 days after parturition. We demonstrated the possible application of a radio transmission pH measurement system for the assessment and monitoring of the ruminal pH of cows. Our new system might contribute to accurate assessment and prevention of SARA. PMID:21930319

Sato, Shigeru; Mizuguchi, Hitoshi; Ito, Kazunori; Ikuta, Kentaro; Kimura, Atushi; Okada, Keiji



Esophageal perforations masked by steroids  

Microsoft Academic Search

Esophageal perforation is usually an acute, life-threatening event, and its diagnosis can be established on the basis of obvious clinical and radiographic findings. This article describes two cases whereby symptoms of esophageal perforations were masked by concomitant administration of steroids, thus causing marked delay in diagnosis and treatment. Esophageal rupture should be considered when patients receiving steroids develop unexplained fever

Linas M. Klygis; Rome Jutabha; Michael B. McCrohan; Arvydas D. Vanagunas



[Advanced esophageal carcinoma recanalization].  


Advanced esophageal carcinoma has poor prognosis with 5-year survival of less than 20%. This poor prognosis is the same for squamous cell carcinoma and adenocarcinoma. Surgical therapy, external radiation and chemotherapy with curative intent are usually impossible because of the advanced disease. Dysphagia is the most frequent symptom affecting quality of life. Bougies or balloon dilation improves dysphagia only short-term (few days). Nd-YAG laser, ACP and photodynamic therapy all have mid-range effect and require repetition after few weeks. Brachytherapy and esophageal self-expanding stent insertion have longer benefit. Stent insertion provides fastest improvement of dysphagia; however, complications in later setting occur in30% and require further endoscopic treatment. Brachytherapy has slower onset of benefit but has fewer complications and longer benefit. Brachytherapy is suitable for patients wit expected lifespan more than 3 months. Most important contraindication of brachytherapy is tracheo-esophageal fistula. PMID:19202963

Molnárová, A



Upper esophageal sphincter during transient lower esophageal sphincter relaxation: effects of reflux content and posture  

PubMed Central

Although some studies show that the upper esophageal sphincter (UES) contracts during transient lower esophageal sphincter relaxation (TLESR), others show that it relaxes. We hypothesized that the posture of the subject and constituents of gastroesophageal reflux (GER) may determine the type of UES response during the TLESR. High-resolution manometry and esophageal pH/impedance recording were performed in 10 healthy volunteers in the right recumbent (1 h) and upright (1 h) positions following the ingestion of a 1,000-Kcal meal. The UES pressure response during TLESR and constituents of GER (liquid, air, and pH) were determined. 109 TLESRs (58 upright and 51 recumbent) were analyzed. The majority of TLESRs were associated with GER (91% upright and 88% recumbent) events. UES relaxation was the predominant response during upright position (81% of TLESRs), and it was characteristically associated with presence of air in the reflux (92%). On the other hand, UES contraction was the predominant response during recumbent position (82% of TLESRs), and it was mainly associated with liquid reflux (71%). The rate of esophageal pressure increase (dP/dt) during the GER, but not the pH, had major influence on the type of UES response during TLESR. The dP/dt during air reflux (127 ± 39 mmHg/s) was significantly higher than liquid reflux (31 ± 6 mmHg/s, P < 0.0001). We concluded that the nature of UES response during TLESR, relaxation or contraction, is related to the posture and the constituents of GER. We propose that the rapid rate of esophageal pressure increase associated with air reflux determines the UES relaxation response to GER.

Babaei, Arash; Bhargava, Valmik



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.



Simulation of crack growth during hydrostatic testing of pipeline steel in near-neutral pH environment  

Microsoft Academic Search

The objective of this investigation was to understand the role of crack dimension, hydrogen, room-temperature creep and loading procedure on crack growth during hydrostatic testing of pipeline steels in near-neutral pH aqueous soil environments. Crack growth was found during hydrotesting, but was not linearly related to the stress intensity factor at the crack tip. Crack growth is mainly driven through

Yongwang Kang; Weixing Chen; Richard Kania; Gregory Van Boven; Robert Worthingham



Screening pre-bariatric surgery patients for esophageal disease with esophageal capsule endoscopy  

PubMed Central

AIM: To determine if esophageal capsule endoscopy (ECE) is an adequate diagnostic alternative to esophagogastroduodenoscopy (EGD) in pre-bariatric surgery patients. METHODS: We conducted a prospective pilot study to assess the diagnostic accuracy of ECE (PillCam ESO2, Given Imaging) vs conventional EGD in pre-bariatric surgery patients. Patients who were scheduled for bariatric surgery and referred for pre-operative EGD were prospectively enrolled. All patients underwent ECE followed by standard EGD. Two experienced gastroenterologists blinded to the patient’s history and the findings of the EGD reviewed the ECE and documented their findings. The gold standard was the findings on EGD. RESULTS: Ten patients with an average body mass index of 50 kg/m2 were enrolled and completed the study. ECE identified 11 of 14 (79%) positive esophageal/gastroesophageal junction (GEJ) findings and 14 of 17 (82%) combined esophageal and gastric findings identified on EGD. Fisher’s exact test was used to compare the findings and no significant difference was found between ECE and EGD (P = 0.64 for esophageal/GEJ and P = 0.66 for combined esophageal and gastric findings respectively). Of the positive esophageal/GEJ findings, ECE failed to identify the following: hiatal hernia in two patients, mild esophagitis in two patients, and mild Schatzki ring in two patients. ECE was able to identify the entire esophagus in 100%, gastric cardia in 0%, gastric body in 100%, gastric antrum in 70%, pylorus in 60%, and duodenum in 0%. CONCLUSION: There were no significant differences in the likelihood of identifying a positive finding using ECE compared with EGD in preoperative evaluation of bariatric patients.

Shah, Ashish; Boettcher, Erica; Fahmy, Marianne; Savides, Thomas; Horgan, Santiago; Jacobsen, Garth R; Sandler, Bryan J; Sedrak, Michael; Kalmaz, Denise



Causes, evaluation, and consequences of eosinophilic esophagitis.  


This paper presents commentaries on whether eosinophilic esophagitis is a food allergy; inflammation in the context of eosinophilic esophagitis; whether eosinophilic esophagitis a cause of noncardiac chest pain; the role of endoscopy in the evaluation of eosinophilic esophagitis; and whether response to proton pump inhibitor therapy can distinguish eosinophilic esophagitis from gastroesophageal reflux disease. PMID:24117638

Chehade, Mirna; Lucendo, Alfredo J; Achem, Sami R; Souza, Rhonda F



Caspofungin Resistance in Candida albicans: Correlating Clinical Outcome with Laboratory Susceptibility Testing of Three Isogenic Isolates Serially Obtained from a Patient with Progressive Candida Esophagitis  

PubMed Central

A patient with azole-refractory thrush-esophagitis responded initially to caspofungin, but the treatment eventually failed. In a murine model, caspofungin was effective against two early isolates for which the MICs of caspofungin were low, but it was less effective against a late isolate for which the MIC of caspofungin was greater. We concluded that there is a correlation between in vivo failure and rising in vitro caspofungin MICs.

Hernandez, Steve; Lopez-Ribot, Jose L.; Najvar, Laura K.; McCarthy, Dora I.; Bocanegra, Rosie; Graybill, John R.




NSDL National Science Digital Library

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


Recurrent spontaneous esophageal rupture  

Microsoft Academic Search

Spontaneous esophageal rupture is an uncommon and poorly understood condition. Recurrent rupture is extremely rare, with only one previously reported case in the literature. Here, we present a case series of two patients who had recurrent ruptures, and discuss the principles underlying the management of such cases.

Omar A. Khan; Clifford W. Barlow; David F. Weeden; Khalid M. Amer



Wrestling and herpetic esophagitis.  


Herpes simplex virus esophagitis has rarely been reported in immunocompetent children. We describe 2 immunocompetent wrestlers on the same team who presented with fever, odynophagia, and dysphagia. Histologic examination of the esophagus showed ulceration and exudate, herpes simplex virus was detected by polymerase chain reaction. We propose that wrestling may be a mode of transmission for this disease. PMID:21544004

Khlevner, Julie; Beneri, Christy; Morganstern, Jeffrey A



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



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


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

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



Esophageal dysfunction in esophagopharyngeal regurgitation.  


Esophageal manometry was performed in 20 patients with esophagopharyngeal regurgitation, in 20 patients with severe chronic heartburn but without regurgitation, and in 20 normal subjects. The purpose of the procedure was to identify possible differences between these groups in upper esophageal sphincter and lower esophageal sphincter resting pressures, and in amplitude of peristaltic contraction in the distal esophagus. The mean peak upper esophageal sphincter pressures in normal subjects and in patients with chronic heartburn were significantly greater than in the patients with esophagopharyngeal regurgitation (101 and 108 vs. 54 mmHg, respectively). In the normal subjects, the mean lower esophageal sphincter resting pressure (19 mmHg) was significantly greater than for the heartburn group (14 mmHg) and for the patients with esophagopharyngeal regurgitation (10 mmHg). The amplitude of peristalsis was significantly lower in the group with regurgitation than in both normal subjects and the group with chronic heartburn. Nine normal subjects responded to intraesophageal infusion of 0.9% NaCl and 0.1 N HCl with a significant increase in upper esophageal sphincter resting pressure, but the group with esophagopharyngeal regurgitation showed no significant change. Patients with esophagopharyngeal regurgitation have lower esophageal sphincter hypotension, diminished peristaltic amplitude, upper esophageal sphincter hypotension, and diminished upper esophageal sphincter response to intraesophageal fluid. We conclude there is in these patients a breakdown of several normal esophageal mechanisms which ordinarily serve as barriers to esophagopharyngeal regurgitation. PMID:7053042

Gerhardt, D C; Castell, D O; Winship, D H; Shuck, T J



Esophageal Motility in Nonacid Reflux Compared with Acid Reflux  

Microsoft Academic Search

Esophageal motility has been well studied in gastroesophageal reflux disease (GERD) and acid reflux, but not in nonacid reflux.\\u000a Consecutive patients who had both 24-h multichannel intraluminal impedance-pH (MII-pH) and esophageal motility tests for suspected\\u000a GERD were studied. Patients were grouped into nonacid refluxers, acid refluxers, and nonrefluxers based on positive symptom\\u000a correlation and objective findings of acid reflux. Of

Victor S. Wang; Natan Feldman; Rie Maurer; Robert Burakoff



21 CFR 878.3610 - Esophageal prosthesis.  

Code of Federal Regulations, 2010 CFR

...Devices § 878.3610 Esophageal prosthesis. (a) Identification. An esophageal prosthesis is a rigid, flexible, or expandable tubular device made of a...esophagus. The metal esophageal prosthesis may be uncovered or...



21 CFR 878.3610 - Esophageal prosthesis.  

Code of Federal Regulations, 2010 CFR

...Devices § 878.3610 Esophageal prosthesis. (a) Identification. An esophageal prosthesis is a rigid, flexible, or expandable tubular device made of a...esophagus. The metal esophageal prosthesis may be uncovered or...



Value of preoperative esophageal function studies before laparoscopic antireflux surgery  

Microsoft Academic Search

Background  The value of esophageal manometry and ambulatory pH monitoring before laparoscopic antireflux surgery (LARS) has been questioned\\u000a because tailoring the operation to the degree of hypomotility often is not required. This study evaluated a consecutive cohort\\u000a of patients referred for esophageal function studies in preparation for LARS to determine the rates of findings that would\\u000a alter surgical decisions.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  High-resolution manometry

Walter W. Chan; Laura R. Haroian; C. Prakash Gyawali


Investigation of the enhancement of N-nitrosomethylbenzylamine-induced esophageal tumorigenesis by 6-phenylhexyl isothiocyanate  

Microsoft Academic Search

Previous studies in our laboratory have shown that 6-phenylhexyl isothiocyanate (PHITC), enhances N-nitrosomethylbenzylamine (NMBA)-induced esophageal tumorigenesis in F344 rats while the shorter chain analogs, phenylethyl isothiocyanate (PEITC), and 3-phenylpropyl isothiocyanate (PPITC), inhibit NMBA-induced esophageal tumorigenesis. To test the hypothesis that PHITC influences the promotional stage of esophageal tumorigenesis, groups of 22–27 rats were dosed with vehicle or NMBA three times

Tamaro S. Hudson; Peter S. Carlton; Ashok Gupta; Gary D. Stoner; Mark A. Morse



The Effects of Nebulized Albuterol on Esophageal Function in Asthmatic Patients  

Microsoft Academic Search

Purpose Albuterol reduces lower esophageal sphincter (LES) pressure in normal volunteers, although the effects of albuterol on esophageal\\u000a function in asthmatic patients are not known. The aim of this study was to evaluate the effects of nebulized albuterol on\\u000a lower esophageal function in asthmatic patients. Symptoms and a methacholine challenge test were used to identify asthmatic\\u000a patients who were then

Brian E. Lacy; Carole Mathis; John DesBiens; Mark C. Liu



Spatial Variability of Soil Test Phosphorus, Potassium, and pH of Ontario Soils  

Microsoft Academic Search

being generated. The field-specific characteristics of the soil test levels (i.e., the range of soil test levels and the Grid soil sampling is typically used for establishing management nature of the spatial variability) ultimately determine zones for site-specific application of nutrients. The geostatistical pro- cedures used to estimate values between sample locations require sam- the sampling intensity required. The increased

John D. Lauzon; Ivan P. O'Halloran; David J. Fallow; A. Peter von Bertoldi; Doug Aspinall



Control of Flavobacterium psychrophilum: tests of erythromycin, streptomycin, osmotic and thermal shocks, and rapid pH change.  


Flavobacterium psychrophilum, the etiological agent that causes bacterial coldwater disease, has been implicated in significant reductions in the numbers of salmonids reared at fish hatcheries. In this study, we performed a series of in vitro experiments to test the effectiveness of rapid temperature, pH, and osmotic pressure changes in killing three strains of the bacterium. We also evaluated the effectiveness of antibiotics (erythromycin, streptomycin, and a penicillin-streptomycin mixture) against F. psychrophilum. The bacterium tolerated temperatures of 40-50°C for up to 30 min (when acclimated to 15°C). The bacterium can survive lower temperatures for >60 min. Although temperatures ?55°C appeared to kill F. psychrophilum on contact, we found that eyed eggs of Rainbow Trout Oncorhynchus mykiss were not able to survive short (<60-s) exposures at these temperatures. We found that rapid changes in pH (15-min exposures to pH 3.0, 4.0, 5.0, 7.0, 9.0, 10.0, and 11.0) and osmotic pressure (15-min exposures to 0, 6, 8, 10, 12% sodium chloride) were not effective at killing the bacterium. Erythromycin concentrations up to 2,000 mg/L for 15 min were also ineffective. However, streptomycin concentrations ?5,000 mg/L killed the bacterium during a 15-min exposure. The combination of penicillin and streptomycin was also effective, killing the bacterium at doses as low as 2.5 × 10(6) IU penicillin + 2,500 mg/L streptomycin. Our trials demonstrate that elevated temperatures and the combination of penicillin and streptomycin can kill F. psychrophilum under in vitro conditions. Erythromycin and rapid changes in pH and osmotic pressure are not effective at killing the bacterium. PMID:23241009

Oplinger, Randall W; Wagner, Eric J



Growth-inhibitory effects of sulfonamides at different pH: dissimilar susceptibility patterns of a soil bacterium and a test bacterium used for antibiotic assays.  


The ionic speciation of sulfonamides is pH-driven and this may be crucial for their bioavailability and sorption to soil constituents, as well as for their uptake into bacterial cells. The inhibition behaviour of a bacterial test strain (Pseudomonas aeruginosa; DSM 1117), which was grown in the presence of different concentrations of 8 sulfonamides at pH values from 5 to 8, could be predicted by models that take the speciation of sulfonamides in- and outside of bacterial cells into account. Assuming a pH of 7.5 inside the cells (pH homeostasis), the strongest inhibition was predicted for the lowest external pH and for sulfonamides with the lowest pK(a) values. Growth experiments with Ps. aeruginosa basically reflected this predicted behaviour. However, Pantoea agglomerans -- a bacterial strain isolated from arable soil -- behaved surprisingly different regarding its pH dependency: all sulfonamides showed the strongest effects at pH 7 to 8 instead of being most effective at lowest pH, although the pK(a) dependencies followed the same pattern. Experimental and modeling results could be brought into good agreement for P. agglomerans if the cell-internal pH was admitted to approximate the external pH instead of implying pH homeostasis for modeling calculations. Thus, besides the actual concentration of sulfonamides, the pH dependent mode of reaction of different bacteria to sulfonamides may additionally govern the population dynamics in soils. PMID:18396316

Tappe, Wolfgang; Zarfl, Christiane; Kummer, Sirgit; Burauel, Peter; Vereecken, Harry; Groeneweg, Joost



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.



Esophageal waveform analysis for detection and quantification of reflux episodes  

US Patent & Trademark Office Database

A system and method for automatically analyzing impedance and pH data from an esophageal probe includes a data collection system that collects and stores the output from the sensors for a certain period of time to locate reflux episodes in the waveforms. The data analysis system uses wavelet analysis to assist in locating bolus entry and exit points in the waveforms and to smooth waveforms for additional analysis. It also distinguishes between candidate acid reflux episodes and candidate non-acid reflux episodes for determining actual acid reflux episodes and non-acid reflux episodes, and it distinguishes between, and provides different signal processing for, signals from patients that have healthy esophageal tissue and those that have diseased esophageal tissue.

Stuebe; Thomas D. (Littleton, CO); Chandrasekar; Venkatachalam (Fort Collins, CO); Al-Zaben; Awad (Irbid, JO)



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:; No.: NCT00233194; URL:

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.



Design of PH-based accelerated life testing plans under multiple-stress-type  

Microsoft Academic Search

Accelerated life testing (ALT) is used to obtain failure time data quickly under high stress levels in order to predict product life performance under design stress conditions. Most of the previous work on designing ALT plans is focused on the application of a single stress. However, as components or products become more reliable due to technological advances, it becomes more

E. A. Elsayed; Hao Zhang



The effect of pH on the uptake and toxicity of the bivalent weak base chloroquine tested on Salix viminalis and Daphnia magna.  


The uptake and accumulation of most electrolytes will change with pH because of the different speciation states of these compounds at various pH. Non-ionized compounds will partition into fatty and organic phases (such as cell membranes) more readily than the corresponding charged compounds, and therefore a higher toxicity can be expected. The current study examines the pH-dependent toxicity and bioaccumulation of the bivalent weak base chloroquine (pK(a): 10.47 and 6.33, log K(OW) 4.67) tested on Salix viminalis (basket willow) and Daphnia magna (water flea). The transpiration rates of hydroponically grown willow cuttings were used to determine the toxicity of chloroquine at pH levels of 6, 7, 8, and 9. Root concentration factors were calculated from solution measurements. Results showed more than 10-fold higher toxicity and four to seven times higher root concentration factor at pH 9 than at pH 6. The toxicity of chloroquine was tested on Daphnia magna using the standard Organisation for Economic Co-operation and Development acute toxicity test modified to accommodate testing at pH levels of 7, 8, and 9. Increasing toxicity was seen at higher pH. The results of the current study confirm that the toxicity of weak bases with intermediate pK(a) values is higher at high pH levels. PMID:21038438

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



Esophageal pain: Emerging concepts  

Microsoft Academic Search

Esophageal pain manifests as symptoms of heartburn, chest pain, or both. It shares features with other types of visceral pain\\u000a in that it is poorly characterized and not well localized, owing to the divergence of visceral afferents. The esophagus is\\u000a innervated by vagal and visceral spinal afferents, both of which are activated by noxious stimuli and convey information to\\u000a specific

Robert Lee; Ravinder K. Mittal



The influence of pH of the culture medium on the sensitivity of Mycoplasma gallisepticum antigens for use in certain serological tests  

PubMed Central

Mycoplasma gallisepticum antigens were prepared from organisms cultured in broth medium with glucose. The influence of period of growth, pH of the medium and duration of incubation at low pH (5·0) on the sensitivity of these antigens was determined in certain tests. The most sensitive antigen for the serum plate test was harvested after no more than 8 hr. incubation at pH 5·0. Sensitivity in serum plate, haemagglutination and gel diffusion tests was impaired if organisms were incubated at pH 5·0 for long periods. Antigens prepared from buffered broth medium were found to be at least as sensitive as those from unbuffered medium for the haemagglutination and gel precipitation tests, but considerably less so for the serum plate test. ImagesPlate 1Plate 1Plate 2Plate 2Plate 2

Bradbury, Janet M.; Jordan, F. T. W.



Adopting a Robotic pH Instrument for Soil and Soil-Buffer pH Measurements in a Soil Test Laboratory  

Microsoft Academic Search

Optimum software settings were evaluated to minimize time of analysis without sacrificing data quality on an AS-3010D LabFit robotic instrument. There was little to no difference between soil and soil-buffer pH values measured via manual methods and LabFit analysis with four software settings. A setting for routine laboratory analysis was determined by evaluating r values from a comparison of LabFit

F. J. Sikora; P. Howe; D. Reid; D. Morgan; E. Zimmer



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



Treatment of esophageal spirocercosis with milbemycin oxime  

Microsoft Academic Search

Six medium sized mixed breed dogs treated with milbemycin oxime (11.5mg on days 0, 7 and 28 and then monthly) stopped shedding Spirocerca lupi ova after 3–44 days. There was no evidence of subsequent shedding in repeated tests (about 5\\/dog) carried out from 31 to 133 days after initiation of treatment. Esophageal nodules disappeared in all dogs within 95–186 days

P. J. Kelly; M. Fisher; H. Lucas; R. C. Krecek



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.



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.



Molecular aspects of esophageal development.  


The following on molecular aspects of esophageal development contains commentaries on esophageal striated myogenesis and transdifferentiation; conversion from columnar into stratified squamous epithelium in the mouse esophagus; the roles for BMP signaling in the developing esophagus and forestomach; and evidence of a direct conversion from columnar to stratified squamous cells in the developing esophagus. PMID:21950820

Rishniw, Mark; Rodriguez, Pavel; Que, Jianwen; Burke, Zoe D; Tosh, David; Chen, Hao; Chen, Xiaoxin



Molecular aspects of esophageal development  

PubMed Central

The following on molecular aspects of esophageal development contains commentaries on esophageal striated myogenesis and transdifferentiation; conversion from columnar into stratified squamous epithelium in the mouse esophagus; the roles for BMP signaling in the developing esophagus and forestomach; and evidence of a direct conversion from columnar to stratified squamous cells in the developing esophagus.

Rishniw, Mark; Rodriguez, Pavel; Que, Jianwen; Burke, Zoe D.; Tosh, David; Chen, Hao; Chen, Xiaoxin



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



21 CFR 868.1920 - Esophageal stethoscope with electrical conductors.  

Code of Federal Regulations, 2010 CFR

...Esophageal stethoscope with electrical conductors. 868.1920 Section...Esophageal stethoscope with electrical conductors. (a) Identification...esophageal stethoscope with electrical conductors is a device that...



21 CFR 868.1920 - Esophageal stethoscope with electrical conductors.  

Code of Federal Regulations, 2013 CFR

...Esophageal stethoscope with electrical conductors. 868.1920 Section 868...Esophageal stethoscope with electrical conductors. (a) Identification. An esophageal stethoscope with electrical conductors is a device that is...



Pediatric esophageal leiomyosarcoma: a case report  

Microsoft Academic Search

Esophageal leiomyosarcoma accounts for only 0.5% of all esophageal tumors. This rare tumor has been reported in middle-aged or elderly patients. In contrast, pediatric esophageal leiomyosarcomas have never been reported. The case described herein is the first report of an esophageal leiomyosarcoma in a pediatric patient with its own characteristics. The patient had symptoms of mild cough without dysphagia. The

Wen-xian Wang; Desai Gaurav; Li Wen; Ming-fu Ye; Qing-rong Sun; Wei-jin Liu; Dong Zhang



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.



Berberine protects against esophageal mucosal damage in reflux esophagitis by suppressing proinflammatory cytokines  

PubMed Central

This study was performed to investigate the effects of berberine (BB) in a rat model of gastroesophageal reflux disease (GERD), induced by pylorus and forestomach ligation. We evaluated cytotoxicity and proinflammatory biomarkers (nitric oxide, interleukin (IL)-1? and prostaglandin E2) in RAW 264.7 cells in vitro and anti-inflammatory effects in vivo. A total of 54 Sprague Dawley rats were divided into six groups: intact control rats; reflux esophagitis (RE) control rats; RE rats treated with 20 mg/kg omeprazole and RE rats treated with BB at doses of 20, 40 and 60 mg/kg, respectively. All rats were fasted. RE was induced by pylorus and forestomach ligation one hour subsequent to the oral treatment. Six hours subsequent to the surgery, the rats were sacrificed, blood was collected from the abdominal vein and the esophagus and stomach were dissected. The gastric volume and the pH of the gastric juice were evaluated, prior to the esophagus being cut longitudinally and an inner mucosal area being imaged, to analyze mucosal damage indices. Proinflammatory biomarkers in the serum, including tumor necrosis factor (TNF)-?, IL-1?, IL-6 and monocyte chemoattractant protein (MCP)-1 were analyzed using an enzyme-linked immunosorbent assay (ELISA) kit, while the mRNA expression of TNF-?, IL-1?, IL-6 and plasminogen activator inhibitor (PAI)-1 was analyzed using a quantitative polymerase chain reaction (qPCR). Esophagic tissue damage in the BB groups was dose-dependently decreased compared with that in the RE control group. This result was consistent with significant reductions in the levels of proinflammatory biomarkers in the serum and in the expression of proinflammatory mRNA, specifically, TNF-?, IL-1?, IL-6 and PAI-1. The results suggest that the anti-inflammatory and protective effects of BB may attenuate the severity of RE and prevent esophageal mucosal damage, in addition to validating the use of BB as a pharmacological treatment for esophageal reflux disease.




Epidemiology of esophageal atresia.  


Esophageal atresia (EA) is a rare congenital malformation consisting of a lack of continuity between the upper and lower esophageal pouches, frequently associated with tracheoesophageal fistula. The prevalence of such rare abnormalities is established by global birth surveillance programs over the world. EUROCAT is a European program covering 1.7 million births since its creation. The prevalence of EA in Europe seems stable over decades. The National Birth Defects Prevention Network in the USA also shows a stable prevalence with a wide range between states or regions. In France, with the implementation of the national rare diseases plan, a reference center for congenital abnormalities of the esophagus was created in 2006 and a national registry for EA began patient inclusion in 2008. This has resulted in the establishment of the national live birth prevalence for EA, prenatal diagnosis rates, and clinical characteristics of EA patients, early survival, and early morbidity. Prevalence rates seem stable all over the world since many decades. Continuous surveillance of congenital abnormalities and specific registries are useful for epidemiologic data but also for public health authorities for helping families of rare diseases patients. PMID:23679022

Sfeir, R; Michaud, L; Salleron, J; Gottrand, F


Treatment of advanced esophageal cancer  

SciTech Connect

When radiation therapy is used for palliation of obstruction in patients with advanced esophageal carcinoma, an improvement in dysphagia can be expected in approximately 50% of patients. Major objective responses have rarely been quantitied but, in one study, were seen in 33% patients. Recurrence of dysphagia is usually seen within 2-6 months of treatment. Radiation toxicities and complications, even when used with palliative intent, can be substantial and include esophagitis, tracheoesophageal or esophageal-aortic fistula, mediastinitis, hemorrhage, pneumonitis, and myelosuppression. (JMT)

Kelsen, D.



Nuclear medicine and esophageal surgery  

SciTech Connect

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

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



Testing the steady-state water chemistry model predictions of pre-industrial lake pH with paleolimnological data from northern Sweden  

Microsoft Academic Search

Criteria are needed for distinguishing naturally acid water from that acidified by air pollution, especially in the organic-rich waters of northern Sweden. The Steady-State Water Chemistry Model (SSWC) was augmented to include organic acidity so that it could predict pre-industrial pH in organic-rich waters. The resulting model predictions of pre-industrial ANC and pH were then tested against diatom predictions of

K. Bishop; L. Rapp; S. Köhler; T. Korsman



Esophageal tissue engineering: A new approach for esophageal replacement  

PubMed Central

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

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



The Frequencies of Gastroesophageal and Extragastroesophageal Symptoms in Patients with Mild Erosive Esophagitis, Severe Erosive Esophagitis, and Barrett's Esophagus in Taiwan  

PubMed Central

Background. Gastroesophageal reflux disease (GERD) may present with gastroesophageal and extraesophageal symptoms. Currently, the frequencies of gastroesophageal and extragastroesophageal symptoms in Asian patients with different categories of GERD remain unclear. Aim. To investigate the frequencies of gastroesophageal and extragastroesophageal symptoms in patients with mild erosive esophagitis, severe erosive esophagitis, and Barrett's esophagus of GERD. Methods. The symptoms of symptomatic subjects with (1) Los Angeles grade A/B erosive esophagitis, (2) Los Angeles grade C/D erosive esophagitis, and (3) Barrett's esophagus proven by endoscopy were prospectively assessed by a standard questionnaire for gastroesophageal and extragastroesophageal symptoms. The frequencies of the symptoms were compared by Chi-square test. Result. Six hundred and twenty-five patients (LA grade A/B: 534 patients; LA grade C/D: 37 patients; Barrett's esophagus: 54 patients) were assessed for gastroesophageal and extragastroesophageal symptoms. Patients with Los Angeles grade A/B erosive esophagitis had higher frequencies of symptoms including epigastric pain, epigastric fullness, dysphagia, and throat cleaning than patients with Los Angeles grade C/D erosive esophagitis. Patients with Los Angeles grade A/B erosive esophagitis also had higher frequencies of symptoms including acid regurgitation, epigastric acidity, regurgitation of food, nausea, vomiting, epigastric fullness, dysphagia, foreign body sensation of throat, throat cleaning, and cough than patients with Barrett's esophagus. Conclusion. The frequencies of some esophageal and extraesophageal symptoms in patients with Los Angeles grade A/B erosive esophagitis were higher than those in patients with Los Angeles grade C/D erosive esophagitis and Barrett's esophagus. The causes of different symptom profiles in different categories of GERD patients merit further investigations.

Kao, Sung-Shuo; Chen, Wen-Chih; Hsu, Ping-I; Chuah, Seng-Kee; Lu, Ching-Liang; Lai, Kwok-Hung; Tsai, Feng-Woei; Chang, Chun-Chao; Tai, Wei-Chen



Spectrum of esophageal disorders in children with chest pain  

Microsoft Academic Search

The charts of 83 children with chest pain who underwent esophageal manometry followed by esophagogastroscopy were reviewed. Forty-seven (57%) had normal esophageal histology and normal motility (group I). Esophagitis and normal motility were demonstrated in 15 children (group II), normal esophageal histology and esophageal dysmotility in 13 (group III), and both esophagitis and abnormal motility in 8 (group IV). Diffuse

Mark S. Glassman; Marvin S. Medow; Stuart Berezin; Leonard J. Newman



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



[Management of caustic esophagitis in children].  


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

Mas, E; Breton, A; Lachaux, A



Giant asymptomatic primary esophageal schwannoma.  


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



Esophageal carcinoma and transthoracic echocardiography.  


