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Sample records for abnormal esophageal acid

  1. Not All Children with Cystic Fibrosis Have Abnormal Esophageal Neutralization during Chemical Clearance of Acid Reflux.

    Science.gov (United States)

    Woodley, Frederick W; Moore-Clingenpeel, Melissa; Machado, Rodrigo Strehl; Nemastil, Christopher J; Jadcherla, Sudarshan R; Hayes, Don; Kopp, Benjamin T; Kaul, Ajay; Di Lorenzo, Carlo; Mousa, Hayat

    2017-09-01

    Acid neutralization during chemical clearance is significantly prolonged in children with cystic fibrosis, compared to symptomatic children without cystic fibrosis. The absence of available reference values impeded identification of abnormal findings within individual patients with and without cystic fibrosis. The present study aimed to test the hypothesis that significantly more children with cystic fibrosis have acid neutralization durations during chemical clearance that fall outside the physiological range. Published reference value for acid neutralization duration during chemical clearance (determined using combined impedance/pH monitoring) was used to assess esophageal acid neutralization efficiency during chemical clearance in 16 children with cystic fibrosis (3 to cystic fibrosis. Duration of acid neutralization during chemical clearance exceeded the upper end of the physiological range in 9 of 16 (56.3%) children with and in 3 of 16 (18.8%) children without cystic fibrosis ( p =0.0412). The likelihood ratio for duration indicated that children with cystic fibrosis are 2.1-times more likely to have abnormal acid neutralization during chemical clearance, and children with abnormal acid neutralization during chemical clearance are 1.5-times more likely to have cystic fibrosis. Significantly more (but not all) children with cystic fibrosis have abnormally prolonged esophageal clearance of acid. Children with cystic fibrosis are more likely to have abnormal acid neutralization during chemical clearance. Additional studies involving larger sample sizes are needed to address the importance of genotype, esophageal motility, composition and volume of saliva, and gastric acidity on acid neutralization efficiency in cystic fibrosis children.

  2. Spectrum of esophageal abnormality seen on thoracic CT

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    Lee, Kyung Hee; Cho, Soon Gu; Jeon, Yong Sun; Jeong, Seok [Inha university Hospital, Incheon (Korea, Republic of); Kim, Hyung Jin [Samsung Medical Center, Seoul (Korea, Republic of)

    2006-04-15

    A variety of diseases involve the esophagus including esophagitis, benign or malignant tumors, varices, and esophageal perforation. We reviewed the thoracic CT of these various esophageal diseases, and classified them by similar CT findings. The CT findings were circumferential wall thickening, nodular wall thickening, abnormal luminal dilatation, fistula formation, and mass or mass like lesion. Although CT alone has limited diagnostic ability in esophageal disease, it may have an important role in diagnosing submucosal dissection, fistula, perforation, and intramural abscess.

  3. Chronic xerostomia increases esophageal acid exposure and is associated with esophageal injury

    International Nuclear Information System (INIS)

    Korsten, M.A.; Rosman, A.S.; Fishbein, S.; Shlein, R.D.; Goldberg, H.E.; Biener, A.

    1991-01-01

    OBJECTIVES: To assess the effects of chronic xerostomia on parameters of gastroesophageal reflux and esophagitis. DESIGN: Observational study of a cohort of male patients with xerostomia and age-matched control subjects. SETTING: Tertiary-care Veterans Affairs Medical Center. SUBJECTS: Sixteen male patients with chronic xerostomia secondary to radiation for head and neck cancers or medications. Nineteen age-matched male control subjects with comparable alcohol and smoking histories. MEASUREMENTS AND MAIN RESULTS: Esophageal motility was similar in patients with xerostomia and controls. Clearance of acid from the esophagus and 24-hour intraesophageal pH were markedly abnormal in patients with xerostomia. Symptoms and signs of esophagitis were significantly more frequent in subjects with xerostomia. CONCLUSIONS: Chronic xerostomia may predispose to esophageal injury, at least in part, by decreasing the clearance of acid from the esophagus and altering 24-hour intraesophageal pH. Esophageal injury is a previously unreported complication of long-term salivary deficiency

  4. Esophagogastric junction outflow obstruction is often associated with coexistent abnormal esophageal body motility and abnormal bolus transit.

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    Zheng, E; Gideon, R M; Sloan, J; Katz, P O

    2017-10-01

    Currently, the diagnosis of esophageal motility disorders is in part based upon a hierarchical algorithm in which abnormalities of the esophagogastric junction (EGJ) is prioritized. An important metric in evaluating the EGJ is the integrated relaxation pressure (IRP). Patients who do not have achalasia but are found to have an elevated IRP are diagnosed with EGJ outflow obstruction. It has been our observation that a subset of these patients also has a second named motility disorder and may also have abnormal bolus transit. The aim of this study is to determine the frequency of abnormal body motility and or abnormal bolus movement in patients with EGJ outflow obstruction. Further, in an effort to evaluate the potential clinical value in measuring bolus transit as a complement to esophageal manometry, specifically in patients with EGJ outflow obstruction, we analyzed the presenting symptoms of these patients. A total of 807 patients with a mean age of 53 years completed esophageal function testing with impedance monitoring and high-resolution manometry between January 2012 and October 2016. There were 74 patients with achalasia who were excluded from the study. Of the remaining 733 patients, 138 (19%) had an elevated IRP and were given a diagnosis of EGJ outflow obstruction. Among these patients, 56 (40%) were diagnosed with an abnormal motility pattern to liquids (ineffective esophageal motility = 28, distal esophageal spasm = 19, Jackhammer = 6), of which 44 (76%) had abnormal bolus transit to liquids, viscous, or both. In contrast, there were 82 patients with EGJ outflow obstruction and normal esophageal motility, of which 33 (40%) had abnormal bolus transit. Patients with preserved esophageal motility and EGJ outflow obstruction were then evaluated. Of the 733 patients, 299 (40%) had intact esophageal motility. Of the 299 patients with normal esophageal motility, 56 patients had an elevated IRP, of which 16 (28%) had abnormal bolus transit. There were 243 (33

  5. Subtle lower esophageal sphincter relaxation abnormalities in patients with unexplained esophageal dysphagia.

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    Herregods, T V K; van Hoeij, F B; Bredenoord, A J; Smout, A J P M

    2018-02-01

    Esophageal dysphagia is a relatively common symptom. We aimed to evaluate whether subtle, presently not acknowledged forms of dysfunction of the lower esophageal sphincter (LES) could explain dysphagia in a subset of patients with normal findings at high-resolution manometry (HRM) according to the Chicago classification v3.0. We used HRM to compare LES relaxation characteristics in 97 patients with unexplained dysphagia with those in 44 healthy subjects. In addition, normative values for time to LES relaxation and completeness of LES relaxation were calculated. Patients with delayed or incomplete LES relaxation were compared with patients with normal relaxation. Dysphagia patients had a higher nadir LES pressure (P=.001) and a longer time to LES relaxation (P=.012) than healthy subjects. Based on the findings in healthy subjects, normal values of LES relaxation were defined as: ≥50% of swallows with normal LES relaxation time (relaxation (not reaching a value below 10 mm Hg). Dysphagia patients had significantly more often >50% swallows with delayed and/or incomplete LES relaxation than healthy controls (25% vs 4.5%; P=.004). Dysphagia patients with >50% delayed and/or incomplete LES relaxation had a significantly higher LES resting pressure (Prelaxation abnormalities, such as a delayed relaxation of the LES and/or incomplete LES relaxation, could be a cause of dysphagia in approximately one quarter of the patients with otherwise unexplained esophageal dysphagia. © 2017 John Wiley & Sons Ltd.

  6. Subtle lower esophageal sphincter relaxation abnormalities in patients with unexplained esophageal dysphagia

    NARCIS (Netherlands)

    Herregods, T. V. K.; van Hoeij, F. B.; Bredenoord, A. J.; Smout, A. J. P. M.

    2018-01-01

    Esophageal dysphagia is a relatively common symptom. We aimed to evaluate whether subtle, presently not acknowledged forms of dysfunction of the lower esophageal sphincter (LES) could explain dysphagia in a subset of patients with normal findings at high-resolution manometry (HRM) according to the

  7. Laparoscopic surgery for gastro-esophageal acid reflux disease

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    Schijven, Marlies P.; Gisbertz, Suzanne S.; van Berge Henegouwen, Mark I.

    2014-01-01

    Gastro-esophageal reflux disease is a troublesome disease for many patients, severely affecting their quality of life. Choice of treatment depends on a combination of patient characteristics and preferences, esophageal motility and damage of reflux, symptom severity and symptom correlation to acid

  8. Cineradiography in normal and abnormal pharyngo-esophageal deglutition

    International Nuclear Information System (INIS)

    Ekberg, O.

    1981-01-01

    With the aid of high-speed cineradiography the pharyngeal stage of deglutition was examined among 150 volunteers without dysphagia in order to evaluate the radiographic pattern of normal deglutition. In order to evaluate the dignostic result of cineradiographic examinations of the pharyngeal stage of deglutition among dysphagial patients 250 such patients were consecutively examined with an identical technique as the volunteers. The result of the investigation has shown that high-speed cineradiography is a convenient radiologic method for studying normal and abnormal deglutition. In nondysphagial individuals the pharyngeal stage of deglutition is executed with precision, smoothness and obviously with efficiency. In a few individuals without swallowing complaints circumscribed functional aberrations can be registered. In the majority of patients with dysphagia high-speed cineradiography is able to detect functional abnormalities during deglutition. An examination of such patients with this techique is therefore indispensable in order to disclose a probable cause of their complaints. (Auth.)

  9. Structural airway abnormalities contribute to dysphagia in children with esophageal atresia and tracheoesophageal fistula.

    Science.gov (United States)

    Baxter, Katherine J; Baxter, Lauren M; Landry, April M; Wulkan, Mark L; Bhatia, Amina M

    2018-01-31

    Long-term dysphagia occurs in up to 50% of repaired esophageal atresia and tracheoesophageal fistula (EA/TEF) patients. The underlying factors are unclear and may include stricture, esophageal dysmotility, or associated anomalies. Our purpose was to determine whether structural airway abnormalities (SAA) are associated with dysphagia in EA/TEF. We conducted a retrospective chart review of children who underwent EA/TEF repair in our hospital system from 2007 to 2016. Children with identified SAA (oropharyngeal abnormalities, laryngeal clefts, laryngomalacia, vocal cord paralysis, and tracheomalacia) were compared to those without airway abnormalities. Dysphagia outcomes were determined by the need for tube feeding and the modified pediatric Functional Oral Intake Scale (FOIS) at 1 year. SAA was diagnosed in 55/145 (37.9%) patients with EA/TEF. Oropharyngeal aspiration was more common in children with SAA (58.3% vs. 36.4%, p=0.028). Children with SAA were more likely to require tube feeding both at discharge (79.6% vs. 48.3%, p<0.001) and at 1 year (52.7% vs. 13.6%, p<0.001) and had lower mean FOIS (4.18 vs. 6.21, p<0.001). In the logistic regression model adjusting for gestational age, long gap EA, and esophageal stricture, the presence of SAA remained a significant risk factor for dysphagia (OR 4.17 (95% CI 1.58-11.03)). SAA are common in children with EA/TEF and are associated with dysphagia, even after accounting for gestational age, esophageal gap and stricture. This study highlights the need for a multidisciplinary approach, including early laryngoscopy and bronchoscopy, in the evaluation of the EA/TEF child with dysphagia. Level II retrospective prognostic study. Copyright © 2018. Published by Elsevier Inc.

  10. Esophageal abnormalities in juvenile localized scleroderma: is it associated with other extracutaneous manifestations?

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    Valões, Clarissa C M; Novak, Glaucia V; Brunelli, Juliana B; Kozu, Katia T; Toma, Ricardo K; Silva, Clovis A

    To assess esophageal involvement (EI) in juvenile localized scleroderma (JLS) population and the possible association between this gastrointestinal manifestation and demographic data, clinical features, laboratory exams, treatments and outcomes. For a period of 30 years, 5881 patients with rheumatic diseases were followed in our Pediatric Rheumatology Division. EI was defined by the presence of symptoms (solid/liquid dysphagia, heartburn, esophageal regurgitation, nausea/vomiting and epigastralgia) and confirmed by at least one EI exam abnormality: barium contrast radiography, upper gastrointestinal endoscopy and 24-hour esophageal pH-monitoring. JLS was observed in 56/5881 patients (0.9%), mainly linear morphea subtype. EI was observed in 23/56(41%) of JLS patients. Eight(35%) of 23 EI patients with JLS were symptomatic and presented heartburn(5/8), solid and liquid dysphagia(3/8), nausea and epigastralgia(1/8). The frequency of any cumulative extracutaneous manifestations (calcinosis, arthritis/arthralgia, central nervous system, interstitial pneumonitis, mesangial nephritis and/or arrhythmia) was significantly higher in JLS patients with EI compared to those without this complication (56% vs. 24%, p=0.024). No differences were evidenced in demographic data, JLS subtypes and in each extracutaneous manifestation in both groups (p>0.05). The frequency of methotrexate use was significantly higher in JLS patients with EI compared to those without (52% vs. 12%, p=0.002). Autoantibody profile (antinuclear antibodies, anti-SCL-70, rheumatoid factor, anticentromere, anti-cardiolipin, anti-Ro/SSA and anti-La/SSB) was similar in both groups (p>0.05). Our study demonstrated that EI was frequently observed in JLS patients, mainly in asymptomatic patients with linear subtype. EI occurred in JLS patients with other extracutaneous manifestations and required methotrexate therapy. Copyright © 2016. Published by Elsevier Editora Ltda.

  11. Esophageal abnormalities in juvenile localized scleroderma: is it associated with other extracutaneous manifestations?

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    Clarissa C.M. Valões

    Full Text Available Abstract Objective: To assess esophageal involvement (EI in juvenile localized scleroderma (JLS population and the possible association between this gastrointestinal manifestation and demographic data, clinical features, laboratory exams, treatments and outcomes. Methods: For a period of 30 years, 5881 patients with rheumatic diseases were followed in our Pediatric Rheumatology Division. EI was defined by the presence of symptoms (solid/liquid dysphagia, heartburn, esophageal regurgitation, nausea/vomiting and epigastralgia and confirmed by at least one EI exam abnormality: barium contrast radiography, upper gastrointestinal endoscopy and 24-hour esophageal pH-monitoring. Results: JLS was observed in 56/5881 patients (0.9%, mainly linear morphea subtype. EI was observed in 23/56(41% of JLS patients. Eight(35% of 23 EI patients with JLS were symptomatic and presented heartburn(5/8, solid and liquid dysphagia(3/8, nausea and epigastralgia(1/8. The frequency of any cumulative extracutaneous manifestations (calcinosis, arthritis/arthralgia, central nervous system, interstitial pneumonitis, mesangial nephritis and/or arrhythmia was significantly higher in JLS patients with EI compared to those without this complication (56% vs. 24%, p = 0.024. No differences were evidenced in demographic data, JLS subtypes and in each extracutaneous manifestation in both groups (p > 0.05. The frequency of methotrexate use was significantly higher in JLS patients with EI compared to those without (52% vs. 12%, p = 0.002. Autoantibody profile (antinuclear antibodies, anti-SCL-70, rheumatoid factor, anticentromere, anti-cardiolipin, anti-Ro/SSA and anti-La/SSB was similar in both groups (p > 0.05. Conclusions: Our study demonstrated that EI was frequently observed in JLS patients, mainly in asymptomatic patients with linear subtype. EI occurred in JLS patients with other extracutaneous manifestations and required methotrexate therapy.

  12. 13 ribs as a predictor of long gap esophageal atresia: myth or reality? Analysis of associated findings of esophageal atresia and abnormal rib count.

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    Durell, Jonathan; Dagash, Haitham; Eradi, Bala; Rajimwale, Ashok; Nour, Shawqui; Patwardhan, Nitin

    2017-08-01

    The presence of 13 pairs of ribs on pre-operative chest x-ray has been postulated to be an indicator for long gap esophageal atresia (EA). This study sought to determine the validity of this theory and identify associated pathological conditions in patients with EA and abnormal rib count. Babies with EA from January 2005 - December 2012 were retrospectively analyzed. Information was gathered from neonatal health records and operation notes. Chest x-rays were reviewed to determine rib count. Long gap EA was defined as failure to achieve primary esophageal anastomosis. Statistical analysis performed with Fisher's exact test. Seventy-six patients were identified. Eight patients had long gap EA, with none of these patients having 13 pairs of ribs. Paradoxically, 10 patients with esophageal atresia +/- trachea-esophageal atresia (EA +/- TEF) and supernumerary ribs underwent primary repair. Nine patients had 11 pairs of ribs, of which 2 had pure EA and a long gap. Using Fisher's exact test to compare the groups of supernumary ribs and non-supernumary ribs there is a p value of 0.587. VACTERL association was identified in 40% of those with supernumerary ribs. Various associated syndromes and concomitant abnormalities were identified. We found no association between 13 pairs of ribs and long gap in esophageal atresia. Those with 13 pairs of ribs were more likely to have associated anomalies, although this was not statistically significant. Our cohort of patients was found to have a range of pathology related to genetic syndromes, further atresias, and malformations, which is well known to be associated with children born with EA +/- TEF. Prognosis study - level IV. Copyright © 2017 Elsevier Inc. All rights reserved.

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

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    Koji Takeuchi

    2014-01-01

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

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

    Science.gov (United States)

    2014-01-01

    Esophagitis was induced in rats within 3 h by ligating both the pylorus and transitional region between the forestomach and glandular portion under ether anesthesia. This esophageal injury was prevented by the administration of acid suppressants and antipepsin drug and aggravated by exogenous pepsin. Damage was also aggravated by pretreatment with indomethacin and the selective COX-1 but not COX-2 inhibitor, whereas PGE2 showed a biphasic effect depending on the dose; a protection at low doses, and an aggravation at high doses, with both being mediated by EP1 receptors. Various amino acids also affected this esophagitis in different ways; L-alanine and L-glutamine had a deleterious effect, while L-arginine and glycine were highly protective, both due to yet unidentified mechanisms. It is assumed that acid/pepsin plays a major pathogenic role in this model of esophagitis; PGs derived from COX-1 are involved in mucosal defense of the esophagus; and some amino acids are protective against esophagitis. These findings also suggest a novel therapeutic approach in the treatment of esophagitis, in addition to acid suppressant therapy. The model introduced may be useful to test the protective effects of drugs on esophagitis and investigate the mucosal defense mechanism in the esophagus. PMID:24672789

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

    International Nuclear Information System (INIS)

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

    1986-01-01

    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

  16. Factors regulating nuclear factor-kappa B activation in esophageal cancer cells: Role of bile acids and acid

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    Mohamed Mahmoud M Abdel-Latif

    2016-01-01

    Conclusions: Our data demonstrate that bile and acid induce NF-κB activation in esophageal cells qualitatively and quantitatively. The induction of COX-2 promoter activity by DCA and acid was mediated via NF-κB and AP-1 transcription. The activation of NF-κB signaling pathway in esophageal cells may contribute to the development of esophageal cancer, and, therefore, modulating of NF-κB pathway may uncover new therapeutic strategies.

  17. Radiographic abnormalities in tricyclic acid overdose

    International Nuclear Information System (INIS)

    Varnell, R.M.; Richardson, M.L.; Vincent, J.M.; Godwin, J.D.

    1987-01-01

    Several case reports have described adult respiratory distress syndrome (ARDS) secondary to tricyclic acid (TCA) overdose. During a 1-year period 83 patients requiring intubation secondary to drug overdose were evaluated. Abnormalities on chest radiographs occurred in 26 (50%) of the 54 patients with TCA overdose, compared to six (21%) of the 29 patients overdosed with other drugs. In addition, five (9%) of the patients with TCA overdose subsequently had radiographic and clinical abnormalities meeting the criteria for ARDS. Only one (3%) of the patients with non-TCA overdose subsequently had change suggesting ARDS. TCAs should be added to the list of drugs associated with ARDS, and TCA overdose should be considered a major risk factor in the development of radiographically evident abnormalities

  18. Esophageal Cancer

    Science.gov (United States)

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

  19. Exhaled breath concentrations of acetic acid vapour in gastro-esophageal reflux disease

    Czech Academy of Sciences Publication Activity Database

    Dryahina, Kseniya; Pospíšilová, Veronika; Sovová, Kristýna; Shestivska, Violetta; Kubišta, Jiří; Spesyvyi, Anatolii; Pehal, F.; Turzíková, J.; Votruba, J.; Španěl, Patrik

    2014-01-01

    Roč. 8, č. 3 (2014), 037109 ISSN 1752-7155 Institutional support: RVO:61388955 Keywords : SIFT-MS * gastro-esophageal reflux * acetic acid Subject RIV: CF - Physical ; Theoretical Chemistry Impact factor: 4.631, year: 2014

  20. Abnormal cerebral functional connectivity in esophageal cancer patients with theory of mind deficits in resting state.

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    Cao, Yin; Xiang, JianBo; Qian, Nong; Sun, SuPing; Hu, LiJun; Yuan, YongGui

    2015-01-01

    To explore the function of the default mode network (DMN) in the psychopathological mechanisms of theory of mind deficits in patients with an esophageal cancer concomitant with depression in resting the state. Twenty-five cases of esophageal cancer with theory of mind deficits (test group) that meet the diagnostic criteria of esophageal cancer and neuropsychological tests, including Beck depression inventory, reading the mind in the eyes, and Faux pas, were included, Another 25 cases of esophageal cancer patients but without theory of mind deficits (control group) were enrolled. Each patient completed a resting-state functional magnetic resonance imaging. The functional connectivity intensities within the cerebral regions in the DMN of all the enrolled patients were analyzed. The results of each group were compared. The functional connectivity of the bilateral prefrontal central region with the precuneus, bilateral posterior cingulate gyrus and bilateral ventral anterior cingulate gyrus in the patients of the test group were all reduced significantly (P theory of mind deficits. The theory of mind deficits might have an important function in the pathogenesis of esophageal cancer.

  1. Acid reflux directly causes sleep disturbances in rat with chronic esophagitis.

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    Kenichi Nakahara

    Full Text Available BACKGROUND & AIMS: Gastroesophageal reflux disease (GERD is strongly associated with sleep disturbances. Proton pump inhibitor (PPI therapy improves subjective but not objective sleep parameters in patients with GERD. This study aimed to investigate the association between GERD and sleep, and the effect of PPI on sleep by using a rat model of chronic acid reflux esophagitis. METHODS: Acid reflux esophagitis was induced by ligating the transitional region between the forestomach and the glandular portion and then wrapping the duodenum near the pylorus. Rats underwent surgery for implantation of electrodes for electroencephalogram and electromyogram recordings, and they were transferred to a soundproof recording chamber. Polygraphic recordings were scored by using 10-s epochs for wake, rapid eye movement sleep, and non-rapid eye movement (NREM sleep. To examine the role of acid reflux, rats were subcutaneously administered a PPI, omeprazole, at a dose of 20 mg/kg once daily. RESULTS: Rats with reflux esophagitis presented with several erosions, ulcers, and mucosal thickening with basal hyperplasia and marked inflammatory infiltration. The reflux esophagitis group showed a 34.0% increase in wake (232.2±11.4 min and 173.3±7.4 min in the reflux esophagitis and control groups, respectively; p<0.01 accompanied by a reduction in NREM sleep during light period, an increase in sleep fragmentation, and more frequent stage transitions. The use of omeprazole significantly improved sleep disturbances caused by reflux esophagitis, and this effect was not observed when the PPI was withdrawn. CONCLUSIONS: Acid reflux directly causes sleep disturbances in rats with chronic esophagitis.