We report a rare case of a patient with esophageal carcinoma diagnosed using transthoracic echocardiography. This examination proved to be useful in the identification of a paracardiac mediastinal mass. Images of the esophageal carcinoma, of the stent in the esophagus, and the bubbles inside the stent generated with the ingestion of a carbonated beverage, have not been previously published. Therefore, we believe our findings may be useful to other echocardiographers. PMID:23834459

Cianciulli, Tomás F; Saccheri, María C; Lax, Jorge A; Bianchi, Ricardo A; Beck, Martín A; Ferreiro, Daniel E



Esophageal malignancy: A growing concern  

PubMed Central

Esophageal cancer is mainly found in Asia and east Africa and is one of the deadliest cancers in the world. However, it has not garnered much attention in the Western world due to its low incidence rate. An increasing amount of data indicate that esophageal cancer, particularly esophageal adenocarcinoma, has been rising by 6-fold annually and is now becoming the fastest growing cancer in the United States. This rise has been associated with the increase of the obese population, as abdominal fat puts extra pressure on the stomach and causes gastroesophageal reflux disease (GERD). Long standing GERD can induce esophagitis and metaplasia and, ultimately, leads to adenocarcinoma. Acid suppression has been the main strategy to treat GERD; however, it has not been proven to control esophageal malignancy effectively. In fact, its side effects have triggered multiple warnings from regulatory agencies. The high mortality and fast growth of esophageal cancer demand more vigorous efforts to look into its deeper mechanisms and come up with better therapeutic options.

Chai, Jianyuan; Jamal, M Mazen



Proteomic profiling of proteins dysregulted in Chinese esophageal squamous cell carcinoma  

Microsoft Academic Search

Esophageal squamous cell carcinoma (ESCC) is one of the leading causes of cancer death in China. In the present study, proteins\\u000a in tumors and adjacent normal esophageal tissues from 41 patients with ESCC were extracted, and two-dimensional electrophoresis\\u000a (2-DE) was performed using the pH 3–10 and 4–7 immobilized pH gradient strips. The protein spots expressed differentially\\u000a between tumors and normal tissues

Xiao-Li Du; Hai Hu; De-Chen Lin; Shu-Hua Xia; Xiao-Ming Shen; Yu Zhang; Man-Li Luo; Yan-Bin Feng; Yan Cai; Xin Xu; Ya-Ling Han; Qi-Min Zhan; Ming-Rong Wang



Vertical lines in distal esophageal mucosa (VLEM): a true endoscopic manifestation of esophagitis in children?  

Microsoft Academic Search

Background: We observed an endoscopic abnormality in a group of children with histological esophagitis. We termed this finding “vertical lines in esophageal mucosa” (VLEM). We examined the relationship between the presence of VLEM and significant histologic changes in esophageal mucosal biopsies. Methods: Between January 1, 1992, and August 31, 1994, the senior author (JFF) performed 255 esophageal biopsies. The procedure

Sandeep K. Gupta; Joseph F. Fitzgerald; Sonny K. F. Chong; Joseph M. Croffie; Margaret H. Collins



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


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



Abnormalities of esophageal and gastric emptying in progressive systemic sclerosis  

SciTech Connect

Gastric and esophageal emptying were assessed using scintigraphic techniques in 12 patients with progressive systemic sclerosis and 22 normal volunteers. Esophageal emptying was significantly delayed in the patient group, with 7 of the 12 patients beyond the normal range. Gastric emptying was slower in patients than in controls, with 9 patients being outside the normal range for solid emptying and 7 patients outside the normal range for liquid emptying. Findings from gastric and esophageal emptying tests generally correlated well with symptoms of dysphagia and gastroesophageal reflux. However, 2 patients with normal emptying studies had symptomatic heartburn, and 2 patients with delay of both solid and liquid gastric emptying gave no history of gastroesophageal reflux. Delayed gastric emptying may be an important factor in the development of upper gastrointestinal symptoms in patients with progressive systemic sclerosis.

Maddern, G.J.; Horowitz, M.; Jamieson, G.G.; Chatterton, B.E.; Collins, P.J.; Roberts-Thomson, P.



21 CFR 868.1910 - Esophageal stethoscope.  

Code of Federal Regulations, 2013 CFR

...Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Diagnostic Devices § 868.1910 Esophageal stethoscope. (a) Identification. An esophageal...



21 CFR 868.5650 - Esophageal obturator.  

Code of Federal Regulations, 2013 CFR

...Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5650 Esophageal obturator. (a) Identification. An esophageal...



Sonographic demonstration of cervical esophageal web.  


We report a case of esophageal web demonstrated with sonography in a 45-year-old woman with dysphagia. The esophageal web was incidentally detected as a circumferential hypoechoic membrane on sonograms of the cervical esophagus. PMID:16547989

Rokade, Muktachand Laxman


21 CFR 876.5365 - Esophageal dilator.  

Code of Federal Regulations, 2013 CFR




Treatment of esophageal spirocercosis with milbemycin oxime.  


Six medium sized mixed breed dogs treated with milbemycin oxime (11.5mg on days 0, 7 and 28 and then monthly) stopped shedding Spirocerca lupi ova after 3-44 days. There was no evidence of subsequent shedding in repeated tests (about 5/dog) carried out from 31 to 133 days after initiation of treatment. Esophageal nodules disappeared in all dogs within 95-186 days and radiographic signs resolved within 85-127 days in the five dogs that were studied. This preliminary data shows milbemycin oxime deserves further evaluation for the treatment of spirocercosis. PMID:18644677

Kelly, P J; Fisher, M; Lucas, H; Krecek, R C



The Role of EUS in Esophageal Cancer  

Microsoft Academic Search

\\u000a Esophageal cancer is the fifth most common gastrointestinal cancer and the ninth leading cause of cancer death in the United\\u000a States. The incidence of esophageal adenocarcinoma is on the rise. Accurate staging of esophageal cancer is critical for the\\u000a selection of appropriate treatment. Endoscopic ultrasound (EUS) plays an important role in the staging of esophageal cancer.\\u000a EUS provides a detailed

Audrey H. Calderwood; Brian C. Jacobson


Esophageal motility disorders after gastric banding.  


The long-term effects of gastric banding on esophageal function are not well described. This report describes a 28-year-old woman who developed signs and symptoms of abnormal esophageal motility and lower esophageal sphincter hypotension after gastric banding for morbid obesity. The current literature addressing the effects of gastric banding on esophageal function in light of this case report is discussed. PMID:17509126

O'Rourke, R W; Deveney, C W; McConnell, D B; Wolfe, B M; Jobe, B A



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



Hundredth molar calcium chloride extraction procedure. part II: Calibration with conventional soil testing methods for pH  

Microsoft Academic Search

Soil pH is probably the most important, single, parameter characterizing its fertility. For theoretical and practical reasons the soil pH is usually measured in salt solutions of different strength. The most common solution used in Europe is 1M potassium chloride (KCl) in a soil\\/solution ratio of 1:2.5 (W\\/V). The ultimate goal of the international project Copernicus of the European Community

Mariusz Fotyma; Tamara Jadczyszyn; Grzegorz Jozefaciuk



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



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))



Reoperation after esophageal replacement in childhood  

Microsoft Academic Search

Background: Esophageal replacement is associated with significant morbidity that may lead to operative interventions. This study reviews the management and outcome of children who underwent reoperation after esophageal replacement.Methods: Eighteen patients who underwent esophageal replacement from 1985 to 1997 were reviewed retrospectively. Ten patients underwent reoperation. Patient management, perioperative morbidity, and the dietary intake at follow-up were recorded for each

James C. Y Dunn; Eric W Fonkalsrud; Harry Applebaum; William W Shaw; James B Atkinson



The history of esophageal surgery: pediatric aspects  

Microsoft Academic Search

An attempt is made to explore those aspects of the history of esophageal surgery relevant to pediatric practice. In some areas, the history is entirely focused on conditions of particular pediatric significance; esophageal atresia is a classic example of this group. In other areas there is considerable overlap, which varies in extent, with the history of esophageal surgery in adult.

N. A. Myers



Clinicopathologic characteristics of high expression of Bmi-1 in esophageal adenocarcinoma and squamous cell carcinoma  

PubMed Central

Background High expression of Bmi-1, a key regulatory component of the polycomb repressive complex-1, has been associated with many solid and hematologic malignancies including esophageal squamous cell carcinoma. However, little is known about the role of Bmi-1 in esophageal adenocarcinoma. The aim of this study is to investigate the amplification and high expression of Bmi-1 and the associated clinicopathologic characteristics in esophageal adenocarcinoma and squamous cell carcinoma. Methods The protein expression level of Bmi-1 was detected by immunohistochemistry (IHC) from tissue microarrays (TMA) constructed at the University of Rochester from using tissues accrued between 1997 and 2005. Types of tissues included adenocarcinoma, squamous cell carcinoma and precancerous lesions. Patients’ survival data, demographics, histologic diagnoses and tumor staging data were collected. The intensity (0–3) and percentage of Bmi-1 expression on TMA slides were scored by two pathologists. Genomic DNA from 116 esophageal adenocarcinoma was analyzed for copy number aberrations using Affymetrix SNP 6.0 arrays. Fisher exact tests and Kaplan-Meier methods were used to analyze data. Results By IHC, Bmi-1 was focally expressed in the basal layers of almost all esophageal squamous mucosa, which was similar to previous reports in other organs related to stem cells. High Bmi-1 expression significantly increased from squamous epithelium (7%), columnar cell metaplasia (22%), Barrett’s esophagus (22%), to low- (45%) and high-grade dysplasia (43%) and adenocarcinoma (37%). The expression level of Bmi-1 was significantly associated with esophageal adenocarcinoma differentiation. In esophageal adenocarcinoma, Bmi-1 amplification was detected by DNA microarray in a low percentage (3%). However, high Bmi-1 expression did not show an association with overall survival in both esophageal adenocarcinoma and squamous cell carcinoma. Conclusions This study demonstrates that high expression Bmi-1 is associated with esophageal adenocarcinoma and precancerous lesions, which implies that Bmi-1 plays an important role in early carcinogenesis in esophageal adenocarcinoma.



Combined pH and high hydrostatic pressure effects on Lactococcus starter cultures and Candida spoilage yeasts in a fermented milk test system during cold storage  

Microsoft Academic Search

The combined effects of high pressure processing (HPP) and pH on the glycolytic and proteolytic activities of Lactococcus lactis subsp. lactis, a commonly used cheese starter culture and the outgrowth of spoilage yeasts of Candida species were investigated in a fermented milk test system. To prepare the test system, L. lactis subsp. lactis C10 was grown in UHT skim milk to

Hossein Daryaei; John Coventry; Cornelis Versteeg; Frank Sherkat



Control of post mortem pH decrease in pig muscles: experimental design and testing of animal models  

Microsoft Academic Search

From a series of experiments aimed at manipulating and relating the resting levels of glycogen and creatine phosphate (CP) in the live muscle four models were selected to induce different rates and extents of pH decrease post mortem in pig muscle. Model A served as the control, animals being slaughtered under minimal stress, in model B animals were subjected to

Poul Henckel; Anders Karlsson; Niels Oksbjerg; Jette Søholm Petersen



Effect of graded exercise on esophageal motility and gastroesophageal reflux in nontrained subjects  

Microsoft Academic Search

The effects of graded exercise on esophageal motility and gastroesophageal reflux were evaluated in nine nontrained subjects, using a catheter with three strain-gauge transducers connected to a solid-state datalogger and an ambulatory intraesophageal pH monitor. Subjects exercised on a stationary bike at 45%, 60%, 75%, and 90% of peak O2 uptake (\\u000a

E. E. Soffer; J. Wilson; G. Duethman; J. Launspach; T. E. Adrian



Solid phase radionuclide esophageal motility in polymyositis and dermatomyositis.  


Polymyositis (PM) and dermatomyositis (DM) may be associated with motor dysfunction of the entire gastrointestinal tract. Abnormal esophageal motor function is a well-recognized complication of these diseases. In this study, we used a solid phase esophageal study to evaluate the motor function in patients with PM or DM. Twenty-three patients and 36 age-matched normal volunteers were studied. Each subject was placed in a supine position above a gamma camera linked to a computer and was given a 4-ml bolus of solid gelatin containing 1 mCi of Tc-99m phytate. Data were acquired in the list mode. A computer method modified from Kelim and Wald and Russell et al. was used to calculate the following: A) total mean transit time (MTT); B) residual fraction after the first swallow (RF); and C) retrograde index (RI). All values are presented as mean +/- standard deviation (SD). The Student's t-test was used to test statistical significance. Our preliminary results suggest: 1) delayed esophageal emptying is common (17/23) in PM/DM, indicating frequent malfunction of the smooth muscle of the upper gastrointestinal tract in PM/DM and 2) measurement of esophageal motility may monitor disease activity in PM/DM. PMID:8340957

Wang, S J; Lin, W Y; Hsu, C Y; Kao, C H; Chang, C P; Lan, J L



Exercise-provoked esophageal motility disorder in patients with recurrent chest pain  

PubMed Central

AIM: To investigate the relationship between exercise-provoked esophageal motility disorders and the prognosis for patients with chest pain. METHODS: The study involved 63 subjects with recurrent angina-like chest pain non-responsive to empirical therapy with proton pump inhibitor (PPI). In all, a coronary artery angiography, panendoscopy, 24-h esophageal pH-metry and manometry, as well as a treadmill stress test with simultaneous esophageal pH-metry and manometry monitoring, were performed. Thirty-five subjects had no significant coronary artery lesions, and 28 had more than 50% coronary artery narrowing. In patients with hypertensive esophageal motility disorders, a calcium antagonist was recommended. The average follow-up period was 977 ± 249 d. RESULTS: The prevalence of esophageal disorders, such as gastroesophageal reflux or diffuse esophageal spasm, was similar in patients both with and without significant coronary artery narrowing. Exercise prompted esophageal motility disorders, such as a decrease in the percentage of peristaltic and effective contractions and their amplitude, as well as an increase in the percentage of simultaneous and non-effective contractions. In 14 (22%) patients the percentage of simultaneous contractions during the treadmill stress test exceeded the value of 55%. Using Kaplan-Meier analysis and the proportional hazard Cox regression model, it was shown that the administration of a calcium channel antagonist in patients with such an esophageal motility disorder significantly decreased the risk of hospitalization as a result of a suspicion of acute coronary syndrome after the 2.7-year follow-up period. CONCLUSION: In patients with chest pain non-responsive to PPIs, a diagnosis of exercise-provoked esophageal spasm may have the effect of lowering the risk of the next hospitalization.

Budzynski, Jacek



Specific Movement of Esophagus During Transient Lower Esophageal Sphincter Relaxation in Gastroesophageal Reflux Disease  

PubMed Central

Background/Aims Transient lower esophageal sphincter relaxation (TLESR) is the main mechanism of gastroesophageal reflux disease (GERD). The aim of this study was to investigate the characteristics of transient lower esophageal sphincter movement in patients with or without gastroesophageal reflux by high-resolution manometry (HRM). Methods From June 2010 to July 2010, we enrolled 9 patients with GERD (GERD group) and 9 subjects without GERD (control group), prospectively. The manometry test was performed in a semi-recumbent position for 120 minutes following ingestion of a standardized, mixed liquid and solid meal. HRM was used to identify the frequency and duration of TLESR, esophageal shortening length from incomplete TLESR, upper esophageal sphincter (UES) response, and the related esophageal motor responses during TLESR. Results TLESR occurred in 33 in the GERD group and 34 in the control group after 120 minutes following food ingestion. Duration of TLESR and length of esophageal shortening did not differ between 2 groups. UES pressure increase during TLESR was mostly detected in patients with GERD, and UES relaxation was observed frequently in the control group during TLESR. TLESR-related motor responses terminating in TLESR were predominantly observed in the control group. Conclusions Increased UES pressure was noted frequently in the GERD group, suggesting a mechanism for preventing harmful reflux, which may be composed mainly of fluid on the larynx or pharynx. However, patients with GERD lacked the related motor responses terminating in TLESR to promote esophageal emptying of refluxate.

Kim, Hoon Il; Han, Jae Pil; Seo, Jung Yeon; Hwang, Kyoung Hwa; Maeng, Hyo Jin; Lee, Tae Hee; Lee, Joon Seong



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

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



Thoracic complications of esophageal disorders.  


Abnormalities of the esophagus are common, and complications associated with these disorders and diseases can involve the mediastinum, tracheobronchial tree, and lungs. The most common complications include mediastinitis secondary to esophageal perforation or postoperative anastomotic leak, or both; empyema due to fistula formation; and aspiration pneumonia. The authors reviewed the radiologic appearances of those and other common thoracic complications associated with esophageal disorders to facilitate early detection, diagnosis, and management. Computed tomographic (CT) findings of acute mediastinitis secondary to esophageal perforation may include esophageal thickening, extraluminal gas, pleural effusion, single or multiple abscesses, and extraluminal contrast medium. The radiologic manifestations of pneumonia secondary to tracheoesophageal fistula are variable, depending on the spread and severity of the aspiration. The most common radiographic pattern is that of bronchopneumonia with scattered air-space opacities. CT has been regarded as the imaging modality of choice for the evaluation of suspected esophagopleural fistula, because the site of communication between the pleural space and the esophagus can often be seen. An awareness of the radiologic manifestations of these complications is thus required to facilitate early diagnosis. PMID:12376614

Giménez, Ana; Franquet, Tomás; Erasmus, Jeremy J; Martínez, Santiago; Estrada, Pilar



Esophageal manifestations of celiac disease.  


Celiac disease (CD) may often be associated with various motor disorders affecting the different segments of the digestive tract, including the esophagus. Although it has not been universally reported, some available evidences indicate that pediatric and adult celiac patients could manifest a higher frequency of esophagitis and gastroesophageal reflux disease-related symptoms compared to nonceliac patients. In addition, several published studies have consistently shown the efficacy of a gluten-free diet in rapidly controlling esophageal symptoms and in preventing their recurrence. Since the participation of gluten in the esophageal symptoms of CD seems clear, its intimate mechanisms have yet to be elucidated, and several hypothesis have been proposed, including the specific immune alterations characterizing CD, the reduction in nutrient absorption determining the arrival of intact gluten to distal gastrointestinal segments, and various dysregulations in the function of gastrointestinal hormones and peptides. Recent studies have suggested the existence of a possible relationship between CD and eosinophilic esophagitis, which should be more deeply investigated. PMID:21438963

Lucendo, A J



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



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.



Ability of pulse contour and esophageal Doppler to estimate rapid changes in stroke volume  

Microsoft Academic Search

Objective  Two technologies to acquire beat-to-beat stroke volume values exist, pulse contour analysis and esophageal Doppler monitoring. Pulse contour analysis assumes fixed aortic impedance. Esophageal Doppler assumes a constant proportional descending aortic flow and diameter. These assumptions may not be correct as arterial tone or myocardial contractility vary. We tested these relationships in the setting of rapidly changing stroke volumes and different

Scott R. Gunn; Hyung Kook Kim; Peter W. J. Harrigan; Michael R. Pinsky



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

Microsoft Academic Search

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

Wooyong Um; Charalambos Papelis



Testing the steady-state water chemistry model predictions of pre-industrial lake pH with paleolimnological data from northern Sweden.  


Criteria are needed for distinguishing naturally acid water from that acidified by air pollution, especially in the organic-rich waters of northern Sweden. The Steady-State Water Chemistry Model (SSWC) was augmented to include organic acidity so that it could predict pre-industrial pH in organic-rich waters. The resulting model predictions of pre-industrial ANC and pH were then tested against diatom predictions of pre-industrial pH and alkalinity in 58 lakes from N. Sweden (after alkalinity was converted to ANC using the CBALK method). The SSWC Model's predictions of pre-industrial lake pH in N. Sweden did not correspond well with the diatom predictions, even when accounting for the uncertainty in the diatom model. This was due to the SSWC's sensitivity to short-term fluctuations in contemporary water chemistry. Thus the SSWC Model is not suitable for judging the acidification of individual lakes in areas such as northern Sweden where the degree of chronic acidification is small, or without a good average value of contemporary water chemistry. These results should be considered when assessing the accuracy of critical loads calculated using SSWC. PMID:19004472

Bishop, K; Rapp, L; Köhler, S; Korsman, T



Long-term outcome of esophageal anastomosis.  


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



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

Microsoft Academic Search

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

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



Transtracheal Esophageal Stent Removal: A Case-Series  

PubMed Central

Benign esophagorespiratory fistula is a rare but often lethal affection and difficult to cure. Possible treatments are surgery or esophageal stenting but may fail and cause respiratory failure. Two patients with spontaneous esophagorespiratory fistula after chemoradiotherapy for an esophageal malignancy were both treated by esophageal exclusion but esophageal stent were left in place. The esophageal stents were transtracheally removed through the fistula. The removals were successful, patients could leave Intensive Care Unit and returned home. Transtracheal esophageal stent removal is technically possible but very risky. Such situations must be avoided: esophageal stents must absolutely be removed before esophageal exclusion.

Buiret, Guillaume; Guiraud, Michel; Pierron, Jerome; Schoeffler, Mathieu; Duperret, Serge; Baulieux, Jacques; Wander, Lionel; Poupart, Marc; Pignat, Jean-Christian



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.




Extended lymphadenectomy in esophageal cancer is debatable.  


Surgery is an essential part of the treatment of patients with esophageal carcinoma. However, there is no consensus on whether the surgical technique can be improved to promote better survival outcome. Specifically, the real value of the addition of a radical lymphadenectomy to the esophageal resection is still elusive and controversial. This paper focuses on the debate of esophagectomy and lymphadenectomy for the treatment of esophageal cancer. PMID:23553174

Herbella, Fernando A M; Laurino Neto, Rafael M; Allaix, Marco E; Patti, Marco G



Epidemiology, Diagnosis, and Staging of Esophageal Cancer  

Microsoft Academic Search

\\u000a Esophageal carcinoma is an uncommon gastrointestinal malignancy with a prevalence rate which is far less than the more common\\u000a colo-rectal cancers. Whereas the overall incidence of esophageal cancer has risen only gradually with time, in the United\\u000a States, Canada, and Western Europe, there has been a dramatic change in the distribution of esophageal cancer by cell type\\u000a (figure 1). Currently

f. Richard; m. d. Heitmiller


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.



Esophageal atresia\\/tracheoesophageal fistula and associated congenital esophageal stenosis  

Microsoft Academic Search

Background. The association of congenital stenosis of the distal esophagus (CES) in children with esophageal atresia\\/tracheoesophageal\\u000a fistula complex (TEF) has been described but is thought to be rare. Most reports have been of individual or small numbers\\u000a of cases. Objective. The objective of the study was to evaluate the incidence, clinical and radiographic features of CES associated with TEF,\\u000a and

Beverley Newman; Thomas M. Bender



A Japanese case of eosinophilic esophagitis.  


Eosinophilic esophagitis (EE) is a rarely diagnosed condition involving eosinophilic infiltration of the esophageal mucosa. Here we present a case of EE in a 69-year-old Japanese man, who presented with abdominal pain, appetite loss, and a history of bronchial asthma. Laboratory findings included peripheral eosinophilia and an increased serum immunoglobulin E level. Computed tomography showed diffuse severe thickening of the esophageal wall, and a barium esophagogram revealed a small caliber of the middle and lower portion of the esophagus, without normal peristaltic contractions. Endoscopy of the esophagus showed a pale mucosa, with adherent whitish exudates resembling fungal infection, and prominent ring-like contractions. Histologic examination of a biopsy specimen revealed marked eosinophil infiltration into the esophageal mucosa. Endoscopic ultrasonography (EUS) demonstrated marked circumferential thickening of the esophageal submucosal layer, and an esophageal manometry study showed a high percentage of ineffective esophageal peristalsis and high-amplitude esophageal body contractions. EUS findings showed no change even after oral corticosteroid therapy, although the histological findings were improved. This is thought to be the first documented Japanese case of EE. EE should be considered in the differential diagnosis in cases of esophageal motility disturbance, even if the patients do not complain of dysphagia. PMID:16933010

Furuta, Koichiro; Adachi, Kyoichi; Kowari, Kentaro; Mishima, Yuko; Imaoka, Hiroshi; Kadota, Chikara; Koshino, Kenji; Miyake, Tatsuya; Kadowaki, Yasunori; Furuta, Kenji; Kazumori, Hideaki; Sato, Shuichi; Ishihara, Shunji; Amano, Yuji; Honda, Masaaki; Kinoshita, Yoshikazu



Pathophysiology of Portal Hypertension and Esophageal Varices  

PubMed Central

Esophageal varices are the major complication of portal hypertension. It is detected in about 50% of cirrhosis patients, and approximately 5–15% of cirrhosis patients show newly formed varices or worsening of varices each year. The major therapeutic strategy of esophageal varices consists of primary prevention, treatment for bleeding varices, and secondary prevention, which are provided by pharmacological, endoscopic, interventional and surgical treatments. Optimal management of esophageal varices requires a clear understanding of the pathophysiology and natural history. In this paper, we outline the current knowledge and future prospect in the pathophysiology of esophageal varices and portal hypertension.

Maruyama, Hitoshi; Yokosuka, Osamu



Indirect immunofluorescence tests in Korean hemorrhagic fever and epidemic (endemic) nephropathia: treatment at low pH for removal of 'nonspecific' fluorescence in tissues from immunocompetent hosts.  


A 'nonspecific' fluorescence probably caused by immunocomplexes appears in the lung tissue of immunocompetent hosts infected with Korean hemorrhagic fever (KHF) or epidemic nephropathy (EN) viruses. Indirect immunofluorescence tests with such KHF- or EN-infected tissue as antigen are unsatisfactory for the detection of low-titer antibody or the reading of titer endpoints. Treatment of acetone-fixed lung sections at pH 3.0 followed by washing with 0.01 M phosphate-buffered saline and distilled water apparently dissolves the immunocomplexes, resulting in an effective removal of the 'nonspecific' fluorescence while the viral antigens are not significantly impaired. Lung sections of KHF-infected Apodemus agrarius coreae and EN-infected Clethrionomys glareolus, acetone-fixed and treated at pH 3.0, were used for the antigenic differentiation of the EN and KHF viruses. PMID:6126464

Lee, P W; Svedmyr, A; Amyx, H L; Gibbs, C J; Gajdusek, D C



Esophageal obstruction due to enteral feed bezoar: A case report and literature review  

PubMed Central

This paper describes a rare complication of enteral feeding, esophageal obstruction due to feeding formula bezoar, and reviews the published cases. An attempt to re-insert the nasogastric tube in a chronically ventilated 80-year-old female fed via a nasogastric tube with Jevity® failed. An esophagogastroduodenoscopy revealed an 18 cm-long concretion of the feeding formula, filling most of the esophageal lumen, which was removed endoscopically. Forty-two cases of feeding formula esophageal bezoars have been reported in the literature. The formation of feeding formula bezoars is triggered by acidic gastroesophageal reflux. The acidic pH in the esophagus causes clotting of the casein in the formula. Predisposing factors for bezoar formation are: mechanical ventilation, supine position, neurological diseases, diabetes mellitus, hypothyroidism, obesity and history of partial gastrectomy. Diagnosis and removal of the bezoar is done endoscopically. Feeding in a semi-recumbent position, administration of prokinetic agents and proton pump inhibitors may prevent this complication.

Marcus, Esther-Lee; Arnon, Ron; Sheynkman, Arkadiy; Caine, Yehezkel G; Lysy, Joseph



Effect of Curculigo orchioides on reflux esophagitis by suppressing proinflammatory cytokines.  


This study was performed to investigate effects of Curculigo orchioides rhizome (curculiginis rhizome) on acute reflux esophigitis (RE) in rats that are induced by pylorus and forestomach ligation operation. Proinflammatory cytokine, as well as tumor necrosis factor (TNF)-?, interleukin (IL)-1? and IL-6 were all assayed and the expression of TNF-? and COX2 analyzed by RT-PCR. The esophagic tissue damage of reflux esophagitis rat was increased compared to that of normal intact group. However, the esophagic damage percentage from the extract of curculiginis rhizoma (ECR) 600 mg/kg and ECR 300 mg/kg were significantly lower than that of the RE control group. Administration of ?-tocopherol (30 mg/kg) and ECR (600 mg/kg, 300 mg/kg, and 150 mg/kg) had a significant effect on the gastric acid pH in rats with induced reflux esophagitis (p < 0.05). The treatment with ECR significantly reduced the production of cytokines TNF-?, IL-1? and IL-6 levels compared to the model group (p < 0.05). The expression of TNF-? and COX2 in the intact esophageal mucosa was low while those of the RE control group were significantly higher due to an inflammatory reaction in the esophagus. Compare to the model group, treatment with ?-tocopherol or ECR significantly inhibited the expression levels of COX2 and TNF-? in a dose-dependent manner. These results suggest that anti-inflammatory and protective effects of ECR could attenuate the severity of reflux esophagitis and prevent esophageal mucosal damage. PMID:23227795

Ku, Sae-Kang; Kim, Jae-Soo; Seo, Young-Bae; Kim, Yong-Ung; Hwang, Seung-Lark; Lee, Young-Chul; Yang, Chae-Ha; Kim, Hui-Young; Seo, Bu-Il; Park, Ji-Ha; Min, You-Hong; Roh, Seong-Soo



[Surgical treatment of esophageal diverticula].  


The aim of this paper is to evaluate the methods and therapeutic principles of esophageal diverticula pathology. We analyze the main pathological mechanisms which establish the therapeutic attitude linked with a complex pretherapeutic evaluation. In our study we enrolled 12 patients operated between 2001-2009 for esophageal diverticula with different topography. In this period of time there were much more patients diagnosed with this pathology, but the need for surgery was establish very tight regarding the actual practical guide which impose the identification and interception of physiological mechanisms by the surgical procedure. We highlight the particular technical details, as well as the important differences of postoperatory complications according to the topography of the diverticula pouch. PMID:21523958

Constantinoiu, S; Constantin, A; Predescu, D; Mates, I N; Mocanu, A; Gheorghe, M; Hoar?, P; Achim, F; Cociu, L


Management of Barrett's esophageal carcinoma.  


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



Vitiligo Associated with Esophageal Adenocarcinoma  

PubMed Central

Vitiligo is a disease that results in depigmented areas in the skin. It may develop at any age but the average age at onset is 20 years. Association of vitiligo and melanoma has been commonly reported, but malignancies other than melanoma have been rarely associated with vitiligo. We report a 73-year-old patient with new onset vitiligo who developed esophageal adenocarcinoma in the following years.

Asilian, Ali; Momeni, Iman; Khosravani, Parastou



Nonsurgical approaches to esophageal malignancy  

Microsoft Academic Search

Esophageal cancer remains one of the leading causes of cancer death worldwide. Patients generally present with progressive\\u000a dysphagia, malnutrition, and weight loss. The diagnosis commonly involves radiologic studies and conventional esophagogastroduodenoscopy.\\u000a Advances in endoscopic evaluation have allowed early detection of premalignant and malignant lesions. These techniques include\\u000a chromoscopy, which can be performed in conjunction with high-resolution\\/magnification endoscopy, and fluorescent endoscopy.

Darius Sorbi; David E. Fleischer



Laryngospasm and pediatric eosinophilic esophagitis  

Microsoft Academic Search

Objective: Symptoms of pediatric eosinophilic esophagitis (EoE) include dysphagia, emesis, regurgitation and feeding difficulties. This symptom complex has been mistaken for refractory gastroesophageal reflux disease (GERD). Whether EoE and GERD are related is controversial. Recently, EoE has been associated with upper airway manifestations including recurrent sinusitis, cough, wheezing, pneumonia, laryngeal edema, and subglottic stenosis. Laryngospasm secondary to EoE has not

Carrie L. Francis; Troy Gibbons; Gresham T. Richter



Basics Pathogenesis of Eosinophilic Esophagitis  

PubMed Central

Eosinophilic esophagitis (EE) is a newly recognized disease, which has largely been called idiopathic EE, emphasizing the poor understanding of its pathogenesis. EE is a severe disease of the esophagus characterized by an accumulation of eosinophils in the esophageal mucosa. EE is highly associated with atopic disease and emerging evidence suggests a primary role for food antigen sensitization in disease etiology. Nevertheless, the nomenclature “Eosinophilic esophagitis” describes only the surface of the iceberg of a complex disorder. Epithelial cells, fibroblasts, endothelial cells and smooth muscles cells are involved in pathologic features of the disease and numerous leukocyte subtypes are recruited (eosinophils, mast cells, lymphocytes). As such, the pathogenesis of EE involves multiple tissues, cell types, genes and derives from complex genetic and environmental factors. “Pathogenesis” is a fusion of two Greek words pathos (disease) and genesis (development). In this review, we aim to define the fundamental piece of knowledge available today that characterizes the mechanisms by which certain etiological factors cause EE, reviewing human studies, murine models and recent knowledge regarding the involvement of environmental, cellular, molecular and genetic factors in the development of EE.

Blanchard, Carine; Rothenberg, Marc E.



Pharmacologic influence on esophageal varices  

SciTech Connect

Selective catherization of the left gastric vein was performed after percutaneous transhepatic portography (PTP) in patients with portal hypertension and esophageal varices. Following the hypothesis that drugs increasing the lower esophageal sphincter (LES) pressure may obstruct the variceal blood flow throught the lower esophagus, the effect of different drugs (i.e., intravenous injection of vasopressin, pentagastrin, domperidone and somatostatin and subcutaneous injection of metacholine) on the variceal blood flow was examined. Vasopressin did not change the variceal blood flow; pentagastrine, with its known effect of increasing the LES pressure produced a total interruption of the flow in four of eight patients; domperiodone, also known to increase the LES pressure obstructed the variceal blood flow in the only patient examined with this drug; somatostatin has no reported action on the LES but blocked the flow in one of two patients; and metacholine, reported to increase the LES pressure did not produce any change in the flow in the three patients examined. LES pressure was recorded before and during vasopressin infusion in seven patients with portal hypertension and esophageal varices. No reaction on the pressure was found. The patient number in the study is small and the results are nonuniform but still they suggest that drugs increasing the LES tonus might be useful to control variceal blood flow.

Lunderquist, A.; Owman, T.; Alwmark, A.; Gullstrand, P.; Hall-Angeras, M.; Joelsson, B.; Tranberg, K.G.; Pettersson, K.I.



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



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))



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

PubMed Central

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

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



Esophageal capnometry during hemorrhagic shock and after resuscitation in rats  

Microsoft Academic Search

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

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



The Activities of Acid DNase and 5'Nucleotidase in Erosive Reflux Esophagitis and Barrett's Epithelium.  


Background/Aims: The study examines the relationship between activity of acid DNase and 5'nucleotidase (5'NT) and histological changes in reflux esophagitis. Methodology: Thirty-three patients were examined, 15 of whom with mild esophagitis, 12 with severe esophagitis and 6 with Barrett's epithelium. Patients were classified into 3 groups, according to Ismail-Beigi histological criteria: mild esophagitis group (ME); severe esophagitis group (SE); Barrett's esophagitis group (BE). DNase and 5'NT levels were measured biochemically both in healthy and injured tissue samples. Results: Difference of acid DNase and 5'NT activity in healthy tissue versus injured tissue samples was the lowest in ME group: 0.55±4.47 U/g for acid DNase and 11.56±37.11 U/g for 5'NT, the difference increased to 4.43±1.64 U/g for acid DNase and 105.57±54.11 U/g for 5'NT in the SE group, while 6.07±2.92 U/g for acid DNase and 109.83±14.02 U/g for 5'NT as the highest levels were measured in the BE group. Difference in BE group is statistically significantly higher (p <0.05) compared to the ME group, confirmed by ANOVA with Dunnett's post hoc test. Conclusions: The study shows significant decrease of apotosis level that is detectable even before metaplasia was morphologically defined. PMID:23803371

Radisavljevic, Mirjana M; Nagorni, Aleksandar V; Kocic, Gordana; Bjelakovic, Goran B; Petrovic, Aleksandar S; Veljkovic, Andrej R; Raicevic-Sibinovic, Suzana R; Radisavljevic, Misa M



Multichannel intraluminal impedance and esophageal manometry data for unrestricted swallowing: establishing normal values.  


Standard esophageal manometric testing evaluates swallowing in the supine position using small boluses, with a recovery period imposed between swallows. Manometric tests of more physiologic unrestricted swallowing have had limited practical application due to highly variable results. The purpose of this study is to apply multichannel intraluminal impedance and manometry (MII-EM) to test esophageal function during unrestricted upright meal consumption, and to assess results in a normal healthy population. Ten healthy volunteers with normal esophageal impedance and manometry by published criteria underwent MII-EM testing using a combined 5-channel catheter. After transnasal placement of the catheter, each subject sat upright and consumed a meal that consisted of two pieces of toasted bread and two ounces of Gatorade. There were no restrictions placed on chewing, swallowing, or eating time. All data assessed by the MII-EM meal test were normally distributed. Impedance results with limited variability included the meal duration, number of swallows, postprandial emptying time and the percent of bolus presence times at 15, 10, and 5 cm above the lower esophageal sphincter. Manometric results with limited variability included the number of peristaltic sequences, mean time between these sequences and their distal esophageal amplitudes. MII-EM can be used to collect data with minimal variability in healthy subjects during unrestricted upright meal consumption. This technique may be used to identify abnormal motility patterns during physiologic swallowing. PMID:18197939

Wilson, J A; Mainie, I; Tutuian, R; Agrawal, A; Castell, D O



Endoscopic diverticulotomy for symptomatic pediatric esophageal diverticula  

Microsoft Academic Search

There have so far been few reports on esophageal diverticulum in children. We experienced two symptomatic pediatric cases with esophageal diverticulum. Our cases manifested high fever and dysphagia with chest pain during swallowing. The patients underwent endoscopic diverticulotomy. The septum between the diverticulum and the esophagus was cut using the argon plasma coagulation (APC 3000) system. We recommend an endoscopic diverticulotomy

Y. Nishimoto; T. Taguchi; K. Ogita; M. Hashizume; S. Suita



Epidemiology of gastro-esophageal reflux disease  

Microsoft Academic Search

Gastro-esophageal reflux disease encompasses a spectrum of disorders in which gastric reflux leads to symptoms and\\/or damage to the esophageal mucosa. Although a common problem in clinical practice, our understanding of the pathophysiology of the condition has not been matched by our knowledge of its epidemiology and natural history. This review examines some of the difficulties inherent in epidemiological studies

P. J. Howard; R. C. Heading



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 /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.



[Eosinophilic esophagitis: the diagnostic contribution of pathology].  


Eosinophilic esophagitis is a chronic, clinically and histologically defined, inflammatory condition of the esophagus. The histological hallmark of eosinophilic esophagitis is a relevant, often patchy infiltration of the esophageal mucosa with eosinophils. In a consensus report a threshold value of approximately 120 eosinophils per mm(2) was arbitrarily fixed as a diagnostic criterion. Noteworthy for the quantification of the eosinophilic infiltration are several technical facts, for instance size and covering extent of the biopsy specimen of the high-power field (hpf) and quality of embedding of biopsy specimens have to be considered. In order to establish the histological diagnosis several additional abnormalities must be included in the assessment and gastrointestinal reflux disease is the main differential diagnosis of eosinophilic esophagitis. Finally it is emphasized that for an affirmative diagnosis of eosinophilic esophagitis, in addition to the histological findings the clinical facts must be included. PMID:23483314

Bussmann, C; Straumann, A



[Current indications of esophageal pH-monitoring].  


Regurgitation is a common manifestation in infants below the age of 1 year and a frequent cause of visits to general practitioners and pediatricians. Accurate diagnosis of this condition requires a good choice of pH monitoring equipment and optimal technique when performing this procedure. The present article is a consensus statement of the Working Group on Gastroesophageal Reflux of the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition (SSPGHN) and reflects the conclusions reached in the VII Congress of the SSPGHN (Vigo, 2000). In general, esophageal pH monitoring is indicated in the following situations: (i) when symptoms of gastroesophageal reflux are present and evolution is not favorable, despite appropriate treatment; (ii) when trying to determine the relationship between gastroesophageal reflux and non-digestive symptoms and (iii) when evaluating the results of treatment, whether medical or surgical. PMID:11792245

Armas Ramos, H; Molina Arias, M; Peña Quintana, L; Eizaguirre Sexmilo, I; Juste Ruiz, M; Sánchez Ruiz, F; Bousoño García, C



Studies on the mechanism of esophagitis-induced lower esophageal sphincter hypotension in cats.  


Perfusion of 0.1 n HC1 5 cm above the lower esophageal sphincter (LES) in cats for 30 min on 4 consecutive days produced biopsy-documented esophagitis and marked decreases in LES pressure. Using this model the effects of experimental esophagitis on the LES response to edrophonium, pentagastrin, and bethanechol were determined. The sphincter response to both edrophonium and pentagastrin after esophagitis was induced was significantly less than preperfusion responses. When the esophagitis had resolved, the pressure response to edrophonium and pentagastrin returned to preperfusion levels. In contrast, the sphincter response to bethanechol during esophagitis was not different from the preperfusion response and remained unchanged after resolution of the esophagitis. Lower esophageal smooth muscle taken from cats with active esophagitis appeared normal by both light and electron microscopy. These studies indicate that besides decreasing resting LES tone, esophageal inflammation causes functional impairment of a cholinergic mechanism regulating LES pressure. In contrast, the smooth muscle appears to be unaffected by inflammation despite the LES hypotension. PMID:1278649

Higgs, R H; Castell, D O; Eastwood, G L



Corrosion tests to determine temperature and pH dependencies of the dissolution rates of sodalite, binder glass, and ceramic waste form.  

SciTech Connect

A glass bonded-sodalite ceramic waste form (CWF) has been developed to immobilize salt wastes from electrometallurgical treatment of sodium-bonded spent nuclear fuel. The CWF is a composite of salt-loaded sodalite and a binder glass formed at high temperature (850-950 C) by hot isostatic pressing (HIP) or pressureless-consolidation (PC) processes. A waste form degradation and radionuclide release model has been developed to support qualification of the CWF for disposal in the proposed repository at Yucca Mountain. Six series of tests were conducted in conjunction with the development of that model. (1) Static tests were conducted to measure the dissolution rate of sodalite, HIP binder glass, and HIP CWF at 40, 70, and 90 C in pH range 4.8-9.8 buffer solution. The parameter values in the degradation model were calculated from the dissolution rates measured by the static tests. (2) Static tests were conducted at 70 C in noncomplexing tertiary amine pH buffers to confirm that the dissolution rate measured with traditional buffers was not affected by the complexation of metal ions. The results showed that the difference between dissolution rate determined with noncomplexing buffer and that determined with traditional buffers was negligible. (3) Static tests were conducted in five buffer solutions in the pH range 4.8-9.8 at 20 C with HIP sodalite, HIP glass, and HIP CWF. The results showed that the model adequately predicts the dissolution rate of these materials at 20 C. (4) Static tests at 20 and 70 C with CWF made by the PC process indicated that the model parameters extracted from the results of tests with HIP CWF could be applied to PC CWF. (5) The dissolution rates of a modified glass made with a composition corresponding to 80 wt% glass and 20 wt% sodalite were measured at 70 C to evaluate the sensitivity of the rate to the composition of binder glass in the CWF. The dissolution rates of the modified binder glass were indistinguishable from the rates of the binder glass. (6) The dissolution rate of a simple five-component glass (CSG) was measured at 70 C using static tests and single-pass flow-through (SPFT) tests. Rates were similar for the two methods; however, the measured rates are about 10X higher than the rates measured previously at Lawrence Livermore National Laboratory (LLNL) for a glass having the same composition using an SPFT test method. Differences are attributed to effects of the solution flow rate on the glass dissolution rate and how the specific surface area of crushed glass is estimated. This comparison indicates the need to standardize the SPFT test procedure.

Jeong, S.-Y.; Fanning, T. H.; Morss, L. R.; Ebert, W. L.



Endoscopic management of esophageal varices.  


The rupture of gastric varices results in variceal hemorrhage, which is one the most lethal complications of cirrhosis. Endoscopic therapies for varices aim to reduce variceal wall tension by obliteration of the varix. The two principal methods available for esophageal varices are endoscopic sclerotherapy (EST) and band ligation (EBL). The advantages of EST are that it is cheap and easy to use, and the injection catheter fits through the working channel of a diagnostic gastroscope. Endoscopic variceal ligation obliterates varices by causing mechanical strangulation with rubber bands. The following review aims to describe the utility of EBL and EST in different situations, such as acute bleeding, primary and secondary prophylaxis. PMID:22816012

Poza Cordon, Joaquin; Froilan Torres, Consuelo; Burgos García, Aurora; Gea Rodriguez, Francisco; Suárez de Parga, Jose Manuel



Suppression of N-nitrosomethylbenzylamine-induced rat esophageal tumorigenesis by dietary feeding of 1'-acetoxychavicol acetate.  


The modifying effects of 1'-acetoxychavicol acetate (ACA) on N-nitrosomethylbenzylamine (NMBA)-induced esophageal tumorigenesis were investigated in male F344 rats. At 5 weeks of age, all test animals, except those given the test chemical alone, and the control rats received s.c. injections of NMBA (0.5 mg/kg body weight/injection, three times per week) for 5 weeks. At the termination of the study (20 weeks), 75% of rats treated with NMBA alone had esophageal neoplasms (papillomas). However, the groups given a dose of 500 ppm ACA during the initiation phase developed a significantly reduced incidence of tumors (29%; P<0.01). Exposure to ACA (500 ppm) during the post-initiation phase also decreased the frequency of the tumors (38%; P<0.05). A reduction of the incidence of preneoplastic lesions (hyperplasia or dysplasia) was obtained when ACA was administered in the initiation phase (P<0.01). Cell proliferation in the esophageal epithelium, determined by assay of proliferating cell nuclear antigen (PCNA), was lowered by ACA (P<0.05). Blood polyamine contents in rats given NMBA and the test compound were also smaller than those of rats given the carcinogen (P<0.05). These findings suggest that dietary ACA is effective in inhibiting the development of esophageal tumors by NMBA when given during the initiation or post-initiation phase, and such inhibition is related to suppression of cell proliferation in the esophageal epithelium. PMID:10761701

Kawabata, K; Tanaka, T; Yamamoto, T; Ushida, J; Hara, A; Murakami, A; Koshimizu, K; Ohigashi, H; Stoner, G D; Mori, H



Supradiaphragmatic correction of esophageal reflux strictures.  

PubMed Central

Intragastric pressure measurements and cineradiographic contrast studies were done in monkeys in order to determine the pressure at which esophageal reflux occurred. Antireflux operative procedures were performed above and below the diaphragm, and the results compared. The Nissen fundoplication proved to be the most effective type of mechanical antireflux valve and worked equally well placed above and below the diaphragm. Of 200 consecutive adult patients undergoing operative correction of esophageal reflux, 19 had severe esophageal strictures. Through a transthoracic approach, two patients had subdiaphragmatic Nissen fundoplications, one with adenocarcinoma of the esophagus had an esophageal resection, and 16 had supradiaphragmatic Nissen fundoplications; those 16 patients form the basis of this report. No patients died; superficial, temporary esophageal ulcerations developed in two. Follow-up times have ranged from six months to eight years; the results in all cases have been good. Experimental and clinical evidence supports the belief that this less radical approach is the treatment of choice in the management of severe esophageal strictures secondary to reflux esophagitis. Images Fig. 1. Fig. 2. Figs. 3. and 4. Figs. 5-7. Figs. 8. and 9. Fig. 10. Figs. 11. and 12.

Pennell, T C



Helicobacter pylori Protection Against Reflux Esophagitis  

PubMed Central

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

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



Esophageal cancer characterization with pneumo-64-MDCT.  


Early diagnosis and accurate staging of esophageal cancer are both essential for therapeutic strategy planning. Endoscopic ultrasound, CT, and positron emission tomography have all been used in the preoperative staging of esophageal cancer separately or in various combinations. Each imaging method has its strengths and weaknesses. Depiction of the tumor's anatomic location conditions the surgical strategy. Endoscopic ultrasound and PET have important advantages but neither provides information for surgical planning. CT scans have some limitations for hollow organ assessment in the absence of lumen distension, since the organ wall may be collapsed. Therefore, optimal esophageal distension could be very useful to overcome these limitations. This potential drawback is crucial at the level of the GE junction, a typically difficult region to evaluate. In order to optimize tumor visualization in the esophageal wall and in the GE junction, we developed a technique named pneumo-64-MDCT. We achieve maximum lumen distension, which better highlights the thickened areas in relation to the normal esophageal wall. At the present time, we have performed 200 studies with this technique and it proved useful, safe and accurate to identify esophageal wall thickening and to stage esophageal cancer. The additional stomach distension led to an adequate definition of both the upper and lower borders of the lesion in tumors located in the GE junction, which in turn was helpful to design the surgical approach. PMID:21842399

Ulla, Marina; Gentile, Ernestina María José; Cavadas, Demetrio; Yeyati, Ezequiel Levy; Frank, Laura; Argerich, Javier Ithurralde; Garcia Mónaco, Ricardo



Current Gene Expression Studies in Esophageal Carcinoma  

PubMed Central

Esophageal carcinoma is one of the deadliest cancers with highly aggressive potency, ranking as the sixth most common cancer among males and ninth most common cancer among females globally. Due to metastasis and invasion of surrounding tissues in early stage, the 5-year overall survival rate (14%) of esophageal cancer remains poor, even in comparison with the dismal survival rates (4%) from the 1970s. Numerous genes and proteins with abnormal expression and function involve in the pathogenesis of esophageal cancer, but the concrete process remains unclear. Microarray technique has been applied to investigating esophageal cancer. Many gene expression studies have been undertaken to look at the specific patterns of gene transcript levels in esophageal cancer. Human tissues and cell lines were used in these geneprofiling studies and a very valuable and interesting set of data has resulted from various microarray experiments. These expression studies have provided increased understanding of the complex pathological mechanisms involved in esophageal cancer. The eventual goal of microarray is to discover new markers for therapy and to customize therapy based on an individual tumor genetic composition. This review summarized the current state of gene expression profile studies in esophageal cancer.

Guo, Wei; Jiang, Yao-Guang



Globus sensation and increased upper esophageal sphincter pressure with distal esophageal acid perfusion.  


The aim of the present study was to determine whether acid perfusion into the distal esophagus causes a globus sensation and an increase in upper esophageal sphincter (UES) pressure. UES pressures were measured using a sleeve-type sensor in 20 healthy volunteers. A 0.1-N HCl solution, the same as gastric acid, was perfused into the distal esophagus at a rate of 20 mL/min. During perfusion, 4-channel pH monitoring was performed to determine whether the HCl reached the hypopharynx. The following parameters were measured: (1) changes in UES pressure before and during acid perfusion, (2) presence or absence of a globus sensation or heartburn, (3) the time at which a globus sensation or heartburn was noted by the patient and (4) the position of the electrode at which the pH drop was recorded. Ten subjects enrolled as the control group received perfusions of distilled water. Acid perfusion raised the UES pressure in 13 of the 20 subjects. All 13 complained of globus at about the same time as the UES pressure increased. Twelve of the 13 subjects who experienced globus also complained of heartburn, which preceded the globus sensation in ten such cases. None of the control subjects reported globus or had elevated UES pressure. In the acid perfusion group, no pH reduction at the two most cranial electrodes was observed in any subject. In conclusion, the globus sensation is due to elevated UES pressure, resulting from gastroesophageal reflux and does not require direct exposure of the hypopharynx to gastric acid. The incidence of heartburn in combination with a globus sensation would be much higher if the cause of the latter were acid reflux. PMID:19882344

Tokashiki, Ryoji; Funato, Nobutoshi; Suzuki, Mamoru



Effects of pH on chromate(VI) adsorption by Spirulina platensis biomass: batch tests and FT-IR studies.  


Raw and methylated biomass of Spirulina platensis was employed in chromate batch adsorption tests at pH range 1-7. The acid conditions seemed to favour the removal of chromium (Cr) with a yield of 87.0 and 97.6% by using raw and methylated biomass, respectively. However, the chromate and total chromium determination, carried out in the same sample, evidenced that a fraction of the initial chromate present in solution was reduced to Cr(III). This was ascribed to the presence of reducing groups on the biomass surface, active in the acid medium. The data showed that the methylated biomass was able to operate an effective Cr(VI) removal only. In fact, the biomass treatment allowed a lowering of the amount of negative functional groups, making the biomass surface available to bind the anions. The real best efficiency of Cr(VI) removal (83.5%) was obtained by methylated biomass of S. platensis at pH about 7.0. The nature of the biomass/chromate interactions was investigated by Fourier transform infrared spectroscopy (FT-IR) analysis. The bands ascribing to the adsorbed Cr(VI) species were well evident in the spectra of the biomass after adsorption, confirming this experimental finding. PMID:23656933

Solisio, Carlo; Lodi, Alessandra; Finocchio, Elisabetta



[Oral blastomycosis, laryngeal papillomatosis and esophageal tuberculosis].  


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



Effect of graded exercise on esophageal motility and gastroesophageal reflux in trained athletes  

Microsoft Academic Search

We evaluated the effect of graded exercise on esophageal motility and gastroesophageal reflux. We studied eight trained cyclists using a catheter with three strain-gauge transducers connected to a solid-state datalogger and an ambulatory intraesophageal pH monitor. Each study lasted 4 hr during which subjects exercised on a stationary bike for 1 hr at 60% of peak O2 uptake (O2 max),

E. E. Soffer; R. K. Merchant; G. Duethman; J. Launspach; C. Gisolfi; T. E. Adrian



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.



Utility and standards in esophageal manometry.  


Esophageal manometry is a specialized procedure used to evaluate lower and upper esophageal sphincter pressure, esophageal body contraction amplitude, and peristaltic sequence. The procedure is clinically useful in evaluation of a patient with nonstructural dysphagia, unexplained or noncardiac chest pain, a compendium of symptoms suggested because of gastroesophageal reflux disease, and in the preoperative evaluation for antireflux surgery. Manometric findings in 95 normal subjects evenly distributed across age groups were reported in 1987, and are the values still used in our and most laboratories today. The subsequent review will offer our "view" on the clinical utility of esophageal manometry, on the basis of years of experience and performance techniques that have remained constant over decades. PMID:18364580

Katz, Philip O; Menin, Richard A; Gideon, R Matthew


21 CFR 878.3610 - Esophageal prosthesis.  

Code of Federal Regulations, 2013 CFR

...SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3610 Esophageal...rigid, flexible, or expandable tubular device made of a plastic, metal, or polymeric material that is...



Tracheoesophageal fistula and esophageal atresia repair  


Tracheoesophageal fistula and esophageal atresia repair is surgery to repair two birth defects in your esophagus and trachea. ... not connect with the lower esophagus and stomach. Tracheoesophageal fistula (TEF) is a connection between the upper part ...


Aurora kinase A (AURKA) and never in mitosis gene A-related kinase 6 (NEK6) genes are upregulated in erosive esophagitis and esophageal adenocarcinoma.  


Gastroesophageal reflux disease is a risk factor for esophageal adenocarcinoma yet studies that have investigated the relationship between erosive esophagitis and esophageal adenocarcinoma have usually focused on symptom-related evidence or polymorphisms. There are no epigenetic gene expression studies on this topic. In this study, we aimed to evaluate the relationship between erosive esophagitis and esophageal adenocarcinoma to identify whether there is a genetic predisposition for esophageal adenocarcinoma. The Human Epigenetic Chromatin Modification Enzyme RT(2) Profiler(™) PCR array (PAHS-085A) was used to detect the expression of 84 key genes encoding enzymes. This was carried out prospectively for samples from 60 patients (20 patients as a control group, 20 patients with erosive esophagitis and 20 patients with esophageal adenocarcinoma). AURKA, AURKB, NEK6 were expressed at significantly higher levels in esophageal adenocarcinoma compared to the control group. MBD2 was expressed at significantly lower levels in the esophageal adenocarcinoma group compared to the control group. AURKA, AURKC, HDAC9 and NEK6 were expressed at significantly higher levels in erosive esophagitis compared to the control group. There was no difference in upregulated gene expression between the erosive esophagitis and esophageal adenocarcinoma. MBD2 was significantly downregulated in esophageal adenocarcinoma compared to erosive esophagitis. NEK6 and AURKA were significantly upregulated in esophageal adenocarcinoma and erosive esophagitis compared to the control group. This is a novel study on the genetic predisposition for erosive esophagitis and esophageal adenocarcinoma. AURKA and NEK6 are two promising genetic markers for erosive esophagitis and esophageal adenocarcinoma. PMID:23060919

Kasap, Elmas; Boyacioglu, Seda Örenay; Korkmaz, Mehmet; Yuksel, Elif Saritas; Unsal, Belkis; Kahraman, Erkan; Ozütemiz, Omer; Yuceyar, Hakan



Aurora kinase A (AURKA) and never in mitosis gene A-related kinase 6 (NEK6) genes are upregulated in erosive esophagitis and esophageal adenocarcinoma  

PubMed Central

Gastroesophageal reflux disease is a risk factor for esophageal adenocarcinoma yet studies that have investigated the relationship between erosive esophagitis and esophageal adenocarcinoma have usually focused on symptom-related evidence or polymorphisms. There are no epigenetic gene expression studies on this topic. In this study, we aimed to evaluate the relationship between erosive esophagitis and esophageal adenocarcinoma to identify whether there is a genetic predisposition for esophageal adenocarcinoma. The Human Epigenetic Chromatin Modification Enzyme RT2 Profiler™ PCR array (PAHS-085A) was used to detect the expression of 84 key genes encoding enzymes. This was carried out prospectively for samples from 60 patients (20 patients as a control group, 20 patients with erosive esophagitis and 20 patients with esophageal adenocarcinoma). AURKA, AURKB, NEK6 were expressed at significantly higher levels in esophageal adenocarcinoma compared to the control group. MBD2 was expressed at significantly lower levels in the esophageal adenocarcinoma group compared to the control group. AURKA, AURKC, HDAC9 and NEK6 were expressed at significantly higher levels in erosive esophagitis compared to the control group. There was no difference in upregulated gene expression between the erosive esophagitis and esophageal adenocarcinoma. MBD2 was significantly downregulated in esophageal adenocarcinoma compared to erosive esophagitis. NEK6 and AURKA were significantly upregulated in esophageal adenocarcinoma and erosive esophagitis compared to the control group. This is a novel study on the genetic predisposition for erosive esophagitis and esophageal adenocarcinoma. AURKA and NEK6 are two promising genetic markers for erosive esophagitis and esophageal adenocarcinoma.




Necrotizing esophagitis presenting as a black esophagus  

Microsoft Academic Search

.   A case of necrotizing esophagitis discovered during upper endoscopy is described. An 88-year-old woman was admitted to our\\u000a hospital with complaints of multiple episodes of coffee ground emesis and dysphagia over 3 months. Ischemia is proposed as\\u000a the etiology of necrotizing esophagitis on the basis of the patient's significant cardiac history, her age, and low-flow state.

R. Obermeyer; K. Kasirajan; V. Erzurum; D. Chung



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

PubMed Central

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

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



Comparison of esophageal motility in patients with solid dysphagia and mixed dysphagia.  


It is unclear whether there is any difference in esophageal motor abnormalities between patients complaining of dysphagia for solids or both solids and liquids. The aim of this study was to determine any difference in the manometric findings between patients with dysphagia for solids and those with mixed dysphagia. Manometric tracings were performed in 200 consecutive patients (66 M, 134 F; mean age = 51 years) with nonobstructive dysphagia. Ambulatory pH studies were performed in all patients. Subjects were divided into two groups: patients with solid dysphagia (n = 94, 33 M, 61 F; mean age = 51 years) and those with mixed dysphagia (n = 106, 33 M, 73 F; mean age = 51 years). A normal motility study was the most frequent finding. Achalasia occurred more frequently in patients with mixed dysphagia than in those with solid dysphagia (12% vs. 3%, p < 0.01). Gastroesophageal reflux disease (GERD) was observed in 59% of patients with solid dysphagia compared with 29% of patients with mixed dysphagia (p < 0.02). The most common esophageal motility abnormality is nonspecific esophageal motility disorders. This study has shown that abnormal esophageal motility occurs slightly more in mixed dysphagia than solid dysphagia. The clinical utility of a symptomatic differentiation of patients with solid or mixed dysphagia appears to be limited. PMID:16633869

Chen, Chien-Lin; Orr, William C



Delayed fistulization from esophageal replacement surgery.  


We present two patients who developed delayed fistulization following esophageal replacement surgery. The first is a 13-year-old child who, at the age of 3 years, underwent a trans-mediastinal colonic esophageal replacement for a refractory corrosive injury followed by a retrosternal reverse gastric tube after an early catastrophic leak. Ten years later, he presented with a history of intermittent chest pain for 6 months. He developed a tension pneumo-pericardial tamponade caused by a fistula between gastric tube and pericardium. He recovered after sternotomy. The second was born prematurely with type C esophageal atresia and other malformations. After esophageal anastomosis, he developed a refractory stricture that was resected at 10 months. Despite a fundoplication at 4 years, the recurrent esophageal stricture required resection at 14 years, accomplished by mobilizing the stomach into the chest through a left thoracoabdominal incision. The postoperative course was complicated by a gastric leak in the chest with empyema, but the patient recovered and was able to eat. Five years later, he underwent an anterior spinal fusion to correct a worsening kyphoscoliosis. Postoperatively, he developed an ARDS picture, leakage of air through the gastrostomy, and a fatal pulmonary hemorrhage secondary to a gastro-bronchial fistula. Fistulization from esophageal replacement surgery represents a rare long-term complication that pediatric surgeons need to be aware of. PMID:19349000

Abdalwahab, Ahmed; Al Namshan, Mohammed; Al Rabeeah, Abdullah; Laberge, Jean-Martin



Effect of total laryngectomy on esophageal motility  

SciTech Connect

Total laryngectomy for cancer can result in dysphagia and altered esophageal motility. Manometric changes in the upper esophageal sphincter (UES), and in proximal and distal esophageal function have been reported. However, most studies have failed to take into account radiation therapy and appropriate controls. We selected ten male patients (54.3 +/- 1.9 yr) for longitudinal manometric evaluation prior to laryngectomy then at two weeks and again six months later. No patient received preoperative radiation therapy, had a previous history of esophageal surgery, or developed a postoperative wound infection or fistula. Seven of ten patients had positive nodes and received 6,000-6,600 rads postoperative radiation therapy. Preoperatively 4 of 10 patients complained of dysphagia which did not significantly change following surgery and radiation. Two of three patients who did not complain of dysphagia preoperatively and received radiation postoperatively developed dysphagia. No patient without dysphagia preoperatively who received no radiation therapy developed symptoms. Our studies show that laryngectomy causes alterations in the UES resting and peak pressures but not in the proximal or distal esophagus, or the lower esophageal sphincter. These data also imply radiation therapy may be associated with progressive alterations in motility and symptomatology. Further study regarding the effects of radiation on esophageal motility and function are urged.

Hanks, J.B.; Fisher, S.R.; Meyers, W.C.; Christian, K.C.; Postlethwait, R.W.; Jones, R.S.



Ingestible capsule for impedance and pH monitoring in the esophagus.  


Twenty-four-hour ambulatory pH monitoring is an essential tool for diagnosing gastroesophageal reflux disease (GERD). Simultaneous impedance and pH monitoring of the esophagus improves the detection and characterization of GERD. Conventional catheter-based monitoring systems are uncomfortable and interfere with the normal activity of the patient. To overcome these disadvantages, different wireless esophageal monitoring systems have been proposed. A capsule containing sensors for impedance and pH monitoring with wireless communication capabilities is presented. A low cost miniature microcontroller was utilized for interfacing between the sensors and a wireless transmitter. The microcontroller program allowed efficient management of the electric power provided by a 3-V battery. Magnetic holding is proposed as an alternative to surgical affixation of the monitoring capsule. Permanent neodymium magnets separated by 27 cm successfully held the capsule in a test tube. Experimental results demonstrated that friction force can aid magnetic holding to overcome peristalsis. The proposed design efficiently detected acid and nonacid reflux. More research regarding the holding method and capsule packaging are necessary to optimize the mechanical performance of the proposed design in order to facilitate clinical testing on human subjects. PMID:18075039

Gonzalez-Guillaumin, Jose L; Sadowski, Daniel C; Kaler, Karan V I S; Mintchev, Martin P



Epigenetic biomarkers in esophageal cancer.  