  2. Preliminary study of efficacy of hyaluronic acid on caustic esophageal burns in an experimental rat model.

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    Cevik, Muazez; Demir, Tuncer; Karadag, Cetin Ali; Ketani, Muzaffer Aydin; Celik, Hakim; Kaplan, Davut Sinan; Boleken, Mehmet Emin

    2013-04-01

    The aim of this study was to investigate the effectiveness of hyaluronic acid on the prevention of esophageal damage and stricture formation after experimental caustic (alkaline) esophageal injury in rats. Twenty-one Wistar albino rats were randomly divided into three groups. A caustic esophageal burn was created following the Gehanno model: Group l (n=7) underwent operation, but no injury; Group 2 (n=7) was injured and left untreated; and Group 3 (n=7) was injured and treated with hyaluronic acid, first topically and then orally by gavage (2×0.3mL; 12.5mg/mL for 7days). The caustic esophageal burn was created by instilling 25% NaOH into the distal esophagus. All rats were euthanized on day 22 for evaluation. The efficacy of hyaluronic acid treatment was assessed histopathologically and biochemically via blood determination of the total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), and sulfhydryl group (SH) and lipid hydroperoxidase (LOOH) levels. Statistical analyses were performed. Weight gain was significantly lower in Group 2 than in the other two groups (POSI, and SH and LOOH levels were higher in Group 2 than in the other two groups. The mean stenosis index, inflammation, TAS, SH and OSI in Group 2 were significantly different than those in the other two groups (P<0.05). Hyaluronic acid treatment is effective in treating damage and preventing strictures after caustic esophageal burn in rats. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Characteristics of gastroesophageal reflux in symptomatic patients with and without excessive esophageal acid exposure

    NARCIS (Netherlands)

    Bredenoord, Albert J.; Weusten, Bas L. A. M.; Timmer, Robin; Smout, Andŕe J. P. M.

    2006-01-01

    OBJECTIVE: In some patients with a physiological esophageal acid exposure, an association between reflux episodes and symptoms can be demonstrated. Besides acidity, other factors such as proximal extent may determine whether a reflux episode is perceived or not. We aimed to investigate the reflux

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

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    Rifat Hasina

    2013-01-01

    Full Text Available Background: World-wide, esophageal cancer is a growing epidemic and patients frequently present with advanced disease that is surgically inoperable. Hence, chemotherapy is the predominate treatment. Cytotoxic platinum compounds are mostly used, but their efficacy is only moderate. Newer alkylating agents have shown promise in other tumor types, but little is known about their utility in esophageal cancer. Methods: We utilized archived human esophageal cancer samples and esophageal cancer cell lines to evaluate O-6-methylguanine-deoxyribonucleic acid methyltransferase (MGMT hypermethylation status and determined sensitivity to the alkylating drug temozolomide (TMZ. Immunoblot analysis was performed to determine MGMT protein expression in cell lines. To assess and confirm the effect of TMZ treatment in a methylated esophageal cancer cell line in vivo, a mouse flank xenograft tumor model was utilized. Results: Nearly 71% (12/17 of adenocarcinoma and 38% (3/8 of squamous cell carcinoma (SCC patient samples were MGMT hypermethylated. Out of four adenocarcinoma and nine SCC cell lines tested, one of each histology was hypermethylated. Immunoblot analyses confirmed that hypermethylated cell lines did not express the MGMT protein. In vitro cell viability assays showed the methylated Kyse-140 and FLO cells to be sensitive to TMZ at an IC 50 of 52-420 μM, whereas unmethylated cells Kyse-410 and SKGT-4 did not respond. In an in vivo xenograft tumor model with Kyse-140 cells, which are MGMT hypermethylated, TMZ treatment abrogated tumor growth by more than 60%. Conclusion: MGMT methylation may be an important biomarker in subsets of esophageal cancers and targeting by TMZ may be utilized to successfully treat these patients.

  5. Serum amino acid abnormalities in pediatric patients with chronic ...

    African Journals Online (AJOL)

    Background: Plasma amino acid concentrations have been reported to be abnormal in patients with chronic renal failure. L-Arginine has been used to improve endothelial function by increasing nitric oxide (NO) bioavailability. The present study aim at investigating the status of plasma amino acids in pediatric patients with ...

  6. Is pH Testing Necessary Before Antireflux Surgery in Patients with Endoscopic Erosive Esophagitis?

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    Schwameis, Katrin; Lin, Brenda; Roman, Jordan; Olengue, Ketetha; Siegal, Steve; DeMeester, Steven R

    2018-01-01

    The relationship between the Los Angeles (LA) grade of esophagitis and acid exposure by pH monitoring is unclear. The aim of this study was to correlate the results of pH testing in patients with esophagitis to determine at what LA grade of esophagitis a pH test is not necessary. A retrospective review was performed of the records of all patients who underwent upper endoscopy and were found to have esophagitis graded using the LA system and who had pH monitoring from 2014 to 2016. An abnormal pH test was determined based on the DeMeester score. There were 56 patients with a median age of 57 years. Esophagitis was LA grade A in 19, B in 20, C in 15 and D in 2 patients. An abnormal pH score was present in 47 patients (84%). All patients with C or D esophagitis had an abnormal pH score compared to 79% and 75% of patients with A and B esophagitis, respectively. The presence of LA C or D esophagitis was always associated with increased esophageal acid exposure on pH testing and is proof of reflux disease. However, pH testing is recommended prior to antireflux surgery in patients with LA A or B esophagitis.

  7. Twenty-four-hour esophageal impedance-pH monitoring in healthy preterm neonates: rate and characteristics of acid, weakly acidic, and weakly alkaline gastroesophageal reflux.

    Science.gov (United States)

    López-Alonso, Manuel; Moya, Maria Jose; Cabo, Jose Antonio; Ribas, Juan; del Carmen Macías, Maria; Silny, Jiry; Sifrim, Daniel

    2006-08-01

    Gastroesophageal reflux is a physiologic process and is considered pathologic (gastroesophageal reflux disease) when it causes symptoms or results in complications. It is common in preterm infants and occurs in healthy neonates. Twenty-four-hour pH monitoring commonly is used in children for diagnosis of gastroesophageal reflux disease, and abnormal reflux is considered with detection of increased esophageal acid exposure. However, in neonates, relatively few gastroesophageal reflux episodes cause esophageal acidification to pH feeds, which can induce a weaker acid secretory response than that observed in older infants and adults. As a consequence, gastric pH may be > 4 for prolonged periods, and reflux of gastric contents might be less acidic or even alkaline. Esophageal impedance monitoring can detect weakly acidic and even alkaline gastroesophageal reflux. The role of weakly acidic reflux in the pathophysiology of gastroesophageal reflux disease in preterm infants is not clear. To date, studies that have used impedance-pH in neonates assessed the association between nonacid reflux and cardiorespiratory symptoms, but no impedance data from healthy preterm neonates have been available to determine whether those symptomatic neonates had an increased number of weakly acidic reflux episodes or increased reactivity to a physiologic number of reflux events. Our aim with this study was to provide impedance-pH values for acid, weakly acidic, and weakly alkaline reflux from healthy preterm neonates. Esophageal impedance was recorded for 24 hours in 21 asymptomatic preterm neonates by replacing the conventional feeding tube with a specially designed feeding tube that included 9 impedance electrodes (8 French). All neonates were asymptomatic, with spontaneous breathing. Reflux monitoring was performed after comprehensive explanation and on receipt of written parental consent. Esophageal and gastric pH were monitored using a separate parallel pediatric catheter (6 French

  8. Esophageal Acidification During Nocturnal Acid-breakthrough with Ilaprazole Versus Omeprazole in Gastroesophageal Reflux Disease.

    Science.gov (United States)

    Karyampudi, Arun; Ghoshal, Uday C; Singh, Rajan; Verma, Abhai; Misra, Asha; Saraswat, Vivek A

    2017-04-30

    Though nocturnal acid-breakthrough (NAB) is common in gastroesophageal reflux disease (GERD) patients, its clinical importance results from esophageal acidification, which has been shown to be uncommon. Ilaprazole, a long-acting proton pump inhibitor, may cause NAB infrequently. Accordingly, we studied prospectively, (1) frequency and degree of esophageal acidification during NAB, and (2) frequency and severity of NAB while on ilaprazole versus omeprazole. Fifty-eight consecutive patients with GERD on once daily ilaprazole, 10 mg (n = 28) or omeprazole, 20 mg (n = 30) for > one month underwent 24-hour impedance-pH monitoring prospectively. NAB was defined as intra-gastric pH one hour during night, and esophageal acidification as pH < 4 for any duration. Nocturnal symptoms (heartburn, regurgitation, and chest pain) were also recorded. Of the 58 patients (age 35.5 [inter-quartile range 26.5-46.0] years, 38 [65.5%], 42 (72.4%) had NAB. Though patients with NAB had lower nocturnal intra-gastric pH than without (2.8 [1.9-4.1] vs 5.7 [4.6-6.8], P < 0.001), frequency and duration of nocturnal esophageal acidification (17/42 vs 4/16, P = 0.360 and 0.0 [0.0-1.0] vs 0.0 [0.0-0.3] minutes, P = 0.260, respectively) and symptoms were comparable (13/42 vs 6/16, P = 0.750). Though ilaprazole was associated with less NABs (1 [range 1-2, n = 19] vs 1 [range 1-3, n = 23], P = 0.010) than omeprazole, the frequency, duration, and mean intra-gastric pH during NAB were comparable (19/28 vs 23/30, P = 0.560; 117 [0-315] vs 159 [69-287] minutes, P = 0.500; 1.02 [0.7-1.4] vs 1.04 [0.44-1.3], P = 0.620, respectively). Though NAB was common while patients were on a proton pump inhibitor, esophageal acidification was uncommon. Frequency and severity of NAB were comparable among patients on ilaprazole and omeprazole, except for the lesser number of NABs with ilaprazole.

  9. Pattern of acid base abnormalities in critically ill patinets

    International Nuclear Information System (INIS)

    Ahmad, T.M.; Mehmood, A.; Malik, T.M.

    2015-01-01

    To find out the pattern of acid base abnormalities in critically ill patients in a tertiary care health facility. Study Design: A descriptive study. Place and Duration of Study: The study was carried out in the department of pathology, Combined Military Hospital Kharian from January 2013 to June 2013. Patients and Methods: Two hundred and fifty patients suffering from various diseases and presenting with exacerbation of their clinical conditions were studied. These patients were hospitalized and managed in acute care units of the hospital. Arterial blood gases were analysed to detect acid base status and their correlation with their clinical condition. Concomitant analysis of electrolytes was carried out. Tests related to concurrent illnesses e.g. renal and liver function tests, cardiac enzymes and plasma glucose were assayed by routine end point and kinetic methods. Standard reference materials were used to ensure internal quantify control of analyses. Results: Two hundred and fifteen patients out of 250 studied suffered from acid base disorders. Gender distribution showed a higher percentage of male patients and the mean age was 70.5 ± 17.4 years. Double acid base disorders were the commonest disorders (34%) followed by metabolic acidosis (30%). Anion gap was calculated to further stratify metabolic acidosis and cases of diabetic ketoacidosis were the commonest in this category (47%). Other simple acid base disorders were relatively less frequent. Delta bicarbonate was calculated to unmask the superimposition of respiratory alkalosis or acidosis with metabolic acidosis and metabolic alkalosis. Though triple acid base disorders were noted in a small percentage of cases (05%), but were found to be the most complicated and challenging. Mixed acid base disorders were associated with high mortality. Conclusion: A large number of critically ill patients manifested acid base abnormalities over the full spectrum of these disorders. Mixed acid base disorders were

  10. Diagnosis of digestive functional disease by the statistics of continuous monitoring of esophageal acidity

    Science.gov (United States)

    Rivera Landa, Rogelio; Cardenas Cardenas, Eduardo; Fossion, Ruben; Pérez Zepeda, Mario Ulises

    2014-11-01

    Technological advances in the last few decennia allow the monitoring of many physiological observables in a continuous way, which in physics is called a "time series". The best studied physiological time series is that of the heart rhythm, which can be derived from an electrocardiogram (ECG). Studies have shown that a healthy heart is characterized by a complex time series and high heart rate variability (HRV). In adverse conditions, the cardiac time series degenerates towards randomness (as seen in, e.g., fibrillation) or rigidity (as seen in, e.g., ageing), both corresponding to a loss of HRV as described by, e.g., Golberger et. al [1]. Cardiac and digestive rhythms are regulated by the autonomous nervous system (ANS), that consists of two antagonistic branches, the orthosympathetic branch (ONS) that accelerates the cardiac rhythm but decelerates the digestive system, and the parasympathetic brand (PNS) that works in the opposite way. Because of this reason, one might expect that the statistics of gastro-esophageal time series, as described by Gardner et. al. [2,3], reflects the health state of the digestive system in a similar way as HRV in the cardiac case, described by Minocha et. al. In the present project, we apply statistical methods derived from HRV analysis to time series of esophageal acidity (24h pHmetry). The study is realized on data from a large patient population from the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Our focus is on patients with functional disease (symptoms but no anatomical damage). We find that traditional statistical approaches (e.g. Fourier spectral analysis) are unable to distinguish between different degenerations of the digestive system, such as gastric esophageal reflux disease (GERD) or functional gastrointestinal disorder (FGID).

  11. Histopathologic profile of esophageal atresia and ...

    African Journals Online (AJOL)

    Purpose Few reports are available in the literature on the histology of the congenital atretic esophagus in humans. Histologic abnormalities including congenital esophageal stenosis (CES) may contribute toward the abnormal esophageal motility after successful repair of esophageal atresia (EA) and tracheoesophageal ...

  12. Clinical predictors of abnormal esophageal pH monitoring in preterm infants Preditores clínicos para pHmetria esofágica anormal em prematuros

    Directory of Open Access Journals (Sweden)

    Maria Aparecida Mezzacappa

    2008-09-01

    Full Text Available BACKGROUND: Risk factors for gastroesophageal reflux disease in preterm neonates have not been yet clearly defined. AIM: To identify factors associated with increased esophageal acid exposition in preterm infants during the stay in the neonatal unit. METHODS: A case-control study in preterm infants who had undergone prolonged monitoring of distal esophageal pH, following clinical indication. Eighty-seven preterms with reflux index (percentage of total time of esophageal pHmetry >10% (cases and 87 unpaired preterms were selected with reflux index 10% in preterms were: vomiting, regurgitation, Apnea, female gender. The variables that were associated with a lower frequency of increased reflux index were: volume of enteral intake at the onset of symptoms >147 mL/kg/day, and postnatal corticoid use. CONCLUSIONS: Vomiting, regurgitation, apnea, female gender and acute respiratory distress during the first week of life were variables predictive of increased esophageal acid exposition in preterm infants with birthweight 10%.RACIONAL: Os fatores de risco para a doença pelo refluxo gastroesofágico em recém-nascidos prematuros não foram, até momento, claramente estabelecidos. OBJETIVO: Identificar fatores associados ao aumento da exposição ácida intra-esofágica em prematuros durante o período de internação em unidade neonatal. MÉTODOS: Realizou-se estudo de caso controle com prematuros que realizaram monitorização prolongada do pH esofágico por suspeita clínica de doença do refluxo. Foram selecionados 87 recém-nascidos com valor do índice de refluxo (percentual do tempo total do exame com pH abaixo de 4 >10% (casos e 87 recém-nascidos com índice de refluxo 10% foram: vômitos, regurgitações, apnéia, sexo feminino e insuficiência respiratória na 1ª semana de vida. As variáveis que se associaram a menor freqüência de índice de refluxo 147mL/kg/d e uso de corticóide pós-natal. CONCLUSÕES: Vômitos, regurgitações, apn

  13. Studies on the regulation of transient lower esophageal sphincter relaxations (TLESRs) by acid in the esophagus and stomach.

    Science.gov (United States)

    Banovcin, P; Halicka, J; Halickova, M; Duricek, M; Hyrdel, R; Tatar, M; Kollarik, M

    2016-07-01

    Transient lower esophageal sphincter relaxation (TLESR) is the major mechanism of gastroesophageal reflux, but the regulation of TLESR by stimuli in the esophagus is incompletely understood. We have recently reported that acid infusion in the esophagus substantially (by 75%) increased the number of meal-induced TLESR in healthy subjects. We concluded that the TLESR reflex triggered by gastric distention with meal was enhanced by the stimulation of esophageal nerves by acid. However, the possibilities that the acid infused into the esophagus acts after passing though lower esophageal sphincter in stomach to enhance TLESR, or that the acid directly initiates TLESR from the esophagus were not addressed. Here, we evaluated the effect of acid infusion into the proximal stomach on meal-induced TLESR (study 1) and the ability of acid infusion into the esophagus to initiate TLESR without prior meal (study 2). We analyzed TLESRs by using high-resolution manometry in healthy subjects in paired randomized studies. In study 1, we found that acid infusion into the proximal stomach did not affect TLESRs induced by standard meal. The number of meal-induced TLESRs following the acid infusion into the proximal stomach was similar to the number of meal-induced TLESRs following the control infusion. In study 2, we found that acid infusion into the esophagus without prior meal did not initiate TLESRs. We conclude that the increase in the meal-induced TLESRs by acid in the esophagus demonstrated in our previous study is not attributable to the action of acid in the stomach or to direct initiation of TLESR from the esophagus by acid. Our studies are consistent with the concept that the stimuli in the esophagus can influence TLESRs. The enhancement of TLESR by acid in the esophagus may contribute to pathogenesis of gastroesophageal reflux in some patients. © 2015 International Society for Diseases of the Esophagus.

  14. Esophageal scintigraphy: Applications and limitations in the study of esophageal disorders

    International Nuclear Information System (INIS)

    O'Connor, M.K.; Byrne, P.J.; Keeling, P.; Hennessy, T.P.

    1988-01-01

    This study examines the scintigraphic transit pattern in a variety of esophageal disorders. Scintigraphy was performed with a semi solid bolus and the patient in an upright position. Condensed esophageal images were obtained from which we derived the esophageal transit time. The pattern of bolus transit was graded by the duration of transit and by the presence of hold up or retrograde motion. Scintigrams were performed in 11 volunteers and 88 patients whose esophageal function had been confirmed by conventional gastroesophageal techniques. Esophageal disorders examined included achalasia, scleroderma, esophageal carcinoma, Barrett esophagus, and reflux esophagitis. We also examined the effects of gastroesophageal surgery on esophageal function. Transit times distinguished grossly abnormal esophageal function from normal but did not distinguish between different esophageal disorders. Graded transit patterns were a more sensitive indicator of esophageal function and permitted some differentiation between esophageal disorders and allowed evaluation of the effects of gastroesophageal surgery. (orig.)

  15. Understanding the sensory irregularities of esophageal disease.

    Science.gov (United States)

    Farmer, Adam D; Brock, Christina; Frøkjaer, Jens Brøndum; Gregersen, Hans; Khan, Sheeba; Lelic, Dina; Lottrup, Christian; Drewes, Asbjørn Mohr

    2016-08-01

    Symptoms relating to esophageal sensory abnormalities can be encountered in the clinical environment. Such sensory abnormalities may be present in demonstrable disease, such as erosive esophagitis, and in the ostensibly normal esophagus, such as non-erosive reflux disease or functional chest pain. In this review, the authors discuss esophageal sensation and the esophageal pain system. In addition, the authors provide a primer concerning the techniques that are available for investigating the autonomic nervous system, neuroimaging and neurophysiology of esophageal sensory function. Such technological advances, whilst not readily available in the clinic may facilitate the stratification and individualization of therapy in disorders of esophageal sensation in the future.

  16. Acid suppression increases rates of Barrett's esophagus and esophageal injury in the presence of duodenal reflux.

    LENUS (Irish Health Repository)

    2012-01-31

    BACKGROUND: The contribution of gastric acid to the toxicity of alkaline duodenal refluxate on the esophageal mucosa is unclear. This study compared the effect of duodenal refluxate when acid was present, decreased by proton pump inhibitors (PPI), or absent. METHODS: We randomized 136 Sprague-Dawley rats into 4 groups: group 1 (n = 33) were controls; group 2 (n = 34) underwent esophagoduodenostomy promoting "combined reflux"; group 3 (n = 34) underwent esophagoduodenostomy and PPI treatment to decrease acid reflux; and group 4, the \\'gastrectomy\\' group (n = 35) underwent esophagoduodenostomy and total gastrectomy to eliminate acid in the refluxate. Esophaguses were examined for inflammatory, Barrett\\'s, and other histologic changes, and expression of proliferative markers Ki-67, proliferating cell nuclear antigen (PCNA), and epidermal growth factor receptor (EGFR). RESULTS: In all reflux groups, the incidence of Barrett\\'s mucosa was greater when acid was suppressed (group C, 62%; group D, 71%) than when not suppressed (group B, 27%; P = 0.004 and P < .001). Erosions were more frequent in the PPI and gastrectomy groups than in the combined reflux group. Edema (wet weight) and ulceration was more frequent in the gastrectomy than in the combined reflux group. Acute inflammatory changes were infrequent in the PPI group (8%) compared with the combined reflux (94%) or gastrectomy (100%) groups, but chronic inflammation persisted in 100% of the PPI group. EGFR levels were greater in the PPI compared with the combined reflux group (P = .04). Ki-67, PCNA, and combined marker scores were greater in the gastrectomy compared with the combined reflux group (P = .006, P = .14, and P < .001). CONCLUSION: Gastric acid suppression in the presence of duodenal refluxate caused increased rates of inflammatory changes, intestinal metaplasia, and molecular proliferative activity. PPIs suppressed acute inflammatory changes only, whereas chronic inflammatory changes persisted.

  17. Prucalopride decreases esophageal acid exposure and accelerates gastric emptying in healthy subjects

    NARCIS (Netherlands)

    Kessing, B. F.; Smout, A. J. P. M.; Bennink, R. J.; Kraaijpoel, N.; Oors, J. M.; Bredenoord, A. J.

    2014-01-01

    The 5-HT4 receptor agonist prucalopride is a prokinetic drug which improves colonic motility. Animal data and in vitro studies suggest that prucalopride also affects gastric and esophageal motor function. We aimed to assess the effect of prucalopride on gastric emptying, esophageal motility, and

  18. Radionuclide Esophageal Transit Study in the Esophageal Motility Disorders

    International Nuclear Information System (INIS)

    Choi, Jae Gol; Lee, Min Jae; Song, Chi Wook

    1993-01-01

    Esophageal motility was evaluated from the analysis of 10 consecutive swallows using liquid bolus containing 0.5 mCi of 99m Tc tin colloid. We have reviewed our experience of esophageal transit study in the 20 normal volunteers and 55 patients with dysphagia that was not related to mechanical obstruction. The purpose of this study is to measure the esophageal transit in normal subjects and in patients with various esophageal motility disorders. The overall sensitivity and specificity of radionuclide esophageal transit study in detecting esophageal motor abnormality were compared with manometric results as a gold standard, which were 80% and 100% respectively. Radionuclide transit study is a safe, rapid, noninvasive test and suitable as a screening test for esophageal motor disorders.

  19. The Incidence of Electrolytes and Acid-Base Abnormalities in ...

    African Journals Online (AJOL)

    Diabetic patients with prolonged insulin insufficiency can present in the emergency department with life threatening ketoacidosis,el ectrolyte abnormalities,an d morbid arrhythmias. A quick and accurate determination of the metabolic abnormalities with rapid intervention is paramount in their management. The aim of this ...

  20. The Role of Adjuvant Acid Suppression on the Outcomes of Bleeding Esophageal Varices after Endoscopic Variceal Ligation.