The aberrant DNA methylation of tumor suppressor genes is well documented in esophageal cancer, including adenocarcinoma (EAC) and squamous cell carcinoma (ESCC) as well as in Barrett's esophagus (BE), a pre-malignant condition that is associated with chronic acid reflux. BE is a well-recognized risk factor for the development of EAC, and consequently the standard of care is for individuals with BE to be placed in endoscopic surveillance programs aimed at detecting early histologic changes that associate with an increased risk of developing EAC. Yet because the absolute risk of EAC in individuals with BE is minimal, a clinical need in the management of BE is the identification of additional risk markers that will indicate individuals who are at a significant absolute risk of EAC so that they may be subjected to more intensive surveillance. The best currently available risk marker is the degree of dysplasia in endoscopic biopsies from the esophagus; however, this marker is suboptimal for a variety of reasons. To date, there are no molecular biomarkers that have been translated to widespread clinical practice. The search for biomarkers, including hypermethylated genes, for either the diagnosis of BE, EAC, or ESCC or for risk stratification for the development of EAC in those with BE is currently an area of active research. In this review, we summarize the status of identified candidate epigenetic biomarkers for BE, EAC, and ESCC. Most of these aberrantly methylated genes have been described in the context of early detection or diagnostic markers; others might prove useful for estimating prognosis or predicting response to treatment. Finally, special attention will be paid to some of the challenges that must be overcome in order to develop clinically useful esophageal cancer biomarkers. PMID:22406828

Kaz, Andrew M; Grady, William M



Through-the-Scope Balloon Dilation for EUS Staging of Stenosing Esophageal Cancer  

PubMed Central

Background Dilation of malignant esophageal strictures is often required to complete staging by EUS. The aim of this study is to determine the successful dilation rate (ability to complete staging) and complication rate of TTS balloon dilation for malignant esophageal strictures during EUS. Methods We retrospectively reviewed EUS reports for all cases of primary esophageal cancer staged at five centers between 1/2002 and 10/2004. All dilations were performed with TTS balloons (Boston Scientific, Natick, MA). Results Among 272 EUSs, dilation was required in 77 (28%) and was successful in 73 cases (95%). There was one esophageal perforation following dilation (1.3%; 95%CI 0.2-7.0) and one esophageal perforation following EUS without dilation (0.5%; 95%CI 0.1-2.8; p=0.48 by 2-sided Fisher's Exact test). There were no other major complications. Conclusions TTS balloon dilation is highly successful in permitting complete staging of obstructing tumors. The rate of complications following dilation with a TTS balloon dilator is low and similar to the baseline rate of EUS in this setting.

Jacobson, Brian C.; Shami, Vanessa M.; Faigel, Douglas O.; Larghi, Alberto; Kahaleh, Michel; Dye, Charles; Pedrosa, Marcos; Waxman, Irving



Eosinophilic esophagitis after esophageal atresia: is there an association? Case presentation and literature review.  


Eosinophilic esophagitis (EoE) is a relatively new condition resulting in dysphagia or symptoms resembling gastroesophageal reflux disease, symptoms that also are common in patients with a history of esophageal atresia. We present 2 patients with persistent dysphagia after repair of esophageal atresia that was caused by EoE. Although the exact etiology and pathogenesis of EoE remain unclear, it is now generally accepted that it is the result of a T-helper cell 2-type immune response with a crucial role for the eosinophil-specific chemotaxis factor eotaxin 3 and eosinophils. Because there are genetic similarities between esophageal atresia and EoE, we speculate that patients with esophageal atresia are at increased risk for developing EoE. PMID:22703825

Gorter, Ramon R; Heij, Hugo A; van der Voorn, J Patrick; Kneepkens, C M Frank



NQO1 C609T polymorphism and esophageal cancer risk: a HuGE review and meta-analysis  

PubMed Central

Background Many studies have been carried out to test the hypothesis that the NQO1 C609T polymorphism might be associated with the risk of esophageal cancer. However, the results are poorly consistent, partly due to genetic or other sources of heterogeneity. To investigate the association between this polymorphism and the risk of esophageal cancer, a meta-analysis was performed. Methods We used odds ratios (ORs) with 95% confidence intervals (CIs) to assess the strength of association. The frequency of the putative risk allele in the controls was estimated by the inverse-variance method. Cochran’s Q statistic and the inconsistency index (I2) were used to check heterogeneity. Egger’s test and an inverted funnel plot were used to assess the publication bias. Results Our study included eight published case-control studies about the NQO1 C609T polymorphism and esophageal cancer, including a total of 1,217 esophageal cancer patients and 1,560 controls. Overall, a significant association was found between the NQO1 C609T variant and esophageal cancer under a recessive model (OR?=?1.647; 95% CI?=?1.233-2.200). Regarding histological type, more significant evidence was found for esophageal squamous cell carcinoma (ESCC) (OR?=?2.03; 95% CI?=?1.29-3.19) than esophageal adenocarcinoma (EAC) (OR?=?1.61; 95% CI?=?1.01-2.56) under a recessive model. Conclusions The meta-analysis suggests that the NQO1 C609T polymorphism considerably increases the risk of esophageal cancer.



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.



The Impact of Prolonged pH Measurements on the Diagnosis of Gastroesophageal Reflux Disease: 4Day Wireless pH Studies  

Microsoft Academic Search

INTRODUCTION:Prolonged, 4-day (96 h) measurement by the wireless Bravo® system provides an opportunity to assess the variance, diagnostic reproducibility, and yield of 24- and 48-h pH and symptom association studies.METHOD:Retrospective analysis of 83 patients with suspected reflux symptoms undergoing wireless pH monitoring with the intention of 96-h measurement. Study periods were classified based on esophageal acid exposure, the DeMeester score

Giuseppe Scarpulla; Salvatore Camilleri; Pietro Galante; Miohele Manganaro; Mark Fox



Genes Associated with Food Allergy and Eosinophilic Esophagitis.  

National Technical Information Service (NTIS)

The ingestion of food antigens plays an essential role in the development of eosinophilic esophagitis (EE) as total removal of dietary antigens by using an amino acid based oral formula improves clinical symptoms and esophageal histology in 98% of patient...

D. Broide



GERD, Barrett's Esophagus and the Risk for Esophageal Cancer  


GERD, Barrett's Esophagus and the Risk for Esophageal Cancer Am I at Risk for Esophageal Cancer? There ... commonly in Caucasians as well as people with gastroesophageal reflux disease (GERD). This cancer is increasing in frequency. ...


Classification of test agent-specific effects in the Syrian hamster embryo assay (pH 6.7) using infrared spectroscopy with computational analysis.  


The Syrian hamster embryo (SHE) cell transformation assay (pH 6.7) has utility in the assessment of potential chemical carcinogenicity (both genotoxic and non-genotoxic mechanisms of action). The assay uses morphological transformation as an end point and has a reported sensitivity of 87%, specificity of 83% and overall concordance of 85% with in vivo rodent bioassay data. However, the scoring of morphologically transformed SHE cells is subjective. We treated SHE cells grown on low-E reflective slides with benzo[a]pyrene, 3-methylcholanthrene, anthracene, N-nitroso-N-methylnitroguanidine, ortho-toluidine HCl, 2,4-diaminotoluene or D-mannitol for 7 days before fixation with methanol. Identified colonies were interrogated by acquiring a minimum of five infrared (IR) spectra per colony using attenuated total reflection Fourier-transform IR spectroscopy. Individual IR spectra were acquired over a spatial area of approximately 250 × 250 ?m. Resultant data were analysed using Fisher's linear discriminant analysis and feature histogram algorithms to extract classifying biomarkers of test agent-specific effects or transformation in SHE cells. Clustering of spectral points suggested co-segregation or discrimination of test agent categories based on mechanism of action. Towards transformation, unifying alterations were associated with alterations in the Amide I and Amide II peaks; these were consistently major classifying biomarkers for transformed versus non-transformed SHE cells. Our approach highlights a novel method towards objectively screening and classifying SHE cells, be it to ascertain test agent treatment based on mechanism of action or transformation. PMID:22362182

Ahmadzai, Abdullah A; Trevisan, Júlio; Pang, Weiyi; Patel, Imran I; Fullwood, Nigel J; Bruce, Shannon W; Pant, Kamala; Carmichael, Paul L; Scott, Andrew D; Martin, Francis L



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:; 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)





We present a retrospective evaluation of our experience in the period that goes from January 1992 to December 1998, clinical records of 58 patients ages from 2 months old to 15 years, male and female, who were treated at the GI service of Instituto de Salud del Ni o, were reviewed. All of them had esophageal stenosis and were included in the Esophageal Dilatation Program with Savary-Gilliard bougies. The causes of Esophageal Stenosis in the study were: Caustic agents 37.9%, gastro esophageal reflux (GER) 20.7%, surgery sequela 19.0%, related to esophageal esclerotherapy 12.1%, foreign body itself or maneuvers to retrieve them 8.6%, stomach adenocarcinoma invading the esophagus. Patients were classified in three groups: Group 1: stenosis due to caustic agents Group 2: stenosis due to GER Group 3: The remaining causes mentioned above., In each the following was calculated: the arithmetical media, the range of dilatations sessions and the total number of them. The higher figures took place in group 1. So we conclude that the number of sessions is directly related with the cause of the stenosis, requiring more number of dilatations to get a better response. Finally the response to treatment is evaluated considering a good response in 72.4%. A mild response in 15.5% and therapeutic failure in 12.1% of patients. The rate of complications was 10.3 per patient and 1.1 in relation to the total number of dilatation sessions. The main complications were: gastric perforation, duodenal perforation, pneumomediastinum, esophago-tracheal fistulae andi pseudodiverticulum formation, with resolution as seen in posterior controls. These complications occured after the proceeding took place. The treatment was installed according to each case. The patients with duodenal perforation died. We conclude that esophageal dilatations in infants with esophageal stenosis, of different ethiology, are secure and efficient. PMID:12181577

Alarcón, Anibal; Talavera, Godofredo; Gonzales, Jóse; Rivera, Juan


The diagnostic value of pleural fluid pH.  


One hundred eighty-three patients had simultaneous blood and pleural fluid pH determinations. Thirty-six effusions were transudates, and 147 were exudates. In 46 effusions, the pleural fluid pH was less than 7.30; all 46 were exudates. A pleural fluid pH less than 7.30 was associated with the following six diagnoses: (1) empyema; (2) malignancy; (3) collagen vascular disease; (4) tuberculosis; (5) esophageal rupture; and (6) hemothorax. The results of pleural fluid pH determination are immediately available, narrow the differential diagnosis of the exudate, and may expedite patient management. The pH of pleural fluid should be measured whenever a diagnostic thoracocentesis is performed. PMID:7471845

Good, J T; Taryle, D A; Maulitz, R M; Kaplan, R L; Sahn, S A



Concomitant herpetic and eosinophilic esophagitis--a causality dilemma.  


Eosinophilic and herpetic esophagitis are listed as independent causes of dysphagia, especially in young adult males. However, herpetic esophagitis rarely affects immunocompetent individuals. We report the case of a young, not immunocompromised patient, admitted because of severe dysphagia secondary to herpes simplex virus esophagitis. After complete resolution, an endoscopic and histologic reevaluation established the diagnosis of eosinophilic esophagitis. The potential association between the two conditions is discussed. PMID:23082710

Monsanto, P; Almeida, N; Cipriano, M A; Gouveia, H; Sofia, C



Broken Esophageal Stent Successfully Treated by Interventional Radiology Technique  

SciTech Connect

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

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



Delayed presentation of intrathoracic esophageal perforation after pneumatic dilation for achalasia  

Microsoft Academic Search

Pneumatic dilation (PD) is considered to be a safe and effective first line therapy for achalasia. The major adverse event caused by PD is esophageal perforation but an immediate gastrografin test may not always detect a perforation. It has been reported that delayed management of perforation for more than 24 h is associated with high mortality. Surgery is the treatment

Ming-Tzung Lin; Wei-Chen Tai; King-Wah Chiu; Yeh-Pin Chou; Ming-Chao Tsai; Tsung-Hui Hu; Chuan-Mo Lee; Chi-Sin Changchien; Seng-Kee Chuah



Does empiric esophageal dilation benefit dysphagia when endoscopy is normal?  

Microsoft Academic Search

Some patients referred for esophagogastroduodenoscopy (EGD) to evaluate symptoms of dysphagia have normal endoscopies. How best to manage these patients is unclear. We reviewed our experience with empiric esophageal dilation in this setting. Over a five-year period, 40 consecutive patients with esophageal dysphagia and normal EGD underwent empiric esophageal dilation at the time of their endoscopy. Postdilation follow-up was available

John B. Marshall; Tabassum A. Chowdhury



Prevention by Rebamipide of Acute Reflux Esophagitis in Rats  

Microsoft Academic Search

Proinflammatory factors, including neutrophil-derived oxygen free radicals and inflammatory cytokines, have recently been implicated in the pathogenesis of reflux esophagitis. Rebamipide has been widely used as an anti-ulcer agent. The aim of the present study was to assess the protective effect of rebamipide against acute reflux esophagitis in rats. Esophagitis was induced in rats by ligation at the limiting ridge

Kazuhiro Katada; Norimasa Yoshida; Yutaka Isozaki; Naoya Tomatsuri; Hiroshi Ichikawa; Yuji Naito; Takeshi Okanoue; Toshikazu Yoshikawa



Genetic players in esophageal atresia and tracheoesophageal fistula  

Microsoft Academic Search

Esophageal atresia is a common and serious developmental anomaly, of which the causes remain largely unknown. Studies in vertebrate models indicate the importance of the sonic hedgehog pathway in esophageal atresia, but its relevance to the human condition remains to be defined. Now, three genes have been identified that cause syndromic forms of esophageal atresia when mutated. NMYC and SOX2

Han G Brunner; Hans van Bokhoven



Endoscopic polypectomy: A promising therapeutic choice for esophageal carcinosarcoma  

Microsoft Academic Search

Esophageal carcinosarcoma is a rare malignant tumor composing of both carcinomatous and sarcomatous elements. Endoscopic therapy is less invasive and may represent an alternative to esophagectomy for superficial esophageal carcinosarcoma. Here, we report a 61-year-old male who was diagnosed as esophageal carcinosarcoma and underwent endoscopic polypectomy with well tolerance and favorable prognosis. We also present a brief review of the

Feng Ji; Yue-Mei Xu; Cheng-Fu Xu



Chronic esophageal foreign bodies in pediatric patients: a retrospective review  

Microsoft Academic Search

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

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



Barrier effect of Esoxx(®) on esophageal mucosal damage: experimental study on ex-vivo swine model.  


The aim of the present study was to assess the potential barrier effect of Esoxx(®), a new nonprescription medication under development for the relief of gastroesophageal reflux symptoms. Esoxx is based on a mixture of hyaluronic acid and chondroitin sulfate in a bioadhesive suspension of Lutrol(®) F 127 polymer (poloxamer 407) which facilitates the product adhesion on the esophageal mucosa. The mucosal damage was induced by 15 to 90 minutes of perfusion with an acidic solution (HCl, pH 1.47) with or without pepsin (2000 U/mL, acidified to pH 2; Sigma-Aldrich). Mucosal esophageal specimens were histologically evaluated and Evans blue dye solution was used to assess the permeability of the swine mucosa after the chemical injury. The results show that: (1) esophageal mucosal damage is related to the perfusion time and to the presence of pepsin, (2) mucosal damage is associated with an increased permeability, documented by an evident Evans blue staining, (3) perfusion with Esoxx is able to reduce the permeability of the injured mucosa, even after saline washing of the swine esophagus. These preliminary results support further clinical studies of Esoxx in the topical treatment of gastroesophageal reflux symptoms. PMID:22767997

Di Simone, Massimo P; Baldi, Fabio; Vasina, Valentina; Scorrano, Fabrizio; Bacci, Maria Laura; Ferrieri, Antonella; Poggioli, Gilberto



Barrier effect of Esoxx® on esophageal mucosal damage: experimental study on ex-vivo swine model  

PubMed Central

The aim of the present study was to assess the potential barrier effect of Esoxx®, a new nonprescription medication under development for the relief of gastroesophageal reflux symptoms. Esoxx is based on a mixture of hyaluronic acid and chondroitin sulfate in a bioadhesive suspension of Lutrol® F 127 polymer (poloxamer 407) which facilitates the product adhesion on the esophageal mucosa. The mucosal damage was induced by 15 to 90 minutes of perfusion with an acidic solution (HCl, pH 1.47) with or without pepsin (2000 U/mL, acidified to pH 2; Sigma-Aldrich). Mucosal esophageal specimens were histologically evaluated and Evans blue dye solution was used to assess the permeability of the swine mucosa after the chemical injury. The results show that: (1) esophageal mucosal damage is related to the perfusion time and to the presence of pepsin, (2) mucosal damage is associated with an increased permeability, documented by an evident Evans blue staining, (3) perfusion with Esoxx is able to reduce the permeability of the injured mucosa, even after saline washing of the swine esophagus. These preliminary results support further clinical studies of Esoxx in the topical treatment of gastroesophageal reflux symptoms.

Di Simone, Massimo P; Baldi, Fabio; Vasina, Valentina; Scorrano, Fabrizio; Bacci, Maria Laura; Ferrieri, Antonella; Poggioli, Gilberto



Multidisciplinary approach for patients with esophageal cancer  

PubMed Central

Patients with esophageal cancer have a poor prognosis because they often have no symptoms until their disease is advanced. There are no screening recommendations for patients unless they have Barrett’s esophagitis or a significant family history of this disease. Often, esophageal cancer is not diagnosed until patients present with dysphagia, odynophagia, anemia or weight loss. When symptoms occur, the stage is often stage III or greater. Treatment of patients with very early stage disease is fairly straight forward using only local treatment with surgical resection or endoscopic mucosal resection. The treatment of patients who have locally advanced esophageal cancer is more complex and controversial. Despite multiple trials, treatment recommendations are still unclear due to conflicting data. Sadly, much of our data is difficult to interpret due to many of the trials done have included very heterogeneous groups of patients both histologically as well as anatomically. Additionally, studies have been underpowered or stopped early due to poor accrual. In the United States, concurrent chemoradiotherapy prior to surgical resection has been accepted by many as standard of care in the locally advanced patient. Patients who have metastatic disease are treated palliatively. The aim of this article is to describe the multidisciplinary approach used by an established team at a single high volume center for esophageal cancer, and to review the literature which guides our treatment recommendations.

Villaflor, Victoria M; Allaix, Marco E; Minsky, Bruce; Herbella, Fernando A; Patti, Marco G



Pharmacological management of esophageal food bolus impaction.  


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

Khayyat, Yasir Mohammed



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



Long-term evaluation of esophageal and pulmonary function in patients with repaired esophageal atresia and tracheoesophageal fistula  

Microsoft Academic Search

Patients who have undergone repair of esophageal atresia and tracehoesophageal fistula as infants have been noted to have residual esophageal dysmotility and pulmonary dysfunction during their childhood years. However, limited information is available about the long-term follow-up of these patients. In this study we performed esophageal and pulmonary function studies on 12 adults who had required surgical repair of these

Jeffrey A. Biller; Julian L. Allen; Samuel R. Schuster; S. T. Treves; Harland S. Winter



Recent developments in esophageal adenocarcinoma.  


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. CA Cancer J Clin 2013. © 2013 American Cancer Society. PMID:23584949

Lagergren, Jesper; Lagergren, Pernilla



Recent developments in esophageal adenocarcinoma.  


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


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


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

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



Integration of Soil pH with Soil?Test Values of Zinc for Prediction of Yield Response in Rice Grown in Mollisols  

Microsoft Academic Search

Seventeen Mollisols having pH(1:2) in the range of 6.00 to 8.42 were analyzed with five extractants, and the extractable zinc (Zn) ranges were 0.84 to 2.75 mg Zn kg soil for diethylenetriaminepentaacetic acid (DTPA) (pH 7.3), 0.91 to 2.72 mg Zn kg soil for DTPA + ammonium bicarbonate (pH 7.6), 1.82 to 7.18 mg Zn kg soil for Mehlich 3, 1.22 to 3.83 mg Zn kg soil for ethylenediaminetetraacetic acid (EDTA) + ammonium carbonate,

Prakash C. Srivastava; Prashant Srivastava





With the goal to assess the efficacy of a simple set of endoscopic ligation of esophageal varices, we conducted a prospective study in the public Goyeneche Hospital, Arequipa, Per . Ten patients between 17 and 68 years old (mean 48 years)diagnosed with digestive hemorrhage due to grade III-IV esophageal varices caused by hepatic cirrhosis were subject to endoscopic ligation. We succesfully used this simple device without overtube, in a total of 34 sessions, with 3 to 6 bands (mean 4) per session in only one introduction of endoscopy without active vericeal hemorrhage. Endoscopic treatment was repeated at 1-to-2 week intervals until variceal eradication was achieved. Only one complication (p<0.001) in the third session due to esophageal distal estenosis that was resolved with dilatation. This procedure could be useful as practical alternative of easy access and lower cost as a therapeutic option to sclerotheraphy and less complications. PMID:12138386

Zevallos, José


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.



MicroRNA involvement in esophageal carcinogenesis  

PubMed Central

MicroRNAs (miRs) have recently emerged as a novel class of gene expression regulators. The number of studies documenting an altered miR expression pattern in cancer continues to expand rapidly. Critical information is continuously gained regarding how aberrantly expressed miRs contribute to carcinogenesis. Current studies provide evidence that analyses of miR expression patterns have potential clinical applications toward developing tumor biomarkers to identify the presence and dissemination of esophageal cancer, as well as to assess tumor chemo- or radiosensitivity. The incidence of esophageal cancer is on the rise, and this disease continues to portend a poor prognosis. The current review addresses ways in which altered miR expression contributes to esophageal carcinogenesis, along with how recent discoveries may be applied clinically.

David, Stefan; Meltzer, Stephen J.



The features of the correlation between the pH values and the dissolved oxygen at the Chistaya Balka test area in the Northern Caspian Sea  

NASA Astrophysics Data System (ADS)

Abnormally high pH values (up to 9 NBS units and over) were registered by different expeditions at the seaward edge of the Volga River delta. Within the report, the relationship of the pH values, the dissolved oxygen content, and the water temperature are considered using the equations of the thermodynamic theory of carbonate equilibrium. It is shown that the changes of the pH values are nonlinear relative to the content of oxygen. The nonlinearity is most pronounced at high values of the water saturation with oxygen (over 110-120%). A pH value over 9 may be reached in well heated waters at a dissolved oxygen content of 8-9 ml/l. The oxygen content as such is of course high but not excessive and might be caused by the high intensity of the production processes in the waters.

Makkaveev, P. N.



Avoiding complications in esophageal cancer surgery.  


Modern handling of esophageal cancer patients is based on a multidisciplinary concept, but surgery remains the primary curative treatment modality. Improvements in the perioperative care have reduced the overall morbidity and mortality, but 2-7% of the patients may still die within 30 days as a direct consequence of complications related to the esophagectomy procedure. Primarily based on results from randomized studies published after 2000 this review describes some of the factors that may contribute to the development of postoperative complications following esophageal cancer surgery as well as studies intended to finding ways of reducing the complication rate. PMID:24019042

Bau Mortensen, M



Drug-induced esophageal injury with an occult vascular ring  

PubMed Central

Drug-induced esophageal injury is an under-recognized clinical problem, and is associated with antibiotic use in more than 50% of cases. The current report describes a teenage girl who presented with symptoms of pill-induced esophagitis following doxycycline use. Subsequent investigations identified a previously undiagnosed vascular ring. Although most patients who experience drug-induced esophageal injury have no underlying anatomical or functional disorder of the esophagus, the condition is more common in areas of esophageal narrowing. The present case illustrates the possibility of an occult esophageal obstruction representing a risk factor for pill esophagitis. The etiologies, mechanisms and management of drug-induced esophageal injury are reviewed, and aspects of vascular rings that are relevant to paediatricians are discussed.

Guttman, Orlee R; Zachos, Mary



Epidermal growth factor receptor: an important target in esophageal cancer.  


Introduction: Even after complete tumor removal by surgery, the clinical outcomes remain poor in patients with advanced esophageal cancer, justifying the need for new treatment options. Epidermal growth factor receptor (EGFR) is a molecular target for antibody-based therapy in various cancer types, and it may play important roles in the development of esophageal cancer. Areas covered: This review evaluates the expression, function, and mechanism of EGFR in esophageal cancer and analyzes its value for the prognosis and therapy of esophageal cancer. Future developments toward the clinical applications of EGFR to cancer treatment are also envisaged. Expert opinion: EGFR may function as an ideal therapeutic target for esophageal cancer. Further investigation of epidermal growth-factor-receptor-mediated pathways will push insight into the novel strategies of target therapy for esophageal cancer. More clinical trials should be performed to promote the success of therapeutic-clinical use of EGFR and its targets in esophageal cancer. PMID:23855932

Hong, Liu; Han, Yu; Brain, Lubi



Roles of ZO-1 and Epidermal Growth Factor in Esophageal Epithelial Defense against Acid  

Microsoft Academic Search

Background: The tight junction plays a crucial role in structural esophageal epithelial defenses that maintain esophageal epithelial integrity. We examined the roles of ZO-1 and epidermal growth factor (EGF) in esophageal epithelial defense against acid using human esophageal epithelial cells. Methods: Human esophageal epithelial cells (TE-1) were incubated with acidified medium in the presence or absence of various doses of

Masatsugu Okuyama; Yasuhiro Fujiwara; Tetsuya Tanigawa; Kenji Watanabe; Masatsugu Shiba; Kazunari Tominaga; Toshio Watanabe; Nobuhide Oshitani; Kazuhide Higuchi; Tetsuo Arakawa



Curative Resection for Esophageal Adenocarcinoma  

PubMed Central

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

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



Prevalence of Increased Esophageal Muscle Thickness in Patients With Esophageal Symptoms  

Microsoft Academic Search

BACKGROUND:Patients with achalasia, diffuse esophageal spasm (DES), and nutcracker esophagus have a thicker muscularis propria than normal subjects. The goal of our study was to determine the prevalence of increased muscle thickness in a group of unselected patients referred to the esophageal function laboratory for evaluation of the symptoms.METHODS:We studied 40 normal subjects and 94 consecutive patients. Manometry and ultrasound

Ibrahim Dogan; James L. Puckett; Bikram S. Padda; Ravinder K. Mittal



Self-expanding esophageal metallic stents in the treatment of esophageal obstruction.  


Esophageal obstruction from any cause is debilitating. In patients with malignant obstruction palliation to relieve pain and dysphagia is the primary goal. Conventional endoluminal prostheses allow variable palliation. Covered expandable metallic stents with an 18-mm lumen allow improved deglutition. From December 1994 through December 1998, 59 patients underwent placement of self-expanding silicone-covered esophageal stents for esophageal obstruction. There were 36 men and 23 women ranging in age from 41 to 94. All patients underwent esophageal dilation using a flexible gastroscope and Savary bougies. After dilation placement of the stent was performed under fluoroscopic control. Follow-up was complete in all patients. Technical success was achieved in all patients. There was one postoperative death (bronchopulmonary fistula), one migration of the stent requiring removal, and one recurrent obstruction. The remaining stents were well tolerated even in the cervical region (four patients). All patients returned to a diet of solid foods. We conclude that covered self-expanding esophageal metallic stents are technically simple and safe to insert and appear to provide durable excellent palliation of esophageal obstruction due to either benign or malignant conditions. PMID:11261624

Cordero, J A; Moores, D W



Case report Recurrent spontaneous esophageal rupture  

Microsoft Academic Search

Spontaneous esophageal rupture is an uncommon and poorly understood condition. Recurrent rupture is extremely rare, with only one previously reported case in the literature. Here, we present a case series of two patients who had recurrent ruptures, and discuss the principles underlying the management of such cases. Q 2005 Elsevier B.V. All rights reserved.

Omar A. Khan; Clifford W. Barlow; David F. Weeden; Khalid M. Amer


Design technology in portable digital esophageal stethoscope  

Microsoft Academic Search

Auscultation of heart sound and breathing sound in anesthesia is very important, because it can provide the information of patient's cardiorespiratory system. In operating room, anesthesiologists use esophageal stethoscope, which is a device to measure heart sound or respiratory sound by inserting a catheter into the esophagus close to heart. It is not only low cost and very simple to

Ji-Yun Shin; Young Cheol Kim; Seung Woon Lim; Eun Jong Cha; Tae Soo Lee



Synchronous primary esophageal and gastric cancers.  


The diagnosed multiple cancer cases have recently been increasing in number. The frequency of synchronous esophageal and gastric carcinomas is increasing due to development of more sophisticated invasive and non-invasive diagnostic tools and an increase in the number of elderly patients. Four cases of synchronous esophageal and gastric cancers were diagnosed in 2nd Department of Radiology, Medical University of Lublin and in Radiological Department of Hospital in Krosno between the 1996 and 2002. In all cases double-contrast barium examinations of upper gastrointestinal tract were performed. In all cases the two lesions were found, separated by normal mucous membrane. In two cases the irregular tumor masses were localized in the gastric cardia. In two patients coexistent lesions form the oval filling defect, with hazy appearance in the middle of the anterior esophageal wall. In three cases the results of contrast examinations were confirmed with CT. Endoscopy with taking the specimens for histopathological examination supplemented the radiological examination. The results of histopathological examinations confirmed the diagnosis. The possibility of multiple primary cancers should be kept in mind during the preoperative examination. In case of esophageal cancer with severe stricture, when endoscope cannot be passed through the esophagus, the stomach should be carefully examined in a barium meal study. PMID:16146021

Pas?awski, Marek; Z?omaniec, Janusz; Ruci?ska, Eulalia; Ko?ty?, Witold



Bioadhesive Dosage Forms for Esophageal Drug Delivery  

Microsoft Academic Search

No Heading The esophagus as a site for drug delivery has been much overlooked in comparison to the remainder of the gastrointestinal tract. The low permeability and transient nature of the esophagus means that it is unsuitable for delivery of drugs for systemic action. However, esophageal disorders including fungal infection, cancers, motility dysfunction, and damage due to gastric reflux may

Hannah Batchelor



A safe treatment option for esophageal bezoars  

PubMed Central

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

Yaqub, Sheraz; Shafique, Muhammad; Kjaestad, Erik; Thorsen, Yngve; Lie, Erik S.; Dahl, Vegard; Bakka, Njal; R?kke, Ola



Congenital tracheoesophageal fistula without esophageal atresia  

Microsoft Academic Search

The authors report a series of eight cases of isolated tracheoesophageal fistula without esophageal atresia (or an H type fistula), treated in three pediatric ENT departments. This is a rare malformation whose diagnosis requires investigation for associated anomalies. The clinical signs are mainly respiratory but also digestive and the symptomatology can be severe. The diagnosis can be made with a

Erwan Genty; Pierre Attal; Richard Nicollas; Gilles Roger; Jean-Michel Triglia; Erea-Noël Garabedian; Serge Bobin



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.



Significance of Platelet Count in Esophageal Carcinomas  

PubMed Central

Background/Aim: Thrombocytosis is found to be associated with unfavorable prognosis in esophageal carcinoma. Platelets produce thymidine phosphorylase which is a platelet-derived endothelial cell growth factor with angiogenic activity. Increased platelet count may be translated into enhanced tumor growth. We examined the relation between platelet count and several prognostic variables in patients with esophageal cancer. Patients and Methods: Three hundred and eighty-one cases with esophageal cancer that underwent esophagectomy in a referral cancer institute during a 5-year period were studied retrospectively. The relation between preoperative platelet count and patient age, gender, site of tumor, presence of multiple cancers and clinicopathological characteristics including histological type, tumor size, depth of penetration (T), lymph node involvement (N), distant metastasis (M), degree of differentiation, presence of vascular, lymphatic and perineural invasion was examined. Results: Squamous cell carcinoma (SCC) constituted 93% and adenocarcinoma 7% of cases. Most of patients were in stage III, followed by stage II. The mean platelet count was 245±76 (× 109 /L). There was no statistically significant correlation between platelet counts with prognostic factors except a weak linear correlation between platelet count and and tumor size (P= 0.03, Pearson correlation coefficient: 0.16). Patients with adenocarcinoma had a higher platelet count than those with SCC (P= 0.003). Conclusion: Platelet count does not correlate with prognostic factors in esophageal cancer. However, it is significantly different between SCC and adenocarcinoma of esophagus.

Aminian, Ali; Karimian, Faramarz; Mirsharifi, Rasoul; Alibakhshi, Abbas; Dashti, Habibollah; Jahangiri, Yosra; Safari, Saeed; Ghaderi, Hamid; Noaparast, Morteza; Hasani, Sharareh M.; Mirsharifi, Alireza



Circulating anti-p53 antibodies in esophageal cancer patients.  


Circulating anti-p53 protein antibodies (p53-Abs) have been detected in some cancer patients. The aim of the study was to determine the presence of circulating anti-p53 protein antibodies and their clinical significance in patients with esophageal carcinoma. Serum specimens from 75 consecutive patients with squamous cell carcinomas and 10 healthy subjects were studied. Enzyme linked immunosorbent assay (ELISA--Pharma Cell) was used to detect p53-Abs. At the time of diagnosis 20 (26.6%) of 75 analyzed patients had positive result in the p53-Abs test, but not any of the healthy subjects. The positive rate was 25% (1/4) cases in stage I, 41% (10/24) cases in stage IIA, 0% (0/8) cases in stage IIB, 28% (8/28) cases in stage III and 9% (1/11) cases in stage IV. In respect of tumour differentiation, cases graded as G1, G2 and G3 were positive in 28.5% (4/14), 25.9% (7/27) and 26.4% (9/34), respectively. There was no correlation between presence of p53-Abs and stage, rumour differentiation, lymph nodes metastases, tumour size, patient age and sex. In conclusion, the results of the present study indicate that serum p53-Abs did not correlate with cliniocopathologic feature of esophageal carcinoma. PMID:11820593

Koz?owski, M; Kovalchuk, O; Nikli?ski, J; Chyczewski, L; Staros?awska, E; Ciecha?ski, A; Dabrowski, A; Nikli?ska, W; Dziegielewski, P; Lapu?, G; Wallner, G; Lauda?ski, J



Non-invasive Predictors of Esophageal Varices  

PubMed Central

Background/Aim: Current guidelines recommend screening cirrhotic patients with an endoscopy to detect esophageal varices and to institute prophylactic measures in patients with large esophageal varices. In this study, we aimed at identifying non-endoscopic parameters that could predict the presence and grades of esophageal varices. Patients and Methods: In a prospective study, 229 newly diagnosed patients with liver cirrhosis, without a history of variceal bleeding, were included. Demographic, clinical, biochemical and ultrasonographic parameters were recorded. Esophageal varices were classified as small and large, at endoscopy. Univariate analysis and multivariate logistic regression analysis were done to identify independent predictors for the presence and grades of varices. Results: Of the 229 patients (141 males; median age 42 years; range 17-73 years) with liver cirrhosis, 97 (42.3%) had small and 81 (35.4%) had large varices. On multivariate analysis, low platelet count (Odd’s Ratio [OR], 4.3; 95% confidence interval [CI], 1.2-14.9), Child Pugh class B/C (OR, 3.3; 95% CI, 1.8-6.3), spleen diameter (OR, 4.3; 95% CI, 1.6-11.9) and portal vein diameter (OR, 2.4; 95% CI, 1.1-5.3) were independent predictors for the presence of varices. Likewise, for the presence of large esophageal varices, low platelet count (OR, 2.7; 95% CI, 1.4-5.2), Child Pugh class B/C (OR, 3.8; 95% CI, 2.3-6.5) and spleen diameter (OR, 3.1; 95% CI, 1.6-6.0) were the independent risk factors. Conclusion: The presence and higher grades of varices can be predicted by a low platelet count, Child-Pugh class B/C and spleen diameter. These may be considered as non-endoscopic predictors for the diagnosis and management of large grade varices.

Cherian, Jijo V.; Deepak, Nandan; Ponnusamy, Rajesh Prabhu; Somasundaram, Aravindh; Jayanthi, V.



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


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


Dysregulated expression of HOX and ParaHOX genes in human esophageal squamous cell carcinoma.  


Homeobox genes function as master regulators in embryonic morphogenesis. We hypothesized that homeobox genes are essential to maintain tissue- or organ-specificity even in adult body and that the dysregulated expression of homeobox genes results in tumor development and progression. To better understand the roles of homeobox genes in development and progression of esophageal cancer, we analyzed the expression patterns of 39 HOX genes and 4 ParaHOX (CDX1, CDX2, CDX4 and PDX1) genes in esophageal squamous cell carcinoma (ESCC) and normal esophageal mucosa tissues. A total of 48 primary ESCC tissues and 7 normal esophageal mucosa tissues were resected from patients who underwent radical surgery without any preoperative chemotherapy or radiotherapy. The expression of HOX and ParaHOX genes were analyzed by a quantitative real-time RT-PCR method and immunohistochemistry. The expression levels of 24 HOX genes, CDX1, CDX2 and PDX1 were significantly higher in ESCC compared to normal mucosa (p<0.01, Mann-Whitney U test). The Immunohistochemical study revealed that HOXA5 and D9 proteins were more cytoplasmic in ESCC than normal mucosa cells. Our data indicate that the disordered expression of HOX and ParaHOX genes are involved in the development of ESCC or its malignancy. PMID:17342311

Takahashi, Osamu; Hamada, Jun-Ichi; Abe, Motoki; Hata, Shinya; Asano, Toshimichi; Takahashi, Yoko; Tada, Mitsuhiro; Miyamoto, Masaki; Kondo, Satoshi; Moriuchi, Tetsuya



Comparative Dietary Therapy Effectiveness in Remission of Pediatric Eosinophilic Esophagitis  

PubMed Central

Background Eosinophilic esophagitis is a chronic, immune-mediated inflammatory disorder that responds to dietary therapy; however, data evaluating the effectiveness of dietary therapeutic strategies is limited. Objective This study compared the effectiveness of three frequently prescribed dietary therapies [elemental, six-food elimination, and skin prick and atopy patch-directed elimination] and assessed the remission predictability of skin tests and their utility in directing dietary planning. Methods A retrospective cohort of proton-pump inhibitor-unresponsive, non-glucocorticoid-treated eosinophilic esophagitis patients who had two consecutive endoscopic biopsies associated with dietary intervention was identified. Biopsy histology and remissions (< 15 eosinophils/high-power field) following dietary therapy and food reintroductions were evaluated. Results Ninety-eight of 513 patients met eligibility criteria. Of these 98, 50% (49), 27% (26), and 23% (23) received elemental, six-food elimination, and directed diets, respectively. Remission occurred in 96%, 81%, and 65% of patients on elemental, six-food elimination, and directed diets, respectively. The odds of post-diet remission vs. non-remission were 5.6-fold higher (P=0.05) on elemental vs. six-food elimination, 12.5-fold higher (P=0.003) on elemental vs. directed, and were not significantly different (P=0.22) on six-food elimination vs. directed diets. Following 116 single-food reintroductions, the negative predictive value of skin testing for remission was 40%–67% (milk 40%, egg 56%, soy 64%, and wheat 67%). Conclusion All three dietary therapies are effective; however, an elemental diet is superior at inducing histologic remission compared with six-food elimination and skin test-directed diets. Notably, an empiric six-food elimination diet is as effective as a skin test-directed diet. The negative predictive values of foods most commonly reintroduced in single-food challenges are not sufficient to support the development of dietary advancement plans solely based on skin tests.

Henderson, Carol J.; Abonia, J. Pablo; King, Eileen C.; Putnam, Philip E.; Collins, Margaret H.; Franciosi, James P.; Rothenberg, Marc E.



Effect of Atilmotin, a Motilin Receptor Agonist, on Esophageal, Lower Esophageal Sphincter, and Gastric Pressures  

PubMed Central

Background Motilin, an endogenous gastrointestinal (GI) hormone, increases upper gastrointestinal tract motility and is associated with phase III of the gastric migrating motor complex. The motilin receptor agonist, atilmotin, at doses of 6, 30 or 60 µg intravenously (IV), increases the early phase of gastric emptying. Prior studies at higher doses of 100–450 µg IV demonstrated that some subjects developed noncardiac chest pain. Aims The aim of this study is to determine the effects of atilmotin on esophageal, lower esophageal sphincter (LES), and gastric contractility and the development of esophageal-related symptoms. Methods Ten healthy volunteers underwent esophageal manometry to study the effects of atilmotin on upper GI motility. Five subjects were studied on three separate days following administration of saline placebo and subsequent IV bolus dose of atilmotin (6, 30 or 150 µg). Another five subjects were studied at the highest dose (150 µg). Results Atilmotin at 150 µg increased proximal gastric pressure by 6.5 mmHg (P = 0.001 compared with placebo). Atilmotin increased LES pressure at all studied doses; LES pressure increased from 24 ± 2 mmHg following placebo injection to 34 ± 4 mmHg following a 30 µg dose of atilmotin (P = 0.007). In the esophagus, atilmotin increased the percentage of failed swallows at the highest dose studied. Failed swallows increased from 17 ± 7% following placebo injection to 36 ± 7% following a 150 µg dose of atilmotin (P = 0.016). Atilmotin decreased distal esophageal contractile amplitude only at the highest dose studied, from 69 ± 8 mmHg (placebo) to 50 ± 5 mmHg following 150 µg atilmotin (P = 0.018). There were no serious adverse effects or episodes of chest pain with atilmotin. Conclusions Atilmotin affects esophageal, LES, and gastric motility. LES and gastric pressures were increased, whereas there was disruption of esophageal peristalsis characterized by lower amplitude and failed contractions.

Korimilli, Annapurna



Functional luminal imaging probe topography: an improved method for characterizing esophageal distensibility in eosinophilic esophagitis  

PubMed Central

Objectives: The aims of this study were to develop a new method for analysis and presentation of esophageal distensibility data using high-resolution impedance planimetry recordings during a volume-controlled distention. Methods: Two control subjects and six patients with eosinophilic esophagitis (EoE) with stricture, narrow caliber or normal endoscopy according to EndoFLIP studies were included for analysis. Median filtering and pulse detection techniques were applied to the pressure signal and a wavelet decomposition technique was applied to the 16 channels of raw esophageal diameter data to reduce vascular artifact, respiratory effect and remove esophageal contraction interference. These data were used to generate a functional luminal imaging probe (FLIP) topography plot that describes regional variation of cross-sectional area (CSA). A previously developed computer program was used to calculate and model the CSA-pressure data to derive the slope of line fitting and distension plateau for each individual subject. The results were compared among the four endoscopic phenotypes. Results: Patients with EoE and normal endoscopy had similar esophageal distensibility parameters to those of normal controls whereas patients with EoE and stricture or narrow caliber had much lower distensibility than patients with EoE and normal endoscopy. The FLIP topography plots provided a global assessment of the esophageal distensibility along the axial plane of measurement that differentiated patients with varying degrees of endoscopic abnormality. Conclusions: New techniques can be leveraged to improve data analysis and presentation using EndoFLIP assessment of the esophageal body in EoE. These techniques may be helpful in defining clinically relevant phenotypes and guiding treatment strategies and should be helpful in structuring future outcome trials.

Kahrilas, Peter J.; Xiao, Yinglian; Nicodeme, Frederic; Gonsalves, Nirmala; Hirano, Ikuo; Pandolfino, John E.



A striking local esophageal cytokine expression profile in eosinophilic esophagitis1  

PubMed Central

Background Eosinophilic esophagitis (EE) is an emerging worldwide disease that mimics gastroesophageal reflux disease. Objective Early studies have suggested that esophageal eosinophilia occurs in association with T helper type 2 allergic responses, yet the local and systemic expression of relevant cytokines has not been well characterized. Methods A human inflammatory cytokine and receptor PCR array containing 84 genes followed by PCR validation and multiplex arrays were used to quantify cytokine mRNA in esophageal biopsies and blood levels. Results Esophageal transcripts of numerous chemokines [e.g. CCL1, CCL23, CCL26 (eotaxin-3), CXCL1, and CXCL2], cytokines (e.g. IL13 and ABCF1), and cytokine receptors (e.g. IL5RA) were induced at least 4-fold in individuals with EE. Analysis of esophageal biopsies (n=288) revealed that eotaxin-3 mRNA level alone had 89% sensitivity for distinguishing EE from non-EE individuals. The presence of allergy was associated with significantly increased esophageal expression of IL4 and IL5 mRNA in active EE patients. We identified 8 cytokines (IL-4, IL-13, IL-5, IL-6, IL-12p70, CD40L, IL-1?, and IL-17) whose blood levels retrospectively distinguished 12 non-EE from 13 EE patients with 100% specificity and 100% sensitivity. When applied to a blinded, prospectively recruited group of 36 patients, the cytokine panel scoring system had a 79% positive predictive value, 68% negative predictive value, 61% sensitivity, and 83% specificity for identifying EE. Conclusion Evidence is presented that IL13 and IL5 associate with eosinophil and eotaxin-3 levels, indicating the key role of adaptive Th2 immunity in regulating eotaxin-3-driven esophageal eosinophilia in the absence of a consistent systemic change in cytokines.

Blanchard, Carine; Stucke, Emily M.; Rodriguez-Jimenez, Beatriz; Burwinkel, Karen; Collins, Margaret H.; Ahrens, Annette; Alexander, Eileen S.; Butz, Bridget K. Buckmeier; Jameson, Sean C.; Kaul, Ajay; Franciosi, James P.; Kushner, Jonathan P.; Putnam, Philip E.; Abonia, J. Pablo; Rothenberg, Marc E.



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.



Molecular factors related to metastasis of esophageal squamous cell carcinoma  

Microsoft Academic Search

The aggressive behavior of esophageal cancer leads to a low survival rate for patients with this disease. Isolated esophageal\\u000a cancer cells seem to have the potential for regrowth and metastasis. To control the metastasis of esophageal carcinoma, detailed\\u000a analysis of various molecular and biological factors should be done in each patient. Recent progress in molecular biology\\u000a has revealed that oncogenes,

Yutaka Shimada; Fumiaki Sato



Diet, Lifestyle and Gender in Gastro-Esophageal Reflux Disease  

Microsoft Academic Search

Background Studies indicate that gastro-esophageal reflux disease (GERD) is associated with obesity, smoking, esophagitis, diet, and\\u000a lifestyle. Aim To identify risk factors associated with GERD among patients presenting to a tertiary GI clinic in Italy. Methods Patients with a first diagnosis of GERD based on heartburn and\\/or regurgitation and\\/or esophagitis at the endoscopic examination\\u000a were enrolled. A control group with

Maria Pina Dore; Emmanouil Maragkoudakis; Ken Fraley; Antonietta Pedroni; Vincenza Tadeu; Giuseppe Realdi; David Y. Graham; Giuseppe Delitala; Hoda M. Malaty



Esophageal lipomatosis: another consequence of the use of steroids  

Microsoft Academic Search

.   After we incidentally found on CT extensive esophageal fat accumulations in a patient with long-term use of steroids, we\\u000a prospectively evaluated during a 6-month period all CT studies of the chest for esophageal lipomatosis and related the findings\\u000a to the possible use of steroids. The diagnosis of esophageal fat on CT was made by density measurements or if too

J. Bogaert; F. Rosseel; S. Verhaegen; J. Verschakelen



The role of pepsin in acid injury to esophageal epithelium  

Microsoft Academic Search

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

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



Carbonated Soft Drink Consumption and Risk of Esophageal Adenocarcinoma  

Microsoft Academic Search

Carbonated soft drinks (CSDs) have been associated with gastroesophageal refl ux, an established risk factor for esophageal adenocarcinoma. As both CSD consumption and esophageal ade- nocarcinoma incidence have sharply increased in recent decades, we exam- ined CSD as a risk factor for esophageal and gastric cancers in a U.S. multi- center, population-based case-control study. Associations between CSD intake and risk

Susan T. Mayne; Harvey A. Risch; Robert Dubrow; Wong-Ho Chow; Marilie D. Gammon; Thomas L. Vaughan; Lauren Borchardt; Janet B. Schoenberg; Janet L. Stanford; A. Brian West; Heidi Rotterdam; William J. Blot; Joseph F. Fraumeni



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.


Cdx1 and c-Myc Foster the Initiation of Transdifferentiation of the Normal Esophageal Squamous Epithelium toward Barrett's Esophagus  

PubMed Central

Background Barrett's esophagus is a premalignant condition whereby the normal stratified squamous esophageal epithelium undergoes a transdifferentiation program resulting in a simple columnar epithelium reminiscent of the small intestine. These changes are typically associated with the stratified squamous epithelium chronically exposed to acid and bile salts as a result of gastroesophageal reflux disease (GERD). Despite this well-defined epidemiologic association between acid reflux and Barrett's esophagus, the genetic changes that induce this transdifferentiation process in esophageal keratinocytes have remained undefined. Methodology/Principal Findings To begin to identify the genetic changes responsible for transdifferentiaiton in Barrett's esophagus, we performed a microarray analysis of normal esophageal, Barrett's esophagus and small intestinal biopsy specimens to identify candidate signaling pathways and transcription factors that may be involved. Through this screen we identified the Cdx1 homeodomain transcription factor and the c-myc pathway as possible candidates. Cdx1 and c-myc were then tested for their ability to induce transdifferentiation in immortalized human esophageal keratinocytes using organotypic culturing methods. Analyses of these cultures reveal that c-myc and cdx1 cooperate to induce mucin production and changes in keratin expression that are observed in the epithelium of Barrett's esophagus. Conclusions/Significance These data demonstrate the ability of Cdx1 and c-myc to initiate the earliest stages of transdifferentiation of esophageal keratinocytes toward a cell fate characteristic of Barrett's esophagus.

Stairs, Douglas B.; Nakagawa, Hiroshi; Klein-Szanto, Andres; Mitchell, Shukriyyah D.; Silberg, Debra G.; Tobias, John W.; Lynch, John P.; Rustgi, Anil K.



Dietary intake of lignans and risk of esophageal and gastric adenocarcinoma: a cohort study in Sweden.  


High intake of phytoestrogen lignans has been found to be associated with decreased risk of esophageal adenocarcinoma in our previous population-based case-control study in Sweden. To further evaluate this possible association, we tested the hypothesis of an inverse association between dietary lignan intake and risk of esophageal and gastric adenocarcinoma using a prospective design. In a population-based cohort study in Sweden, 81,670 participants who were cancer-free at baseline were followed up during 1998 to 2009. All participants completed a 96-item food frequency questionnaire (FFQ), which was used to assess dietary exposure to lignans (secoisolariciresinol, matairesinol, lariciresinol, pinoresinol, medioresinol, and syringaresinol). All cases of esophageal, gastroesophageal junctional, and gastric adenocarcinoma were identified through linkage to the Swedish Cancer Register. Cox proportional hazard models were used to estimate HRs and 95% confidence intervals (CI), with adjustment for potential confounding factors. During an average follow-up of 9.9 years, a total of 211 cases were identified, including 83 cases of esophageal or junctional adenocarcinoma, and 128 cases of gastric adenocarcinoma. There was no statistically significant association between dietary intake of lignans and any of the studied adenocarcinomas. Compared with participants in the lowest quartile of lignan intake, the adjusted HR of the highest quartile was 0.96 (95% CI, 0.46-2.00; P(trend) = 0.70) for adenocarcinoma of the esophagus or gastroesophageal junction, and 0.89 (95% CI, 0.52-1.55: P(trend) = 0.78) for gastric adenocarcinoma. No clear support for a protective role of dietary intake of lignans in the development of esophageal or gastric adenocarcinoma was found. PMID:23195991

Lin, Yulan; Wolk, Alicja; Håkansson, Niclas; Lagergren, Jesper; Lu, Yunxia



Prevalence of eosinophilic esophagitis in children with refractory aerodigestive symptoms.  


IMPORTANCE Eosinophilic esophagitis (EoE) is an increasingly important diagnosis for children; it has a remarkable impact on their quality of life and can present with aerodigestive symptoms commonly evaluated by otolaryngologists. OBJECTIVES To evaluate the prevalence of EoE in children presenting to a pediatric aerodigestive clinic, to describe their presentation, and to review the role of subsequent food allergy evaluation and treatment. DESIGN Review of a prospective database. SETTING Tertiary pediatric multispecialty aerodigestive center. PATIENTS Children with aerodigestive symptoms refractory to medical treatment who underwent direct laryngoscopy with rigid or flexible bronchoscopy and esophagoscopy with or without pH probe study. MAIN OUTCOMES AND MEASURES Diagnosis of EoE. RESULTS Between 2003 and 2012, 376 of 1540 children seen in the center (mean [range] age, 4.54 [0-18.6] years; male to female ratio, 1.72:1) remained symptomatic despite medical therapy and thus underwent triple endoscopic evaluation. Of the 376 children, 14 (3.7%) were eventually diagnosed as having EoE, as defined by 15 or more eosinophils per high-power field on esophageal biopsy and either a negative pH study result or nonresponse to a trial of high-dose proton pump inhibitors. The subpopulation with EoE presented with airway symptoms and diagnoses, most commonly cough (n?=?6; 42.9%). Inflammatory subglottic stenosis due to EoE was identified in 1 patient. Of the 14 children with EoE, 6 presented with gastrointestinal symptomatology, most commonly choking or gagging. Subsequent treatment including food allergy challenge and elimination diet resulted in a clinical improvement in half of the cases identified. CONCLUSIONS AND RELEVANCE This represents the largest multispecialty clinic epidemiologic study evaluating the prevalence of EoE in children presenting not strictly with gastrointestinal symptoms but rather with aerodigestive symptoms that are frequently evaluated by pediatric otolaryngologists. Although the prevalence is low, EoE should be considered for children with appropriate symptoms in whom other medical therapies fail. PMID:24051745

Hill, Courtney A; Ramakrishna, Jyoti; Fracchia, M Shannon; Sternberg, Daniel; Ojha, Shilpa; Infusino, Scott; Hartnick, Christopher J



Esophageal Carcinoma in African Americans: A Five-Decade Experience  

Microsoft Academic Search

Background  Esophageal cancer accounts for a considerable proportion of carcinomas of the upper gastrointestinal tract in African Americans.\\u000a Our aim was to describe the epidemiology of esophageal squamous cell cancer (ESCC) and esophageal adenocarcinoma (EA) among\\u000a African Americans in the last five decades.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A total of 601 records of patients with documented esophageal cancer between 1959 and 2007 at Howard University

Hassan Ashktorab; Zahra Nouri; Mehdi Nouraie; Hadi Razjouyan; Edward E. Lee; Ehsan Dowlati; El-Waleed El-Seyed; Adeyinka Laiyemo; Hassan Brim; Duane T. Smoot


Prospective evaluation of biopsy number for the diagnosis of viral esophagitis in patients with HIV infection and esophageal ulcer  

Microsoft Academic Search

Background: Establishing a diagnosis of viral esophagitis in patients with human immunodeficiency virus (HIV) infection has important clinical relevance. However, the number of biopsies required to diagnose viral esophagitis is currently unknown. Methods: Over a 34-month period, all HIV-infected patients with esophageal ulcer underwent 10 biopsies of the largest and\\/or most accessible lesion, primarily from the ulcer base. The first

C. Mel Wilcox; Robert F. Straub; David A. Schwartz



Eosinophilic Esophagitis in Brazilian Pediatric Patients  

PubMed Central

We examined 11 pediatric patients with eosinophilic esophagitis with a tardy diagnosis. The symptoms were initially thought to be related to other diseases, leading to the use of inadequate therapeutic approaches. The patients were between 3 and 17 years old (mean 7.8 ± 3.8 years), and 8 of the patients were male. Common symptoms included abdominal pain, regurgitation, difficulty in gaining weight, vomiting, dysphagia, and coughing. The mean age for the onset of symptoms was 4.3 ± 2.9 years. Endoscopic findings included normal mucosa in five (45%) patients, thickening of the mucosa with longitudinal grooves in three (27%), erosive esophagitis in two (18%), and a whitish stippling in one (9%) patient. Treatment included the use of a topical corticosteroid for 10 patients. In eight (73%) cases, the treatment made the symptoms disappear. Ten patients underwent histopathological management after treatment, with a decrease in the number of eosinophils.

Pinheiro, Mayra Isabel Correia; de Goes Cavalcanti, Luciano Pamplona; Honorio, Rodrigo Schuler; de Alencar Moreno, Luis Helder; Fortes, Mayara Carvalho; da Silva, Carlos Antonio Bruno



Eosinophilic esophagitis in brazilian pediatric patients.  


We examined 11 pediatric patients with eosinophilic esophagitis with a tardy diagnosis. The symptoms were initially thought to be related to other diseases, leading to the use of inadequate therapeutic approaches. The patients were between 3 and 17 years old (mean 7.8 ± 3.8 years), and 8 of the patients were male. Common symptoms included abdominal pain, regurgitation, difficulty in gaining weight, vomiting, dysphagia, and coughing. The mean age for the onset of symptoms was 4.3 ± 2.9 years. Endoscopic findings included normal mucosa in five (45%) patients, thickening of the mucosa with longitudinal grooves in three (27%), erosive esophagitis in two (18%), and a whitish stippling in one (9%) patient. Treatment included the use of a topical corticosteroid for 10 patients. In eight (73%) cases, the treatment made the symptoms disappear. Ten patients underwent histopathological management after treatment, with a decrease in the number of eosinophils. PMID:24106430

Pinheiro, Mayra Isabel Correia; de Góes Cavalcanti, Luciano Pamplona; Honório, Rodrigo Schuler; de Alencar Moreno, Luís Hélder; Fortes, Mayara Carvalho; da Silva, Carlos Antônio Bruno



An novel role of sphingosine kinase-1 (SPHK1) in the invasion and metastasis of esophageal carcinoma  

PubMed Central

Background Treatment failure for esophageal carcinoma is frequently due to lymph node metastasis and invasion to neighboring organs. The aim of the present study was to investigate invasion- and metastasis-related genes in esophageal carcinoma cells in vitro and in vivo. Methods A metastasis model using a Matrigel invasion clonal selection approach was employed to establish a highly invasive subline EC9706-P4 from the esophageal carcinoma cell (ESCC) line EC9706. The differentially expressed genes of the subline and the parental cells determined by gene microarrays were further analyzed by RT-PCR and Western blotting. Results We identified sphingosine kinase 1 (SPHK1) as an invasion and metastasis-related gene of esophageal cancer. SPHK1 was overexpressed in the EC9706-P4 subline with high invasive capacity. Among six ESCC lines tested, KYSE2 and KYSE30 cells showed the highest SPHK1 mRNA and protein expressions as well as the most invasive phenotype. By Western blotting, in 7/12 cases (58%), SPHK1 expression was higher in esophageal carcinomas than in the companion normal tissue. In 23/30 cases (76%), SPHK1 protein expression was upregulated in the tumors compared to matched normal tissue by immunohistochemistry (IHC). Esophageal carcinoma tissue microarray analysis indicated that SPHK1 expression correlated with the depth of tumor invasion (P < 0.0001) and lymph node metastasis (P = 0.016). By Kaplan-Meier analysis, strong SPHK1 expression was significantly associated with clinical failure (P < 0.01), suggesting the involvement of SPHK1 in aggressiveness of human esophageal carcinoma. SPHK1 overexpression significantly increased the invasiveness of EC9706 cells in vitro and also increased EC9706 cell growth and spontaneous metastasis in vivo, promoting significant increases in tumor growth, tumor burden and spontaneous lung metastasis in nude mice. SPHK1 expression significantly correlated with the expression of many EGFR pathway genes associated with invasion of cancer cells. SPHK1 protein expression also significantly correlated with the phosphorylation of EGFR. Conclusion In summary, our data implicate SPHK1 in the metastasis of esophageal cancer. Our study also identified downstream mediators of SPHK1 in esophageal cancer cells that may mediate enhanced malignant behavior, and several of these mediators may be useful as therapeutic targets.



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


A 65-year-old woman suffered from both chronic gastroesophageal reflux, which was complicated by columnar metaplasia (Barrett's epithelium), and profound hypothyroidism. An esophageal motility tracing showed absence of peristalsis in the lower esophagus and the lower esophageal sphincter (LES) could not be identified. Thyroid replacement therapy, in conjunction with antacid and cimetidine treatment, was associated not only with improvement in the gastroesophageal reflux symptoms, but also with a return of esophageal peristalsis and LES pressure to normal. To support our clinical observations, we rendered four cats hypothyroid with 131I and documented a fall in LES pressure. We propose that abnormal smooth-muscle function of the esophagus may be another manifestation of the gastrointestinal motility disturbances which are associated with hypothyroidism. PMID:7119407

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



Pellagra associated with esophageal carcinoma and alcoholism.  


Pellagra is a nutritional disease caused by the deficiency of niacin. It presents with a photodistributed rash, gastrointestinal symptoms, and neuropsychiatric disturbances. In the Western world, this disease is mostly confined to alcoholics or the impoverished. However, this condition must be recognized in other clinical settings because it is easily treated and can be fatal if not identified. We describe a case of pellagra caused by esophageal carcinoma and alcoholism; we also review the literature. PMID:19624986

Nogueira, Ana; Duarte, Ana F; Magina, Sofia; Azevedo, Filomena



Eosinophilic Esophagitis in Infants and Toddlers  

Microsoft Academic Search

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

Scott P. Pentiuk; Claire Kane Miller; Ajay Kaul



Medical management of iatrogenic esophageal perforations  

Microsoft Academic Search

Opinion statement  Esophageal perforation is an uncommon, potentially disastrous occurrence with high mortality rates even when managed with\\u000a surgery. Over the past few decades, several case series have shown that nonoperative management is a feasible option in some\\u000a patients, although the criteria for selecting such patients are neither firmly established nor accepted by all those who manage\\u000a these critical patients. The

Ryan D. Madanick



Outcomes in esophageal atresia and tracheoesophageal fistula  

Microsoft Academic Search

Background\\/Purpose: The purpose of this analysis was to investigate outcomes in newborns with esophageal atresia (EA) or tracheoesophageal fistula (TEF) with respect to prognostic classifications and complications.Methods: Charts of all 144 infants with EA\\/TEF treated at British Columbia Children’s Hospital (BCCH) from 1984 to 2000 were reviewed. Patient demographics, frequency of associated anomalies, and details of management and outcomes were

David E Konkin; Wael A O’Hali; Eric M Webber; Geoffrey K Blair



Volumetric modulated arc radiotherapy for esophageal cancer  

Microsoft Academic Search

A treatment planning study was performed to evaluate the performance of volumetric arc modulation with RapidArc (RA) against 3D conformal radiation therapy (3D-CRT) and conventional intensity-modulated radiation therapy (IMRT) techniques for esophageal cancer. Computed tomgraphy scans of 10 patients were included in the study. 3D-CRT, 4-field IMRT, and single-arc and double-arc RA plans were generated with the aim to spare

Nagarajan Vivekanandan; Padmanaban Sriram; S. A. Syam Kumar; Narayanan Bhuvaneswari; Kamalakannan Saranya


PET-CT of Esophageal Cancer  

Microsoft Academic Search

\\u000a There is no established role for the use of 18FDG PET in the screening or initial diagnosis of esophageal carcinoma, although\\u000a T4 tumors may be diagnosed with PET-CT. In the detection of distant metastatic lymph nodes and other organ metastases FDG\\u000a PET is more accurate than EUS and CT combined. FDG PET-CT response has been used to guide subsequent treatment.