    Directory of Open Access Journals (Sweden)

    Cheng-Kun Wu

    Full Text Available The impact of adjuvant acid suppression via proton pump inhibitors or histamine-2 receptor antagonists after endoscopic variceal ligation remains uncertain. We therefore aimed to evaluate the effect of adjuvant acid suppression on the rebleeding and mortality rates in patients who received endoscopic variceal ligation and vasoconstrictor therapy for bleeding esophageal varices. Data from 1997 to 2011 were extracted from the National Health Insurance Research Database in Taiwan. A total of 1576 cirrhotic patients aged > 18 years with a primary diagnosis of acute esophageal variceal bleeding who received endoscopic variceal ligation therapy were screened. After strict exclusion, 637 patients were recruited. The exclusion criteria included patients with gastric variceal bleeding, failure in the control of bleeding, mortality within 12 hours, and history of hepatocellular carcinoma or gastric cancer. Patients were divided into two groups: the vasoconstrictors group (n = 126 and vasoconstrictors plus acid suppression group (n = 511. We observed that the rebleeding and mortality rates were not significantly different between 2 groups during hospitalization and the 15-year follow-up period after discharge. A Charlson score ≥3 (odds ratio: 2.42, 95% confidence interval: 1.55 ~3.79, P = 0.0001, presence of hepatitis C virus (odds ratio: 1.70, 95% confidence interval: 1.15 ~2.52, P = 0.0085, and cirrhosis (odds ratio: 1.69, 95% confidence interval: 1.08 ~2.66, P = 0.0229 were the independent risk factors of mortality after discharge. In conclusion, the results of the current study suggest that adjuvant acid suppression prescription to patients who received endoscopic variceal ligation and vasoconstrictor therapy for bleeding esophageal varices may not change the rebleeding and mortality outcomes compared to that for those who received endoscopic variceal ligation and vasoconstrictor agents without acid suppression.

  1. Esophageal stricture - benign

    Science.gov (United States)

    ... esophagus. These may include household cleaners, lye, disc batteries, or battery acid. Treatment of esophageal varices . ... keep you from getting enough fluids and nutrients. Solid food, especially meat, can get stuck above the ...

  2. Lower pH values of weakly acidic refluxes as determinants of heartburn perception in gastroesophageal reflux disease patients with normal esophageal acid exposure.

    Science.gov (United States)

    de Bortoli, N; Martinucci, I; Savarino, E; Franchi, R; Bertani, L; Russo, S; Ceccarelli, L; Costa, F; Bellini, M; Blandizzi, C; Savarino, V; Marchi, S

    2016-01-01

    Multichannel impedance pH monitoring has shown that weakly acidic refluxes are able to generate heartburn. However, data on the role of different pH values, ranging between 4 and 7, in the generation of them are lacking. The aim of this study was to evaluate whether different pH values of weakly acidic refluxes play a differential role in provoking reflux symptoms in endoscopy-negative patients with physiological esophageal acid exposure time and positive symptom index and symptom association probability for weakly acidic refluxes. One hundred and forty-three consecutive patients with gastroesophageal reflux disease, nonresponders to proton pump inhibitors (PPIs), were allowed a washout from PPIs before undergoing: upper endoscopy, esophageal manometry, and multichannel impedance pH monitoring. In patients with both symptom index and symptom association probability positive for weakly acidic reflux, each weakly acidic reflux was evaluated considering exact pH value, extension, physical characteristics, and correlation with heartburn. Forty-five patients with normal acid exposure time and positive symptom association probability for weakly acidic reflux were identified. The number of refluxes not heartburn related was higher than those heartburn related. In all distal and proximal liquid refluxes, as well as in distal mixed refluxes, the mean pH value of reflux events associated with heartburn was significantly lower than that not associated. This condition was not confirmed for proximal mixed refluxes. Overall, a low pH of weakly acidic reflux represents a determinant factor in provoking heartburn. This observation contributes to better understand the pathophysiology of symptoms generated by weakly acidic refluxes, paving the way toward the search for different therapeutic approaches to this peculiar condition of esophageal hypersensitivity. © 2014 International Society for Diseases of the Esophagus.

  3. Chemoprevention of esophageal cancer with black raspberries, their component anthocyanins, and a major anthocyanin metabolite, protocatechuic acid.

    Science.gov (United States)

    Peiffer, Daniel S; Zimmerman, Noah P; Wang, Li-Shu; Ransom, Benjamin W S; Carmella, Steven G; Kuo, Chieh-Ti; Siddiqui, Jibran; Chen, Jo-Hsin; Oshima, Kiyoko; Huang, Yi-Wen; Hecht, Stephen S; Stoner, Gary D

    2014-06-01

    Diets containing either freeze-dried black raspberries (BRBs) or their polyphenolic anthocyanins (ACs) have been shown to inhibit the development of N-nitrosomethylbenzylamine (NMBA)-induced esophageal cancer in rats. The present study was conducted to determine whether PCA, a major microbial metabolite of black raspberry (BRB) ACs, also prevents NMBA-induced esophageal cancer in rats. F344 rats were injected with NMBA three times a week for 5 weeks and then fed control or experimental diets containing 6.1% BRBs, an anthocyanin (AC)-enriched fraction derived from BRBs, or protocatechuic acid (PCA). Animals were exsanguinated at weeks 15, 25, and 35 to quantify the development of preneoplastic lesions and tumors in the esophagus, and to relate this to the expression of inflammatory biomarkers. At weeks 15 and 25, all experimental diets were equally effective in reducing NMBA-induced esophageal tumorigenesis, as well as in reducing the expression of pentraxin-3 (PTX3), a cytokine produced by peripheral blood mononuclear cells in response to interleukin (IL)-1β and TNF-α. All experimental diets were also active at reducing tumorigenesis at week 35; however, the BRB diet was significantly more effective than the AC and PCA diets. Furthermore, all experimental diets inhibited inflammation in the esophagus via reducing biomarker (COX-2, iNOS, p-NF-κB, and sEH) and cytokine (PTX3) expression. Overall, our data suggest that BRBs, their component ACs, and PCA inhibit NMBA-induced esophageal tumorigenesis, at least in part, by their inhibitory effects on genes associated with inflammation. ©2014 American Association for Cancer Research.

  4. Esophageal polyps in pediatric patients undergoing routine diagnostic upper gastrointestinal endoscopy: a multicenter study.

    Science.gov (United States)

    Septer, S; Cuffari, C; Attard, T M

    2014-01-01

    Esophageal polyps are uncommon findings in pediatric patients, and reports have been limited to case reports. Esophageal polyps have been previously ascribed to esophagitis secondary to gastroesophageal reflux, medications, infections and recurrent vomiting. They have been associated with underlying conditions such as hiatal hernia, Barrett's esophagus, eosinophilic esophagitis and Crohn's disease. Presenting complaints of children with esophageal polyps have included vomiting, dysphagia, hematemesis and abdominal pain. The aim of this paper is to characterize the incidence, clinical presentation and progression, histologic subtypes and associated mucosal abnormalities in children with esophageal polyps. A retrospective multicenter study was performed at four institutions identifying diagnosis of esophageal polyps in pediatric patients (pediatric pathologists for all included cases. Esophageal polyps were identified in 13 patients (9 M) from 9438 esophagogastroduodenoscopies (0.14%). Mean age of subjects was 9.2 years. Vomiting was the most common indication for endoscopy. Polyp location was at the gastroesophageal junction in 7 of the 13 cases. Most polyps were inflammatory (n = 7). Esophagitis was noted in 69% of those with esophageal polyps. Repeat endoscopies in six patients at a mean interval of 8 months noted persistence of polyps in all six patients. This paper is the first to characterize esophageal polyps in pediatrics. These polyps are rare in children and often are associated with esophagitis. Presenting complaints seem to vary by age. Polyps did not consistently change with either time or acid suppression. The optimal management strategy has yet to be defined and likely depends on the underlying pathophysiologic process. © 2013 Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

  5. Acetylsalicylic Acid Exhibits Antitumor Effects in Esophageal Adenocarcinoma Cells In Vitro and In Vivo.

    Science.gov (United States)

    Piazuelo, Elena; Esquivias, Paula; De Martino, Alba; Cebrián, Carmelo; Conde, Blanca; Santander, Sonia; Emperador, Sonia; García-González, María Asunción; Carrera-Lasfuentes, Patricia; Lanas, Angel

    2016-10-01

    Recent observational studies have shown therapeutic benefits of acetylsalicylic acid (ASA) in several types of cancer. We examined whether ASA exerts antitumor activity in esophageal adenocarcinoma (EAC). Human EAC cells (OE33) were treated with ASA (0-5 mM) to evaluate proliferation, apoptosis, and migration. In vivo model: OE33-derived tumors were subcutaneously implanted into athymic mice which were allocated to ASA (5 or 50 mg/kg/day)/vehicle (5-6 animals/group). Tumor growth was assessed every 2-3 days, and after 40 days, mice were euthanized. Plasma drug levels were determined by high-performance liquid chromatography. Histological and immunohistochemical (Ki67, activated caspase-3) analysis of tumors were performed. The effect of ASA on tumor prostaglandin E2 (PGE2) levels was also evaluated. In vitro cell proliferation and migration were significantly inhibited while apoptosis increased (p < 0.05) by ASA. Although ASA did not induce tumor remission, tumor progression was significantly lower in ASA-treated mice when compared to non-treated animals (478 % in mice treated with 5 mg/kg/day ASA vs. 2696 % control; 748 % in mice treated with 50 mg/kg/day ASA vs. 2670 % control). Maximum tumor inhibition was 92 and 85 %, respectively. This effect was associated with a significant decrease of proliferation index in tumors. ASA 5 mg/kg/day did not modify tumor PGE2 levels. Whereas tumor PGE2 content in mice treated with ASA 50 mg/kg was lower than in control mice, the difference was not significant. Although these results need to be confirmed in other EAC cells, our data suggest a role for ASA in the treatment of this tumor.

  6. Pediatric GERD (Gastro-Esophageal Reflux Disease)

    Science.gov (United States)

    ... Doctor Near You Pediatric GERD (Gastro-Esophageal Reflux Disease) Pediatric GERD (Gastro-Esophageal Reflux Disease) Patient Health ... pH probe: A small wire with an acid sensor is placed through the nose down to the ...

  7. Esophageal atresia

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/000961.htm Esophageal atresia To use the sharing features on this page, please enable JavaScript. Esophageal atresia is a disorder of the digestive system in ...

  8. Esophageal Cancer

    Science.gov (United States)

    ... Tumors Mediastinal Tumors Achalasia and Esophageal Motility Disorders Pleural Diseases Mesothelioma Esophageal Cancer Overview The esophagus (ĕ-sof´ah-gus) is the hollow, muscular tube that moves food and liquid from the mouth ...

  9. PAR-2 activation enhances weak acid-induced ATP release through TRPV1 and ASIC sensitization in human esophageal epithelial cells.

    Science.gov (United States)

    Wu, Liping; Oshima, Tadayuki; Shan, Jing; Sei, Hiroo; Tomita, Toshihiko; Ohda, Yoshio; Fukui, Hirokazu; Watari, Jiro; Miwa, Hiroto

    2015-10-15

    Esophageal visceral hypersensitivity has been proposed to be the pathogenesis of heartburn sensation in nonerosive reflux disease. Protease-activated receptor-2 (PAR-2) is expressed in human esophageal epithelial cells and is believed to play a role in inflammation and sensation. PAR-2 activation may modulate these responses through adenosine triphosphate (ATP) release, which is involved in transduction of sensation and pain. The transient receptor potential vanilloid receptor 1 (TRPV1) and acid-sensing ion channels (ASICs) are both acid-sensitive nociceptors. However, the interaction among these molecules and the mechanisms of heartburn sensation are still not clear. We therefore examined whether ATP release in human esophageal epithelial cells in response to acid is modulated by TRPV1 and ASICs and whether PAR-2 activation influences the sensitivity of TRPV1 and ASICs. Weak acid (pH 5) stimulated the release of ATP from primary human esophageal epithelial cells (HEECs). This effect was significantly reduced after pretreatment with 5-iodoresiniferatoxin (IRTX), a TRPV1-specific antagonist, or with amiloride, a nonselective ASIC blocker. TRPV1 and ASIC3 small interfering RNA (siRNA) transfection also decreased weak acid-induced ATP release. Pretreatment of HEECs with trypsin, tryptase, or a PAR-2 agonist enhanced weak acid-induced ATP release. Trypsin treatment led to the phosphorylation of TRPV1. Acid-induced ATP release enhancement by trypsin was partially blocked by IRTX, amiloride, or a PAR-2 antagonist. Conversely, acid-induced ATP release was augmented by PAR-2 activation through TRPV1 and ASICs. These findings suggested that the pathophysiology of heartburn sensation or esophageal hypersensitivity may be associated with the activation of PAR-2, TRPV1, and ASICs. Copyright © 2015 the American Physiological Society.

  10. Dependence of abnormalities in the esophageal axis and wall thickness measured by computed tomography and its significance in the assessment of the depth of invasion in case of esophageal carcinoma; Abhaengigkeit der Achsdeformierungen im Oesophagogramm von der computertomographisch bestimmten Wanddicke und deren Wertigkeit bei der Beurteilung der Invasionstiefe des Oesophaguskarzinoms

    Energy Technology Data Exchange (ETDEWEB)

    Hacklaender, T. [Duesseldorf Univ. (Germany). Inst. fuer Diagnostische Radiologie; Ziegenhahn, E. [Duesseldorf Univ. (Germany). Inst. fuer Diagnostische Radiologie; Katoh, E. [St. Marien-Krankenhaus Ratingen (Germany). Chirurgische Abt.; Jungblut, R.M. [Duesseldorf Univ. (Germany). Abt. fuer Allgemein- und Unfallchirurgie; Moedder, U. [Duesseldorf Univ. (Germany). Abt. fuer Allgemein- und Unfallchirurgie

    1997-07-01

    Purpose: In this study we compared the abnormalities of the esophageal axis seen in the esophagogram with the thickness of the esophageal wall measured by computed tomography. We have investigated, how exactly both methods assess the local tumor invasion according to the TNM criteria and whether there is a relation between the esophageal axis and the wall thickness. Methods: In a retrospective study we examined the esophagograms of 65 tumorpatients. Computed tomography examinations were available in 40 cases. Using a graphical method the wall thickness was transferred to the esophagograms under consideration of the different scales of the images. Results: There is no correlation between the different types of distortion of the esophageal axis and the wall thickness in computed tomography. However, it can be demonstrated that the distortion results from specific fixation effects with the surrounding tissue. Conclusions: Both radiological methods cannot determinate the tumor invasion correctly. (orig.) [Deutsch] Ziel: Im Rahmen dieser Studie wird in einem Vergleich von Achsdeformierungen im Oesophagogramm und den in diesem Bereich computertomographisch ausgemessenen Wanddicken untersucht, wie genau beide Methoden in Invasionstiefe des Primaertumors im Sinne der TNM-Klassifikation beurteilen koennen. Ferner soll ueberprueft werden, ob ein kausaler Zusammenhang zwischen der Wanddicke und einer Achsdeformierung besteht. Methode: In einer retrospektiven Studie wurden die Oesophagogramme von 65 Karzinompatienten unter dem Gesichtspunkt moeglicher Achsdeformierungen ausgewertet. Bei 40 dieser Patienten wurde zus{epsilon}tzlich mit der Computertomographie die Dicke der Oesophaguswandung im Tumorbereich bestimmt und graphisch in die Oesophagogramme uebertragen. Ergebnisse: Es besteht keine Korrelation zwischen der Achsdeformierung und der computertomographisch sichtbaren Wandverdickung. Die verschiedenen Typen der Achsdeformierung koennen aber auf spezifische

  11. [Impact of glutamine, eicosapntemacnioc acid, branched-chain amino acid supplements on nutritional status and treatment compliance of esophageal cancer patients on concurrent chemoradiotherapy and gastric cancer patients on chemotherapy].

    Science.gov (United States)

    Cong, Minghua; Song, Chenxin; Zou, Baohua; Deng, Yingbing; Li, Shuluan; Liu, Xuehui; Liu, Weiwei; Liu, Jinying; Yu, Lei; Xu, Binghe

    2015-03-17

    To explore the effects of glutamine, eicosapntemacnioc acid (EPA) and branched-chain amino acids supplements in esophageal cancer patients on concurrent chemoradiotherapy and gastric cancer patients on chemotherapy. From April 2013 to April 2014, a total of 104 esophageal and gastric carcinoma patients on chemotherapy or concurrent chemoradiotherapy were recruited and randomly divided into experimental and control groups. Both groups received dietary counseling and routine nutritional supports while only experimental group received supplements of glutamine (20 g/d), EPA (3.3 g/d) and branched-chain amino acids (8 g/d). And body compositions, blood indicators, incidence of complications and completion rates of therapy were compared between two groups. After treatment, free fat mass and muscle weight increased significantly in experiment group while decreased in control group (P nutrition status, decrease the complications and improve compliance for esophageal cancer patients on concurrent chemo-radiotherapy and gastric cancer patients on postoperative adjuvant chemotherapy.

  12. Rho Kinase ROCK2 Mediates Acid-Induced NADPH Oxidase NOX5-S Expression in Human Esophageal Adenocarcinoma Cells.

    Directory of Open Access Journals (Sweden)

    Jie Hong

    Full Text Available Mechanisms of the progression from Barrett's esophagus (BE to esophageal adenocarcinoma (EA are not fully understood. We have shown that NOX5-S may be involved in this progression. However, how acid upregulates NOX5-S is not well known. We found that acid-induced increase in NOX5-S expression was significantly decreased by the Rho kinase (ROCK inhibitor Y27632 in BE mucosal biopsies and FLO-1 EA cells. In addition, acid treatment significantly increased the Rho kinase activity in FLO-1 cells. The acid-induced increase in NOX5-S expression and H2O2 production was significantly decreased by knockdown of Rho kinase ROCK2, but not by knockdown of ROCK1. Conversely, the overexpression of the constitutively active ROCK2, but not the constitutively active ROCK1, significantly enhanced the NOX5-S expression and H2O2 production. Moreover, the acid-induced increase in Rho kinase activity and in NOX5-S mRNA expression was blocked by the removal of calcium in both FLO-1 and OE33 cells. The calcium ionophore A23187 significantly increased the Rho kinase activity and NOX5-S mRNA expression. We conclude that acid-induced increase in NOX5-S expression and H2O2 production may depend on the activation of ROCK2, but not ROCK1, in EA cells. The acid-induced activation of Rho kinase may be mediated by the intracellular calcium increase. It is possible that persistent acid reflux present in BE patients may increase the intracellular calcium, activate ROCK2 and thereby upregulate NOX5-S. High levels of reactive oxygen species derived from NOX5-S may cause DNA damage and thereby contribute to the progression from BE to EA.

  13. Herpetic esophagitis

    International Nuclear Information System (INIS)

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

    1981-01-01

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

  14. Esophageal scintigraphy: A comparison with esophagoscopy

    Energy Technology Data Exchange (ETDEWEB)

    Kjellen, G.; Andersson, P.; Sandstroem, S.

    1987-01-01

    Fifty consecutive patients with different esophageal symtoms were investigated with esophageal endoscopy, transit scintigraphy, and gastroesophageal (GE) scintigraphy with extra-abdominal compression. Scintigraphic findings were abnormal in 27 of those 31 patients (87%) who were classified as abnormal at endoscopy. A prolonged transit time was the commonest finding, but hiatal hernia and GE reflux were also found. However, the scintigraphic procedure showed abnormalities in 6 of 19 (31%) patients who were classified as normal at endoscopy. Esophageal scintigraphy is recommended as a screening test before endoscopy is decided on. 20 refs.

  15. Esophageal Atresia

    DEFF Research Database (Denmark)

    Pedersen, Rikke Neess; Markøw, Simone; Kruse-Andersen, Søren

    2013-01-01

    Esophageal atresia (EA) is one of the most frequent congenital alimentary tract anomalies with a considerable morbidity throughout childhood. This study evaluates the gastroesophageal problems in 5-15year old children with EA and aims to identify factors predisposing to esophagitis in EA....

  16. Histopathologic profile of esophageal atresia and ...

    African Journals Online (AJOL)

    esophageal motility after successful repair of esophageal atresia (EA) and ... tissue were observed in only three LP specimens. Gastric- ... type of muscle fibers was identified. Muscles were examined for fibrosis and/or abnormally seated glands, ducts, or cartilage. Sections were also examined for the. Original article 1.

  17. Study of immunosuppressive factor (ISF) and immunosuppressive acidic protein (IAP) levels in 23 patients with uterus or esophageal cancer on radiotherapy

    International Nuclear Information System (INIS)

    Seno, Masao; Tsuru, Sumiaki; Kitani, Hideo; Zinnaka, Yutaka.

    1984-01-01

    Immunosuppressive factor (ISF) and immunosuppressive acidic protein (IAP) levels in 23 patients with uterus or esophageal cancer were assayed before and after radiotherapy. The results were as follows: (1) Serum ISF level increased while serum IAP level decreased with progress of radiotherapy. A negative correlation between ISF and IAP was found. (2) Administration of RSK (Krestin) for patients after radiotherapy was found to be effective in the follow-up examination of serum ISF level. (author)

  18. Esophageal Spasms

    Science.gov (United States)

    ... Symptom Checker Esophageal spasms Symptoms & causes Diagnosis & treatment Advertisement Mayo Clinic does not endorse companies or products. ... a Job Site Map About This Site Twitter Facebook Google YouTube Pinterest Mayo Clinic is a not- ...

  19. Pathophysiology and treatment of patients with globus sensation ―from the viewpoint of esophageal motility dysfunction―

    Science.gov (United States)

    Manabe, Noriaki; Tsutsui, Hideaki; Kusunoki, Hiroaki; Hata, Jiro; Haruma, Ken

    2014-01-01

    "Globus sensation" is often described as the sensation of a lump in the throat associated with dry swallowing or the need for dry swallowing, which disappears completely during eating or drinking and for which no organic cause can be established. Due to the uncertain etiology of "globus sensation", it remains difficult to establish standard treatment strategies for affected patients. Lately most attention has been focused on gastroesophageal reflux disease and several reports have indicated that there is a close relationship between esophageal acid reflux and globus sensation. Nowadays, empirical therapy with a high dose of a proton pump inhibitor (PPI) is considered to be indicated for patients with globus sensation, after excluding organic diseases such as pharyngeal cancer, Zenker's diverticulum, or thyroid enlargement. If patients are nonresponsive to PPI therapy, evaluation of esophageal motility should be done. In our recent study, 47.9% had abnormal esophageal motility, with the most common esophageal motility abnormality being an ineffective esophageal motility in PPI-resistant patients with globus sensation. This suggests that prokinetics alone or adding prokinetics to PPI should be the treatment to be considered, although few studies have investigated the efficacy of prokinetics in the treatment of patients with globus sensation. If patients without any esophageal motility dysfunctions are nonresponsive to PPI therapy, either cognitive-behavioral therapy, anti-depressants, or gabapentin could be helpful, although further well-designed, randomized controlled large-scale studies will be necessary to determine the effectiveness of each treatment strategy on patients with globus sensation. PMID:26081369

  20. Imaging of Esophageal Tuberculosis

    Energy Technology Data Exchange (ETDEWEB)

    Nagi, B.; Kochhar, R.; Bhasin, D.K.; Singh, K. [PGIMER, Chandigarh (India). Dept. of Gastroenterology; Lal, A.; Gulati, M.; Suri, S. [PGIMER, Chandigarh (India). Dept. of Radiodiagnosis

    2003-05-01

    Purpose: To evaluate the various radiological abnormalities in patients with proven esophageal tuberculosis. Material and Methods: The case records of 23 patients with proven esophageal tuberculosis were evaluated retrospectively for various radiological abnormalities. Twenty-two patients had secondary involvement of esophagus in the form of direct extension of mediastinal and pulmonary tuberculosis or spinal tuberculosis. Only 1 patient had primary involvement of the esophagus with no evidence of disease elsewhere. The diagnosis was confirmed by endoscopic and CT-guided biopsy/aspiration cytology in 7 and 6 cases, respectively. Diagnosis was made on the basis of surgical biopsy of lymph node and autopsy in 1 patient each. In the remaining 8 patients the diagnosis was based on radiological and endoscopic findings and the response to antituberculous treatment. Results: Chest radiography (CXR) was abnormal in 65% patients. While the findings were non-conclusive for esophageal tuberculosis, characteristic lesions of tuberculosis in lungs or spine were suggestive of tuberculous etiology. In 15 patients, CT of the chest confirmed the corresponding CXR findings and also showed additional findings of mediastinal lymphadenopathy when CXR was normal. Fourteen patients showed mediastinal lymphadenopathy on CT of the chest. In all these patients, more than one group of lymph nodes was involved. The characteristic hypodense center of lymph nodes suggestive of tuberculosis was seen in 12 patients. Radiological abnormalities seen in barium swallow examination were extrinsic compression, traction diverticula, strictures, sinus/fistulous tracts, kinking and pseudotumor mass of esophagus in decreasing order of frequency. The middle third of the esophagus was found to be the most frequent site of involvement.