Gary J. R. Cook


Spirocercosis-associated esophageal sarcomas in dogs  

Microsoft Academic Search

Seventeen client-owned dogs diagnosed with spirocercosis-associated esophageal sarcomas were retrospectively reviewed. The most common clinical signs noticed were vomiting and\\/or regurgitation (94%), lethargy and depression (59%), pyrexia and anorexia (41% each). Leukocytosis (82%) and microcytic hypochromic anemia (30%) were the most common hematological abnormalities. Caudal thoracic masses were demonstrated on survey radiographs of 13\\/15 of the dogs and thoracic spondylitis

Eyal Ranen; Eran Lavy; Izhac Aizenberg; Shmuel Perl; Shimon Harrus



Pharyngo-Esophageal Dysphagia in Parkinson's Disease  

Microsoft Academic Search

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

Norman A. Leopold; Marion C. Kagel



Vascular endothelial growth factor in esophageal cancer.  


Vascular endothelial growth factor (VEGF) plays a crucial role in angiogenesis of many solid malignancies. The influence of angiogenesis and VEGF expression on progression and recurrence of esophageal cancer has been investigated over the last years. This article reviews the prognostic significance of VEGF expression, microvessel density (MVD), and lymphangiogenic factors in squamous cell carcinoma (SCC), Barrett's dysplasia, and adenocarcinoma (AC) of the esophagus, their predictive value for treatment response to chemo-radiotherapy and new anti-angiogenic treatment strategies. PMID:15282704

Kleespies, Axel; Guba, Markus; Jauch, Karl-Walter; Bruns, Christiane J



Unusual Esophageal Foreign Body: A Table Fork  

PubMed Central

The presence of an esophageal foreign body (EFB) is a medical emergency requiring urgent evaluation and treatment. Swallowing of foreign bodies is most common in children aged between 6 months and 6 years, in whom it usually occurs during games. In adults, foreign bodies tend to be ingested accidentally together with food. The authors report an unusual case of EFB (a table fork) in an adult and briefly report the clinical presentation and the therapeutic procedures adopted in this case and similar cases.

Mevio, Emilio; Mevio, Niccolo



Acute esophageal necrosis: a rare syndrome  

Microsoft Academic Search

Background  Acute esophageal necrosis, which presents as a black esophagus on endoscopy, is a rare disorder that is poorly described in\\u000a the medical literature. In this study, we analyze all cases reported to date to define risk factors, clinical presentation,\\u000a endoscopic features, histologic appearance, treatment, complications, outcome and etiopathogenesis of the disease and to describe\\u000a a distinct medical syndrome and propose

Grigoriy E. Gurvits; Alexander Shapsis; Nancy Lau; Nicholas Gualtieri; James G. Robilotti



Glycemic index, carbohydrate and fiber intakes and risk of reflux esophagitis, Barrett’s esophagus, and esophageal adenocarcinoma  

Microsoft Academic Search

Objective  To examine the association between dietary glycemic index (GI), glycemic load (GL), total carbohydrate, sugars, starch, and\\u000a fiber intakes and the risk of reflux esophagitis, Barrett’s esophagus, and esophageal adenocarcinoma.\\u000a \\u000a \\u000a \\u000a Methods  In an all-Ireland study, dietary information was collected from patients with esophageal adenocarcinoma (n = 224), long-segment Barrett’s esophagus (n = 220), reflux esophagitis (n = 219), and population-based controls (n = 256). Multiple logistic regression analysis examined

Helen G. Mulholland; Marie M. Cantwell; Lesley A. Anderson; Brian T. Johnston; R. G. Peter Watson; Seamus J. Murphy; Heather R. Ferguson; Jim McGuigan; John V. Reynolds; Harry Comber; Liam J. Murray



A new endoscopic technique for suspension of esophageal prosthesis for refractory caustic esophageal strictures.  


There is no clear consensus concerning the best endoscopic treatment of benign refractory esophageal strictures due to caustic ingestion. Different procedures are currently used: frequent multiple dilations, retrievable self-expanding stent, nasogastric intubation and surgery. We describe a new technique to fix a suspended esophageal silicone prosthesis to the neck in benign esophageal strictures; this permits us to avoid the frequent risk of migration of the expandable metallic or plastic stents. Under general anesthesia a rigid esophagoscope was placed in the patient's hypopharynx. Using transillumination from the optical device, the patient's neck was pierced with a needle. A n.0 monofilament surgical wire was pushed into the needle, grasped by a standard foreign body forceps through the esophagoscope and pulled out of the mouth (as in percutaneous endoscopic gastrostomy procedure). After tying the proximal end of the silicone prosthesis with the wire, it was placed through the strictures under endoscopic view. This procedure was successfully utilized in four patients suffering from benign refractory esophageal strictures due to caustic ingestion. The prosthesis and its suspension from the neck were well-tolerated until removal (mean duration 4 months). A postoperative transitory myositis was diagnosed in only one patient. One of the most frequent complications of esophageal prostheses in refractory esophageal strictures due to caustic ingestion is distal migration. Different solutions were proposed. For example the suspension of a wire coming from the nose and then fixed behind the ear. This solution is not considered optimal because of patient complaints and moreover the aesthetic aspect is compromised. The procedure we utilized in four patients utilized the setting of a silicone tube hanging from the neck in a way similar to that of endoscopic pharyngostomy. This solution is a valid alternative both for quality of life and for functional results. PMID:18430109

Ancona, E; Guido, E; Cutrone, C; Bocus, P; Rampado, S; Vecchiato, M; Salvador, R; Donach, M; Battaglia, G



Herpes simplex ulcerative esophagitis in healthy children.  


Herpes simplex virus is a common cause of ulcerative esophagitis in the immunocompromised or debilitated host. Despite a high prevalence of primary and recurrent Herpes simplex virus infection in the general population, Herpes simplex virus esophagitis (HSVE) appears to be rare in the immunocompetent host. We report three cases of endoscopically-diagnosed HSVE in apparently immunocompetent children; the presentation was characterized by acute onset of fever, odynophagia, and dysphagia. In two cases, the diagnosis was confirmed histologically by identification of herpes viral inclusions and culture of the virus in the presence of inflammation. The third case was considered to have probable HSVE based on the presence of typical cold sore on his lip, typical endoscopic finding, histopathological evidence of inflammation in esophageal biopsies and positive serologic evidence of acute Herpes simplex virus infection. Two cases received an intravenous course of acyclovir and one had self-limited recovery. All three cases had normal immunological workup and excellent health on long-term follow-up. PMID:21912064

Al-Hussaini, Abdulrahman A; Fagih, Mosa A


Benign esophageal schwannoma: report of a case.  


We report herein the case of an otherwise asymptomatic 62-year-old woman who was found to have an incidental esophageal lesion during endoscopic follow-up of an unrelated disorder. An esophageal submucosal tumor was diagnosed, and the patient was subsequently monitored on a regular yearly basis. As the diameter of the tumor doubled over a 4-year period, the possibility of a malignant lesion could not be excluded, and she was admitted to our hospital for further investigations. Esophagography, endoscopy, endoscopic ultrasonography, and computed tomography confirmed a submucosal tumor, 35 mm in length, in the thoracic midesophagus. A leiomyoma or leiomyosarcoma was suspected based on the known incidence of such tumors, and tumor enucleation was performed. Gross inspection revealed a solid tumor arising from the wall of the esophagus. Histopathologic examination showed intertwined bundles of spindle cells with spiral-like proliferation, and immunohistochemical studies were positive for S-100 protein, whereby a diagnosis of esophageal schwannoma was established. The patient experienced no postoperative complications, and her clinical course to date has been satisfactory. To date, 2 years 8 months after surgery, she has shown no sign of tumor recurrence and remains in good health. PMID:10883464

Kobayashi, N; Kikuchi, S; Shimao, H; Hiki, Y; Kakita, A; Mitomi, H; Ohbu, M



Esophageal pulse oximetry utilizing reflectance photoplethysmography.  


Peripheral perfusion is often poor and barely pulsatile in patients undergoing prolonged major surgery. Hence, the arterial blood oxygen saturation (SpO2) readings from commercial finger pulse oximeters can become unreliable or cease when they are most needed. To overcome this limitation, the esophagus has been investigated as an alternative measurement site, as perfusion may be preferentially preserved centrally. A reflectance esophageal pulse oximeter probe, and a processing system implemented in LabVIEW were developed. The system was evaluated in clinical measurements on 49 cardiothoracic surgery patients. The SpO2 values from the esophagus were in good agreement with arterial blood oxygen saturation (SaO2) values obtained from blood gas analysis and CO-oximetry. The means (+/-SD) of the differences between the esophageal SpO2 and SaO2 results from blood gas analysis and CO-oximetry were 0.02 +/- 0.88% and -0.73 +/- 0.72%, respectively. In five (10.2%) of the patients, the finger pulse oximeter failed for at least 10 min while the esophageal SpO2 readings remained reliable. The results confirm that the esophagus may be used as an alternative monitoring site for pulse oximetry even in patients with compromised peripheral perfusion. PMID:12450366

Kyriacou, Panayiotis A; Powell, Sarah; Langford, Richard M; Jones, Deric P



A New Ultrasound-Guided Esophageal Variceal PressureMeasuring Device  

Microsoft Academic Search

OBJECTIVE:To develop a noninvasive method and device to determine intravariceal pressure and variceal wall tension by measuring the variables of the Laplace equation and test this device in a model of esophageal varices.METHODS:Two variceal pressure measurement devices were constructed. The first device consists of an Olympus 20 MHz ultrasound transducer placed next to a latex balloon catheter attached to a

Larry S. Miller; Qing Dai; Antonia Thomas; Chan Y. Chung; June Park; Stephanie Irizarry; Tung Nguyen; Vinod Thangada; Elan S. Miller; Joseph K. Kim



Psychiatric illness delays diagnosis of esophageal cancer  

PubMed Central

SUMMARY Evidence suggests that patients with psychiatric illnesses may be more likely to experience a delay in diagnosis of coexisting cancer. The association between psychiatric illness and timely diagnosis and survival in patients with esophageal cancer has not been studied. The specific aim of this retrospective cohort study was to determine the impact of coexisting psychiatric illness on time to diagnosis, disease stage and survival in patients with esophageal cancer. All patients with a diagnosis of esophageal cancer between 1989 and 2003 at the Portland Veteran’s Administration hospital were identified by ICD-9 code. One hundred and sixty patients were identified: 52 patients had one or more DSM-IV diagnoses, and 108 patients had no DSM-IV diagnosis. Electronic charts were reviewed beginning from the first recorded encounter for all patients and clinical and demographic data were collected. The association between psychiatric illness and time to diagnosis of esophageal cancer and survival was studied using Cox proportional hazard models. Groups were similar in age, ethnicity, body mass index, and history of tobacco and alcohol use. Psychiatric illness was associated with delayed diagnosis (median time from alarm symptoms to diagnosis 90 days vs. 35 days in patients with and without psychiatric illness, respectively, P < 0.001) and the presence of advanced disease at the time of diagnosis (37% vs. 18% of patients with and without psychiatric illness, respectively, P = 0.009). In multivariate analysis, psychiatric illness and depression were independent predictors for delayed diagnosis (hazard ratios 0.605 and 0.622, respectively, hazard ratio < 1 indicating longer time to diagnosis). Dementia was an independent risk factor for worse survival (hazard ratio 2.984). Finally, psychiatric illness was associated with a decreased likelihood of receiving surgical therapy. Psychiatric illness is a risk factor for delayed diagnosis, a diagnosis of advanced cancer, and a lower likelihood of receiving surgical therapy in patients with esophageal cancer. Dementia is associated with worse survival in these patients. These findings emphasize the importance of prompt evaluation of foregut symptoms in patients with psychiatric illness.

O'Rourke, R. W.; Diggs, B. S.; Spight, D. H.; Robinson, J.; Elder, K. A.; Andrus, J.; Thomas, C. R.; Hunter, J. G.; Jobe, B. A.



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




PubMed Central

Purpose To report the esophageal toxicity from single-fraction paraspinal stereotactic radiosurgery (SRS) and identify dosimetric and clinical risk factors for toxicity. Methods and Materials 204 spinal metastases abutting the esophagus (182 patients) were treated with high-dose single-fraction SRS during 2003-2010. Toxicity was scored using NCI CTCAE 4.0. Dose-volume histograms (DVHs) were combined to generate a comprehensive atlas of complication incidence that identifies risk factors for toxicity. Correlation of dose-volume factors with esophageal toxicity were assessed using Fishers exact test and logistic regression. Clinical factors were correlated with toxicity. Results The median dose to the planning treatment volume was 24 Gy. Median follow-up was 12 months (range 3-81). There were 31 (15%) acute and 24 (12%) late esophageal toxicities. The rate of grade ?3 acute or late toxicity was 6.8% (14 patients). Fisher’s exact test resulted in significant median splits for grade ?3 toxicity at V12 = 3.78 cm3 (relative risk [RR] 3.7, p = 0.05), V15 = 1.87 cm3 (RR 13, p = 0.0013), V20 = 0.11 cm3 (RR = 6, p = 0.01), and V22 = 0.0 cm3 (RR 13, p = 0.0013). The median split for D2.5 cm3 (14.02 Gy) was also a significant predictor of toxicity (RR6; p=0.01). A highly significant logistic regression model was generated based on D2.5 cm3. 100% (n = 7) of grade ?4 toxicities were associated with radiation recall reactions after adriamycin or gemcitabine chemotherapy or iatrogenic manipulation of the irradiated esophagus. Conclusions High dose, single fraction paraspinal SRS has a low rate of grade ? 3 esophageal toxicity. Severe esophageal toxicity is minimized with careful attention to esophageal doses during treatment planning. Iatrogenic manipulation of the irradiated esophagus and systemic agents classically associated with radiation recall reactions are associated with development of grade ?4 toxicity.

Cox, Brett W.; Jackson, Andrew; Hunt, Margie; Bilsky, Mark; Yamada, Yoshiya



A new device for measuring esophageal variceal pressure  

Microsoft Academic Search

Background: Esophageal varices are a frequent source of bleeding in patients with cirrhosis. Elevated intravariceal pressure is associated with variceal bleeding. There is no simple, easy-to-use device for noninvasive measurement of intravariceal pressure. The purposes of this study were to develop a noninvasive method for measuring intravariceal pressure, and to develop a model of esophageal varices that can be used

Elan S. Miller; Joseph K. Kim; Jasneet Gandehok; Mak Hara; Qing Dai; Aslam Malik; Aaron Miller; Larry Miller



Eosinophilic Esophagitis: Red on Microscopy, White on Endoscopy  

Microsoft Academic Search

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

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



Long-term survival after photodynamic therapy for esophageal cancer  

Microsoft Academic Search

Background\\/Aims: Photodynamic therapy (PDT) has been adapted to the endoscopic treatment of digestive cancer, but its indications and efficacy remain uncertain. The aim of this study was to assess its feasibility in the curative treatment of small esophageal tumors. Methods: From 1983 to 1991, PDT was used to treat 123 patients with esophageal cancer who were recommended for nonsurgical treatment

Alain Sibille; René Lambert; Jean-Christophe Souquet; Ghislaine Sabben; Françoise Descos



Esophageal Bacteria and Barrett's Esophagus: A Preliminary Report  

Microsoft Academic Search

The objective of this study was to investigate if esophageal bacteria are associated with Barrett's esophagus (BE). This study was comprised of a retrospective (Part 1) and a subsequent prospective (Part 2) study. In Part 1, Gram stains were performed on esophageal biopsy specimens obtained in 47 patients. Bacteria were quantitated from 0 to 4. In Part II, Gram stains

Glenn L. Osias; Matthew Q. Bromer; Rebecca M. Thomas; David Friedel; Larry S. Miller; Byungse Suh; Bennett Lorber; Henry P. Parkman; Robert S. Fisher



Vitamin supplement use and risk for oral and esophageal cancer  

Microsoft Academic Search

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

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



Early dilation in the treatment of esophageal disruption.  


During the past four years, 11 patients with disruption of esophageal continuity have received dilation therapy prior to the healing of the fistula. In 7 patients undergoing transhiatal esophagectomy with a cervical esophagogastric anastomosis, anastomotic leaks within 2 to 13 days (average, 8 days) after operation were treated by drainage, bedside esophageal dilations to at least a 46F bougie, and supplemental jejunostomy tube feedings. Bougienage was performed within 1 to 12 days (average, 6 days) of the diagnosis of a leak, and oral intake was not discontinued for more than 72 hours average. Fistula drainage stopped within 1 to 12 days (average, 6 days) of dilation in all patients. Four patients referred with chronic intrathoracic esophageal disruptions (2, middle third and 2, distal third) following resection of diverticula (2), esophageal dilation (1), and trauma from Harrington rods (1) were also treated successfully by drainage, esophageal dilation, or both. Periesophageal inflammation associated with an esophageal leak, esophageal spasm due to local irritation, or relative anastomotic narrowing may all contribute to obstruction distal to an esophageal disruption and adversely affect spontaneous closure. Dilation of the leaking esophagus is not dangerous if performed carefully and selectively, and in fact may promote healing of the injury. PMID:3778004

Orringer, M B; Lemmer, J H



Genetics Home Reference: Esophageal atresia/tracheoesophageal fistula  


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


Esophageal Atresia and Tracheoesophageal Fistula: Surgical Experience Over Two Decades  

Microsoft Academic Search

Background. Despite improvements in survival, for infants born with esophageal atresia tracheoesophageal fistula, or both, the morbidity associated with repair of these anomalies remains high.Methods. This report retrospectively analyzes 81 patients with esophageal atresia, tracheoesophageal fistula, or both presenting to our institution between 1975 and 1995, with a focus on anastomotic complications.Results. There were 46 male and 35 female patients

Josephine Y Tsai; Leah Berkery; David E Wesson; S. Frank Redo; Nitsana A Spigland



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



MicroRNA and its roles in esophageal cancer  

PubMed Central

Summary Esophageal cancer is the eighth most common cancer and causes the sixth highest cancer-related mortality worldwide. The 5-year survival of patients suffering from esophageal cancer in either advanced stage or metastasis is less than 20%. MicroRNAs are small, well conserved, non-coding RNA molecules that either repress translation or promote mRNA degradation based on the degree of complementary between miRNAs and mRNAs. Based on biogenesis and function of microRNAs, specific microRNA profiles, either from cancerous tissues or serum, were able to serve as diagnostic and prognostic biomarkers of esophageal cancer and predicted the effectiveness of surgery and chemoradiotherapy. MicroRNAs could also influence the biological behaviors of esophageal cancer cells, such as cellular proliferation, apoptosis, invasion and metastasis. MicroRNAs were also associated with multi-drug resistance of esophageal cancer. Further studies on the roles of microRNAs in esophageal cancer would provide a strategy to prevent and treat esophageal cancer, and reverse multi-drug resistance of esophageal cancer.

Fang, Yu; Fang, Dianchun; Hu, Jianguo



Lipoblastoma with unique localization requiring tracheal and esophageal resection.  


Lipoblastoma and lipoblastomatosis are rare tumors of infancy. They originate from embryonic fat and localize in soft tissues. We present the case of a lipoblastoma of the neck with localization in tracheal and esophageal walls that required an extended laryngotracheal and esophageal resection. To our knowledge, this is the first report of such localization of this tumor. PMID:20920704

Torre, Michele; Borel, Cecilia; Saitua, Francisco; Ossandon, Francisco; Latorre, Juan Jose; Varela, Patricio



Celecoxib (Celebrex) Increases Canine Lower Esophageal Sphincter Pressure  

Microsoft Academic Search

Background. Prostaglandins inhibit the contraction of gastrointestinal smooth muscle and may decrease lower esophageal sphincter tone. The purpose of this study was to determine whether the cyclooxygenase-2 inhibitor celecoxib (Celebrex) could increase lower esophageal pressure (without affecting gastric emptying) compared to placebo and cisapride (Prepulsid), a compound previously used to treat reflux disease.Materials and methods. Six mongrel dogs were assigned

Sebastian G. de la Fuente; Ross L. McMahon; Erik M. Clary; Mary B. Harris; D. Curtis Lawson; James D. Reynolds; W. Steve Eubanks; Theodore N. Pappas



Esophageal laceration and obstruction caused by a foreign body in 2 young foals  

PubMed Central

This report describes 2 foals with esophageal laceration due to ingestion of foreign bodies. Endoscopic examination of the esophagus revealed full thickness esophageal laceration in 1 colt and partial thickness laceration of the esophagus in the other. The esophageal obstruction was relieved by repetitive esophageal lavages and flush under general anesthesia in both foals.

Abutarbush, Sameeh M.



Effects of cisapride on parameters of oesophageal motility and on the prolonged intraoesophageal pH test in infants with gastro-oesophageal reflux disease.  

PubMed Central

The effect of cisapride, a new gastrointestinal prokinetic drug, on oesophageal motility and acid reflux was studied in 14 children with gastro-oesophageal reflux disease, receiving either placebo or cisapride 0.15 mg/kg intravenously. Cisapride significantly (p less than 0.01) increased the lower oesophageal sphincter pressure (+124%), the amplitude (+84%) and duration (+24%) of oesophageal peristaltic waves, whereas the placebo treatment did not produce any changes. Subsequently, all 14 children underwent 24 hour oesophageal pH-monitoring before and after four weeks of treatment with oral cisapride 0.2 mg/kg tid given in addition to postural therapy and thickened feedings. The 24 hour intraoesophageal pH recordings and symptomatic scores were compared with those of 10 control patients treated only by postural therapy and thickened feedings. When compared with baseline pH data, cisapride significantly reduced the oesophageal acid exposure time, the mean duration of each reflux episode, the duration of the longest reflux episode and the number of long lasting reflux episodes; the number of reflux episodes was not influenced. The effect of cisapride was marked and consistent during fasting and sleep periods. Oesophageal acid exposure was reduced more significantly in patients given cisapride (-61%) than in controls (-24%; p less than 0.001). Symptom improvement was greater after four weeks of cisapride treatment (score reduction: 61%) than after postural and dietary therapy alone (score reduction: 42%; p less than 0.01). No adverse effects occurred. These findings suggest that cisapride is a valuable drug in the management of gastro-oesophageal reflux disease in children.

Cucchiara, S; Staiano, A; Boccieri, A; De Stefano, M; Capozzi, C; Manzi, G; Camerlingo, F; Paone, F M



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

Microsoft Academic Search

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

Beverly Barrett Dahms



Coronary spasm reflects inputs from adjacent esophageal system.  


Mechanisms underlying coronary spasm are still poorly understood. The aim of the study was to assess the hypothesis that fluctuations in the development of coronary spasm might reflect inputs from the adjacent esophageal system. We enrolled patients admitted to the coronary care unit for episodes of nocturnal angina. Seven patients with variant angina and five with coronary artery disease (CAD) had concurrent ECG and esophageal manometric monitoring. ECG monitoring documented 28 episodes of ST elevation in variant angina patients and 16 episodes of ST depression in CAD patients. Manometric analysis showed that esophageal spasms resulted remarkably more frequently in variant angina patients (143 total spasms; individual range 9-31) than in CAD patients (20 total spasms; individual range 0-9; P < 0.01). Time series analysis was used to assess fluctuations in the occurrence of abnormal esophageal waves and its relationship with spontaneous episodes of ST shift. Episodes of esophageal spasm in CAD were sporadic (<1 in 30 min) and not related to ECG-recorded ischemia. In the variant angina group, esophageal spasms were time related to ischemia (>1 into 5 min before ECG-recorded ischemia) (P < 0.05). A bidirectional analysis of causal effects showed that the influence processes between esophageal and coronary spasms were mutual and reciprocal (transfer function model, P < 0.05) in variant angina. We concluded that in variant angina patients, episodes of esophageal spasms and myocardial ischemia influenced each other. Mechanisms that cause esophageal spasm can feed back to produce coronary spasm. Coronary spasm may feed forward to produce additional episodes of esophageal spasm. PMID:16387792

Manfrini, Olivia; Bazzocchi, Gabriele; Luati, Alessandra; Borghi, Alberigo; Monari, Paola; Bugiardini, Raffaele



[Eosinophilic esophagitis due to allergy to sheep and goat milk proteins].  


Eosinophilic esophagitis is an inflammatory disease of the esophagus characterized by the presence of high numbers of eosinophils in the esophageal mucosal layer (> 20 high-power field). It is uncommon in adults but in such cases intermittent dysphagia and food impaction are the most common presenting symptoms. We report the case of a male with long-standing intermittent dysphagia after eating selected goat and sheep cheese types, who required medical help following the impaction of an ibuprofen pill in the esophagus. A biopsy demonstrated the presence of eosinophilic inflammation, and allergy testing showed specific IgE against proteins in the milk of goats and sheep. Topical steroid therapy with oral fluticasone, and the elimination of these dairy products from the diet induced complete symptom resolution, and biopsy specimens taken 4 months later showed no eosinophils. PMID:18358063

Armisén, M; Vidal, C; López-Rosés, L; Rodríguez, V; Bartolomé, B



IGF-1 and Its Receptor in Esophageal Cancer: Association with Adenocarcinoma and Visceral Obesity  

Microsoft Academic Search

OBJECTIVES:The insulin-like growth factor (IGF) pathway and visceral obesity have been independently linked with esophageal cancer. This study aimed to delineate the differential and interlinked role of visceral obesity and the IGF-1 system in esophageal adenocarcinoma and esophageal squamous-cell carcinoma (SCC).METHODS:IGF-1 receptor (IGF-1R) mRNA and protein were examined in esophageal SCC (KYSE 410, OE21) and esophageal adenocarcinoma (OE19, OE33) cell

Suzanne L Doyle; Claire L Donohoe; Stephen P Finn; Julia M Howard; Fiona E Lithander; John V Reynolds; Graham P Pidgeon; Joanne Lysaght



Evolution in surgical management of esophageal cancer.  


Esophageal resection remains the primary treatment for local regional esophageal cancer, although its role in superficial (T1A) cancers and squamous cell cancer is in evolution. Mortality associated with esophagectomy has historically been high but is improving with the current expectation of in-hospital mortality rates of 2-4% in high-volume centers. Most patients with regional cancers (T2-4 N0-3) are recommended for neoadjuvant therapy, which most commonly involves radiochemotherapy. Some centers have proposed treating with definitive chemoradiation and reserving surgery for patients who have persistent or recurrent disease. 'Salvage resections' are possible but are associated with higher levels of perioperative morbidity and mortality, and treatment decisions should routinely be based on multidisciplinary discussion in the tumor board. Although open surgical resection (both transthoracic and transhiatal operations) remain the most common approach, minimally invasive or hybrid operations are being done in up to 30% of procedures internationally. There are some indications that minimally invasive esophagectomy may decrease the incidence of respiratory complications and decrease length of stay. At this point, oncologic outcomes appear equivalent between open and minimally invasive procedures. Recent reviews from high-volume esophagectomy centers demonstrate that elderly patients can selectively undergo esophagectomy with the expectation of increased complications but similar mortality and survival to younger patients. Multiple studies confirm that quality of life following esophagectomy can be equivalent to the general population when surgery is done in experienced centers. Patients requiring surgical treatment of esophageal cancer should be referred to high-volume centers, especially those with established care pathways or enhanced recovery programs to improve outcomes including morbidity, mortality, survival, and quality of life. PMID:23797119

Low, Donald E



Black esophagus: Acute esophageal necrosis syndrome  

PubMed Central

Acute esophageal necrosis (AEN), commonly referred to as “black esophagus”, is a rare clinical entity arising from a combination of ischemic insult seen in hemodynamic compromise and low-flow states, corrosive injury from gastric contents in the setting of esophago-gastroparesis and gastric outlet obstruction, and decreased function of mucosal barrier systems and reparative mechanisms present in malnourished and debilitated physical states. AEN may arise in the setting of multiorgan dysfunction, hypoperfusion, vasculopathy, sepsis, diabetic ketoacidosis, alcohol intoxication, gastric volvulus, traumatic transection of the thoracic aorta, thromboembolic phenomena, and malignancy. Clinical presentation is remarkable for upper gastrointestinal bleeding. Notable symptoms may include epigastric/abdominal pain, vomiting, dysphagia, fever, nausea, and syncope. Associated laboratory findings may reflect anemia and leukocytosis. The hallmark of this syndrome is the development of diffuse circumferential black mucosal discoloration in the distal esophagus that may extend proximally to involve variable length of the organ. Classic “black esophagus” abruptly stops at the gastroesophageal junction. Biopsy is recommended but not required for the diagnosis. Histologically, necrotic debris, absence of viable squamous epithelium, and necrosis of esophageal mucosa, with possible involvement of submucosa and muscularis propria, are present. Classification of the disease spectrum is best described by a staging system. Treatment is directed at correcting coexisting clinical conditions, restoring hemodynamic stability, nil-per-os restriction, supportive red blood cell transfusion, and intravenous acid suppression with proton pump inhibitors. Complications include perforation with mediastinal infection/abscess, esophageal stricture and stenosis, superinfection, and death. A high mortality of 32% seen in the setting of AEN syndrome is usually related to the underlying medical co-morbidities and diseases.

Gurvits, Grigoriy E



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



Primary esophageal meningioma: first literature report.  


We have described a primary esophageal meningioma (MG) clinical case diagnosed in a 62-year-old woman; also, we review the literature about extracranial MGs. To our knowledge, this is the first case report of an extracranial MG occurring primarily in the esophagus. These are benign neoplasms reported classically in the central nervous system (CNS). The extrancranial MGs have histopathologic and inmunohistochemical features identical to those observed in CNS MGs; thus, the main diagnostic hurdle is to keep it in the differential for lesions occurring outside the CNS. PMID:22647829

Romero-Rojas, Alfredo E; Diaz-Perez, Julio A; Amaro, Deirdre; Messa-Botero, Oscar A; Castilla, Elias A



Medical management of patients with reflux esophagitis.  


Medical management of reflux esophagitis includes physical manipulations, antacids, and antireflux medications (bethanechol and alginic acid). Their combined usage in the continuous dyspeptic and the problem case help "break the cycle," providing relief for long periods of time. Identification of possible inciting factors in cases of recurrence should be pointed out to the patient so that he will develop an instinctive antireflux behavior. The effect of this combined therapy on the pathophysiology and natural history of the disease remains to be determined. PMID:628873

Roufail, W M



Unusual esophageal foreign body: a table fork.  


The presence of an esophageal foreign body (EFB) is a medical emergency requiring urgent evaluation and treatment. Swallowing of foreign bodies is most common in children aged between 6 months and 6 years, in whom it usually occurs during games. In adults, foreign bodies tend to be ingested accidentally together with food. The authors report an unusual case of EFB (a table fork) in an adult and briefly report the clinical presentation and the therapeutic procedures adopted in this case and similar cases. PMID:23634316

Mevio, Emilio; Mevio, Niccolò



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)



Four-dimensional computed tomographic analysis of esophageal mobility during normal respiration  

SciTech Connect

Background: Chemo-radiotherapy for thoracic tumors can result in high-grade radiation esophagitis. Treatment planning to reduce esophageal irradiation requires organ motion to be accounted for. In this study, esophageal mobility was assessed using four-dimensional computed tomography (4DCT). Methods and Materials: Thoracic 4DCT scans were acquired on a 16-slice CT scanner in 29 patients. The outer esophageal wall was contoured in two extreme phases of respiration in 9 patients with nonesophageal malignancies. The displacement of the center of contour was measured at 2-cm intervals. In 20 additional patients with Stage I lung cancer, the esophagus was contoured in all 10 phases of each 4DCT at five defined anatomic levels. Both approaches were then applied to 4DCT scans of 4 patients who each had two repeat scans performed. A linear mixed effects model was constructed with fixed effects: measurement direction, measurement type, and measurement location along the cranio-caudal axis. Results: Measurement location and direction were significant descriptive parameters (Wald F-tests, p < 0.001), and the interaction term between the two was significant (p = 0.02). Medio-lateral mobility exceeded dorso-ventral mobility in the lower half of the esophagus but was of a similar magnitude in the upper half. Margins that would have incorporated all movement in medio-lateral and dorso-ventral directions were 5 mm proximally, 7 mm and 6 mm respectively in the mid-esophagus, and 9 mm and 8 mm respectively in the distal esophagus. Conclusions: The distal esophagus shows more mobility. Margins for mobility that can encompass all movement were derived for use in treatment planning, particularly for stereotactic radiotherapy.