  1. Imaging of Esophageal Tuberculosis

    International Nuclear Information System (INIS)

    Nagi, B.; Kochhar, R.; Bhasin, D.K.; Singh, K.; Lal, A.; Gulati, M.; Suri, S.

    2003-01-01

    Purpose: To evaluate the various radiological abnormalities in patients with proven esophageal tuberculosis. Material and Methods: The case records of 23 patients with proven esophageal tuberculosis were evaluated retrospectively for various radiological abnormalities. Twenty-two patients had secondary involvement of esophagus in the form of direct extension of mediastinal and pulmonary tuberculosis or spinal tuberculosis. Only 1 patient had primary involvement of the esophagus with no evidence of disease elsewhere. The diagnosis was confirmed by endoscopic and CT-guided biopsy/aspiration cytology in 7 and 6 cases, respectively. Diagnosis was made on the basis of surgical biopsy of lymph node and autopsy in 1 patient each. In the remaining 8 patients the diagnosis was based on radiological and endoscopic findings and the response to antituberculous treatment. Results: Chest radiography (CXR) was abnormal in 65% patients. While the findings were non-conclusive for esophageal tuberculosis, characteristic lesions of tuberculosis in lungs or spine were suggestive of tuberculous etiology. In 15 patients, CT of the chest confirmed the corresponding CXR findings and also showed additional findings of mediastinal lymphadenopathy when CXR was normal. Fourteen patients showed mediastinal lymphadenopathy on CT of the chest. In all these patients, more than one group of lymph nodes was involved. The characteristic hypodense center of lymph nodes suggestive of tuberculosis was seen in 12 patients. Radiological abnormalities seen in barium swallow examination were extrinsic compression, traction diverticula, strictures, sinus/fistulous tracts, kinking and pseudotumor mass of esophagus in decreasing order of frequency. The middle third of the esophagus was found to be the most frequent site of involvement

  2. Esophageal transit scintigraphy in systemic sclerosis

    Directory of Open Access Journals (Sweden)

    Marek Chojnowski

    2016-11-01

    Full Text Available Systemic sclerosis is a rare connective tissue disease, distinctive features of which are fibrosis and microangiopathy. The esophagus is one of the most commonly involved internal organs. Most patients experience dysphagia, difficulties in swallowing and gastro-esophageal reflux. However, in up to one third of cases, the initial onset of esophageal disease may be clinically silent. There are several diagnostic modalities available for assessing both morphological and functional abnormalities of the esophagus. If structural abnormalities are suspected, endoscopy is the method of choice. Functional evaluation is best achieved with manometry. Both endoscopy and manometry are invasive techniques, with low patient acceptance. Barium-contrast study is well tolerated, but qualitative assessment of functional abnormalities is imprecise. Esophageal scintigraphy is an easy, non-invasive, sensitive and specific diagnostic modality. It can detect esophageal dysfunction even in asymptomatic patients. In patients already diagnosed with systemic sclerosis, scintigraphy is useful in evaluating severity and progression of the disease.

  3. Gastric outlet obstruction without esophageal involvement: A late sequelae of acid ingestion in children

    Directory of Open Access Journals (Sweden)

    Sharma Shyam

    2007-01-01

    Full Text Available Accidental corrosive ingestion is not a rare occurrence in children because of easy access to strong household cleansers. Gastric injury as a predominant finding following acid ingestion in pediatric age group is less widely known with a few cases being reported in Indian literature. We report two such cases of gastric outlet obstruction following accidental ingestion of dilute acid. Both children have typical clinical presentation just 4-6 weeks after the ingestion. Upper GI endoscopy and barium meal studies confirmed the diagnosis. Early surgical intervention resulted in a satisfactory recovery. Both patients are doing well on follow up.

  4. Esophageal pH monitoring (image)

    Science.gov (United States)

    Esophageal pH monitoring is a test that measures how often and how long stomach acid is entering the esophagus. ... to a monitor which records the level of acidity in the esophagus. The patient records symptoms and ...

  5. Esophageal cancer

    International Nuclear Information System (INIS)

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

    2010-01-01

    Esophageal cancers are highly malignant tumours with often a poor prognosis, 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. (authors)

  6. Esophageal leiomyosarcoma

    International Nuclear Information System (INIS)

    Filartiga Lacroix, A.; Wattiez Gonzalez, C.; Gimenez Villarejo, A.; Lemir Marchese, P.

    1997-01-01

    Esophageal leiomyosarcoma is an infrequent non-epithelial malignant tumor very difficult to diagnose preoperatively.The diagnosis is based on barium swallow,endoscopy and biopsy.CT scan can be helpful for staging. The mitotic index is the main difference between leiomyosarcoma.Standard treatment is extensive esophagectomy will adjuvant radiotherapy.This report ia a case of esophageal leiomyosarcoma diagnosed and treated in our service.First Department of Surgery of the de Clinic Hospital in Asuncion,Paraguay; with a review of the literature

  7. Tongue Abnormalities Are Associated to a Maternal Folic Acid Deficient Diet in Mice

    OpenAIRE

    Estela Maldonado; Yamila López-Gordillo; Teresa Partearroyo; Gregorio Varela-Moreiras; Concepción Martínez-Álvarez; Juliana Pérez-Miguelsanz

    2017-01-01

    It is widely accepted that maternal folic acid (FA) deficiency during pregnancy is a risk factor for abnormal development. The tongue, with multiple genes working together in a coordinated cascade in time and place, has emerged as a target organ for testing the effect of FA during development. A FA-deficient (FAD) diet was administered to eight-week-old C57/BL/6J mouse females for 2–16 weeks. Pregnant dams were sacrificed at gestational day 17 (E17). The tongues and heads of 15 control and 21...

  8. A novel once daily microparticulate dosage form comprising lansoprazole to prevent nocturnal acid breakthrough in the case of gastro-esophageal reflux disease: preparation, pharmacokinetic and pharmacodynamic evaluation.

    Science.gov (United States)

    Alai, Milind; Lin, Wen Jen

    2013-01-01

    The objective of this study was to formulate and evaluate the lansoprazole (LPZ)-loaded microparticles to prevent nocturnal acid breakthrough in the case of gastro-esophageal reflux disease (GERD). The microparticulate delivery system was prepared by solvent evaporation method using Eudragit RS100 as a matrix polymer followed by enteric coated with Eudragit S100 and hydroxypropyl methylcellulose phthalate HP55 using spray drying method. The enteric coated microparticles were stable in gastric pH condition. In vivo pharmacokinetic and pharmacodynamic studies in male Wistar rats demonstrated that enteric coated microparticles sustained release of LPZ and promoted ulcer healing activity. In other words, the microparticulate dosage form provided effective drug concentration for a longer period as compared to conventional extended release dosage form, and showed sufficient anti-acid secretion activity to treat acid related disorders including the enrichment of nocturnal acid breakthrough event based on a once daily administration.

  9. Acid-base and hormonal abnormalities in dogs with naturally occurring diabetes mellitus.

    Science.gov (United States)

    Durocher, Lawren L; Hinchcliff, Kenneth W; DiBartola, Stephen P; Johnson, Susan E

    2008-05-01

    To examine acid-base and hormonal abnormalities in dogs with diabetes mellitus. Cross-sectional study. 48 dogs with diabetes mellitus and 17 healthy dogs. Blood was collected and serum ketone, glucose, lactate, electrolytes, insulin, glucagon, cortisol, epinephrine, norepinephrine, nonesterified fatty acid, and triglyceride concentrations were measured. Indicators of acid-base status were calculated and compared between groups. Serum ketone and glucose concentrations were significantly higher in diabetic than in healthy dogs, but there was no difference in venous blood pH or base excess between groups. Anion gap and strong ion difference were significantly higher and strong ion gap and serum bicarbonate concentration were significantly lower in the diabetic dogs. There were significant linear relationships between measures of acid-base status and serum ketone concentration, but not between measures of acid-base status and serum lactate concentration. Serum insulin concentration did not differ significantly between groups, but diabetic dogs had a wider range of values. All diabetic dogs with a serum ketone concentration > 1,000 micromol/L had a serum insulin concentration diabetic dogs was related to the glucagon-insulin ratio with only low concentrations of insulin required to prevent ketosis. Acidosis in ketotic dogs was attributable largely to high serum ketone concentrations.

  10. Esophageal intramural pseudodiverticulosis characterized by barium esophagography: a case report

    LENUS (Irish Health Repository)

    O'Connor, Owen J

    2010-05-21

    Abstract Introduction Esophageal intramural pseudodiverticulosis is a rare condition characterized by the dilatation of the submucosal glands. Case presentation We present a case of esophageal intramural pseudodiverticulosis in a 72-year-old Caucasian man who presented with dysphagia and with a background history of alcohol abuse. An upper gastrointestinal endoscopy of our patient showed an esophageal stricture with abnormal mucosal appearances, but no malignant cells were seen at biopsy. Appearances on a barium esophagram were pathognomonic for esophageal intramural pseudodiverticulosis. Conclusion We demonstrate the enduring usefulness of barium esophagography in the characterization of abnormal mucosal appearances at endoscopy.

  11. Esophageal cancer

    DEFF Research Database (Denmark)

    Mortensen, M. B.

    2007-01-01

    The distribution of adenocarcinomas and squamous cell carcinomas in esophageal cancer (EC) has changed, and focus directed towards tumors of the distal esophagus and the esophagogastric junction. The genetic events leading to EC are not fully clarified, but important risk factors have been...

  12. Electrocardiographic left ventricular hypertrophy without echocardiographic abnormalities evaluated by myocardial perfusion and fatty acid metabolic imaging

    International Nuclear Information System (INIS)

    Narita, Michihiro; Kurihara, Tadashi

    2000-01-01

    The pathophysiologic process in patients with electrocardiographic left ventricular hypertrophy with ST, T changes but without echocardiographic abnormalities was investigated by myocardial perfusion imaging and fatty acid metabolic imaging. Exercise stress 99m Tc-methoxy-isobutyl isonitrile (MIBI) imaging and rest 123 I-beta-methyl-p-iodophenyl pentadecanoic acid (BMIPP) imaging were performed in 59 patients with electrocardiographic hypertrophy including 29 without apparent cause including hypertension and echocardiographic hypertrophy, and 30 with essential hypertension. Coronary angiography was performed in 6 patients without hypertension and 4 with hypertension and biopsy specimens were obtained from the left ventricular apex from 6 patients without hypertension. Myocardial perfusion and 123 I-BMIPP images were classified into 3 types: normal, increased accumulation of the isotope at the left ventricular apex (high uptake) and defect. Transient perfusion abnormality and apical defect observed by 123 I-BMIPP imaging were more frequent in patients without hypertension than in patients with hypertension (32% vs. 17%, p=0.04671 in perfusion; 62% vs. 30%, p=0.0236 in 123 I-BMIPP). Eighteen normotensive patients with apical defect by 123 I-BMIPP imaging included 3 of 10 patients with normal perfusion at exercise, 6 of 10 patients with high uptake and 9 of 9 patients with perfusion defect. The defect size revealed by 123 I-BMIPP imaging was greater than that of the perfusion abnormality. Coronary stenoses were not observed and myocardial specimens showed myocardial disarray with hypertrophy. Moreover, 9 patients with hypertension and apical defects by 123 I-BMIPP showed 3 different types of perfusion. Many patients without hypertension show a pathologic process similar to hypertrophic cardiomyopathy. Perfusion and 123 I-BMIPP imaging are useful for the identification of these patients. (author)

  13. Electrocardiographic left ventricular hypertrophy without echocardiographic abnormalities evaluated by myocardial perfusion and fatty acid metabolic imaging

    Energy Technology Data Exchange (ETDEWEB)

    Narita, Michihiro; Kurihara, Tadashi [Sumitomo Hospital, Osaka (Japan)

    2000-01-01

    The pathophysiologic process in patients with electrocardiographic left ventricular hypertrophy with ST, T changes but without echocardiographic abnormalities was investigated by myocardial perfusion imaging and fatty acid metabolic imaging. Exercise stress {sup 99m}Tc-methoxy-isobutyl isonitrile (MIBI) imaging and rest {sup 123}I-beta-methyl-p-iodophenyl pentadecanoic acid (BMIPP) imaging were performed in 59 patients with electrocardiographic hypertrophy including 29 without apparent cause including hypertension and echocardiographic hypertrophy, and 30 with essential hypertension. Coronary angiography was performed in 6 patients without hypertension and 4 with hypertension and biopsy specimens were obtained from the left ventricular apex from 6 patients without hypertension. Myocardial perfusion and {sup 123}I-BMIPP images were classified into 3 types: normal, increased accumulation of the isotope at the left ventricular apex (high uptake) and defect. Transient perfusion abnormality and apical defect observed by {sup 123}I-BMIPP imaging were more frequent in patients without hypertension than in patients with hypertension (32% vs. 17%, p=0.04671 in perfusion; 62% vs. 30%, p=0.0236 in {sup 123}I-BMIPP). Eighteen normotensive patients with apical defect by {sup 123}I-BMIPP imaging included 3 of 10 patients with normal perfusion at exercise, 6 of 10 patients with high uptake and 9 of 9 patients with perfusion defect. The defect size revealed by {sup 123}I-BMIPP imaging was greater than that of the perfusion abnormality. Coronary stenoses were not observed and myocardial specimens showed myocardial disarray with hypertrophy. Moreover, 9 patients with hypertension and apical defects by {sup 123}I-BMIPP showed 3 different types of perfusion. Many patients without hypertension show a pathologic process similar to hypertrophic cardiomyopathy. Perfusion and {sup 123}I-BMIPP imaging are useful for the identification of these patients. (author)

  14. Abnormal myocardial free fatty acid utilization deteriorates with morphological changes in the hypertensive heart

    International Nuclear Information System (INIS)

    Nakayama, Hiroyuki; Morozumi, Takakazu; Nanto, Shinsuke

    2001-01-01

    The left ventricle's morphological adaptation to high blood pressure is classified into 4 patterns based on mass and wall thickness. The geometric changes caused by maladaptation to pressure overload possibly relate to progression of contractile dysfunction with abnormal energy metabolism. The present study assessed whether the geometric adaptation of the left ventricle (LV) to high blood pressure relates to changes in myocardial energy metabolism, especially free fatty acid (FFA) utilization. Thirty-five patients with essential hypertension underwent echocardiography and dual isotopes myocardial scintigraphy using iodine-123 labeled 15-p-iodophenyl-3-(R,S)-methylpentadecanoic acid (BMIPP, an analogue of a FFA) and thallium-201 (Tl-201). Systolic (endocardial fractional shortening; %FS) and diastolic indices (the ratio of early to atrial filling waves; E/A) of LV function were also assessed. Quantitative myocardial BMIPP uptake was evaluated by the BMIPP/Tl-201 myocardial uptake ratio (B/T). The subjects were divided into 4 groups based on LV mass and wall thickness: concentric hypertrophy (CH), eccentric hypertrophy (EH), concentric remodeling (CR), and normal geometry (N). The %FS was lower in the EH group than in the other groups. The mitral E/A ratio in the CH group was lowest. B/T was significantly decreased in the EH group compared with the N group (p<0.05). B/T correlated with the mitral E/A ratio significantly (p<0.05, r=0.42), whereas there was no relationship between %FS and B/T. These results indicate that the geometric changes occurring in hypertensive hearts strongly correlate with alternations in cardiac function and with abnormal myocardial FFA metabolism, and that the latter is associated with diastolic abnormality, but not with systolic function. (author)

  15. Abnormal myocardial free fatty acid utilization deteriorates with morphological changes in the hypertensive heart

    Energy Technology Data Exchange (ETDEWEB)

    Nakayama, Hiroyuki; Morozumi, Takakazu; Nanto, Shinsuke [Kansai Rosai Hospital, Amagasaki, Hyogo (Japan)] (and others)

    2001-09-01

    The left ventricle's morphological adaptation to high blood pressure is classified into 4 patterns based on mass and wall thickness. The geometric changes caused by maladaptation to pressure overload possibly relate to progression of contractile dysfunction with abnormal energy metabolism. The present study assessed whether the geometric adaptation of the left ventricle (LV) to high blood pressure relates to changes in myocardial energy metabolism, especially free fatty acid (FFA) utilization. Thirty-five patients with essential hypertension underwent echocardiography and dual isotopes myocardial scintigraphy using iodine-123 labeled 15-p-iodophenyl-3-(R,S)-methylpentadecanoic acid (BMIPP, an analogue of a FFA) and thallium-201 (Tl-201). Systolic (endocardial fractional shortening; %FS) and diastolic indices (the ratio of early to atrial filling waves; E/A) of LV function were also assessed. Quantitative myocardial BMIPP uptake was evaluated by the BMIPP/Tl-201 myocardial uptake ratio (B/T). The subjects were divided into 4 groups based on LV mass and wall thickness: concentric hypertrophy (CH), eccentric hypertrophy (EH), concentric remodeling (CR), and normal geometry (N). The %FS was lower in the EH group than in the other groups. The mitral E/A ratio in the CH group was lowest. B/T was significantly decreased in the EH group compared with the N group (p<0.05). B/T correlated with the mitral E/A ratio significantly (p<0.05, r=0.42), whereas there was no relationship between %FS and B/T. These results indicate that the geometric changes occurring in hypertensive hearts strongly correlate with alternations in cardiac function and with abnormal myocardial FFA metabolism, and that the latter is associated with diastolic abnormality, but not with systolic function. (author)

  16. Prevalence of reflux esophagitis among patients undergoing ...

    African Journals Online (AJOL)

    Ahmed Gado

    2013-10-25

    Oct 25, 2013 ... 2.1. Definitions. Gastro-esophageal RS are defined as heartburn with or with- out acid regurgitation.11 RE is defined as mucosal breaks in the lower esophagus, as seen by endoscopy.12 Severity of esophagitis was defined based on endoscopic findings accord- ing to the Savary-Miller grading system.13 ...

  17. Simultaneous retention index analysis of urinary amino acids and carboxylic acids for graphic recognition of abnormal state.

    Science.gov (United States)

    Paik, Man-Jeong; Lee, Hong-Jin; Kim, Kyoung-Rae

    2005-07-05

    Simultaneous profiling analysis of urinary amino acids (AAs) and carboxylic acids (CAs) was combined with retention index (I) analysis for graphic recognition of abnormal metabolic state. The temperature-programmed I values of the AA and CA standards measured as ethoxycarbonyl (EOC)/methoxime (MO)/tert-butyldimethylsilyl (TBDMS) derivatives were used as the reference I values. Urine samples were subjected to the sequential EOC, MO and TBDMS reactions for the analysis by gas chromatography (GC) and GC-mass spectrometry. The complex GC profiles were then transformed into their respective I patterns in bar graphic forms by plotting the normalized peak area ratios (%) of the identified AAs and CAs against their reference I values as the identification numbers. When the present method was applied to infant urine specimens from normal controls and patients with inherited metabolic diseases such as phenylketonuria, maple syrup urine disease, methylmalonic aciduria or isovaleric aciduria, each I pattern of bar graph more distinctly displayed quantitative abundances of urinary AAs and CAs in qualitative I scale, thus allowing graphic discrimination between normal and abnormal states.

  18. High-resolution esophageal pressure topography for esophageal motility disorders

    Directory of Open Access Journals (Sweden)

    Hashem Fakhre Yaseri

    2016-04-01

    Full Text Available Background: High-resolution manometer (HRM of the esophagus has become the main diagnostic test in the evaluation of esophageal motility disorders. The development of high-resolution manometry catheters and software displays of manometry recordings in color-coded pressure plots have changed the diagnostic assessment of esophageal disease. The first step of the Chicago classification described abnormal esophagogastric junction deglutitive relaxation. The latest classification system, proposed by Pandolfino et al, includes contraction patterns and peristalsis integrity based on integrated relaxation pressure 4 (IRP4. It can be discriminating the achalasia from non-achalasia esophageal motility disorders. The aim of this study was to assessment of clinical findings in non-achalasia esophageal motility disorders based on the most recent Chicago classification. Methods: We conducted a prospective cross-sectional study of 963 patients that had been referred to manometry department of Gastrointestinal and Liver Research Center, Firozgar Hospital, Tehran, Iran, from April, 2012 to April, 2015. They had upper GI disorder (Dysphasia, non-cardiac chest pain, regurgitation, heartburn, vomiting and asthma and weight loss. Data were collected from clinical examinations as well as patient questionnaires. Manometry, water-perfused, was done for all patients. Manometry criteria of the patients who had integrated relaxation pressure 4 (IRP4 ≤ 15 mmHg were studied. Results: Our finding showed that the non-achalasia esophageal motility disorders (58% was more common than the achalasia (18.2%. Heartburn (68.5%, regurgitation (65.4% and non-cardiac chest pain (60.6% were the most common clinical symptoms. Although, vomiting (91.7% and weight loss (63% were the most common symptoms in referring patients but did not discriminate this disorders from each other’s. Borderline motor function (67.2% was the most common, absent peristalsis (97% and the hyper

  19. The expression profile of acid-sensing ion channel (ASIC) subunits ASIC1a, ASIC1b, ASIC2a, ASIC2b, and ASIC3 in the esophageal vagal afferent nerve subtypes.

    Science.gov (United States)

    Dusenkova, Svetlana; Ru, Fei; Surdenikova, Lenka; Nassenstein, Christina; Hatok, Jozef; Dusenka, Robert; Banovcin, Peter; Kliment, Jan; Tatar, Milos; Kollarik, Marian

    2014-11-01

    Acid-sensing ion channels (ASICs) have been implicated in esophageal acid sensing and mechanotransduction. However, insufficient knowledge of ASIC subunit expression profile in esophageal afferent nerves hampers the understanding of their role. This knowledge is essential because ASIC subunits form heteromultimeric channels with distinct functional properties. We hypothesized that the esophageal putative nociceptive C-fiber nerves (transient receptor potential vanilloid 1, TRPV1-positive) express multiple ASIC subunits and that the ASIC expression profile differs between the nodose TRPV1-positive subtype developmentally derived from placodes and the jugular TRPV1-positive subtype derived from neural crest. We performed single cell RT-PCR on the vagal afferent neurons retrogradely labeled from the esophagus. In the guinea pig, nearly all (90%-95%) nodose and jugular esophageal TRPV1-positive neurons expressed ASICs, most often in a combination (65-75%). ASIC1, ASIC2, and ASIC3 were expressed in 65-75%, 55-70%, and 70%, respectively, of both nodose and jugular TRPV1-positive neurons. The ASIC1 splice variants ASIC1a and ASIC1b and the ASIC2 splice variant ASIC2b were similarly expressed in both nodose and jugular TRPV1-positive neurons. However, ASIC2a was found exclusively in the nodose neurons. In contrast to guinea pig, ASIC3 was almost absent from the mouse vagal esophageal TRPV1-positive neurons. However, ASIC3 was similarly expressed in the nonnociceptive TRPV1-negative (tension mechanoreceptors) neurons in both species. We conclude that the majority of esophageal vagal nociceptive neurons express multiple ASIC subunits. The placode-derived nodose neurons selectively express ASIC2a, known to substantially reduce acid sensitivity of ASIC heteromultimers. ASIC3 is expressed in the guinea pig but not in the mouse vagal esophageal TRPV1-positive neurons, indicating species differences in ASIC expression. Copyright © 2014 the American Physiological Society.

  20. Assessment of esophageal involvement in systemic sclerosis and morphea (localized scleroderma) by clinical, endoscopic, manometric and pH metric features: a prospective comparative hospital based study.

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    Arif, Tasleem; Masood, Qazi; Singh, Jaswinder; Hassan, Iffat

    2015-02-15

    Systemic sclerosis (SSc) is a generalized disorder of unknown etiology affecting the connective tissue of the body. It affects the skin and various internal organs. Gastrointestinal tract involvement is seen in almost 90% of the patients. Esophagus is the most frequently affected part of the gastrointestinal tract. Esophageal motility disturbance classically manifests as a reduced lower esophageal sphincter pressure (LESP) and loss of distal esophageal body peristalsis. Consequently, SSc patients may be complicated by erosive esophagitis and eventually by Barrett's esophagus and esophageal adenocarcinoma. Morphea, also known as localized scleroderma, is characterized by predominant skin involvement, with occasional involvement of subjacent muscles and usually sparing the internal organs. The involvement of esophagus in morphea has been studied very scarcely. The proposed study will investigate the esophageal involvement in the two forms of scleroderma (systemic and localized), compare the same and address any need of upper gastrointestinal evaluation in morphea (localized scleroderma) patients. 56 and 31 newly and already diagnosed cases of SSc and morphea respectively were taken up for the study. All the patients were inquired about the dyspeptic symptoms (heartburn and/or acid regurgitation and/or dysphagia). Upper gastrointestinal endoscopy, esophageal manometry and 24-hour pH monitoring were done in 52, 47 and 41 patients of SSc; and 28, 25 and 20 patients of morphea respectively. Esophageal symptoms were present in 39 cases (69.6%) of SSc which were mild in 22 (39.3%), moderate in 14 (25%), severe in three (5.3%); while only four cases (7.1%) of morphea had esophageal symptoms all of which were mild in severity. Reflux esophagitis was seen in 17 cases (32.7%) of SSc and only two cases (7.14%) of morphea. Manometric abnormalities were seen in 32 cases (68.1%) of SSc and none in morphea. Ambulatory 24-hour esophageal pH monitoring documented abnormal reflux in

  1. Esophageal Mucormycosis

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    Benjamin Boatright

    2014-01-01

    Full Text Available Mucormycosis is a rare invasive fungal infection with high mortality. It usually affects patients with poorly controlled diabetes, immunosuppression, or hematological malignancies. Gastroenterologists need to be aware of this rare infection because endoscopy can facilitate early diagnosis and prompt appropriate therapy. Here we describe a case of invasive esophageal mucormycosis that developed in a 63-year-old man with diabetes, acute promyelocytic leukemia, and prolonged leukopenia after chemotherapy. Upper endoscopy showed distal circumferential esophageal wall thickening with devitalization. The mucosa did not bleed after endoscopic biopsy. Histopathology confirmed mucormycosis. He was treated with various antifungal agents including echinocandins, fluconazole, and liposomal amphotericin B. Despite aggressive antifungal therapy and supportive care, the patient died 24 days later.

  2. Branched-chain amino acid metabolism in rat muscle: abnormal regulation in acidosis

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    May, R.C.; Hara, Y.; Kelly, R.A.; Block, K.P.; Buse, M.G.; Mitch, W.E.

    1987-06-01

    Branched-chain amino acid (BCAA) metabolism is frequently abnormal in pathological conditions accompanied by chronic metabolic acidosis. To study how metabolic acidosis affects BCAA metabolism in muscle, rats were gavage fed a 14% protein diet with or without 4 mmol NH/sub 4/Cl x 100 g body wt/sup -1/ x day/sup -1/. Epitrochlearis muscles were incubated with L-(1-/sup 14/C)-valine and L-(1-/sup 14/C)leucine, and rates of decarboxylation, net transamination, and incorporation into muscle protein were measured. Plasma and muscle BCAA levels were lower in acidotic rats. Rates of valine and leucine decarboxylation and net transamination were higher in muscles from acidotic rats; these differences were associated with a 79% increase in the total activity of branched-chain ..cap alpha..-keto acid dehydrogenase and a 146% increase in the activated form of the enzyme. They conclude that acidosis affects the regulation of BCAA metabolism by enhancing flux through the transaminase and by directly stimulating oxidative catabolism through activation of branched-chain ..cap alpha..-keto acid dehydrogenase.

  3. Tongue Abnormalities Are Associated to a Maternal Folic Acid Deficient Diet in Mice.

    Science.gov (United States)

    Maldonado, Estela; López-Gordillo, Yamila; Partearroyo, Teresa; Varela-Moreiras, Gregorio; Martínez-Álvarez, Concepción; Pérez-Miguelsanz, Juliana

    2017-12-28

    It is widely accepted that maternal folic acid (FA) deficiency during pregnancy is a risk factor for abnormal development. The tongue, with multiple genes working together in a coordinated cascade in time and place, has emerged as a target organ for testing the effect of FA during development. A FA-deficient (FAD) diet was administered to eight-week-old C57/BL/6J mouse females for 2-16 weeks. Pregnant dams were sacrificed at gestational day 17 (E17). The tongues and heads of 15 control and 210 experimental fetuses were studied. In the tongues, the maximum width, base width, height and area were compared with width, height and area of the head. All measurements decreased from 10% to 38% with increasing number of weeks on maternal FAD diet. Decreased head and tongue areas showed a harmonic reduction (Spearman nonparametric correlation, Rho = 0.802) with respect to weeks on a maternal FAD diet. Tongue congenital abnormalities showed a 10.9% prevalence, divided in aglossia (3.3%) and microglossia (7.6%), always accompanied by agnathia (5.6%) or micrognathia (5.2%). This is the first time that tongue alterations have been related experimentally to maternal FAD diet in mice. We propose that the tongue should be included in the list of FA-sensitive birth defect organs due to its relevance in several key food and nutrition processes.

  4. Tongue Abnormalities Are Associated to a Maternal Folic Acid Deficient Diet in Mice

    Directory of Open Access Journals (Sweden)

    Estela Maldonado

    2017-12-01

    Full Text Available It is widely accepted that maternal folic acid (FA deficiency during pregnancy is a risk factor for abnormal development. The tongue, with multiple genes working together in a coordinated cascade in time and place, has emerged as a target organ for testing the effect of FA during development. A FA-deficient (FAD diet was administered to eight-week-old C57/BL/6J mouse females for 2–16 weeks. Pregnant dams were sacrificed at gestational day 17 (E17. The tongues and heads of 15 control and 210 experimental fetuses were studied. In the tongues, the maximum width, base width, height and area were compared with width, height and area of the head. All measurements decreased from 10% to 38% with increasing number of weeks on maternal FAD diet. Decreased head and tongue areas showed a harmonic reduction (Spearman nonparametric correlation, Rho = 0.802 with respect to weeks on a maternal FAD diet. Tongue congenital abnormalities showed a 10.9% prevalence, divided in aglossia (3.3% and microglossia (7.6%, always accompanied by agnathia (5.6% or micrognathia (5.2%. This is the first time that tongue alterations have been related experimentally to maternal FAD diet in mice. We propose that the tongue should be included in the list of FA-sensitive birth defect organs due to its relevance in several key food and nutrition processes.

  5. Indications of 24-h esophageal pH monitoring, capsule pH monitoring, combined pH monitoring with multichannel impedance, esophageal manometry, radiology and scintigraphy in gastroesophageal reflux disease?

    Science.gov (United States)

    Vardar, Rukiye; Keskin, Muharrem

    2017-12-01

    Ambulatory esophageal pH monitoring is an essential method in patients exhibiting signs of non-erosive reflux disease (NERD) to make an objective diagnosis. Intra-esophageal pH monitoring is important in patients who are non-responsive to medications and in those with extraesophageal symptoms, particularly in NERD, before surgical interventions. With the help of the wireless capsule pH monitoring, measurements can be made under more physiological conditions as well as longer recordings can be performed because the investigation can be better tolerated by patients. Ambulatory esophageal pH monitoring can be detected within normal limits in 17%-31.4% of the patients with endoscopic esophagitis; therefore, normal pH monitoring cannot exclude the diagnosis of gastroesophageal reflux disease (GERD). Multi-channel intraluminal impedance pH (MII-pH) technology have been developed and currently the most sensitive tool to evaluate patients with both typical and atypical reflux symptoms. The sensitivity of a pH catheter test is 58% for the detection of acid reflux compared with MII-pH monitoring; further, its sensitivity is 28% for the detection of weak acid reflux compared with MII-pH monitoring. By adding impedance to pH catheter in patients with reflux symptoms, particularly in those receiving PPIs, it has been demonstrated that higher rates of diagnoses and symptom analyses can be obtained than those using only pH catheter. Esophageal manometry is used in the evaluation of patients with functional dysphagia and unexplained noncardiac chest pain and prior to antireflux surgery. The use of esophageal manometry is suitable for the detection of esophageal motor patterns and extreme motor abnormalities (e.g., achalasia and extreme hypomotility). Esophageal manometry and ambulatory pH monitoring are often used in assessments prior to laparoscopic antireflux surgery and in patients with reflux symptoms refractory to medical treatment. Although the esophageal motility is

  6. Doxycycline induced Esophagitis

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    Banu Karakus Yilmaz

    2014-02-01

    Full Text Available Esophagitis is a hazardous condition such as acid reflux of esophageal mucosa, infection, systemic diseases, radiation, drugs and trauma. Drug- induced esophagial injury (DIEI is a disease with the use of variety of drugs that caused serious damage and ulcer in the mucosa of the esophagus. The most commonly implicated drugs are non-steroidal anti-inflammatory drugs (NSAIDs, chloride and especially antibiotics. Thirty-six year-old female patient presented to the emergency department with odynophagia during swallowing and complaining of retrosternal pain. One week before 100 mg doxycycline (2x1 PO for therapeutic abortion were prescribed. It was learned that in the third day of the initiation of medication, the patient\\'s symptoms began and stopped using drug by the fourth day due to advers effect of drugs, but her symptoms didn’t regressed although she didn’t use them. Endoscopy appointment was taken, proton pump inhibitor and antiacid treatment was given, than patient was discharged from the emergency department. In the endoscopy, 20 mm segment esophageal ulcer was seen approximately in the 30.th cm of the esophagius. DIEI is a relatively common, although under-recognized, so this case was presented for remainding DIEI to emergency medicine personals and reweiving its diagnosis, treatment and follow-up.

  7. Scintiscanning study of esophageal transit on the chronic chagasic esophagopaty

    International Nuclear Information System (INIS)

    Rezende Filho, J.

    1985-01-01

    The passage of a radionuclide labelled 10 ml liquid bolus through the esophagus was evaluated by a scintigraphic method in 13 normal subjects, 13 asymptomatic Chagas' disease patients, and 39 Chagas' disease patients with esophageal symptoms and/or radiological esophageal abnormalities. The manometric evaluation of esophagus was performed on 44 Chagas' disease patients by a standard manometric technique. (author)

  8. Environmental enrichment attenuates behavioral abnormalities in valproic acid-exposed autism model mice.

    Science.gov (United States)

    Yamaguchi, Hiroshi; Hara, Yuta; Ago, Yukio; Takano, Erika; Hasebe, Shigeru; Nakazawa, Takanobu; Hashimoto, Hitoshi; Matsuda, Toshio; Takuma, Kazuhiro

    2017-08-30

    We recently demonstrated that prenatal exposure to valproic acid (VPA) at embryonic day 12.5 causes autism spectrum disorder (ASD)-like phenotypes such as hypolocomotion, anxiety-like behavior, social deficits and cognitive impairment in mice and that it decreases dendritic spine density in the hippocampal CA1 region. Previous studies show that some abnormal behaviors are improved by environmental enrichment in ASD rodent models, but it is not known whether environmental enrichment improves cognitive impairment. In the present study, we examined the effects of early environmental enrichment on behavioral abnormalities and neuromorphological changes in prenatal VPA-treated mice. We also examined the role of dendritic spine formation and synaptic protein expression in the hippocampus. Mice were housed for 4 weeks from 4 weeks of age under either a standard or enriched environment. Enriched housing was found to increase hippocampal brain-derived neurotrophic factor mRNA levels in both control and VPA-exposed mice. Furthermore, in VPA-treated mice, the environmental enrichment improved anxiety-like behavior, social deficits and cognitive impairment, but not hypolocomotion. Prenatal VPA treatment caused loss of dendritic spines in the hippocampal CA1 region and decreases in mRNA levels of postsynaptic density protein-95 and SH3 and multiple ankyrin repeat domains 2 in the hippocampus. These hippocampal changes were improved by the enriched housing. These findings suggest that the environmental enrichment improved most ASD-like behaviors including cognitive impairment in the VPA-treated mice by enhancing dendritic spine function. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Elimination diets in the management of eosinophilic esophagitis

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    Wechsler JB

    2014-05-01

    Full Text Available Joshua B Wechsler, Sally Schwartz, Katie Amsden, Amir F Kagalwalla Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA Abstract: Eosinophilic esophagitis, an increasingly recognized chronic inflammatory disorder isolated to the esophagus, is triggered by an abnormal allergic response to dietary antigens. Current treatment includes swallowed topical steroids and dietary modification, which aim to resolve symptoms and prevent long-term complications such as formation of strictures. The dietary approach has become more widely accepted because long-term steroid therapy is associated with potential risks. Dietary treatment includes elemental and elimination diets. An exclusive elemental diet, which requires replacement of all intact protein with amino acid-based formula, offers the best response of all available therapies, with remission in up to 96% of subjects proving it to be superior to all other available therapies including topical steroids. However, compliance with this approach is challenging because of poor taste and monotony. The high cost of formula and the associated psychosocial problems are additional drawbacks of this approach. Empiric and allergy test-directed elimination diets have gained popularity given that elimination of a limited number of foods is much easier and as such is more readily acceptable. There is a growing body of literature supporting this type of therapy in both children and adults. This paper reviews the evidence for all types of dietary therapy in eosinophilic esophagitis. Keywords: eosinophilic esophagitis, dietary therapy, empiric elimination, elemental, allergy test-directed

  10. The Pathophysiology of Eosinophilic Esophagitis

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    Daniel Avi Lemberg

    2014-05-01

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

  11. The radiology of early esophageal cancer

    International Nuclear Information System (INIS)

    Uematsu, S.

    1988-01-01

    The radiographic diagnosis of early esophageal cancer is described based on 25 cases in which depth of invasion was limited to not more than the submucosal layer. It is emphasized that double contrast radiography should be designed to delineate the subtle abnormalities of the esophageal mucosa and margins of lesions which are characteristic of early cancer, and that further investigation should be directed to improving the method of examination so that the detection of ep- and mm-cancer which has a better prognosis than sm cancer can be detected more readily. A macroscopic classification of early esophageal cancer (elevated, flat, depressed and mixed type) which is useful for both endoscopic and radiographic diagnosis is proposed. The 5-year survival rate of esophageal cancer which was limited to the submucosal layer or less (ep-, mm- and sm-cancer) was 50%

  12. Tannic acid label indicates abnormal cell development coinciding with regeneration of renal tubules.

    Science.gov (United States)

    Minuth, Will W; Denk, Lucia

    2014-01-01

    Stem/progenitor cells are in the focus of research as a future therapeutic option to stimulate regeneration in diseased renal parenchyma. However, current data indicate that successful seeding of implanted stem/progenitor cells is prevented by harmful interstitial fluid and altered extracellular matrix. To find out possible parameters for cell adaptation, the present investigation was performed. Renal stem/progenitor cells were mounted in an artificial interstitium for perfusion culture. Exposure to chemically defined but CO2-independent culture media was tested during 13 days. Cell biological features were then analyzed by histochemistry, while structural details were investigated by transmission electron microscopy after conventional and improved fixation of specimens. Culture of renal stem/progenitor cells as well in Leibovitz's L-15 Medium as CO2 Independent Medium shows in fluorescence microscopy spatial development of numerous tubules. Specimens of both media fixed by conventional glutaraldehyde exhibit in electron microscopy a homogeneous cell population in developed tubules. In contrast, fixation by glutaraldehyde including tannic acid illuminates that dispersed dark marked cells of unknown function are present. The screening further demonstrates that the dark cell type does not comply with cells found in embryonic, maturing or matured renal parenchyma. The actual data show that development of abnormal cell features must be taken into account, when regeneration of renal tubules is simulated under in vitro conditions.

  13. Abnormalities in the tricarboxylic Acid cycle in Huntington disease and in a Huntington disease mouse model.

    Science.gov (United States)

    Naseri, Nima N; Xu, Hui; Bonica, Joseph; Vonsattel, Jean Paul G; Cortes, Etty P; Park, Larry C; Arjomand, Jamshid; Gibson, Gary E

    2015-06-01

    Glucose metabolism is reduced in the brains of patients with Huntington disease (HD). The mechanisms underlying this deficit, its link to the pathology of the disease, and the vulnerability of the striatum in HD remain unknown. Abnormalities in some of the key mitochondrial enzymes involved in glucose metabolism, including the pyruvate dehydrogenase complex (PDHC) and the tricarboxylic acid (TCA) cycle, may contribute to these deficits. Here, activities for these enzymes and select protein levels were measured in human postmortem cortex and in striatum and cortex of an HD mouse model (Q175); mRNA levels encoding for these enzymes were also measured in the Q175 mouse cortex. The activities of PDHC and nearly all of the TCA cycle enzymes were dramatically lower (-50% to 90%) in humans than in mice. The activity of succinate dehydrogenase increased with HD in human (35%) and mouse (23%) cortex. No other changes were detected in the human HD cortex or mouse striatum. In Q175 cortex, there were increased activities of PDHC (+12%) and aconitase (+32%). Increased mRNA levels for succinyl thiokinase (+88%) and isocitrate dehydrogenase (+64%) suggested an upregulation of the TCA cycle. These patterns of change differ from those reported in other diseases, which may offer unique metabolic therapeutic opportunities for HD patients.

  14. Verapamil reverses PTH- or CRF-induced abnormal fatty acid oxidation in muscle

    International Nuclear Information System (INIS)

    Perna, A.F.; Smogorzewski, M.; Massry, S.G.

    1988-01-01

    Chronic renal failure (CRF) is associated with impaired long chain fatty acids (LCFA) oxidation by skeletal muscle mitochondria. This is due to reduced activity of carnitine palmitoyl transferase (CPT). These derangements were attributed to the secondary hyperparathyroidism of CRF, since prior parathyroidectomy in CRF rats reversed these abnormalities and PTH administration to normal rats reproduced them. It was proposed that these effects of PTH are mediated by its ionophoric property leading to increased entry of calcium into skeletal muscle. A calcium channel blocker may, therefore, correct these derangements. The present study examined the effects of verapamil on LCFA oxidation, CPT activity by skeletal muscle mitochondria, and 45 Ca uptake by skeletal muscle obtained from CRF rats and normal animals treated with PTH with and without verapamil. Both four days of PTH administration and 21 days of CRF produced significant (P less than 0.01) reduction in LCFA oxidation and CPT activity of skeletal muscle mitochondria, and significant (P less than 0.01) increment in 45 Ca uptake by skeletal muscle. Simultaneous treatment with verapamil corrected all these derangements. Administration of verapamil alone to normal rats did not cause a significant change in any of these parameters. The data are consistent with the proposition that the alterations in LCFA in CRF or after PTH treatment are related to the ionophoric action of the hormone and could be reversed by a calcium channel blocker

  15. Verapamil reverses PTH- or CRF-induced abnormal fatty acid oxidation in muscle

    Energy Technology Data Exchange (ETDEWEB)

    Perna, A.F.; Smogorzewski, M.; Massry, S.G.

    1988-12-01

    Chronic renal failure (CRF) is associated with impaired long chain fatty acids (LCFA) oxidation by skeletal muscle mitochondria. This is due to reduced activity of carnitine palmitoyl transferase (CPT). These derangements were attributed to the secondary hyperparathyroidism of CRF, since prior parathyroidectomy in CRF rats reversed these abnormalities and PTH administration to normal rats reproduced them. It was proposed that these effects of PTH are mediated by its ionophoric property leading to increased entry of calcium into skeletal muscle. A calcium channel blocker may, therefore, correct these derangements. The present study examined the effects of verapamil on LCFA oxidation, CPT activity by skeletal muscle mitochondria, and /sup 45/Ca uptake by skeletal muscle obtained from CRF rats and normal animals treated with PTH with and without verapamil. Both four days of PTH administration and 21 days of CRF produced significant (P less than 0.01) reduction in LCFA oxidation and CPT activity of skeletal muscle mitochondria, and significant (P less than 0.01) increment in /sup 45/Ca uptake by skeletal muscle. Simultaneous treatment with verapamil corrected all these derangements. Administration of verapamil alone to normal rats did not cause a significant change in any of these parameters. The data are consistent with the proposition that the alterations in LCFA in CRF or after PTH treatment are related to the ionophoric action of the hormone and could be reversed by a calcium channel blocker.

  16. [Esophageal moniliasis].

    Science.gov (United States)

    Ramírez Degollado, J; Martínez Aguilar, A; Peniche Bojórquez, J

    1978-01-01

    Esophageal moniliasis is found rarely. It has been described mainly in chronically ill patients, who receive antibiotics and corticoesteroids. Early diagnosis and treatment betters their prognosis. Nine patients, 5 males and 4 females were studies in Hospital General del Centro Medico Nacional in Mexico City. Their agesranged from 26 to 77 years, with a mean of 49 years. All patients were chronically ill and 7 of them were treated in the intensive care unit. Three had disphagia, 3 retrosternal pain, and 2 gastrointestinal hemorrhage. Eight patients had high W.B.C., 3 irregular filling defects on X ray studies, and on endoscopy, all showed a pseudomembranous white yellowish exudate, underneath it the mucosa was inflamed, irregular and bled scantily. In 5 out of 9 patients biopsy and a smear confirmed the diagnosis. Eight patients treated with nystatin were cured. This disorder must be suspected in patients with disphagia and retrosternal pain; esophagoscopy is the prefered procedure to establish this diagnosis.

  17. Role of diagnostic tests in esophageal evaluation

    International Nuclear Information System (INIS)

    Silverstein, B.D.; Pope, C.E. II

    1980-01-01

    In the evaluation of esophageal disease, the appropriate question must be asked before the correct tests can be selected. Reflux can be demonstrated by radiologic methods, pH testing or radioisotopic techniques. Esophageal mucosal damage is best evaluated by x-ray, endoscopy, or biopsy. Chest pain is demonstrated by acid infusion or by manometry. Two algorithms are presented for the evaluation of chest pain and reflux symptoms

  18. Brain processing of visceral sensation upon esophageal chemical stimulation in different types of GERD

    International Nuclear Information System (INIS)

    Xu Shuchang; Zheng Fangfang; Zhao Xiaohu; Chen Ying; Kong Xuan; Wang Chen; Zhu Liren; Wang Zhiyong

    2010-01-01

    We designed to investigate the cortical response to esophageal acid exposure in different types of gastroesophageal reflux disease (GERD) by functional magnetic resonance imaging (fMRI). Fifteen healthy volunteers, 13 with reflux esophagitis (RE), 12 with non-erosive reflux disease with abnormal acid reflux (NERD+) and nine with non-erosive reflux disease with normal acid reflux (NERD-) received intraesophageal perfusion with isotonic saline followed by 0.1 N hydrochloric acid. Modified block-design model of fMRI scanning was performed simultaneously to the intraesophageal perfusion. The sensitized regions in different types of GERD were not completely identical but were more widely distributed compared to the sensitized regions in the healthy individuals. The activated intensity of the ACC was significantly higher in the healthy volunteers compared to the GERD patients (P < 0.001). Nevertheless, healthy volunteers exhibited a significantly lighter intensity in the right side of the DLPFC (P < 0.001) and a lower intensity in the left side of the insula than the GERD patients (P < 0.05). In conclusion, the underlying central mechanisms of esophageal visceral sensation in different types of GERD patients are quite different. The deactivation of the ACC, the activation of the right side of the DLPFC and the right side of the insula may play an important role in the occurrence of GERD.

  19. Liquid-containing Refluxes and Acid Refluxes May Be Less Frequent in the Japanese Population Than in Other Populations: Normal Values of 24- hour Esophageal Impedance and pH Monitoring.