Dieleman, Edith [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands); Senan, Suresh [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands)]. E-mail:; Vincent, Andrew [Department of Bioinformatics, Antoni van Leeuwenhoek Hospital, Amsterdam (Netherlands); Lagerwaard, Frank J. [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands); Slotman, Ben J. [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands); Soernsen de Koste, John R. van [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands)



Development of the Pediatric Quality of Life Inventory(TM) Eosinophilic Esophagitis Module items: qualitative methods  

PubMed Central

Background Currently there is no disease-specific outcome measure to assess the health-related quality of life (HRQOL) of pediatric patients with Eosinophilic Esophagitis (EoE). Therefore, the objective of this qualitative study was to further develop and finalize the items and support the content validity for the new Pediatric Quality of Life Inventory™ (PedsQL™) Eosinophilic Esophagitis Module. Methods Multiphase qualitative methodology was utilized in the development of the PedsQL™ EoE Module conceptual model. Focus interview transcripts of pediatric patients with EoE and their parents and expert review were previously used to develop the initial items and domains for the PedsQL™ EoE Module. In the current investigation, utilizing the respondent debriefing methodology, cognitive interviewing was conducted individually with pediatric patients with EoE and their parents on each newly developed item. Results Information from a total of 86 participants was obtained in combination from the previous investigation and the current study. From the previous 42 focus interviews, items were developed around the domain themes of symptoms, difficulties with eating food, treatment adherence, worry about symptoms and illness, feelings of being different than family and peers, and problems discussing EoE with others. In the current study’s cognitive interviewing phase, a separate cohort of 44 participants systematically reviewed and provided feedback on each item. Items were added, modified or deleted based on this feedback. Items were finalized after this feedback from patients and parents. Conclusions Using well-established qualitative methods, the content validity of the new PedsQL™ Eosinophilic Esophagitis Module items was supported in the current investigation. In the next iterative instrument development phase, the PedsQL™ Eosinophilic Esophagitis Module is now undergoing multisite national field testing.



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



Diffuse esophageal spasm in children referred for manometry.  


Diffuse esophageal spasm (DES) causes chest pain and/or dysphagia in adults. We reviewed charts of 278 subjects 0 to 18 years of age after esophageal manometry to describe the frequency and characteristics of DES in children. Patient diagnoses included normal motility (61%), nonspecific esophageal motility disorder (20%), DES (13%, n=36), and achalasia (4%). Of patients with DES, the most common chief complaint was food refusal in subjects younger than 5 years (14/24, 58%) and chest pain in subjects older than 5 years (4/12, 33%). Comorbid medical conditions, often multiple, existed in 33 subjects. DES should be considered when young children present with food refusal. PMID:23114472

Rosen, John M; Lavenbarg, Teri; Cocjin, Jose; Hyman, Paul E



[Reflux, smoking, alcohol. Approach to prevention of esophageal carcinoma].  


In western industrialized countries, esophageal cancer is a rare entity. While smoking and alcohol are the major risk factors for squamous cell carcinoma, the most important etiological factor for adenocarcinoma is Barrett's esophagus caused by gastro-esophageal reflux. Over the past few decades there has been a dramatic increase in the incidence of adenocarcinoma. The prognosis for both types of esophageal cancer is poor, with a 5-year survival rate of < 10%. Only early stages have a good prognosis. While prevention of squamous cell carcinoma is limited to avoiding drinking and smoking, prevention of adenocarcinoma requires endoscopic surveillance of Barrett's esophagus and the treatment of any dysplasia arising in it. PMID:12198874

Rotthauwe, J; Lingenfelser, Th; Malfertheiner, P



Update on Staging and Surgical Treatment Options for Esophageal Cancer  

Microsoft Academic Search

Introduction  Esophageal cancer remains a challenging clinical problem, with overall long-term survivorship consistently at a level of approximately\\u000a 30%. The incidence of esophageal cancer is increasing worldwide, with the most dramatic increase being seen with respect to\\u000a esophageal adenocarcinoma.\\u000a \\u000a \\u000a \\u000a \\u000a Discussion  Pretreatment staging accuracy has improved with the utilization of CT and PET scans, as well as endoscopic ultrasound and\\u000a endoscopic mucosal resection.

Donald E. Low



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



[Empyema from spontaneous esophageal rupture treated by thoracoscopic surgery].  


A 61-year-old man who had been admitted for vomiting and abdominal pain 5 days before at another hospital was transferred to our hospital. He was diagnosed as pyo-pneumothorax, and chest drainage was initiated. Seven days after admission, food residue was observed in the drainage tube. A subsequent gastrointestinal fiberscopic examination could not identify the esophageal injury, but the acute empyema caused by spontaneous esophageal rupture was suggested by clinical signs. Thoracoscopic surgery for curettage and irrigation of the pleural cavity was performed. Esophageal rupture could not be confirmed at surgery. Spontaneous closure of the fistula was observed 2 weeks post-surgery. PMID:24105119

Tomiyama, Ken-Ichi; Yamamoto, Takahisa



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



Removable Self-Expanding Plastic Esophageal Stent as a Continuous, Non-Permanent Dilator in Treating Refractory Benign Esophageal Strictures: A Prospective Two-Center Study  

Microsoft Academic Search

BACKGROUND:Refractory benign esophageal strictures (RBES) are difficult to treat requiring frequent dilatations or surgery. Conceptually, while maintaining luminal patency, if a dilator is kept in place continuously for several weeks, the benefits may be longer lasting. An expandable esophageal stent will be ideal in achieving the above. Preliminary results on using a removable self-expanding plastic esophageal stent, Polyflex stent (PS),

Kulwinder S. Dua; Frank P. Vleggaar; Rajesh Santharam; Peter D. Siersema



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


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. PMID:22860235

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



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.



Clinical and dosimetric factors of radiation-induced esophageal injury: Radiation-induced esophageal toxicity  

Microsoft Academic Search

Abstract Abstract Abstract Abstract AIM: To analyze the clinical and dosimetric predictive factors for radiation-induced esophageal injury in patients with non-small-cell lung cancer (NSCLC) during three- dimensional conformal radiotherapy (3D-CRT). METHODS: We retrospectively analyzed 208 consecutive patients (146 men and 62 women) with NSCLC treated with 3D-CRT. The median age of the patients was 64 years (range 35-87 years). The

Wen-Bo Qiao; Yan-Hui Zhao; Yan-Bin Zhao; Rui-Zhi Wang


Interlaboratory study of the reproducibility of the single-pass flow-through test method : measuring the dissolution rate of LRM glass at 70 {sup {degree}}C and pH 10.  

SciTech Connect

An international interlaboratory study (ILS) was conducted to evaluate the precision with which single-pass flow-through (SPFT) tests can be conducted by following a method to be standardized by the American Society for Testing and Materials - International. Tests for the ILS were conducted with the low-activity reference material (LRM) glass developed previously for use as a glass test standard. Tests were conducted at 70 {+-} 2 C using a LiCl/LiOH solution as the leachant to impose an initial pH of about 10 (at 70 C). Participants were provided with LRM glass that had been crushed and sieved to isolate the -100 +200 mesh size fraction, and then washed to remove fines. Participants were asked to conduct a series of tests using different solution flow rate-to-sample mass ratios to generate a range of steady-state Si concentrations. The glass dissolution rate under each test condition was calculated using the steady-state Si concentration and solution flow rate that were measured in the test. The glass surface area was estimated from the mass of glass used in the test and the Si content of LRM glass was known. A linear relationship between the rate and the steady-state Si concentration (at Si concentrations less than 10 mg/L) was used to estimate the forward dissolution rate, which is the rate in the absence of dissolved Si. Participants were asked to sample the effluent solution at least five times after reaction times of between 3 and 14 days to measure the Si concentration and flow rate, and to verify that steady-state was achieved. Results were provided by seven participants and the data sets provided by five participants were sufficient to determine the forward rates independently.

Ebert, W. L.; Chemical Engineering



Estrogen, male dominance and esophageal adenocarcinoma: Is there a link?  

PubMed Central

Esophageal adenocarcinoma is a cancer with poor prognosis, and its incidence has risen sharply over recent decades. Obesity is a major risk factor for developing this cancer and there is a clear male gender bias in the incidence that cannot be fully explained by known risk factors. It is possible that a difference in the expression of estrogen, or its signaling axes, may contribute to this gender bias. We undertook a comprehensive literature search and analyzed the available data regarding estrogen and estrogen receptor expression, and the possible sex-specific links with esophageal adenocarcinoma development. Potentially relevant associations between visceral vs subcutaneous fat deposition and estrogen expression, and the effect of crosstalk between estrogen and leptin signaling were identified. We also found limited studies suggesting a role for estrogen receptor ? expression in esophageal adenocarcinoma development. The current literature supports speculation on an etiological role for estrogen in the male gender bias in esophageal adenocarcinoma, but further studies are required.

Yang, Huiqi; Sukocheva, Olga A; Hussey, Damian J; Watson, David I



Atypical presentation of an impacted radiolucent esophageal foreign body.  


Patients with impacted esophageal foreign bodies usually present with gastrointestinal and rarely with respiratory symptoms. Impacted esophageal foreign bodies may be identified by radiologic studies. Ingested radiolucent foreign bodies may be more difficult to diagnose, especially if the patient presents with minimal symptoms. We report a rare case of a child who presented with stridor and obstructive sleep apnea. The cause of respiratory symptoms was thought to be due to enlarged tonsils and adenoids, and the patient was scheduled for tonsillectomy and adenoidectomy. On re-evaluation by the surgeon on the day of surgery, the procedure was changed to diagnostic microlaryngoscopy and bronchoscopy to rule out any other cause. The patient's respiratory symptoms were resolved when an incidental discovery and retrieval of the radiolucent esophageal foreign body was made. The diagnosis of radiolucent esophageal foreign body can be difficult and can be easily missed without reasonable clinical suspicion. PMID:20607312

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



21 CFR 868.1920 - Esophageal stethoscope with electrical conductors.  

Code of Federal Regulations, 2010 CFR

...Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Diagnostic Devices § 868.1920 Esophageal stethoscope with electrical conductors. (a)...



The intelligibility of time-domain-edited esophageal speech.  


The intelligibility of esophageal speech has been shown to be significantly lower than that of normal laryngeal speech. The current study investigated the possibility of enhancing the intelligibility of esophageal speech by manipulating samples in the time domain. Specifically, injection noises and nonphrasal pauses were digitally edited from the speech samples of 5 esophageal talkers. Twenty-five sentences were selected and edited in the time domain and presented to 15 naive listeners who were instructed to write down the words that they heard. The percentage of correct words heard for each sentence was determined and compared across listeners, sentences, and talkers. The overall effect of the editing was a small but significant gain in the intelligibility of the esophageal speech. The improvement in intelligibility, however, depended on the individual talker, the speech material, and the number of editing changes made to a particular sample. PMID:11407558

Prosek, R A; Vreeland, L L



2013 Update on Celiac Disease and Eosinophilic Esophagitis  

PubMed Central

Celiac disease is a chronic, immune-mediated disorder, characterized by small intestinal inflammation and villous atrophy after the ingestion of gluten by genetically susceptible individuals. Several extraintestinal manifestations have been associated to celiac disease. Eosinophilic esophagitis is a primary disorder of the esophagus characterized by upper gastrointestinal symptoms, absence of gastroesophageal reflux disease and more than 15 eosinophils per high-power field in biopsy specimens. Both celiac disease and eosinophilic esophagitis are caused by aberrant, but distinct, immune responses to ingested antigens and can be responsive to restricted food intake. The aim of this review is to assess whether there is an association between these two pathologies. In the majority of the studies examined, including the studies in pediatric population, the prevalence of eosinophilic esophagitis in subjects with celiac disease was about 10-times that of the general population. We suggest searching for eosinophilic esophagitis in all children undergoing endoscopy for suspicious celiac disease.

Pellicano, Rinaldo; De Angelis, Claudio; Ribaldone, Davide Giuseppe; Fagoonee, Sharmila; Astegiano, Marco



Esophageal cancer presenting as a brain metastasis: A case report  

PubMed Central

Carcinoma of unknown primary origin (CUP) is defined as the histological diagnosis of metastasis without the detection of a primary tumor. The incidence of CUP in all patients with a malignant disease has been reported to be between 3 and 15%. Esophageal cancer is the third most common type of cancer of the digestive tract and the seventh most common cause of cancer-related mortality worldwide. The overall incidence of the disease is highest in males >50 years old. Brain metastases have been reported in only 1.7–3.6% of all patients with different types of esophageal cancer. Brain metastasis as the presenting form of esophageal carcinoma is highly uncommon. The present study reports the case of a patient with an unknown primary tumor who presented with a cerebral metastasis, without extra-neurological symptoms. The CUP was subsequently diagnosed as an esophageal carcinoma.




Metastases of esophageal carcinoma to skeletal muscle: single center experience.  


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. PMID:23002370

Cincibuch, Jan; Myslive?ek, Miroslav; Melichar, Bohuslav; Neoral, Cestmír; Metelková, Iva; Zezulová, Michaela; Procházková-Študentová, Hana; Flodr, Patrik; Zlevorová, Miloslava; Aujeský, René; Cwiertka, Karel



Cetuximab and Chemoradiotherapy for Locally Advanced Esophageal Cancer

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.


2013 update on celiac disease and eosinophilic esophagitis.  


Celiac disease is a chronic, immune-mediated disorder, characterized by small intestinal inflammation and villous atrophy after the ingestion of gluten by genetically susceptible individuals. Several extraintestinal manifestations have been associated to celiac disease. Eosinophilic esophagitis is a primary disorder of the esophagus characterized by upper gastrointestinal symptoms, absence of gastroesophageal reflux disease and more than 15 eosinophils per high-power field in biopsy specimens. Both celiac disease and eosinophilic esophagitis are caused by aberrant, but distinct, immune responses to ingested antigens and can be responsive to restricted food intake. The aim of this review is to assess whether there is an association between these two pathologies. In the majority of the studies examined, including the studies in pediatric population, the prevalence of eosinophilic esophagitis in subjects with celiac disease was about 10-times that of the general population. We suggest searching for eosinophilic esophagitis in all children undergoing endoscopy for suspicious celiac disease. PMID:23974065

Pellicano, Rinaldo; De Angelis, Claudio; Ribaldone, Davide Giuseppe; Fagoonee, Sharmila; Astegiano, Marco



Patients With Esophageal Cancer May Be Able to Avoid Surgery

Patients with esophageal cancer lived just as long after receiving chemoradiation therapy alone as did those whose chemoradiation therapy was followed by surgery, according to the April 1, 2007, Journal of Clinical Oncology.


Urine pH  


... Drugs that can decrease urine pH include ammonium chloride, thiazide diuretics, and methenamine mandelate. Eat a normal, ... is associated with xanthine, cystine, uric acid , and calcium oxalate stones. Alkaline urine is associated with calcium ...


Atypical presentation of an impacted radiolucent esophageal foreign body  

Microsoft Academic Search

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

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



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.



A case of eosinophilic esophagitis with atypical clinical course  

Microsoft Academic Search

Eosinophilic esophagitis is a rare chronic disease that mainly occurs in middle-aged males. Treatment with a glucocorticoid\\u000a and\\/or proton pump inhibitor is usually necessary to relieve unpleasant symptoms. An 83-year-old female patient with dysphagia\\u000a and heartburn was diagnosed with eosinophilic esophagitis based on endoscopic findings, while histological examination identified\\u000a dense infiltration of intraepithelial eosinophils. The symptoms and eosinophil infiltration spontaneously

Yuji Tamagawa; Tatsuya Miyake; Tsuyoshi Mishiro; Shunji Ohara; Kenji Furuta; Hideaki Kazumori; Shunji Ishihara; Yuji Amano; Yoshikazu Kinoshita


Circulating microRNAs: Novel biomarkers for esophageal cancer  

Microsoft Academic Search

Esophageal carcinogenesis is a multi-stage process, involving a variety of changes in gene expression and physiological structure change. MicroRNAs (miRNAs) are a class of small non-coding endogenous RNA molecules. Recent innovation in miRNAs profiling technology have shed new light on the pathology of esophageal carci- noma (EC), and also heralded great potential for explor- ing novel biomarkers for both EC

Sheng-Li Zhou; Li-Dong Wang; Mitsuyoshi Urashima



Esophageal replacement using the colon: Is it a good choice?  

Microsoft Academic Search

Thirty-eight children (2 months to 26 years of age) underwent esophageal replacement at our institution between 1962 and 1993. Twenty-four patients had esophageal atresia, with the replacement performed at a mean age of 17 months. The remaining patients (37%) had strictures and were older (mean, 7.4 years). Replacement procedures involved the right colon in 61% of cases and the transverse

Syed A. Ahmad; Karl G. Sylvester; Andre Hebra; Andrew M. Davidoff; Steve McClane; Perry W. Stafford; Louise Schnaufer; James O'Neill



Study on vasculogenic mimicry in malignant esophageal stromal tumors  

Microsoft Academic Search

AIM: To investigate whether malignant esophageal stromal tumors contain PAS-positive patterned matrix-associated vascular channels, which are lined by tumor cells, but not vascular endothelial cells. That is vasculogenic mimicry (VM) independent of tumor angiogenesis. METHODS: Thirty-six tissue samples of malignant esophageal stromal tumors were analyzed. Tissue sections were stained for Vascular endothelial growth factor (VEGF), CD31 and periodic acid Schiff

Hui Zhao; Xiao-Meng Gu; Satoshi Osawa



Free radical scavengers prevent reflux esophagitis in rats  

Microsoft Academic Search

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

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



Esophageal perforation by a tooth in child abuse  

Microsoft Academic Search

A unique case of child abuse in a six-year-old Hispanic girl is reported. In this case, a tooth avulsed and swallowed during an episode of physical abuse and\\/or sexual abuse, caused an esophageal perforation resulting in a retropharyngeal abscess and mediastinal abscess containing the tooth. Although traumatic esophageal injuries in child abuse have occurred, the presence of a tooth within

D. S. Ablin; M. A. Reinhart



Esophageal cancer in Central and Eastern Europe: tobacco and alcohol.  


Esophageal cancer mortality rates in Central and Eastern Europe have been increasing steadily and are expected to increase further in the future. To evaluate the role of risk factors for esophageal cancer in this population, a multicenter study was conducted, with investigation of tobacco and alcohol as one of the principal aims. We have included 192 squamous cell carcinoma (SCC) and 35 adenocarcinoma cases of the esophagus diagnosed at designated hospitals in 5 centers from Romania, Russia, the Czech Republic and Poland. Controls were frequency matched from patients in the same hospital as the cases (n=1,114). Our results showed that the risk of esophageal SCC may be increased by approximately 7-fold for current smokers (OR=7.41, 95% CI 3.98-13.79) and by 3-fold for ever alcohol drinkers (OR=2.86, 95% CI 1.06-7.74). Dose-response relations were evident for both the frequency and duration of tobacco and of alcohol on the risk of esophageal SCC. Risk estimates for tobacco smoking were highest for lower esophageal SCCs, while risk estimates for alcohol drinking were highest for upper esophageal SCCs; though differences were not statistically significant. For adenocarcinoma of the esophagus, our results suggested a more modest increase in risk because of tobacco smoking than that for SCC of the esophagus and no association with alcohol consumption, although our sample size was small. A synergistic interaction between tobacco and alcohol was observed for the risk of esophageal SCC, highlighting the importance of both factors for esophageal cancers in Central and Eastern Europe. PMID:17205526

Hashibe, Mia; Boffetta, Paolo; Janout, Vladimir; Zaridze, David; Shangina, Oxana; Mates, Dana; Szeszenia-Dabrowska, Neonila; Bencko, Vladimir; Brennan, Paul



Defective sonic hedgehog signaling in esophageal atresia with tracheoesophageal fistula  

Microsoft Academic Search

Background. The pathogenesis of esophageal atresia and tracheoesophageal fistula (EA\\/TEF) remains unknown. We have found previously that an initial esophageal atresia, followed by an abnormal (absent) branching pattern of the middle branch of a trifurcation of the lung\\/tracheal bud, leads to the neonatal finding of TEF. Mice null mutant for hedgehog signaling can experience the development of EA\\/TEF, but the

Troy L. Spilde; Amina M. Bhatia; Sheilendra Mehta; Daniel J. Ostlie; Mark J. Hembree; Barry L. Preuett; Krishna Prasadan; Zhixing Li; Charles L. Snyder; George K. Gittes



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


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

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


[Eosinophilic esophagitis in adults: report of a case].  


Eosinophilic esophagitis is a chronic inflammatory disease. The most typical symptoms are recurrent dysphagia and episodes of food impactions. This pathology is quite frequently associated with atopy. We report the case of a 39-year-old patient, suffering from allergic asthma, admitted to hospital for an episode of food impaction. Clinical, endoscopic and histological findings lead to the diagnosis of eosinophilic esophagitis. From data of the litterature, we discuss the diagnosis, the pathogeny and the treatment of this pathology. PMID:18575072

Marting, A; Leclercq, Ph; Gast, P; Scagnol, I; Belaiche, J



[Symptomatic laser endoscopic recanalization in inoperable esophageal cancer].  


The results of clinical usage of conventional and original methods of laser endoscopic recanalization in patients with inoperable esophageal cancer were analyzed. It was established, that application of modifications, elaborated in the clinic--combined laser endoscopic recanalization with bougienage and without it have permitted to raise essentially a rate of the complete esophageal recanalization achievement, to reduce a quantity of the procedures needed to restore the tumoral stenotic region passability and to reduce a recanalization course duration. PMID:21548321

Todurov, I M; Nazarenko, O Iu



Helicobacter pylori infection inhibits reflux esophagitis by inducing atrophic gastritis  

Microsoft Academic Search

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

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



Esophageal hematoma and tear requiring emergency surgical intervention  

Microsoft Academic Search

Summary Esophageal hematoma is a disorder characterized by the sudden development of pain, hematemesis, or dysphagia, commonly with minimal precipitant. We present the case of 59-year-old man with esophageal hematoma, precipitated by eating, with massive hematemesis requiring surgical intervention. A review of 31 additional cases in the literature since 1980 is discussed. The Mallory-Weiss syndrome and Boerhaave syndrome are distinct

Richard D. Folan; Robert E. Smith; John M. Head



Computer-aided analysis of human esophageal peristalsis  

Microsoft Academic Search

Manual and computer analysis of esophageal peristaltic activity induced by swallows of 5ml water were compared in 6 healthy subjects under basal conditions and following i.v. injection of 4 pharmacological agents: edrophonium (E, 0.08mg\\/kg), atropine (A, 0.6mg), pentagastrin (PG, 0.6mcg\\/kg), and glucagon (GL, lmcg). Esophageal manometry was performed using a low compliance perfusion system and recorded on paper for standard

Donald O. Castell; Andre Dubois; Cynthia R. Davis; Carmel M. Cordova; Douglas O. Norman



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



Research advances in esophageal diseases: bench to bedside  

PubMed Central

Over the last year, significant steps have been made toward understanding the pathogenesis of esophageal diseases and translating this knowledge to clinical practice. Gastroesophageal reflux disease (GERD) is the most common outpatient diagnosis in gastroenterology and has a high prevalence in the general population. As many as 40% of patients with GERD have incomplete response to medical therapy, and the pathophysiological mechanisms underlying lack of response are now better understood. Novel medical and minimally invasive interventions are available to optimize management of GERD. Esophageal cancer, regardless of the histological subtype, has among the worst survival statistics among all malignancies. Taking advantage of technological advances in genome sequencing, the mutational spectra in esophageal cancer are now emerging, offering novel avenues for targeted therapies. Early diagnosis is another strand for improving survival. While genome-wide association studies are providing insights into genetic susceptibility, novel approaches to early detection of cancer are being devised through the use of biomarkers applied to esophageal samples and as part of imaging technologies. Dysmotility and eosinophilic esophagitis are the differential diagnoses in patients with dysphagia. New pathophysiological classifications have improved the management of motility disorders. Meanwhile, exciting progress has been made in the endoscopic management of these conditions. Eosinophilic esophagitis is still a relatively new entity, and the pathogenesis remains poorly understood. However, it is now clear that an allergic reaction to food plays an important role, and dietary interventions as well as biologic agents to block the inflammatory cascade are novel, promising fields of clinical research.

di Pietro, Massimiliano



Esophageal atresia. Prognostic factors and contribution of preoperative telescopic endoscopy.  

PubMed Central

In recent years, the surgical correction of esophageal atresia with distal tracheoesophageal fistula (TEF) has become increasingly successful. However, there remains a group of high-risk patients with specific anatomical abnormalities in whom the mortality remains appreciable. These associated disorders include cardiac, renal, and chromosomal anomalies as well as severe respiratory distress syndrome. These factors, rather than low birth weight or early gestational age, are primarily responsible for surgical mortality. Preoperative telescopic bronchoscopy has been a useful adjuvant confirming the diagnosis, identifying unusual variants, and permitting the proper anatomic placement of the endotracheal tube. A Fogarty balloon catheter can be passed bronchoscopically into the distal TEF in patients with severe respiratory distress syndrome to occlude the fistula and facilitate effective positive pressure ventilation. Thirty-two patients were treated for esophageal atresia among whom 28 had esophageal atresia with distal TEF, three had esophageal atresia alone, and one had esophageal atresia with proximal TEF. The higher-risk group comprised those with severe respiratory insufficiency as evidenced by a room air paO2 of less than 60 mmHg; this group accounted for nine of the ten deaths in the total series. There was one late death following surgical correction. In summary, in the absence of severe respiratory insufficiency or associated life-threatening congenital anomalies, the results of surgical correction for esophageal atresia are remarkably good and survival in this group approximates 100%. Images Fig. 1A, 1B.

Filston, H C; Rankin, J S; Grimm, J K



[Biomarkers of predicting response to neoadjuvant chemoradiotherapy in esophageal cancer].  


The prognosis of patients with locally advanced esophageal cancer treated by surgery alone is poor. The neoadjuvant chemoradiotherapy is considered to improve the long-term survival of patients with locally advanced esophageal cancer. The combination of neoadjuvant chemoradiotherapy and surgery has been recommended to be the standard treatment for the locally advanced esophageal cancer in China even in Europe and America countries. However, available evidence suggests that only those who had histopathologic response seemed to benefit the most from neoadjuvant chemotherapy while non-responders even had rather worse outcome compared to patients with surgery alone. Therefore, predictive markers of response to neoadjuvant chemoradiotherapy in locally advanced esophageal cancer are highly significant and needed. These markers would allow a tailored treatment to guide non-responders to alternative preoperative therapies and ultimately avoid ineffective, costly and seriously cytotoxic treatments. Results of most studies on biomarkers for predicting response to neoadjuvant chemoradiotherapy in esophageal cancer are promising. The potential utilization of biomarkers in clinical practice is urgently expected and needed, which plays an important role in guiding and improving the individualization of multimodality therapy in locally advanced esophageal cancer. PMID:24061981

Fu, Jian-Hua



Serum acute phase proteins in dogs with symptomatic esophageal spirocercosis.  


Canine spirocercosis (CS) is a helminthic infection caused by the nematode Spirocerca lupi. The clinical hallmark of the disease is esophageal dysphagia due to parasite-induced esophageal nodules. Currently, there is limited information on the involvement of serum acute phase proteins (APPs) in the symptomatic CS. The objective of this study was to investigate whether C-reactive protein (CRP), serum amyloid A (SAA), haptoglobin (Hp) and albumin are involved in CS, and if their concentrations measured on admission reflect the severity of benign esophageal lesions. Nineteen dogs with spontaneous symptomatic esophageal spirocercosis and 7 clinically healthy dogs were studied retrospectively. The most consistently increased APP in the symptomatic dogs was Hp (95% of the dogs), followed by CRP (68%). The SAA concentrations were infrequently increased (5% of the dogs), while albumin concentrations were decreased in 58% of the affected dogs. The dogs with spirocercosis had significantly higher median concentrations of Hp (p=0.0001) and CRP (p=0.02) compared to healthy dogs. Median albumin concentrations did not differ between the two groups of dogs. The median concentrations of Hp, CRP and albumin did not differ significantly between the dogs having a single or multiple esophageal nodules. The results of this study indicate that in symptomatic CS, Hp and CRP are significantly and consistently increased, while SAA and albumin may be of limited value as diagnostic markers. No association was established between the concentrations of Hp, CRP and albumin measured on admission and the number of esophageal nodules. PMID:22683300

Mylonakis, Mathios E; Ceron, Jose J; Leontides, Leonidas; Rallis, Tim S; Koutinas, Alexander F



Esophageal tolerance to high-dose stereotactic ablative radiotherapy.  


Dose-volume parameters are needed to guide the safe administration of stereotactic ablative radiotherapy (SABR). We report on esophageal tolerance to high-dose hypofractionated radiation in patients treated with SABR. Thirty-one patients with spine or lung tumors received single- or multiple-fraction SABR to targets less than 1 cm from the esophagus. End points evaluated include D(5cc) (minimum dose in Gy to 5 cm(3) of the esophagus receiving the highest dose), D(2cc) , D(1cc) , and D(max) (maximum dose to 0.01 cm(3) ). Multiple-fraction treatments were correlated using the linear quadratic and linear quadratic-linear/universal survival models. Three esophageal toxicity events occurred, including esophagitis (grade 2), tracheoesophageal fistula (grade 4-5), and esophageal perforation (grade 4-5). Chemotherapy was a cofactor in the high-grade events. The median time to development of esophageal toxicity was 4.1 months (range 0.6-6.1 months). Two of the three events occurred below a published D(5cc) threshold, all three were below a D(2cc) threshold, and one was below a D(max) threshold. We report a dosimetric analysis of incidental dose to the esophagus from SABR. High-dose hypofractionated radiotherapy led to a number of high-grade esophageal adverse events, suggesting that conservative parameters to protect the esophagus are necessary when SABR is used, especially in the setting of chemotherapy or prior radiotherapy. PMID:22168251

Abelson, J A; Murphy, J D; Loo, B W; Chang, D T; Daly, M E; Wiegner, E A; Hancock, S; Chang, S D; Le, Q-T; Soltys, S G; Gibbs, I C



Prevention by rebamipide of acute reflux esophagitis in rats.  


Proinflammatory factors, including neutrophil-derived oxygen free radicals and inflammatory cytokines, have recently been implicated in the pathogenesis of reflux esophagitis. Rebamipide has been widely used as an anti-ulcer agent. The aim of the present study was to assess the protective effect of rebamipide against acute reflux esophagitis in rats. Esophagitis was induced in rats by ligation at the limiting ridge and the lower portion of the duodenum. Vehicle or rebamipide were given as a single dose intraduodenally. Lesion index (LI), thiobarbituric acid-reactive substances (TBA-RS), myeloperoxidase (MPO) activity, mRNA and protein of tumor necrosis factor (TNF)-alpha and cytokine-induced neutrophil chemoattractant (CINC)-1 in the esophageal mucosa were markedly increased; pretreatment with rebamipide, however, significantly reduced both macroscopic and microscopic injuries and increases in inflammatory mediators. The results of this study indicate that rebamipide protects against the occurrence of esophagitis and has highly promising potential as a new therapeutic agent for reflux esophagitis. PMID:16184428

Katada, Kazuhiro; Yoshida, Norimasa; Isozaki, Yutaka; Tomatsuri, Naoya; Ichikawa, Hiroshi; Naito, Yuji; Okanoue, Takeshi; Yoshikawa, Toshikazu



Breast cancer, colorectal cancer, and esophageal cancer.  