    Science.gov (United States)

    Kawamura, Osamu; Kohata, Yukie; Kawami, Noriyuki; Iida, Hiroshi; Kawada, Akiyo; Hosaka, Hiroko; Shimoyama, Yasuyuki; Kuribayashi, Shiko; Fujiwara, Yasuhiro; Iwakiri, Katsuhiko; Inamori, Masahiko; Kusano, Motoyasu; Hongo, Micho

    2016-10-30

    Twenty-four-hour esophageal impedance and pH monitoring allows detection of all types of reflux episodes and is considered the best technique for identifying gastroesophageal refluxes. However, normative data for the Japanese population are lacking. This multicenter study aimed to establish the normal range of 24-hour esophageal impedance and pH data both in the distal and the proximal esophagus in Japanese subjects. Forty-two healthy volunteers (25 men and 17 women) with a mean ± standard deviation age of 33.3 ± 12.4 years (range: 22-72 years) underwent a combined 24-hour esophageal impedance and pH monitoring. According to the physical and pH properties, distal or proximal esophageal reflux events were categorized. Median 45 reflux events occurred in 24 hours, and the 95th percentile was 85 events. Unlike previous reports, liquid-containing reflux events are median 25/24 hours with the 95th percentile of 62/24 hours. Acidic reflux events were median 11/24 hours with the 95th percentile of 39/24 hours. Non-acidic gas reflux events were median 15/24 hours with the 95th percentile of 39/24 hours. Proximal reflux events accounted for 80% of the total reflux events and were mainly non-acidic gas refluxes. About 19% of liquid and mixed refluxes reached the proximal esophagus. Unlike previous studies, liquid-containing and acidic reflux events may be less frequent in the Japanese population. Non-acidic gas reflux events may be frequent and a cause of frequent proximal reflux events. This study provides important normative data for 24-hour impedance and pH monitoring in both the distal and the proximal esophagus in the Japanese population.

  20. Computed tomography and upper gastrointestinal series findings of esophageal bronchi in infants

    Energy Technology Data Exchange (ETDEWEB)

    Colleran, Gabrielle C. [Boston Children' s Hospital and Harvard Medical School, Department of Radiology, Boston, MA (United States); Our Lady' s Children' s Hospital Crumlin, Department of Radiology, Dublin (Ireland); Ryan, Ciara E. [Our Lady' s Children' s Hospital Crumlin, Department of Pathology, Dublin (Ireland); Lee, Edward Y. [Boston Children' s Hospital and Harvard Medical School, Department of Radiology, Boston, MA (United States); Sweeney, Brian [Our Lady' s Children' s Hospital Crumlin, Department of Surgery, Dublin (Ireland); Rea, David; Brenner, Clare [Our Lady' s Children' s Hospital Crumlin, Department of Radiology, Dublin (Ireland)

    2017-02-15

    Esophageal bronchus is a rare form of communicating bronchopulmonary foregut malformation and a rare but important cause of an opaque hemithorax on chest radiography. A higher incidence of esophageal bronchus is associated with esophageal atresia, tracheo-esophageal fistula (TEF) and VACTERL (vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities) association. In the presence of these conditions, the pediatric radiologist may be the first to consider the diagnosis of esophageal bronchus or esophageal lung. To describe the imaging features in five children with esophageal bronchus. We reviewed hospital records and teaching files at two large pediatric tertiary referral centers over the 24-year period from January 1992 to January 2016. We reviewed all imaging studies and tabulated findings on radiography, fluoroscopic upper gastrointestinal (GI) series and CT. We then described the imaging features of esophageal bronchi with emphasis on CT and upper GI findings in four infants and one toddler. Three cases were identified from one institution (cases 2, 3, 4) and two from another (cases 1, 5). All five cases occurred in association with other midline malformations: four of the five had VACTERL association and three of the five had esophageal atresia and TEF. Lung opacification, ipsilateral mediastinal shift, and an abnormal carina and anomalous vascular anatomy suggest an esophageal bronchus or an esophageal lung on CT. While esophageal bronchus is a rare cause of an opaque hemithorax, CT and upper GI imaging play key roles in its diagnosis. Associations with esophageal atresia with tracheo-esophageal fistula and VACTERL association are particularly pertinent. Early diagnosis of esophageal bronchus might prevent complications such as aspiration and infection, which can allow for parenchymal sparing surgery as opposed to pneumonectomy. (orig.)

  1. Radionuclide transit in esophageal varices

    International Nuclear Information System (INIS)

    Yeh, S.H.; Wang, S.J.; Wu, L.C.; Liu, R.S.; Tsai, Y.T.; Chiang, T.T.

    1985-01-01

    This study assessed esophageal motility in patients with esophageal varices by radionuclide transit studies. Data were acquired in list mode after an oral dose of 0.5 mCi Tc-99m sulfur colloid in 10 ml of water in the supine position above a low-energy all-purpose collimator of a gamma camera. The condensed image (CI) superimposed with a centroid curve was also produced in each case. Twenty-five normal subjects (N) and 32 patients (pts) with esophageal varices by endoscopy (large varices in Grades IV and V in 8 and small varices in Grade III or less in 24) were studied. TMTT, RTT, RF, and RI were all significantly increased in pts as compared to N. Especially, the transit time for the middle third (6.7 +- 2.6 sec vs 3.5 +- 0.9 sec in N, rho < 0.005) had the optimal sensitivy and specificity of 88% each at the cutoff value of 4.2 sec as determined by ROC analysis. In summary, radionuclide transit disorders occur in the majority of pts with esopageal varices. The middle RTT and CI are both optimal in sensitivity and specificity for detecting the abnormalities

  2. Fatty acid metabolic and perfusion abnormalities in hypertrophied myocardium assessed by dual tracer tomography using thallium-201 and iodine-123-beta-methylpentadecanoic acid

    Energy Technology Data Exchange (ETDEWEB)

    Kobayashi, Hiroshi; Nakata, Tomoaki; Han, Shizui (Sapporo Medical Coll. (Japan)) (and others)

    Fatty acid and perfusion abnormalities associated with cardiac hypertrophy were investigated using dual tracer tomography with thallium and a cardiac metabolic tracer, 15-(p-iodophenyl)-3-R, S-methylpentadecanoic acid (BMIPP), in eight patients with hypertrophic cardiomyopathy (HCM) and in three with hypertension (HT). Thallium and BMIPP uptakes were scored and analyzed in 143 segments (13/heart) by comparison with the left ventricular wall thickness measured by two dimensional echocardiography. Complete agreement of both scores in HT patients was significantly higher than that in HCM patients (64% vs 24%, p<0.001), while a lower BMIPP uptake compared to that of thallium (mismatching) was observed more frequently in HCM than in HT patients (65% vs 31%, p<0.001). The wall thickness significantly (p<0.005) correlated with BMIPP uptake score. HCM patients showed a low BMIPP uptake in 22 hypertrophic segments (59%) and 15 non-hypertrophic segments (41%), and reduced BMIPP uptake in 29% hypertrophic segments, while HT patients showed just five segments with decreased BMIPP uptake of which 4 were non-hypertrophic and only one hypertrophic. The left ventricular ejection fraction assessed by radionuclide ventriculography was normal and no regional wall motion abnormality was detected in any patient by echocardiographic and scintigraphic studies. Metabolic abnormalities detected by the iodine-123-beta-methyl fatty acid analog in hypertrophic cardiomyopathy may be independent of thallium myocardial perfusion, regional wall motion, or the magnitude of cardiac hypertrophy, suggesting that fatty acid imaging may be useful in investigating the pathogenesis and subclinical abnormality of hypertrophic cardiomyopathy, and differentiation from secondary, induced cardiac hypertrophy. (author).

  3. Abnormalities in plasma and red blood cell fatty acid profiles of patients with colorectal cancer.

    OpenAIRE

    Bar??, L.; Hermoso, J. C.; N????ez, M. C.; Jim??nez-Rios, J. A.; Gil, A.

    1998-01-01

    We evaluated total plasma fatty acid concentrations and percentages, and the fatty acid profiles for the different plasma lipid fractions and red blood cell lipids, in 17 patients with untreated colorectal cancer and 12 age-matched controls with no malignant diseases, from the same geographical area. Cancer patients had significantly lower total plasma concentrations of saturated, monounsaturated and essential fatty acids and their polyunsaturated derivatives than healthy controls; when the v...

  4. Esophageal lichen planus*

    Science.gov (United States)

    de Oliveira, Janine Pichler; Uribe, Natalia Caballero; Abulafia, Luna Azulay; Quintella, Leonardo Pereira

    2015-01-01

    Lichen planus is a chronic inflammatory disease that affects the skin, mucous membranes, nails and scalp. Esophageal lichen planus is a rarely reported manifestation of lichen planus, presenting itself commonly in middle-aged women, with symptoms such as dysphagia. We report a case of esophageal lichen planus in a 54-year-old woman associated with oral, cutaneous and ungual lichen planus. Although lichen planus is a disorder well known by dermatologists, reports of esophageal lichen planus are rare in dermatologic literature. The esophageal lichen planus is little known and underdiagnosed, with a significant delay between the onset of symptoms and diagnosis. PMID:26131872

  5. Esophageal lichen planus.

    Science.gov (United States)

    Oliveira, Janine Pichler de; Uribe, Natalia Caballero; Abulafia, Luna Azulay; Quintella, Leonardo Pereira

    2015-01-01

    Lichen planus is a chronic inflammatory disease that affects the skin, mucous membranes, nails and scalp. Esophageal lichen planus is a rarely reported manifestation of lichen planus, presenting itself commonly in middle-aged women, with symptoms such as dysphagia. We report a case of esophageal lichen planus in a 54-year-old woman associated with oral, cutaneous and ungual lichen planus. Although lichen planus is a disorder well known by dermatologists, reports of esophageal lichen planus are rare in dermatologic literature. The esophageal lichen planus is little known and underdiagnosed, with a significant delay between the onset of symptoms and diagnosis.

  6. High-Performance Thin-Layer Chromatographic Quantification of Rosmarinic Acid and Rutin in Abnormal Savda Munziq

    Directory of Open Access Journals (Sweden)

    S. G. Tian

    2013-01-01

    Full Text Available A high-performance thin-layer chromatographic (HPTLC method has been established for simultaneous analysis of rosmarinic acid and rutin in Abnormal Savda Munziq (ASMq. A methanol extract of ASMq was used for quantification. The compounds were separated on silica gel H thin layer plate with ethyl acetate-formic acid-acetic acid-water 15 : 1 : 1 : 1.5 (v/v as a developer, trichloroethanol as the color reagent. The plates were scanned at 365 nm. The linear calibration data of rosmarinic acid and rutin were in the range of 0.0508 to 0.2540 μg (r=0.9964, 0.2707 to 1.35354 μg (r=0.9981, respectively. The recovery rate of rosmarinic acid was 99.17% (RSD = 2.92% and rutin was 95.24% (RSD = 2.38%. The method enables rapid screening, precise, selective, and sensitive quantification for pharmaceutical analysis.

  7. CD36 abnormality and impaired myocardial long-chain fatty acid uptake in patients with hypertrophic cardiomyopathy

    Energy Technology Data Exchange (ETDEWEB)

    Okamoto, Fumio; Tanaka, Takao; Sohmiya, Koichi; Kawamura, Keishiro [Osaka Medical Coll., Takatsuki (Japan)

    1998-07-01

    In this study, in order to discover the relationship between hypertrophic cardiomyopathy (HCM) and the CD36 molecular abnormality, the expression level of platelet CD36 and CD36 cDNA in 55 HCM patients was analyzed. Twelve patients showed negligible (<5%) CD36 expression on their platelets. Among them, one was found to be homozygous for the C-478{yields}T substitution and 6 were heterozygous for the C-478{yields}T substitution. In 9 patients, CD36 was expressed by less than 50% of the platelets. One of them was found to be heterozygous for the C-478{yields}T substitution. Two other patients were also found to be heterozygous for this point mutation, although their platelets expressed CD36. Thus, 23 out of 55 (41.8%) HCM patients had negligible (<5%) or reduced (<50%) levels of CD36 expression on platelets, or had a point mutation of CD36 cDNA. These 55 HCM patients were also evaluated with myocardial scintigraphy both for long-chain fatty acid (LCFA) uptake and perfusion, which showed a moderate to severe discrepancy between myocardial LCFA accumulation and myocardial perfusion in 95.5% of the patients (21/23). On the other hand, 70% of the patients with normal (>90%) CD36 expression (14/20) did not show any severe discrepancies between myocardial LCFA accumulation and myocardial perfusion. These data could suggest that abnormal myocardial LCFA metabolism seen in HCM patients may be related to abnormality of the CD36 molecule, and that abnormalities of this molecule may be linked to the cause of some types of HCM. (K.H.)

  8. Time esophageal pH < 4 overestimates the prevalence of pathologic esophageal reflux in subjects with gastroesophageal reflux disease treated with proton pump inhibitors

    Directory of Open Access Journals (Sweden)

    Sloan Sheldon

    2008-05-01

    Full Text Available Abstract Background A Stanford University study reported that in asymptomatic GERD patients who were being treated with a proton pump inhibitor (PPI, 50% had pathologic esophageal acid exposure. Aim We considered the possibility that the high prevalence of pathologic esophageal reflux might simply have resulted from calculating acidity as time pH Methods We calculated integrated acidity and time pH Results The prevalence of pathologic 24-hour esophageal reflux in both studies was significantly higher when measured as time pH Conclusion In GERD subjects treated with a PPI, measuring time esophageal pH

  9. Nicotinic acid receptor abnormalities in human skin cancer: implications for a role in epidermal differentiation.

    Directory of Open Access Journals (Sweden)

    Yira Bermudez

    Full Text Available Chronic UV skin exposure leads to epidermal differentiation defects in humans that can be largely restored by pharmacological doses of nicotinic acid. Nicotinic acid has been identified as a ligand for the human G-protein-coupled receptors GPR109A and GPR109B that signal through G(i-mediated inhibition of adenylyl cyclase. We have examined the expression, cellular distribution, and functionality of GPR109A/B in human skin and skin derived epidermal cells.Nicotinic acid increases epidermal differentiation in photodamaged human skin as judged by the terminal differentiation markers caspase 14 and filaggrin. Both GPR109A and GPR109B genes are transcribed in human skin and in epidermal keratinocytes, but expression in dermal fibroblasts is below limits of detection. Receptor transcripts are greatly over-expressed in squamous cell cancers. Receptor protein in normal skin is prominent from the basal through granular layers of the epidermis, with cellular localization more dispersive in the basal layer but predominantly localized at the plasma membrane in more differentiated epidermal layers. In normal human primary and immortalized keratinocytes, nicotinic acid receptors show plasma membrane localization and functional G(i-mediated signaling. In contrast, in a squamous cell carcinoma derived cell line, receptor protein shows a more diffuse cellular localization and the receptors are nearly non-functional.The results of these studies justify future genetic and pharmacological intervention studies to define possible specific role(s of nicotinic acid receptors in human skin homeostasis.

  10. The incidence of electrolyte and acid-base abnormalities in critically ...

    African Journals Online (AJOL)

    Background: Electrolytes and acid-base disorders are common challenges seen in the intensive care unit (ICU) resulting in difficulty in weaning patients off the ventilator, prolonged admission periods, preventable cardiac arrhythmias and cardiac arrest. These require prompt lab results most of which are done serially, ...

  11. Esophageal trachealization: A feature of eosinophilic esophagitis

    International Nuclear Information System (INIS)

    AlHussaini, Abdulrahman A; Semaan, Toufic; ElHag, Imad A

    2009-01-01

    Eosinophilic esophagitis (EE) is an inflammatory condition characterized by intense eosinophilic infiltration of the esophagus. EE is frequently misdiagnosed as gastroesophageal reflux disease. Here, we present a child with EE and a characteristic endoscopic finding, r inged esophagus . An 11-year-old Saudi boy presented with dysphagia for 1 year. He had experienced an intermittent sensation of solid food sticking in his chest, which was relieved by drinking liquids. A barium swallow excluded anatomical causes of dysphagia, but revealed multiple-ringed esophagus. Endoscopy showed a furrowing and trachealizing appearance of the entire esophagus. Hisologically, extensive eosinophilic infiltration was a feature in biopsies obtained from the esophagus. The child responded well to a 2-month course of inhaled fluticasone. Symptoms recurred 3 months after discontinuation of therapy, which necessitated resumption of inhaled fluticasone. The endoscopic appearance of multiple esophageal rings should raise suspicion of EE and be confirmed by esophageal biopsies. (author)

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

    International Nuclear Information System (INIS)

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

    1982-01-01

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

  13. Abnormalities in the tricarboxylic acid (TCA) cycle in the brains of schizophrenia patients.

    Science.gov (United States)

    Bubber, P; Hartounian, V; Gibson, G E; Blass, J P

    2011-03-01

    Images of brain metabolism and measurements of activities of components of the electron transport chain support earlier studies that suggest that brain glucose oxidation is inherently abnormal in a significant proportion of persons with schizophrenia. Therefore, we measured the activities of enzymes of the tricarboxylic (TCA) cycle in dorsolateral-prefrontal-cortex from schizophrenia patients (N=13) and non-psychiatric disease controls (N=13): the pyruvate dehydrogenase complex (PDHC), citrate synthase (CS), aconitase, isocitrate dehydrogenase (ICDH), the alpha-ketoglutarate dehydrogenase complex (KGDHC), succinate thiokinase (STH), succinate dehydrogenase (SDH), fumarase and malate dehydrogenase (MDH). Activities of aconitase (18.4%, pTCA cycle, were lower, but SDH (18.3%, pTCA cycle and cognitive function, age or choline acetyl transferase activity, except for aconitase activity which decreased slightly with age (r=0.55, p=003). The increased activities of dehydrogenases in the second half of the TCA cycle may reflect a compensatory response to reduced activities of enzymes in the first half. Such alterations in the components of TCA cycle are adequate to alter the rate of brain metabolism. These results are consistent with the imaging studies of hypometabolism in schizophrenia. They suggest that deficiencies in mitochondrial enzymes can be associated with mental disease that takes the form of schizophrenia. Copyright © 2010 Elsevier B.V. and ECNP. All rights reserved.

  14. Ductular and proliferative response of esophageal submucosal glands in a porcine model of esophageal injury and repair.

    Science.gov (United States)

    Krüger, Leandi; Gonzalez, Liara M; Pridgen, Tiffany A; McCall, Shannon J; von Furstenberg, Richard J; Harnden, Ivan; Carnighan, Gwendolyn E; Cox, Abigail M; Blikslager, Anthony T; Garman, Katherine S

    2017-09-01

    Esophageal injury is a risk factor for diseases such as Barrett's esophagus (BE) and esophageal adenocarcinoma. To improve understanding of signaling pathways associated with both normal and abnormal repair, animal models are needed. Traditional rodent models of esophageal repair are limited by the absence of esophageal submucosal glands (ESMGs), which are present in the human esophagus. Previously, we identified acinar ductal metaplasia in human ESMGs in association with both esophageal injury and cancer. In addition, the SOX9 transcription factor has been associated with generation of columnar epithelium and the pathogenesis of BE and is present in ESMGs. To test our hypothesis that ESMGs activate after esophageal injury with an increase in proliferation, generation of a ductal phenotype, and expression of SOX9, we developed a porcine model of esophageal injury and repair using radiofrequency ablation (RFA). The porcine esophagus contains ESMGs, and RFA produces a consistent and reproducible mucosal injury in the esophagus. Here we present a temporal assessment of this model of esophageal repair. Porcine esophagus was evaluated at 0, 6, 18, 24, 48, and 72 h and 5 and 7 days following RFA and compared with control uninjured esophagus. Following RFA, ESMGs demonstrated an increase in ductal phenotype, echoing our prior studies in humans. Proliferation increased in both squamous epithelium and ESMGs postinjury with a prominent population of SOX9-positive cells in ESMGs postinjury. This model promises to be useful in future experiments evaluating mechanisms of esophageal repair. NEW & NOTEWORTHY A novel porcine model of injury and repair using radiofrequency ablation has been developed, allowing for reproducible injury to the esophagus to study repair in an animal model with esophageal submucosal glands, a key anatomical feature and missing in rodent models but possibly harboring progenitor cells. There is a strong translational component to this porcine model given

  15. Nuclear abnormalities in buccal mucosa cells of patients with type I and II diabetes treated with folic acid.

    Science.gov (United States)

    Gómez-Meda, B C; Zamora-Perez, A L; Muñoz-Magallanes, T; Sánchez-Parada, M G; García Bañuelos, J J; Guerrero-Velázquez, C; Sánchez-Orozco, L V; Vera-Cruz, J M; Armendáriz-Borunda, J; Zúñiga-González, G M

    2016-02-01

    Diabetes mellitus (DM) is characterized by high blood glucose. Excessive production of free radicals may cause oxidative damage to DNA and other molecules, leading to complications of the disease. It may be possible to delay or reduce such damage by administration of antioxidants such as folic acid (FA). The objective of this study was to determine the effect of FA on nuclear abnormalities (NAs) in the oral mucosa of patients with DM. NAs (micronucleated cells, binucleated cells, pyknotic nuclei, karyorrhexis, karyolysis, abnormally condensed chromatin, and nuclear buds) were analyzed in 2000 cells from 45 healthy individuals (control group) and 55 patients with controlled or uncontrolled type I or II DM; 35 patients in the latter group were treated with FA. Samples were taken from the FA group before and after treatment. An increased rate of NAs was found in patients with DM in comparison with that of the control group (Pabnormally condensed chromatin, karyolysis, and nuclear buds produced by FA supplementation in DM patients (P<0.02) are consistent with the idea that free radicals are responsible for the increased frequency of NAs in DM patients. Copyright © 2015 Elsevier B.V. All rights reserved.

  16. Administration of the bisphosphonate zoledronic acid during tooth development inhibits tooth eruption and formation and induces dental abnormalities in rats.

    Science.gov (United States)

    Hiraga, Toru; Ninomiya, Tadashi; Hosoya, Akihiro; Nakamura, Hiroaki

    2010-06-01

    Bisphosphonates (BPs) are potent inhibitors of osteoclastic bone resorption and widely used for the treatment of osteoporosis and metastatic bone diseases. Recently, BPs have also been shown to benefit children with primary and secondary osteoporosis, including osteogenesis imperfecta; however, their long-term safety has not been established yet. Clinical and experimental studies have demonstrated that BPs delay or inhibit tooth eruption. The failure of tooth eruption causes several dental abnormalities. In this study, to determine the effects of BPs on tooth formation, the BP zoledronic acid (ZOL) was injected into 7- and 14-day-old rats, and the development of the mandibular teeth was examined. X-ray analysis demonstrated that ZOL inhibited the eruption of both incisors and molars and their formation, especially in the molar roots. Histological examination showed that, in ZOL-treated animals, alveolar bone remained unresorbed around tooth crowns, which injured ameloblasts and enamel matrix, leading to defects of the enamel. Furthermore, haphazard proliferation of odontogenic epithelium and mesenchyme associated with primitive tooth structures, which resembles human odontomas, was induced at the basal end of incisors but not around the molars. Tooth ankylosis to alveolar bone was occasionally observed in molars. These results suggest that administration of BPs during tooth development has the potential to inhibit tooth eruption and formation and to induce several types of dental abnormalities, which may be attributed to the altered osteoclastic activities.

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

    Science.gov (United States)

    Lin, Zhiyue; Kahrilas, Peter J; Xiao, Yinglian; Nicodème, Frédéric; Gonsalves, Nirmala; Hirano, Ikuo; Pandolfino, John E

    2013-03-01

    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. 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. 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. 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.

  18. Esophageal transit and in vivo disintegration of branded risedronate sodium tablets and two generic formulations of alendronic acid tablets: a single-center, single-blind, six-period crossover study in healthy female subjects.

    Science.gov (United States)

    Perkins, Alan C; Blackshaw, P Elaine; Hay, Peter D; Lawes, Simon C; Atherton, Clare T; Dansereau, Richard J; Wagner, Leigh K; Schnell, Dan J; Spiller, Robin C

    2008-05-01

    Delayed esophageal transit or disintegration of oral bisphosphonate tablets before they enter the stomach may be of concern with respect to iatrogenic complications among patients receiving longterm treatment. Different formulations of generic bisphosphonate tablets meeting regulatory requirements may have substantial differences in pharmaceutical attributes from the branded product that may result in different characteristics during esophageal transit. The primary objective of this study was to evaluate and compare esophageal transit times and in vivo disintegration of 3 bisphosphonate formulations, one branded and the others generic, that are commercially available in Canada and the United Kingdom. This was a single-center, randomized, singleblind, 6-period crossover study in healthy postmenopausal women aged >50 years. Each subject received a single oral dose of a branded risedronate sodium 35-mg tablet and 2 generic formulations of alendronic acid 70-mg tablets (Novopharm Limited, Toronto, Canada, and Teva UK Limited, Morley, United Kingdom) in both the erect and semisupine (45 degrees ) positions. Although the products are labeled to be taken in the erect position, the semisupine position was included to simulate dosing in bedridden patients. Subjects took tablets with 30 mL of water in the morning after an overnight fast. The tablets were radiolabeled with technetium-99m ion-exchange resins to enable visualization and measurement of esophageal transit time and disintegration using a gamma camera. Dynamic scintigraphic images were obtained for a total of 10 minutes: 2 images per second for the first 30 seconds and 1 image every 15 seconds for 9.5 minutes. This was a mechanistic study and tolerability was not assessed. The study was conducted in 20 healthy white female subjects with a mean age of 62 years (range, 51-77 years). The effect of body position was statistically significant (P = 0.043), with the estimated hazard ratio (HR) of 0.74 indicating longer

  19. Myocardial metabolic abnormalities in hypertrophic cardiomyopathy assessed by iodine-123-labeled beta-methyl-branched fatty acid myocardial scintigraphy and its relation to exercise-induced ischemia

    Energy Technology Data Exchange (ETDEWEB)

    Matsuo, Shinro; Nakamura, Yasuyuki; Takahashi, Masayuki; Mitsunami, Kenichi; Kinoshita, Masahiko [Shiga Univ. of Medical Science, Otsu (Japan)

    1998-03-01

    Reversible thallium-201 ({sup 201}Tl) abnormalities during exercise stress have been used as markers of myocardial ischemia in hypertrophic cardiomyopathy (HCM) and are most likely to identify relatively underperfused myocardium. Although metabolic abnormalities in HCM were reported, the relationship between impaired energy metabolism and exercise-induced ischemia has not been fully elucidated as yet. To assess the relationship between myocardial perfusion abnormalities and fatty acid metabolic abnormalities, 28 patients with HCM underwent exercise {sup 201}Tl and rest {sup 123}I-15-(p-iodophenyl)-3-methyl pentadecanoic acid (BMIPP) scintigraphy. Perfusion abnormalities were observed by exercise {sup 201}Tl in 19/28 patients with HCM. {sup 123}I-BMIPP uptake was decreased compared with delayed {sup 201}Tl in 106/364 (29%) of the total myocardial segments (p<0.01, McNemar symmetry test). Such disparity between {sup 123}I-BMIPP and {sup 201}Tl was observed more often in the 49/75 (65%) segments with reversible exercise {sup 201}Tl defects (p<0.001). Our results indicate that exercise-induced myocardial ischemia exists in HCM, resulting in metabolic abnormalities. The combination of {sup 123}I-BMIPP and {sup 201}Tl suggests that myocardial ischemia may play an important role in metabolic abnormalities in HCM. (author)

  20. Short antisense-locked nucleic acids (all-LNAs) correct alternative splicing abnormalities in myotonic dystrophy.

    Science.gov (United States)

    Wojtkowiak-Szlachcic, Agnieszka; Taylor, Katarzyna; Stepniak-Konieczna, Ewa; Sznajder, Lukasz J; Mykowska, Agnieszka; Sroka, Joanna; Thornton, Charles A; Sobczak, Krzysztof

    2015-03-31

    Myotonic dystrophy type 1 (DM1) is an autosomal dominant multisystemic disorder caused by expansion of CTG triplet repeats in 3'-untranslated region of DMPK gene. The pathomechanism of DM1 is driven by accumulation of toxic transcripts containing expanded CUG repeats (CUG(exp)) in nuclear foci which sequester several factors regulating RNA metabolism, such as Muscleblind-like proteins (MBNLs). In this work, we utilized very short chemically modified antisense oligonucleotides composed exclusively of locked nucleic acids (all-LNAs) complementary to CUG repeats, as potential therapeutic agents against DM1. Our in vitro data demonstrated that very short, 8- or 10-unit all-LNAs effectively bound the CUG repeat RNA and prevented the formation of CUG(exp)/MBNL complexes. In proliferating DM1 cells as well as in skeletal muscles of DM1 mouse model the all-LNAs induced the reduction of the number and size of CUG(exp) foci and corrected MBNL-sensitive alternative splicing defects with high efficacy and specificity. The all-LNAs had low impact on the cellular level of CUG(exp)-containing transcripts and did not affect the expression of other transcripts with short CUG repeats. Our data strongly indicate that short all-LNAs complementary to CUG repeats are a promising therapeutic tool against DM1. © The Author(s) 2015. Published by Oxford University Press on behalf of Nucleic Acids Research.

  1. Fructose diet-induced skin collagen abnormalities are prevented by lipoic acid.

    Science.gov (United States)

    Thirunavukkarasu, V; Nandhini, A T Anitha; Anuradha, C V

    2004-01-01

    Nonenzymatic glycation of proteins, leading to chemical modification and cross-linking are of importance in the pathology of diabetic complications. We studied the effect alpha-lipoic acid (LA) on the content and characteristics of the protein collagen from skin of high-fructose fed rats. The rats were divided into 4 groups of 6 each. Two groups of rats were fed with a high fructose diet (60 g/100 g diet) and administered either LA (35 mg/kg b.w., i.p) (FRU+LA) or 0.2 ml vehicle (saline) (FRU) for 45 days. The other 2 groups were fed with control diet containing starch (60 g/100 g diet) and administered either saline (CON) or lipoic acid (CON+LA). The rats were maintained for 45 days and then sacrificed. Plasma glucose, insulin, fructosamine, protein glycation, and blood glycated hemoglobin (HbA1C) were measured. Collagen was isolated from skin and the physicochemical properties of collagen were studied. Fructose administration caused accumulation of collagen in skin. Extensive cross-linking was evidenced by enhanced glycation and AGE-linked fluorescence. Increased peroxidation and changes in physicochemical properties such as shrinkage temperature, aldehyde content, solubililty pattern, susceptibility to denaturing agents were observed in fructose-fed rats. SDS gel pattern of collagen from these rats showed elevated beta component of type I collagen. These changes were alleviated by the simultaneous administration of LA. Administration of LA to fructose-fed rats had a positive influence on both quantitative and qualitative properties of collagen. The results suggest a mechanism for the ability of LA to delay diabetic complications.

  2. Primary prevention of neural-tube defects and some other congenital abnormalities by folic acid and multivitamins: history, missed opportunity and tasks

    Science.gov (United States)

    Bártfai, Zoltán; Bánhidy, Ferenc

    2011-01-01

    The history of intervention trials of periconception folic acid with multivitamin and folic acid supplementation in women has shown a recent breakthrough in the primary prevention of structural birth defects, namely neural-tube defects and some other congenital abnormalities. Recently, some studies have demonstrated the efficacy of this new method in reducing congenital abnormalities with specific origin; for example, in the offspring of diabetic and epileptic mothers, and in pregnancy with high fever. The benefits and drawbacks of four possible uses of periconception folate/folic acid and multivitamin supplementation are discussed: we believe there has been a missed opportunity to implement this preventive approach in medical practice. The four methods are as follows: (i) dietary intake of folate and other vitamins, (ii) periconception folic acid/multivitamin supplementation, (iii) food fortification with folic acid, and (iv) the combination of oral contraceptives with 6S-5-methytetrahydrofolate (‘folate’). PMID:25083211

  3. Fatty-acid alkyl esters in table olives in relation to abnormal fermentation and poorly conducted technological treatments

    Energy Technology Data Exchange (ETDEWEB)

    Lanza, B.; Serio, M.G. di; Giacinto, L. di

    2016-07-01

    There are several methods to prepare table olives, and each of the steps and conditions during this processing can affect the composition and nutritional value of the product. The influence of abnormal fermentation and poorly conducted technological treatments was examined here in terms of the lipid fraction of table olives. In ‘Greek style’ olives, a low concentration of brine can allow the growth of spontaneous microflora and consequent organoleptic defects (‘putrid/butyric fermentation’, ‘winey-vinegary’). Here, the ‘Kalamata’ and ‘Moresca’ cultivars can produce methyl esters (methyl oleate/ linoleate: 553 and 450 mg·kg−1 oil, respectively) and ethyl esters (ethyl oleate/ inoleate: 4764 and 4195; palmitate: 617 and 886 mg·kg −1 oil, respectively). In ‘Sevillan style’ olives, a high NaOH concentration influences the fatty-acid composition less, but is difficult to eliminate, for a ‘soapy’ defect. The ‘Giarraffa’ and ‘Nocellara del Belice’ cultivars produce only ethyl esters (ethyl oleate/ linoleate: 222 and 289 mg·kg−1 oil, respectively). With this production of ethyl and methyl esters from the principal fatty acids in the lipid fractions of table olives, methods that provide only biological treatments (i.e., Greek style) pose more risk than methods that provide only chemical treatments (i.e., Sevillan style). (Author)

  4. Fatty-acid alkyl esters in table olives in relation to abnormal fermentation and poorly conducted technological treatments

    Directory of Open Access Journals (Sweden)

    Lanza, B.

    2016-06-01

    Full Text Available There are several methods to prepare table olives, and each of the steps and conditions during this processing can affect the composition and nutritional value of the product. The influence of abnormal fermentation and poorly conducted technological treatments was examined here in terms of the lipid fraction of table olives. In ‘Greek style’ olives, a low concentration of brine can allow the growth of spontaneous microflora and consequent organoleptic defects (‘putrid/butyric fermentation’, ‘winey-vinegary’. Here, the ‘Kalamata’ and ‘Moresca’ cultivars can produce methyl esters (methyl oleate/ linoleate: 553 and 450 mg·kg-1 oil, respectively and ethyl esters (ethyl oleate/ inoleate: 4764 and 4195; palmitate: 617 and 886 mg·kg-1 oil, respectively. In ‘Sevillan style’ olives, a high NaOH concentration influences the fatty-acid composition less, but is difficult to eliminate, for a ‘soapy’ defect. The ‘Giarraffa’ and ‘Nocellara del Belice’ cultivars produce only ethyl esters (ethyl oleate/ linoleate: 222 and 289 mg·kg-1 oil, respectively. With this production of ethyl and methyl esters from the principal fatty acids in the lipid fractions of table olives, methods that provide only biological treatments (i.e., Greek style pose more risk than methods that provide only chemical treatments (i.e., Sevillan style.H

  5. Stages of Esophageal Cancer

    Science.gov (United States)

    ... the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds , ... stage of the cancer being treated. External and internal radiation therapy are used to treat esophageal cancer. A plastic ...

  6. Dose-Finding Study of Omeprazole on Gastric pH in Neonates with Gastro-Esophageal Acid Reflux Using a Bayesian Sequential Approach.

    Science.gov (United States)

    Kaguelidou, Florentia; Alberti, Corinne; Biran, Valerie; Bourdon, Olivier; Farnoux, Caroline; Zohar, Sarah; Jacqz-Aigrain, Evelyne

    2016-01-01

    Proton pump inhibitors are frequently administered on clinical symptoms in neonates but benefit remains controversial. Clinical trials validating omeprazole dosage in neonates are limited. The objective of this trial was to determine the minimum effective dose (MED) of omeprazole to treat pathological acid reflux in neonates using reflux index as surrogate marker. Double blind dose-finding trial with continual reassessment method of individual dose administration using a Bayesian approach, aiming to select drug dose as close as possible to the predefined target level of efficacy (with a credibility interval of 95%). Neonatal Intensive Care unit of the Robert Debré University Hospital in Paris, France. Neonates with a postmenstrual age ≥ 35 weeks and a pathologic 24-hour intra-esophageal pH monitoring defined by a reflux index ≥ 5% over 24 hours were considered for participation. Recruitment was stratified to 3 groups according to gestational age at birth. Five preselected doses of oral omeprazole from 1 to 3 mg/kg/day. Primary outcome, measured at 35 weeks postmenstrual age or more, was a reflux index <5% during the 24-h pH monitoring registered 72±24 hours after omeprazole initiation. Fifty-four neonates with a reflux index ranging from 5.06 to 27.7% were included. Median age was 37.5 days and median postmenstrual age was 36 weeks. In neonates born at less than 32 weeks of GA (n = 30), the MED was 2.5mg/kg/day with an estimated mean posterior probability of success of 97.7% (95% credibility interval: 90.3-99.7%). The MED was 1mg/kg/day for neonates born at more than 32 GA (n = 24). Omeprazole is extensively prescribed on clinical symptoms but efficacy is not demonstrated while safety concerns do exist. When treatment is required, the daily dose needs to be validated in preterm and term neonates. Optimal doses of omeprazole to increase gastric pH and decrease reflux index below 5% over 24 hours, determined using an adaptive Bayesian design differ among

  7. Dose-Finding Study of Omeprazole on Gastric pH in Neonates with Gastro-Esophageal Acid Reflux Using a Bayesian Sequential Approach.

    Directory of Open Access Journals (Sweden)

    Florentia Kaguelidou

    Full Text Available Proton pump inhibitors are frequently administered on clinical symptoms in neonates but benefit remains controversial. Clinical trials validating omeprazole dosage in neonates are limited. The objective of this trial was to determine the minimum effective dose (MED of omeprazole to treat pathological acid reflux in neonates using reflux index as surrogate marker.Double blind dose-finding trial with continual reassessment method of individual dose administration using a Bayesian approach, aiming to select drug dose as close as possible to the predefined target level of efficacy (with a credibility interval of 95%.Neonatal Intensive Care unit of the Robert Debré University Hospital in Paris, France.Neonates with a postmenstrual age ≥ 35 weeks and a pathologic 24-hour intra-esophageal pH monitoring defined by a reflux index ≥ 5% over 24 hours were considered for participation. Recruitment was stratified to 3 groups according to gestational age at birth.Five preselected doses of oral omeprazole from 1 to 3 mg/kg/day.Primary outcome, measured at 35 weeks postmenstrual age or more, was a reflux index <5% during the 24-h pH monitoring registered 72±24 hours after omeprazole initiation.Fifty-four neonates with a reflux index ranging from 5.06 to 27.7% were included. Median age was 37.5 days and median postmenstrual age was 36 weeks. In neonates born at less than 32 weeks of GA (n = 30, the MED was 2.5mg/kg/day with an estimated mean posterior probability of success of 97.7% (95% credibility interval: 90.3-99.7%. The MED was 1mg/kg/day for neonates born at more than 32 GA (n = 24.Omeprazole is extensively prescribed on clinical symptoms but efficacy is not demonstrated while safety concerns do exist. When treatment is required, the daily dose needs to be validated in preterm and term neonates. Optimal doses of omeprazole to increase gastric pH and decrease reflux index below 5% over 24 hours, determined using an adaptive Bayesian design differ

  8. Esophageal intramural pseudoverticulosis

    International Nuclear Information System (INIS)

    Cho, S.R.; Sanders, M.M.; Turner, M.A.; Liu, C.I.

    1981-01-01

    Esophageal intramural pseudodiverticulosis (EIP) is a rare condition of unknown etiology. It is characterized by multiple, small, flaskshaped outpouchings in the esophageal wall. Involvement may be segmental or diffuse. Since this entity was first reported in 1960, there have been 43 cases described in the English literature. These cases are reviewed and six additional cases are reported with emphasis on clinical and radiographic parameters of this entity. (orig.) [de

  9. Prevention strategies for esophageal cancer: Perspectives of the East vs. West.

    Science.gov (United States)

    Chung, Chen-Shuan; Lee, Yi-Chia; Wu, Ming-Shiang

    2015-12-01

    Esophageal cancer is the eighth most common cancer worldwide. Esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC) are the two major phenotypes in Western and Eastern countries, respectively. Because of different pathways in carcinogenesis, the risk factors and effective steps for prevention of esophageal cancer are different between EAC and ESCC. The carcinogenesis of EAC is initiated by the acid exposure of the esophageal mucosa from stomach while that of the ESCC are related to the chronic irritation of carcinogens mainly by the alcohol, cigarette, betel quid, and hot beverage. To eliminate the burden of esophageal cancer on the global health, the effective strategy should be composed of the primary, secondary, and tertiary prevention. In this article, we perform a systematic review of the preventive strategies for esophageal cancer with special emphasis on the differences from the perspectives of Western and Eastern countries. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Abnormal emotional learning in a rat model of autism exposed to valproic acid in utero

    Directory of Open Access Journals (Sweden)

    Anwesha eBanerjee

    2014-11-01

    Full Text Available Autism Spectrum Disorders (ASD are complex neurodevelopmental disorders characterized by repetitive behavior and impaired social communication and interactions. Apart from these core symptoms, a significant number of ASD individuals display higher levels of anxiety and some ASD individuals exhibit impaired emotional learning. We therefore sought to further examine anxiety and emotional learning in an environmentally induced animal model of ASD that utilizes the administration of the known teratogen, valproic acid (VPA during gestation. Specifically we exposed dams to one of two different doses of VPA (500 and 600 mg/kg or vehicle on day 12.5 of gestation and examined the resultant progeny. Our data indicate that animals exposed to VPA in utero exhibit enhanced anxiety in the open field test and normal object recognition memory compared to control animals. Animals exposed to 500 mg/kg of VPA displayed normal acquisition of auditory fear conditioning, and exhibited reduced extinction of fear memory and normal litter survival rates as compared to control animals. We observed that animals exposed to 600 mg/kg of VPA exhibited a significant reduction in the acquisition of fear conditioning, a significant reduction in social interaction and a significant reduction in litter survival rates as compared to control animals. VPA (600 mg/kg exposed animals exhibited similar shock sensitivity and hearing as compared to control animals indicating the fear conditioning deficit observed in these animals was not likely due to sensory deficits, but rather due to deficits in learning or memory retrieval. In conclusion, considering that progeny from dams exposed to rather similar doses of VPA exhibit striking differences in emotional learning, the VPA model may serve as a useful tool to explore the molecular and cellular mechanisms that contribute to not only ASD, but also emotional learning.

  11. Acid sphingomyelinase (aSMase) deficiency leads to abnormal microglia behavior and disturbed retinal function

    Energy Technology Data Exchange (ETDEWEB)

    Dannhausen, Katharina; Karlstetter, Marcus; Caramoy, Albert [Laboratory for Experimental Immunology of the Eye, Department of Ophthalmology, University of Cologne, Cologne (Germany); Volz, Cornelia; Jägle, Herbert [Department of Ophthalmology, University Hospital Regensburg, Regensburg (Germany); Liebisch, Gerhard [Institute for Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg (Germany); Utermöhlen, Olaf [Institute for Medical Microbiology, Immunology and Hygiene and Center for Molecular Medicine Cologne, University of Cologne, Cologne (Germany); Langmann, Thomas, E-mail: thomas.langmann@uk-koeln.de [Laboratory for Experimental Immunology of the Eye, Department of Ophthalmology, University of Cologne, Cologne (Germany)

    2015-08-21

    Mutations in the acid sphingomyelinase (aSMase) coding gene sphingomyelin phosphodiesterase 1 (SMPD1) cause Niemann-Pick disease (NPD) type A and B. Sphingomyelin storage in cells of the mononuclear phagocyte system cause hepatosplenomegaly and severe neurodegeneration in the brain of NPD patients. However, the effects of aSMase deficiency on retinal structure and microglial behavior have not been addressed in detail yet. Here, we demonstrate that retinas of aSMase{sup −/−} mice did not display overt neuronal degeneration but showed significantly reduced scotopic and photopic responses in electroretinography. In vivo fundus imaging of aSMase{sup −/−} mice showed many hyperreflective spots and staining for the retinal microglia marker Iba1 revealed massive proliferation of retinal microglia that had significantly enlarged somata. Nile red staining detected prominent phospholipid inclusions in microglia and lipid analysis showed significantly increased sphingomyelin levels in retinas of aSMase{sup −/−} mice. In conclusion, the aSMase-deficient mouse is the first example in which microglial lipid inclusions are directly related to a loss of retinal function. - Highlights: • aSMase-deficient mice show impaired retinal function and reactive microgliosis. • aSMase-deficient microglia express pro-inflammatory transcripts. • aSMase-deficient microglia proliferate and have increased cell body size. • In vivo imaging shows hyperreflective spots in the fundus of aSMase-deficient mice. • aSMase-deficient microglia accumulate sphingolipid-rich intracellular deposits.

  12. Neonatal Acid-Base Status in Fetuses with Abnormal Vertebro- and Cerebro-Placental Ratios.

    Science.gov (United States)

    Morales-Roselló, José; Khalil, Asma; Ferri-Folch, Blanca; Perales-Marín, Alfredo

    2015-01-01

    A low cerebro-placental ratio (CPR) at term suggests the existence of failure to reach growth potential (FRGP) with a higher risk of poor neonatal acid-base status. This study aimed to evaluate whether similar findings were also seen in the vertebral artery (vertebro-placental ratio, VPR), supplying 30% of the cerebral flow. We studied term fetuses classified into groups according to birth weight (BW), CPR and VPR. BW was expressed in centiles and ratios in multiples of the median (MoM). Subsequently, associations with neonatal pH values were evaluated by means of regression curves and Mann-Whitney tests. VPR MoM correlated with BW centiles (p < 0.0001, R2 = 0.042) and its distribution resembled that of CPR MoM (p < 0.001). When both arteries were compared, adequate-for-gestational-age (AGA) fetuses with either low CPR or low VPR had lower neonatal venous pH values (p < 0.05, p < 0.01, respectively). However, in case of small-for-gestational-age (SGA) fetuses, only those with low VPR had significantly lower neonatal arterial and venous pH values (p < 0.05). Blood flow in the vertebral artery mimics that in the middle cerebral artery supporting the FRGP model. Both CPR and VPR identify AGA fetuses with lower neonatal pH values, but only VPR identifies SGA with lower pH values. Hypoxemia might be reflected as a generalized cerebral vasodilation demonstrated as low CPR and VPR.

  13. α-Lipoic Acid Mitigates Arsenic-Induced Hematological Abnormalities in Adult Male Rats

    Directory of Open Access Journals (Sweden)

    Sonali Ghosh

    2017-05-01

    Full Text Available Background: Arsenic toxicity is a major global health problem and exposure via contaminated drinking water has been associated with hematological and other systemic disorders. The present investigation has been conducted in adult male rats to evaluate the protective ability of α-lipoic acid (ALA against such hematological disorders. Methods: Twenty-four adult male Wister rats (b.wt.130±10g were grouped and accordingly group I (control received the normal diet, group II (treated was given arsenic orally for 28 consecutive days as arsenic trioxide (3 mg/kgbw/rat/day whereas group III (supplemented received the same dose of arsenic along with ALA (25 mg/kgbw/rat/day as oral supplement. Hematological profile, plasma oxidant/antioxidant status, and erythrocyte morphology were assessed. Statistical analysis was done by one-way ANOVA using SPSS software (version 16.0. Results: Arsenic exposure caused reduction of erythrocyte (P=0.021, leucocyte (P<0.001, and hemoglobin (P=0.031 associated with echinocytic transformation as evidenced by light and scanning electron microscopic studies. The other significantly altered parameters include increased mean corpuscular volume (P=0.041 and lymphocytopenia (P<0.001 with insignificant neutropenia and eosinophilia. Altered serum oxidative balance as evidenced by decreased TAS (P<0.001 and increased TOS (P<0.001 with OSI (P<0.001 was also noted. The dietary supplementation of ALA has a beneficial effect against the observed (P<0.05 arsenic toxicities. It brings about the protection by restoring the hematological redox and inflammatory status near normal in treated rats. Arsenic-induced morphological alteration of erythrocytes was also partially attenuated by ALA supplementation. Conclusion: It is concluded that arsenicosis is associated with hematological alterations and ALA co-supplementation can partially alleviate these changes in an experimental male rat model.