This is the second of a six-part series on metastatic spread and natural history of 18 common tumors. Part one summarized symptom/problem anticipation, cancer metastasis, and the 18 tumors that each cause more than 6,000 deaths per year in the United States. Bladder and brain cancer were discussed, with information given on tumor types, metastatic spread and invasion, and common symptoms. Part two charts the natural histories of breast, colorectal, and esophageal cancers. Each of these cancers is presented separately, with information given on mortality rates, the most common tumor types, sites of metastases, common problems, and common oncologic emergencies. Sites of spread, resulting problems (including site-specific symptoms), and assessment parameters are presented as tables. Material is presented so that clinicians will be able to anticipate the spread of these cancers and thus identify problems early in their development so that the problems are more easily managed. PMID:10085798

Kemp, C


Foscarnet-Resistant Cytomegalovirus Esophagitis with Stricturing  

PubMed Central

We report the case of a 52-year-old man with HIV-AIDS, non-complaint with highly active antiretroviral therapy, who presented with long-standing dysphagia. He was treated for three episodes of severe Candida esophagitis with fluconazole and later caspofungin due to poor response. In spite of the prolonged treatment courses the patient did not report an improvement in his symptoms. He was also concomitantly being treated for other opportunistic infections including cytomegalovirus (CMV) retinitis with i.v. foscarnet for almost 2 months prior to the index presentation. Upper esophagogastroduodenoscopy revealed multiple superficial ulcers with stricturing. Bougie dilatation was attempted but failed. The biopsy specimens revealed multiple intracellular inclusion bodies pathognomonic of CMV infection. We aim to highlight the increasing resistance of CMV to conventional first-line antiviral agents such as foscarnet.

Gaduputi, Vinaya; Patel, Harish; Vootla, Vamshidhar; Khan, Usman; Chilimuri, Sridhar



Esophageal replacement with colon interposition in children.  

PubMed Central

During a 21-year period, 39 colon interposition operations were performed on 37 children at the UCLA Medical Center and the Childrens Hospital of Los Angeles. The average age at the time of operation was 5.8 years. The indications for operation were esophageal atresia in 23 patients and other benign strictures in 14 patients. The duration of patient follow-up ranged from 6 months to 21 years (mean: 9.7 years). The most common complications were esophagocolonic anastomotic leak (12), esophagocolonic anastomotic stricture (14), pneumonia, and pneumothorax. Fourteen of the 25 patients with retrosternal colon interposition had complications (56%), whereas 10 of 14 patients with left thoracic colon interposition had complications (71%). One patient died (mortality: 3%) after left thoracic interposition because of severe respiratory distress associated with other malformations. Each of the 18 patients with isoperistaltic colon interposition showed rapid transit and emptying, provided that obstruction or extensive dilatation did not occur; reverse colon segments were more dilated and emptied more slowly. The 25 patients with retrosternal colon segments had less colonic distension with better emptying than did the 14 patients with left thoracic interposition. Thirty-two of the 36 children increased their weight percentile after colon interposition. Within 2 years after cervical anastomotic stricture or leak, 78% of these children were asymptomatic and gaining weight. Thirty-one of the 37 patients (84%) had excellent results with colon interposition, with a mean follow-up of 9.7 years. Most of the major postoperative complications occurred within the first few weeks and were corrected during the first few months after operation. Preservation of the esophagus should be the surgeon's first priority; however, prolonged attempts to elongate the esophagus for anastomosis in certain patients with long-gap esophageal atresia have been more hazardous in our experience than has colon interposition. Images FIG. 1.

Stone, M M; Fonkalsrud, E W; Mahour, G H; Weitzman, J J; Takiff, H



Eosinophilic esophagitis: review of nonsurgical treatment modalities.  


Eosinophilic esophagitis (EoE) is a clinicopathological condition characterized by the combination of upper gastrointestinal symptoms such as dysphagia and even food impaction in association with histological findings of >15 eosinophils/high-powered field found in endoscopic biopsy specimens. EoE is considered an atopic disease with food and aeroallergen sensitivity. Current treatment options include elemental and elimination diets and topical corticosteroids. This study was designed to provide a review of the literature on the nonsurgical treatment modalities for EoE to understand the therapeutic challenges. A Medline and PubMed search was conducted using the key words eosinophilic esophagitis and treatment. EoE guidelines, randomized controlled trials, case studies, and evidence-based treatment articles in the English literature were selected. EoE patients can have symptomatic and pathological resolutions with dietary modifications and topical swallowed corticosteroids with continued therapy. However, these effects are not long-lasting and adverse reactions, both local and systemic, are possible. Newer targeted therapies using monoclonal antibodies against interleukin-5 (IL-5) appear to be well tolerated but various studies have not consistently shown symptomatic or histological improvement. Current therapies for EoE including specific diets and topical corticosteroids have shown only short-term symptomatic relief. Biological therapies such as anti-IL-5 agents are still under investigation. Long-term effects of treatments are not known and studies regarding safety of these therapies and specific dosing regimens are needed. Therapies targeting the molecules involved in the pathogenesis of EoE may be future options. Treatment should be individualized with careful consideration of patient's age, allergen sensitivity, lifestyle, and compliance. PMID:23998238

Reddy, Vinitha; Ghaffari, Gisoo


Endoplasmic reticulum stress sensitizes human esophageal cancer cell to radiation  

PubMed Central

AIM: To investigate the role of endoplasmic reticulum (ER) stress in cancer radiotherapy and its molecular mechanism. METHODS: Tunicamycin (TM) was applied to induce ER stress in human esophageal cancer cell line EC109, and the radiosensitization effects were detected by acute cell death and clonogenic survival assay. Cell cycle arrest induced by TM was determined by flow cytometric analysis after the cellular DNA content was labeled with propidium iodide. Apoptosis of EC109 cells induced by TM was detected by annexin V staining and Western blotting of caspase-3 and its substrate poly ADP-ribose polymerase. Autophagic response was determined by acridine orange (AO) staining and Western blotting of microtubule-associated protein-1 light chain-3 (LC3) and autophagy related gene 5 (ATG5). In order to test the biological function of autophagy, specific inhibitor or Beclin-1 knockdown was used to inhibit autophagy, and its effect on cell apoptosis was thus detected. Additionally, involvement of the phosphatidylinositol-3 kinase (PI3K)/Akt/mammalian target of the rapamycin (mTOR) pathway was also detected by Western blotting. Finally, male nude mice inoculated subcutaneously with EC109 cells were used to confirm cell model observations. RESULTS: Our results showed that TM treatment enhanced cell death and reduced the colony survival fraction induced by ionizing radiation (IR), which suggested an obvious radiosensitization effect of TM. Moreover, TM and IR combination treatment led to a significant increase of G2/M phase and apoptotic cells, compared with IR alone. We also observed an increase of AO positive cells, and the protein level of LC3-II and ATG5 was induced by TM treatment, which suggested an autophagic response in EC109 cells. However, inhibition of autophagy by using a chemical inhibitor or Beclin-1 silencing led to increased cell apoptosis and decreased cell viability, which suggested a cytoprotective role of autophagy in stressed EC109 cells. Furthermore, TM treatment also activated mTORC1, and in turn reduced Akt phosphorylation, which suggested the PI3K/Akt/mTOR signal pathway was involved in the TM-induced autophagic response in EC109 cells. Tumor xenograft results also showed synergistic retarded tumor growth by TM treatment and IR, as well as the involvement of the PI3K/Akt/mTOR pathway. CONCLUSION: Our data showed that TM treatment sensitized human esophageal cancer cells to radiation via apoptosis and autophagy both in vitro and in vivo.

Pang, Xue-Li; He, Gang; Liu, Yang-Bo; Wang, Yan; Zhang, Bo



International Survey on Evaluation and Management of Eosinophilic Esophagitis  

PubMed Central

Background Recommendations regarding evaluation and management of eosinophilic esophagitis (EoE) remain incompletely defined. This survey assesses: how providers across the world diagnose, evaluate, and treat EoE and how educational activities affect management. Methods A web-based survey was sent to the members of World Allergy Organization, American College of Allergy, Asthma, and Immunology, and American Academy of Allergy, Asthma, and Immunology. A ?2 analysis compared responses based on personal and practice demographics and participation in educational activities. Results Of the 200 respondents, 68.5% were from the United States. The majority were allergists, who require biopsy to diagnose EoE, perform allergy testing, and obtain follow-up biopsy after treatment. The following variables had significant differences: (1) US practitioners were more likely to test for immediate-type hypersensitivity to foods and obtain follow-up endoscopic biopsies after the initial treatment; (2) Practitioners encountering patients with EoE more frequently were more likely to ask about personal and family history of atopy, test for immediate-type hypersensitivity to aeroallergens and foods, and recommend follow-up biopsy after treatment; and (3) Practitioners who participate more often in EoE workshops were more likely to perform patch testing for foods, while attendance at EoE lectures increased EoE management confidence. Conclusions Diagnostic and management strategies differ based on practice location, EoE patient load, and participation in educational activities. Practitioners who attend more EoE lectures are more confident managing EoE.



Indomethacin but not a selective cyclooxygenase-2 inhibitor inhibits esophageal adenocarcinogenesis in rats  

PubMed Central

AIM: To evaluate the effects of indomethacin [dual cyclooxygenase (COX)-1/COX-2 inhibitor] and 3-(3,4-difluorophenyl)-4-(4-(methylsulfonyl) phenyl)-2-(5H)-furanone (MF-tricyclic) (COX-2 selective inhibitor) in a rat experimental model of Barrett’s esophagus and esophageal adenocarcinoma. METHODS: A total of 112 surviving post-surgery rats were randomly divided into three groups: the control group (n = 48), which did not receive any treatment; the indomethacin group (n = 32), which were given 2 mg/kg per day of the COX-1/COX-2 inhibitor; and the MF-tricyclic group (n = 32), which received 10 mg/kg per day of the selective COX-2 inhibitor. Randomly selected rats were killed either 8 wk or 16 wk after surgery. The timing of the deaths was in accordance with a previous study performed in our group. Only rats that were killed at the times designated by the protocol were included in the study. We then assessed the histology and prostaglandin E2 (PGE2) expression levels in the rat esophagi. An additional group of eight animals that did not undergo esophagojejunostomy were included in order to obtain normal esophageal tissue as a control. RESULTS: Compared to a control group with no treatment (vehicle-treated rats), indomethacin treatment was associated with decreases in ulcerated esophageal mucosa (16% vs 35% and 14% vs 17%, 2 mo and 4 mo after surgery, respectively; P = 0.021), length of intestinal metaplasia in continuity with anastomosis (2 ± 1.17 mm vs 2.29 ± 0.75 mm and 1.25 ± 0.42 mm vs 3.5 ± 1.54 mm, 2 mo and 4 mo after surgery, respectively; P = 0.007), presence of intestinal metaplasia beyond anastomosis (20% vs 71.4% and 0% vs 60%, 2 mo and 4 mo after surgery, respectively; P = 0.009), severity of dysplasia (0% vs 71.4% and 20% vs 85.7% high-grade dysplasia, 2 mo and 4 mo after surgery, respectively; P = 0.002), and adenocarcinoma incidence (0% vs 57.1% and 0% vs 60%, 2 mo and 4 mo after surgery, respectively; P < 0.0001). Treatment with the selective COX-2 inhibitor, MF-tricyclic, did not prevent development of intestinal metaplasia or adenocarcinoma. In parallel, we observed a significant decrease in PGE2 levels in indomethacin-treated rats, but not in those treated with MF-tricyclic, at both 2 mo and 4 mo. Compared to control rats that did not undergo surgery (68 ± 8 ng/g, P = 0.0022 Kruskal-Wallis test) there was a significant increase in PGE2 levels in the esophageal tissue of the rats that underwent surgery either 2 mo (1332 ± 656 ng/g) or 4 mo (1121 ± 1015 ng/g) after esophagojejunostomy. However, no differences were found when esophageal PGE2 levels were compared 2 mo vs 4 mo post-esophagojejunostomy. At both the 2- and 4-mo timepoints, we observed a significant decrease in PGE2 levels in indomethacin-treated rat esophagi compared to those in either the control or MF-tricyclic groups (P = 0.049 and P = 0.017, respectively). No differences in PGE2 levels were found when we compared levels in rats treated with MF-tricyclic to not-treated rats. CONCLUSION: In this rat model of gastrointestinal reflux, indomethacin was associated with a decrease in the severity of esophagitis and reduced development of esophageal intestinal metaplasia and adenocarcinoma.

Esquivias, Paula; Morandeira, Antonio; Escartin, Alfredo; Cebrian, Carmelo; Santander, Sonia; Esteva, Francisco; Garcia-Gonzalez, Maria Asuncion; Ortego, Javier; Lanas, Angel; Piazuelo, Elena



Endoscopic management of suspected esophageal foreign body in adults.  


Foreign bodies should not be allowed to remain in the esophagus beyond 24 hours after presentation. However, some patients with esophageal foreign body ingestion do not come to the hospital immediately and may delay medical intervention from the time of ingestion. The aim of this study was to investigate the outcomes of adults with suspected esophageal foreign body ingestion according to the time of ingestion and types of foreign bodies. A total of 326 adult patients (151 men and 175 women) were analyzed, and divided into two groups according to the time period: within or beyond 24 hours from ingestion to endoscopic intervention. A total of 172 patients (52.7%) were found to have ingested foreign bodies; 73.5% were removed smoothly, 10.3% were treated by push technique and 16.0% with failed retrieval received alternative treatments. A higher proportion of patients in the beyond-24 hours group suffered from odynophagia (25.9 vs. 12.9%, P < 0.05). Negative identification of esophageal foreign bodies was more frequent in the beyond-24 hours group (67 vs. 40.2%, P < 0.05), but these patients showed higher proportions of esophageal ulcers (21.1 vs. 7.2%, P < 0.05). The beyond-24 hours group also showed a significantly higher rate of foreign bodies in the lower esophagus (40.0 vs. 15.3%, P < 0.05). Patients with esophageal food bolus impaction had significant delayed endoscopic intervention, longer therapeutic endoscopic time, higher proportions of esophageal cancer, stricture and fewer complications. Endoscopic intervention within 24 hours from the time of ingestion should be considered early in adults, because delaying intervention may produce more symptomatic esophageal ulcerations with odynophagia. PMID:20946132

Wu, W-T; Chiu, C-T; Kuo, C-J; Lin, C-J; Chu, Y-Y; Tsou, Y-K; Su, M-Y



Gastric secretion of acid and pepsin in patients with esophageal stricture and appropriate controls  

Microsoft Academic Search

Most cases of esophageal stricture are associated with acid\\/peptic reflux esophagitis. While patients with strictures commonly have disordered lower esophageal sphincters and poor clearance and neutralization mechanisms, it is not known whether they also have abnormal gastric secretion. This study examined fasting, basal, and stimulated acid and pepsin secretion. With an endoscopic diagnosis of esophagitis, patients with stricture (N=9), Zollinger-Ellison

Basil I. Hirschowitz



Hematemesis from esophageal varices associated with esophageal perforation: sclerotherapy and endoscopic clipping.  


A 46-year-old man was referred to our Unit for hematemesis. The medical history of the patient revealed an HCV-related cirrhosis, a human immunodeficiency virus (HIV) infection and recent and persistent episodes of emesis. An urgent gastroscopy disclosed evidence of active bleeding from varices of the lower third of the esophagus and a concomitant laceration of the esophageal wall due to the emesis. These two conditions have been endoscopically diagnosed and successfully treated by sclerotherapy and endoscopic clipping. PMID:22774417

Zippi, M; Traversa, G; Pica, R; Occhigrossi, G



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



Morphological Features of the Esophageal Enteric Nervous System and Its Stereological Changes during Aging  

Microsoft Academic Search

Following the enteric nervous system (ENS) of the gastrointestinal tract, the esophageal ENS attracts more and more attention of neuroscience researchers. Despite its continuity with the ENS of the gastrointestinal tract, the esophageal ENS possesses many unique morphological and functional features. This review collates the evidence of recent years, focusing mainly on the morphological features of the esophageal ENS in

Mei Wu; Chen Zhang; J.-P. Timmermans



Clinicopathological and Biological Characteristics of Esophageal Squamous Cell Carcinoma Associated with Head and Neck Cancer  

Microsoft Academic Search

Objective: Esophageal cancer has been reported to be frequently associated with cancer of the head and neck. The iodine dye method is reportedly useful to detect early esophageal cancer. The aim of this study was to clarify clinicopathological and biological characteristics of esophageal squamous cell carcinoma associated with head and neck cancer (HN group). Methods: Thirty-seven patients of the HN

Masataka Matsumoto; Shoji Natsugoe; Hiroshi Okumura; Sumiya Ishigami; Hiroyuki Takatori; Hiroshi Nakashima; Sonshin Takao; Takashi Aikou



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



Pralatrexate and Oxaliplatin in Treating Patients With Unresectable or Metastatic Esophageal, Stomach, or Gastroesophageal Junction Cancer

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



Quantification of the Esophageal Diaphragm Electromyogram with Magnetic Phrenic Nerve Stimulation  

Microsoft Academic Search

Measurement of the amplitude of the esophageal diaphragm compound muscle action potential (CMAP) could be useful for the diagnosis and monitoring of neuromuscular disease. However, quan- tification of the diaphragm CMAP has been hampered by difficulty in positioning the esophageal electrode at the diaphragm's electrically active center and many investigators report arbitrary units rather than voltage. To quantify the esophageal




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



Çocuklari Evde Bekleyen Tehlike: Korozif Özofagus Yaniklari (Dangers to Children at Home: Corrosive esophageal burn)  

Microsoft Academic Search

Inappropriate storage of cleaners which excessively used in daily is hazardous to children. Ingestion of potent corrosive agents, especially alkaline solutions may lead to acute esophageal burns, esophageal or stomach perforation, and even to death. Early of these injuries may be associated with esophageal strictures in later and the treatment of strictures might be and take long follow-up. This article

Ahmet Güven


[Lymphocytic esophagitis: an entity to be excluded in chronic inflammatory diseases of the esophagus].  


Lymphocytic esophagitis is a rare, ill-defined inflammatory disease of the esophagus and is characterized by an increased number of intraepithelial lymphocytes. Up to now no distinct clinical symptom or endoscopic finding could be linked to histopathological changes. Hence lymphocytic esophagitis remains a diagnosis by exclusion after ruling out other possible causes of esophageal intraepithelial lymphocytosis. PMID:23420514

Veits, L; Drgac, J; Rieker, R J



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



Volumetric modulated arc radiotherapy for esophageal cancer.  


A treatment planning study was performed to evaluate the performance of volumetric arc modulation with RapidArc (RA) against 3D conformal radiation therapy (3D-CRT) and conventional intensity-modulated radiation therapy (IMRT) techniques for esophageal cancer. Computed tomgraphy scans of 10 patients were included in the study. 3D-CRT, 4-field IMRT, and single-arc and double-arc RA plans were generated with the aim to spare organs at risk (OAR) and healthy tissue while enforcing highly conformal target coverage. The planning objective was to deliver 54 Gy to the planning target volume (PTV) in 30 fractions. Plans were evaluated based on target conformity and dose-volume histograms of organs at risk (lung, spinal cord, and heart). The monitor unit (MU) and treatment delivery time were also evaluated to measure the treatment efficiency. The IMRT plan improves target conformity and spares OAR when compared with 3D-CRT. Target conformity improved with RA plans compared with IMRT. The mean lung dose was similar in all techniques. However, RA plans showed a reduction in the volume of the lung irradiated at V(??Gy) and V(??Gy) dose levels (range, 4.62-17.98%) compared with IMRT plans. The mean dose and D(??%) of heart for the RA plans were better than the IMRT by 0.5-5.8%. Mean V(??Gy) and integral dose to healthy tissue were almost similar in all techniques. But RA plans resulted in a reduced low-level dose bath (15-20 Gy) in the range of 14-16% compared with IMRT plans. The average MU needed to deliver the prescribed dose by RA technique was reduced by 20-25% compared with IMRT technique. The preliminary study on RA for esophageal cancers showed improvements in sparing OAR and healthy tissue with reduced beam-on time, whereas only double-arc RA offered improved target coverage compared with IMRT and 3D-CRT plans. PMID:21940159

Vivekanandan, Nagarajan; Sriram, Padmanaban; Kumar, S A Syam; Bhuvaneswari, Narayanan; Saranya, Kamalakannan



Volumetric modulated arc radiotherapy for esophageal cancer  

SciTech Connect

A treatment planning study was performed to evaluate the performance of volumetric arc modulation with RapidArc (RA) against 3D conformal radiation therapy (3D-CRT) and conventional intensity-modulated radiation therapy (IMRT) techniques for esophageal cancer. Computed tomgraphy scans of 10 patients were included in the study. 3D-CRT, 4-field IMRT, and single-arc and double-arc RA plans were generated with the aim to spare organs at risk (OAR) and healthy tissue while enforcing highly conformal target coverage. The planning objective was to deliver 54 Gy to the planning target volume (PTV) in 30 fractions. Plans were evaluated based on target conformity and dose-volume histograms of organs at risk (lung, spinal cord, and heart). The monitor unit (MU) and treatment delivery time were also evaluated to measure the treatment efficiency. The IMRT plan improves target conformity and spares OAR when compared with 3D-CRT. Target conformity improved with RA plans compared with IMRT. The mean lung dose was similar in all techniques. However, RA plans showed a reduction in the volume of the lung irradiated at V{sub 20Gy} and V{sub 30Gy} dose levels (range, 4.62-17.98%) compared with IMRT plans. The mean dose and D{sub 35%} of heart for the RA plans were better than the IMRT by 0.5-5.8%. Mean V{sub 10Gy} and integral dose to healthy tissue were almost similar in all techniques. But RA plans resulted in a reduced low-level dose bath (15-20 Gy) in the range of 14-16% compared with IMRT plans. The average MU needed to deliver the prescribed dose by RA technique was reduced by 20-25% compared with IMRT technique. The preliminary study on RA for esophageal cancers showed improvements in sparing OAR and healthy tissue with reduced beam-on time, whereas only double-arc RA offered improved target coverage compared with IMRT and 3D-CRT plans.

Vivekanandan, Nagarajan, E-mail: [Department of Medical Physics, Cancer Institute, Chennai (India); Sriram, Padmanaban; Syam Kumar, S.A.; Bhuvaneswari, Narayanan; Saranya, Kamalakannan [Department of Medical Physics, Cancer Institute, Chennai (India)



Investigating pH of common household substances  

NSDL National Science Digital Library

This activity is a classroom lab where students test common household liquids for pH level on the pH continuum, 1-14. They compare and contrast everyday use of the liquids, and how this relates to the liquids' pH property.


An update on the immunopathogenesis of eosinophilic esophagitis.  


Eosinophilic esophagitis (EoE) is a chronic clinicopathological entity characterized by large numbers of intraepithelial eosinophils infiltrating the esophageal mucosa, which is not caused by gastroesophageal reflux. This disease has become widely recognized over the past few years and new methods have been developed to reveal its underlying pathophysiological mechanisms. Owing to the high prevalence of food and/or airborne allergen sensitization in EoE patients, the allergic nature of the disease had to be defined, which has certain factors in common with other IgE-dependent entities, such as bronchial asthma or allergic rhinitis. Of these, some cytokines and chemokines previously studied in asthma have also been implicated in molecular mechanisms causing eosinophil-rich esophageal inflammation. However, the role played by IgE in relation to the esophageal eosinophilic infiltrate must be clarified, together with the possible function of mast cells in the inflammatory infiltrate and its activation stimuli. A putative role has also been recently suggested for gastroesophageal reflux in the origin of EoE that should be profoundly analyzed, together with the role of specific genes implicated in other digestive inflammatory disorders. This article reviews recent advances in the immunopathogenesis of EoE, which should also consider other pathways to activate the esophageal mucosal immune system. PMID:20350261

Lucendo, Alfredo J; Lucendo, Baltasar



Effect of bolus osmolality on human esophageal function.  


The effect of bolus osmolality on human esophageal function is undefined. We sought to define the response of the human esophagus to boluses with a wide range of osmolalities in 10 healthy male volunteers. Intraluminal pressure events were measured with an infused catheter system, and lower esophageal sphincter pressure was monitored continuously with a Dent sleeve. Each subject was given a series of 10 swallows of each of seven boluses, which consisted of water, mannitol solutions with osmolalities of 142, 296, 449, 704, and 1481 mOsm/kg, and orange juice (585 mOsm/kg), in a randomized fashion. Tracings were coded and analyzed blindly. Alterations in bolus osmolality did not elicit any significant changes in amplitude and duration of contraction, velocity of wave propagation, or the duration of relaxation of the lower esophageal sphincter. We conclude that bolus osmolality does not play a significant role in the control of human esophageal motility, and that this lack of effect is explained by consideration of esophageal muscle mechanics. PMID:2499185

Bilder, C R; Dooley, C P; Valenzuela, J E



Heart sounds analysis via esophageal stethoscope system in beagles.  


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



Laparoscopic Transhiatal Treatment of Large Epiphrenic Esophageal Diverticulum  

PubMed Central

Background: Epiphrenic diverticulum is an uncommon disorder of the distal third of the esophagus. We report the case of a 73-year-old woman with a large symptomatic esophageal epiphrenic diverticulum, diffuse nonspecific esophageal dysmotility, and a hiatal hernia. Methods: Surgery was indicated by the patient's symptoms, the size of the diverticulum (maximum diameter 10 cm), and the associated esophageal motor disorder. Preoperative study included barium swallow, upper gastrointestinal endoscopy, and esophageal manometry. A laparoscopic transhiatal diverticulectomy associated with a Heller myotomy, hiatoplasty, and a Dor's fundoplication was carried out. The overall operative time was 230 minutes. Results: No intraoperative complications occurred. Gastrografin swallow performed on postoperative day 4 did not show any signs of leakage from the staple line. The postoperative hospital stay was 5 days. The patient was readmitted 10 days after discharge complaining of fever and chest pain. A new Gastrografin swallow demonstrated a small leak from the staple line successfully treated with 3 weeks of total enteral nutrition. Conclusion: The laparoscopic approach to epiphrenic diverticulum is feasible. Postoperative Gastrografin swallow is not 100% sensitive in detecting small suture-line leaks if a preexisting esophageal motility disorder is present. In case of late postoperative fever and pleural effusion, a suture-line leak should be suspected. Conservative management of the small suture-line leak should be considered as an effective therapeutic option.

Casella, Giovanni; Recchia, Carlo Luigi; Bianchi, Ermanno; Lomartire, Nazzareno



Primary esophageal and gastro-esophageal junction cancer xenograft models: clinicopathological features and engraftment.  


There are very few xenograft models available for the study of esophageal (E) and gastro-esophageal junction (GEJ) cancer. Using a NOD/SCID model, we implanted 90 primary E and GEJ tumors resected from patients and six endoscopic biopsy specimens. Of 69 resected tumors with histologically confirmed viable adenocarcinoma or squamous cell carcinoma, 22 (32%) was engrafted. One of 11 tumors, considered to have had a complete pathological response to neo-adjuvant chemo-radiation, also engrafted. Of the 23 patients whose tumors were engrafted, 65% were male; 30% were early stage while 70% were late stage; 22% received neo-adjuvant chemo-radiation; 61% were GEJ cancers. Engraftment occurred in 18/54 (33%) adenocarcinomas and 5/16 (31%) squamous cell carcinomas. Small endoscopic biopsy tissue had a 50% (3/6) engraftment rate. Of the factors analyzed, pretreatment with chemo-radiation and well/moderate differentiation showed significantly lower correlation with engraftment (P<0.05). In the subset of patients who did not receive neo-adjuvant chemo-radiation, 18/41 (44%) engrafted compared with those with pretreatment where 5/29 (17%, P=0.02) engrafted. Primary xenograft lines may be continued through 4-12 passages. Xenografts maintained similar histology and morphological characteristics with only minor variations even after multiple passaging in most instances. PMID:23399854

Dodbiba, Lorin; Teichman, Jennifer; Fleet, Andrew; Thai, Henry; Sun, Bin; Panchal, Devang; Patel, Devalben; Tse, Alvina; Chen, Zhuo; Faluyi, Olusola O; Renouf, Daniel J; Girgis, Hala; Bandarchi, Bizhan; Schwock, Joerg; Xu, Wei; Bristow, Robert G; Tsao, Ming-Sound; Darling, Gail E; Ailles, Laurie E; El-Zimaity, Hala; Liu, Geoffrey



Minimally Invasive Surgical Treatment of Esophageal Carcinoma  

PubMed Central

Surgical resection has proven successful in eradicating cancer of the esophagus, and it remains one of the main treatment modalities available for the curative management of patients with this disease. Unfortunately, patient morbidity is high because of the extensive nature of the surgery, which traditionally involves opening the chest and abdomen. Most time-honored techniques used to resect the esophagus and reconstruct the alimentary passage use the stomach as the replacement conduit, and a major abdominal dissection is therefore involved. Hoping to decrease the perioperative morbidity associated with esophagectomy, a number of thoracic surgeons have started to experiment with resection of the esophagus using aminimally invasive approach in select groups of patients. In minimally invasive esophagectomy (MIE), body cavities are accessed using a camera and fine, narrow instruments inserted through small incisions. Experience with abdominal surgery over the past decade suggests that a number of operative variables are improved using minimally invasive procedures, such as blood loss, rate of perioperative complications, and length of hospital stay. Data also suggest that the minimally invasive approach is comparable to or more advantageous than open procedures, in terms of both short- and long-term outcomes. Similarly, based on the limited data available today, shortterm outcomes after MIE are at least comparable with outcomes associated with open procedures. Minimally invasive resection of the esophagus for the management of esophageal cancer is feasible and safe. Whether MIE is better than traditional open techniques remains to be determined.



PhET: Research  

NSDL National Science Digital Library

This web page contains links to published research articles relating to the Physics Education Technology Project (PhET). This project provides technology-based resources and information for physics education, most notably, simulations on a wide range of topics including Newton's Laws, electricity, waves, light, and quantum physics. The simulations are developed in conjunction with careful research to enhance their effectiveness as learning tools.

Project, The P.



Type II congenital cystic pulmonary malformation in an esophageal lung.  


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-Muñiz, Irma; Vargas, Mario H; Flores-Salgado, Rosalinda


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



Esophageal Sarcoidosis: A Review of Cases and an Update  

PubMed Central

Sarcoidosis is a chronic disorder that can virtually affect any organ system in the body. Histologically, it is characterized by the presence of T lymphocytes, mononuclear phagocytes, and noncaseating granulomas. Most commonly affected are the intrathoracic structures, with 90% of the reported cases involving the lungs. Esophageal involvement in sarcoidosis is extremely rare. Dysphagia is the most common presentation in these patients and can be attributed to various mechanisms such as direct esophageal wall infiltration, extrinsic compression, cranial neuropathy, and brainstem involvement. A thorough online literature review revealed only 23 reported cases of esophageal involvement in sarcoidosis. This paper reviews these reported cases in detail along with newer diagnostic and treatment options, including direction of future therapy.

Hajar, Rabab; Virdi, Ravi; Singh, Jaspreet; Mustacchia, Paul



Milk temperature influences esophageal motility in the newborn lamb.  


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



Novel diagnostic and prognostic biomarkers in esophageal cancer.  


Introduction: This article provides an overview of actual biomarkers with an impact on improvement of diagnosis and treatment of esophageal cancer patients. Areas covered: Recent literature has been analyzed and provides information regarding the potential role of molecular markers as a diagnostic or prognostic factor in esophageal cancer. Expert opinion: Until now, the role of molecular markers is far from being firmly established for routine use and is not without obstacles. However, with reliable standardized methods, established cut-off values and promising candidates in marker panels with markers of genetic, epigenetic and proteomic origin might result in a marker tool worthwhile of being validated in large, prospective, randomized trials. Novel validated marker combinations have to be clinically applied to prove their putative role in complementing clinical techniques within the development of better detection concepts of esophageal cancer, improving patients' long-term prognosis by early and purposive therapy within individualized treatment concepts. PMID:24093836

Plum, Patrick S; Bollschweiler, Elfriede; Hölscher, Arnulf H; Warnecke-Eberz, Ute