  14. The usefulness of esophagogram with marchmallow bolus in patients with esophageal related symptoms

    International Nuclear Information System (INIS)

    Yoon, Sang Wook; Kim, Ki Whang; Park, Hyo Jin; Kim, Eun Kyung; Yu, Jeong Sik; Seo, Jung Kun; Kwon, Ryang; Shin, Hyung Cheol

    1996-01-01

    To evaluate the usefulness of the esophagogram using marshmallow bolus in the evaluation of the causes of variable esophageal-related symptoms. Esophagograms using marshmallow bolus were performed on 44 patients with esophageal-related symptoms and on ten normal volunteers. Videofluoroscopic studies were also made. Patients were classified into three groups according to their esophageal-related symptoms ; those with dysphagia, those with globus symptom, and those with chest pain. Abnormal findings on an esophagogram with marshmallow were graded in to three categories ; mild, moderate, and severe. Provocation of the same symptom was also evaluated. Esophageal monometric studies were performed on 16 patients and those results were compared with the results obtained from the esophagogram using marshmallow bolus. The provocation rate of the some symptom was 33% in the first group, 47% in the second, and 24% in the third. The provocation rate was highest in the second group. The provocation rate was also higher in patients with a severe degree of abnormality on an esophagogram using marshmallow bolus. Where there were abnormal findings, an esophagogram using marshmallow bolus showed a higher abnormality rate than did a conventional esophagogram. In cases showing abnormal finding son the esophageal monometric study, an esophagogram using marshmallow bolus showed a higher provocation rate and more severe abnormality than in cases showing normal findings on manometric study. An esophagogram using marshmallow bolus will a useful radiologic screening modality for the evaluation of patients with esophageal-related symptoms

  15. The usefulness of esophagogram with marchmallow bolus in patients with esophageal related symptoms

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Sang Wook; Kim, Ki Whang; Park, Hyo Jin; Kim, Eun Kyung; Yu, Jeong Sik; Seo, Jung Kun; Kwon, Ryang; Shin, Hyung Cheol [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    1996-03-01

    To evaluate the usefulness of the esophagogram using marshmallow bolus in the evaluation of the causes of variable esophageal-related symptoms. Esophagograms using marshmallow bolus were performed on 44 patients with esophageal-related symptoms and on ten normal volunteers. Videofluoroscopic studies were also made. Patients were classified into three groups according to their esophageal-related symptoms ; those with dysphagia, those with globus symptom, and those with chest pain. Abnormal findings on an esophagogram with marshmallow were graded in to three categories ; mild, moderate, and severe. Provocation of the same symptom was also evaluated. Esophageal monometric studies were performed on 16 patients and those results were compared with the results obtained from the esophagogram using marshmallow bolus. The provocation rate of the some symptom was 33% in the first group, 47% in the second, and 24% in the third. The provocation rate was highest in the second group. The provocation rate was also higher in patients with a severe degree of abnormality on an esophagogram using marshmallow bolus. Where there were abnormal findings, an esophagogram using marshmallow bolus showed a higher abnormality rate than did a conventional esophagogram. In cases showing abnormal finding son the esophageal monometric study, an esophagogram using marshmallow bolus showed a higher provocation rate and more severe abnormality than in cases showing normal findings on manometric study. An esophagogram using marshmallow bolus will a useful radiologic screening modality for the evaluation of patients with esophageal-related symptoms.

  16. [Esophageal motility disorders].

    Science.gov (United States)

    Hannig, C; Wuttge-Hannig, A; Rummeny, E

    2007-02-01

    For the better understanding of esophageal motility, the muscle texture and the distribution of skeletal and smooth muscle fibers in the esophagus are of crucial importance. Esophageal physiology will be shortly mentioned as far as necessary for a comprehensive understanding of peristaltic disturbances. Besides the pure depiction of morphologic criteria, a complete esophageal study has to include an analysis of the motility. New diagnostic tools with reduced radiation for dynamic imaging (digital fluoroscopy, videofluoroscopy) at 4-30 frames/s are available. Radiomanometry is a combination of a functional pressure measurement and a simultaneous dynamic morphologic analysis. Esophageal motility disorders are subdivided by radiologic and manometric criteria into primary, secondary, and nonclassifiable forms. Primary motility disorders of the esophagus are achalasia, diffuse esophageal spasm, nutcracker esophagus, and the hypertonic lower esophageal sphincter. The secondary motility disorders include pseudoachalasia, reflux-associated motility disorders, functionally caused impactions, Boerhaave's syndrome, Chagas'disease, scleroderma, and presbyesophagus. The nonclassificable motility disorders (NEMD) are a very heterogeneous collective.

  17. [Congenital Esophageal Atresia].

    Science.gov (United States)

    Suzuki, Makoto; Kuwano, Hiroyuki

    2015-07-01

    In this report, we describe the esophageal atresia in terms of current surgical management on the basis of our experience and literatures. Traditionally, infants with esophageal atresia have presented shortly after birth because of an inability to pass an orogastric tube, respiratory distress, or an inability to tolerate feeding. And also, an isolated trachea-esophageal fistula (TEF) usually cases coughing, recurrent pneumonia, or choking during feedings. To ignore these symptoms is to risk a delayed diagnosis. The condition may be associated with other major congenital anomalies such as those seen in the vertebral, anal, cardiac, tracheo-esophageal, renal/radial (VACTER) association, or it may be an isolated defect. Therapeutic strategies for esophageal atresia are a prevention of pulmonary complication by TEF closing and an early establishment of enteral alimentation. We promptly repair healthy infants without performing a gastrostomy and delay repair in infants with high-risk factors such as associated severe cardiac anomaly and respiratory insufficiency. Esophageal atresia has been classically approached through a thoracotomy. The disadvantages of such a thoracotomy have been recognized for a long time, for example winged scapula, elevation of fixation of shoulder, asymmetry of the chest wall, rib fusion, scoliosis, and breast and pectoral muscle maldevelopment. To avoid such disadvantages, thoracoscopic repair was recently reported.

  18. Myocardial metabolic abnormalities in hypertrophic cardiomyopathy assessed by iodine-123-labeled beta-methyl-branched fatty acid myocardial scintigraphy and its relation to exercise-induced ischemia

    International Nuclear Information System (INIS)

    Matsuo, Shinro; Nakamura, Yasuyuki; Takahashi, Masayuki; Mitsunami, Kenichi; Kinoshita, Masahiko

    1998-01-01

    Reversible thallium-201 ( 201 Tl) abnormalities during exercise stress have been used as markers of myocardial ischemia in hypertrophic cardiomyopathy (HCM) and are most likely to identify relatively underperfused myocardium. Although metabolic abnormalities in HCM were reported, the relationship between impaired energy metabolism and exercise-induced ischemia has not been fully elucidated as yet. To assess the relationship between myocardial perfusion abnormalities and fatty acid metabolic abnormalities, 28 patients with HCM underwent exercise 201 Tl and rest 123 I-15-(p-iodophenyl)-3-methyl pentadecanoic acid (BMIPP) scintigraphy. Perfusion abnormalities were observed by exercise 201 Tl in 19/28 patients with HCM. 123 I-BMIPP uptake was decreased compared with delayed 201 Tl in 106/364 (29%) of the total myocardial segments (p 123 I-BMIPP and 201 Tl was observed more often in the 49/75 (65%) segments with reversible exercise 201 Tl defects (p 123 I-BMIPP and 201 Tl suggests that myocardial ischemia may play an important role in metabolic abnormalities in HCM. (author)

  19. Esophageal radionuclide in transit in patient with Diabetes Mellitus

    International Nuclear Information System (INIS)

    Pruzzo, R.; Sirandoni, G.; Olea, E.

    1985-01-01

    Nineteen unselected patients with Diabetes Mellitus (D.M.), were studied by Esophageal Radionuclide Transit (ERT), with positive or negative gastrointestinal symptoms, and/or peripheral neuropathy. Esophageal Manometry (EM) was performed to 10 of them. 6/10 symptomatic patients had abnormal ERT, 5 of which had dysphagia, 6/9 asymptomatic patients also had an altered ERT. 83% of those patients with peripheral neuropathy, had altered ERT. We found a 90% diagnostic correlation between ERT and EM. Our findings confirm that abnormal esophageal motor function, often subclinical, is present in most of the long term diabetic patients. This can be highly correlated with the presence of peripheral neuropathy and can be easily evaluated through a non-invasive method like TER. (Author)

  20. Role of mitotic motors, dynein and kinesin, in the induction of abnormal centrosome integrity and multipolar spindles in cultured V79 cells exposed to dimethylarsinic acid.

    Science.gov (United States)

    Ochi, Takafumi

    2002-01-29

    The role of microtubule-based motors in the induction of abnormal centrosome integrity by dimethylarsinic acid (DMAA) was investigated with the use of monastrol, a specific inhibitor of mitotic kinesin, and vanadate, an inhibitor of dynein ATPase. Cytoplasmic dynein co-localized with multiple foci of gamma-tubulin in mitotic cells arrested by DMAA. Disruption of microtubules caused dispersion of dynein while multiple foci of gamma-tubulin were coalesced to a single dot. Vanadate also caused dispersion of dynein, which had been co-localized with multiple foci of gamma-tubulin by DMAA, without affecting spindle organization. However, the dispersion of dynein did not prohibit the induction of abnormal centrosome integrity by DMAA. Inhibition of mitotic kinesin by monastrol resulted in monoastral cells with non-migrated centrosomes in the cell center. Monastrol, when applied to mitotic cells with abnormal centrosome integrity, rapidly reduced the incidence of cells with the centrosome abnormality. Moreover, monastrol completely inhibited reorganization of abnormal centrosomes that had been coalesced to a single dot by microtubule disruption. These results suggest that abnormal centrosome integrity caused by DMAA is not simply due to dispersion of fragments of microtubule-organizing centers, but is dependent on the action of kinesin. In addition, the results suggest that kinesin plays a role not only in the induction of mitotic centrosome abnormality, but also in maintenance.

  1. Spontaneous Esophageal Injury: Esophageal Intramural Hematoma

    Directory of Open Access Journals (Sweden)

    Yu-Hui Chiu

    2009-09-01

    Full Text Available Acute chest pain can indicate a life-threatening condition and it is important for physicians to diagnose and treat it as a matter of urgency. We report 1 rare case of esophageal intramural hematoma (IMH that presented with chest pain at the emergency department and which was initially clinically suspected to be due to aortic dissection. The case was diagnosed preoperatively by multidetector computed tomography. Esophageal IMH may represent an intermediate stage between Mallory-Weiss tear (mucosal and Boerhaave's syndrome (transmural. Multidetector computed tomography is a useful noninvasive imaging modality for accurate diagnosis of these spontaneous intramural and transmural ruptures of the esophagus, and aids in the differential diagnosis of aortic and other mediastinal diseases with acute chest pain.

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

    Science.gov (United States)

    Keren, S; Argaman, E

    1992-09-01

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

  3. Associated anomalies in cases with esophageal atresia.

    Science.gov (United States)

    Stoll, Claude; Alembik, Yves; Dott, Beatrice; Roth, Marie-Paule

    2017-08-01

    Esophageal atresia (EA) is a common type of congenital anomaly. The etiology of esophageal atresia is unclear and its pathogenesis is controversial. Infants with esophageal atresia often have other non-EA associated congenital anomalies. The purpose of this investigation was to assess the prevalence and the types of these associated anomalies in a defined population. The associated anomalies in cases with EA were collected in all livebirths, stillbirths, and terminations of pregnancy during 29 years in 387,067 consecutive births in the area covered by our population-based registry of congenital malformations. Of the 116 cases with esophageal atresia, representing a prevalence of 2.99 per 10,000, 54 (46.6%) had associated anomalies. There were 9 (7.8%) cases with chromosomal abnormalities including 6 trisomies 18, and 20 (17.2%) nonchromosomal recognized dysmorphic conditions including 12 cases with VACTERL association and 2 cases with CHARGE syndrome. Twenty five (21.6%) of the cases had multiple congenital anomalies (MCA). Anomalies in the cardiovascular, the digestive, the urogenital, the musculoskeletal, and the central nervous systems were the most common other anomalies. The anomalies associated with esophageal atresia could be classified into a recognizable malformation syndrome or pattern in 29 out of 54 cases (53.7%). This study included special strengths: each affected child was examined by a geneticist, all elective terminations were ascertained, and the surveillance for anomalies was continued until 2 years of age. In conclusion the overall prevalence of associated anomalies, which was close to one in two cases, emphasizes the need for a thorough investigation of cases with EA. A routine screening for other anomalies may be considered in infants and in fetuses with EA. © 2017 Wiley Periodicals, Inc.

  4. Esophageal Replacement for Long-Gap Esophageal Atresia in a ...

    African Journals Online (AJOL)

    The management of esophageal atresia in a resourcelimited environment is plagued with challenges that often lead to poor outcome. The diagnosis and management of babies with long-gap esophageal atresia adds a new dimension to these challenges. We report the success of esophageal replacement surgery for a ...

  5. Pediatric eosinophilic esophagitis: radiologic findings with pathologic correlation

    International Nuclear Information System (INIS)

    Binkovitz, Larry A.; Lorenz, Emily A.; Di Lorenzo, Carlo; Kahwash, Samir

    2010-01-01

    Eosinophilic esophagitis is increasingly recognized as a cause of dysphagia or food impaction in pediatric patients. It has a high male predominance and is often associated with a history of allergy or asthma. To correlate fluoroscopic findings in eosinophilic esophagitis with the endoscopic and histologic findings. We retrospectively reviewed the upper gastrointestinal (UGI) findings of eosinophilic esophagitis and correlated them with the clinical, endoscopic and histologic findings in a series of 17 children (12 boys, 5 girls). UGI findings were normal in 12 children, including 4 who had a normal UGI exam after endoscopic disimpaction for an obstructing food bolus. Five children had strictures identified on UGI: one was demonstrated with endoscopy. This suggests that the impactions and strictures were due to an esophageal dysmotility rather than a fixed anatomic abnormality. Because the UGI findings are frequently normal in eosinophilic esophagitis, radiologists need to have a high index of suspicion for this disease. In children with a strong clinical history, especially impaction in the absence of an esophageal stricture, endoscopy and biopsy are indicated for further evaluation. (orig.)

  6. Black and White Esophagus: Rare Presentations of Severe Esophageal Ischemia.

    Science.gov (United States)

    Kim, Daniel B; Bowers, Steven; Thomas, Mathew

    2017-01-01

    Benign esophageal strictures are typically the result of long-standing gastroesophageal reflux, and are usually treated with serial dilations and acid-suppressive therapy. Other causes of benign esophageal strictures include external beam radiation, caustic ingestions, prior surgery, and external compression from mediastinal fibrosis. We report 2 rare causes of ischemic esophageal structuring occurring after operations unrelated to the esophagus. The first is a patient who developed esophageal injury following radiofrequency ablation for atrial fibrillation. The direct thermal injury resulted in a "white esophagus" with a full-thickness, long-segmental stricture. The second patient presented with a "black esophagus" also known as acute necrotizing esophagitis. This occurred after an orthotopic liver transplant, which was complicated by multiple organ dysfunction secondary to hemorrhagic shock. In this report, we present 2 rare causes of esophageal stricturing that occurred after procedures not necessarily related to the esophagus itself. Early recognition and active management of these esophageal injuries may lead to better outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. VIDEOFLUOROSCOPIC SWALLOWING STUDY: esophageal alterations in patients with dysphagia

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    Betina SCHEEREN

    2014-09-01

    Full Text Available Context Videofluoroscopic swallowing study is a dynamic exam and allows the evaluation of the complete swallowing process. However, most published studies have only reported alterations in the oropharynx and pharyngoesophageal transition, leaving the analysis of the esophagus as a secondary goal. Objectives The goal of this study was to investigate the prevalence of alterations in the esophageal phase thorough videofluoroscopic swallowing study in patients with dysphagia. Methods Consecutive patients with dysphagia who underwent videofluoroscopic swallowing study including esophageal analysis between May 2010 and May 2012 had their exams retrospectively reviewed. Patients were classified into two groups: Group I - without a pre-established etiological diagnosis and Group II - with neurological disease. During the exam, the patients ingested three different consistencies of food (liquid, pasty and solid contrasted with barium sulfate and 19 items were analyzed according to a protocol. The esophageal phase was considered abnormal when one of the evaluated items was compromised. Results Three hundred and thirty-three (n = 333 consecutive patients were studied - 213 (64% in Group I and 120 (36% in Group II. Esophageal alterations were found in 104 (31% patients, with a higher prevalence in Group I (36.2%, especially on the items esophageal clearance (16.9% and tertiary contractions (16.4%. It was observed that 12% of individuals in Group I only presented alterations on the esophageal phase. Conclusion Evaluation of the esophageal phase of swallowing during videofluoroscopic swallowing study detects abnormalities in patients with cervical dysphagia, especially in the group without pre-established etiological diagnosis.

  8. Does the Use of Pacifier Affect Gastro-Esophageal Reflux in Preterm Infants?

    Science.gov (United States)

    Corvaglia, Luigi; Martini, Silvia; Corrado, Maria Francesca; Mariani, Elisa; Legnani, Elena; Bosi, Isabella; Faldella, Giacomo; Aceti, Arianna

    2016-05-01

    This crossover study showed that non-nutritive sucking, provided with a pacifier in 30 preterm infants, had no effect on acid and nonacid gastro-esophageal reflux evaluated by esophageal pH-impedance, and thus may be reasonably used in preterm neonates with symptoms of gastro-esophageal reflux. ClinicalTrials.gov: NCT02023216. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Practice guidelines on the use of esophageal manometry - A GISMAD-SIGE-AIGO medical position statement.

    Science.gov (United States)

    Savarino, Edoardo; de Bortoli, Nicola; Bellini, Massimo; Galeazzi, Francesca; Ribolsi, Mentore; Salvador, Renato; Savarino, Vincenzo; Penagini, Roberto

    2016-10-01

    Patients with esophageal symptoms potentially associated to esophageal motor disorders such as dysphagia, chest pain, heartburn and regurgitation, represent one of the most frequent reasons for referral to gastroenterological evaluation. The utility of esophageal manometry in clinical practice is: (1) to accurately define esophageal motor function, (2) to identify abnormal motor function, and (3) to establish a treatment plan based on motor abnormalities. With this in mind, in the last decade, investigations and technical advances, with the introduction of high-resolution esophageal manometry, have enhanced our understanding and management of esophageal motility disorders. The following recommendations were developed to assist physicians in the appropriate use of esophageal manometry in modern patient care. They were discussed and approved after a comprehensive review of the medical literature pertaining to manometric techniques and their recent application. This position statement created under the auspices of the Gruppo Italiano di Studio per la Motilità dell'Apparato Digerente (GISMAD), Società Italiana di Gastroenterologia ed Endoscopia Digestiva (SIGE) and Associazione Italiana Gastroenterologi ed Endoscopisti Digestivi Ospedalieri (AIGO) is intended to help clinicians in applying manometric studies in the most fruitful manner within the context of their patients with esophageal symptoms. Copyright © 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  10. Esophageal Lichen Planus: Clinical and Radiographic Findings in Eight Patients.

    Science.gov (United States)

    Rauschecker, Andreas M; Levine, Marc S; Whitson, Matthew J; Tondon, Rashmi; Rubesin, Stephen E; Furth, Emma E; Metz, David C

    2017-01-01

    The purpose of this study is to present the clinical and radiographic findings of esophageal lichen planus. A search of computerized medical records identified 15 patients with pathologic findings of esophageal lichen planus on endoscopic biopsy specimens. Three other patients had presumed esophageal lichen planus, although no biopsy specimens were obtained. Twelve of these 18 patients (67%) had double-contrast esophagography performed at our institution; for eight of the 12 patients (67%), the studies revealed abnormalities in the esophagus. These eight patients constituted our study group. The barium esophagrams and medical records of these eight patients were reviewed to determine the clinical, radiographic, and endoscopic findings of esophageal lichen planus as well as the treatment and patient outcome. All eight patients were women (median age, 66.5 years), and all eight presented with dysphagia (mean duration, 3.2 years). Four patients had previous lichen planus that involved the skin (n = 1), the oral cavity (n = 2), or both (n = 1), and one patient later had lichen planus that involved the vagina. Five patients had a small-caliber esophagus with diffuse esophageal narrowing. The remaining three patients had segmental strictures in the cervical (n = 1), upper thoracic (n = 1), and distal thoracic (n = 1) esophagus. Esophageal lichen planus typically occurs in older women with longstanding dysphagia and often develops in the absence of extraesophageal disease. Barium esophagrams may reveal a small-caliber esophagus or, less commonly, segmental esophageal strictures. Greater awareness of the radiographic findings of esophageal lichen planus hopefully will lead to earlier diagnosis and better management of this condition.

  11. The Potential Benefits of Applying Recent Advances in Esophageal Motility Testing in Patients with Esophageal Atresia

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    Nathalie Rommel

    2017-06-01

    Full Text Available Infants and children with esophageal atresia commonly present with swallowing dysfunction or dysphagia. Dysphagia can lead to a range of significant consequences such as aspiration pneumonia, malnutrition, dehydration, and food impaction. To improve oral intake, the clinical diagnosis of dysphagia in patients with esophageal atresia should focus on both the pharynx and the esophagus. To characterize the complex interactions of bolus flow and motor function between mouth, pharynx, and esophagus, a detailed understanding of normal and abnormal deglutition is required through the use of adequate and objective assessment techniques. As clinical symptoms do not correlate well with conventional assessment methods of motor function such as radiology or manometry but do correlate with bolus flow, the current state-of-the-art diagnosis involves high-resolution manometry combined with impedance measurements to characterize the interplay between esophageal motor function and bolus clearance. Using a novel pressure flow analysis (PFA method as an integrated analysis method of manometric and impedance measurements, differentiation of patients with impaired esophago-gastric junction relaxation from patients with bolus outflow disorders is clinically relevant. In this, pressure flow matrix categorizing the quantitative PFA measures may be used to make rational therapeutic decisions in patients with esophageal atresia. Through more advanced diagnostics, improved understanding of pathophysiology may improve our patient care by directly targeting the failed biomechanics of both the pharynx and the esophagus.

  12. [Corrosive esophagitis in children (author's transl)].

    Science.gov (United States)

    Arcand, P; Guerguerian, A J

    1982-01-01

    The treatment of corrosive esophagitis in children remains a controversial subject. A review of the literature and the various forms of treatment is presented with a retrospective study done a the Ste-Justine Hospital in Montreal. We studied the charts (327) of patients hospitalized for ingestion of corrosive substances for the period extending between 1970 to 1976 inclusively. The mean age of the patients involved was 2 years 4 months with a slight male predominance (60%). Javel water, sodium hydroxide, Chlorine, ammoniac and different acids were, in this order, the agents most frequently encountered. Esophageal burns proven by endoscopy was noted in 81 cases. Even in the absence of oropharyngeal burns, esophageal involvement was still present in 46% of cases. The low incidence of stenosis (9%) tends to confirm the beneficial role of steroids in the treatment of corrosive esophagitis. This is particularly true for 1st and 2nd degree burns whereas their administration in severe 3rd degree burn remains controversial.

  13. Radionuclide esophageal transit test to detect esophageal disorders in patients with mitral valve prolapse

    Energy Technology Data Exchange (ETDEWEB)

    Kao Chiahung [Dept. of Nuclear Medicine, Taichung Veterans General Hospital (Taiwan); Tsai Shihchuan [Dept. of Nuclear Medicine, Show-Chwan Memorial Hospital, Changhua (Taiwan); Hsieh Jihfang [Dept. of Nuclear Medicine, Chi-Mei Foundation Hospital, Tainan (Taiwan); Ho Yungjen [Dept. of Radiology, Jen-Ai Hospital, Taichung (Taiwan); Ding Hueischjy [Dept. of Nuclear Medicine, Kaohsiung Medicine Coll. (Taiwan)

    2000-06-01

    Aim: The origin of chest discomfort in patients with mitral valve prolapse (MVP) is controversial. Our aim was to prospectively determine the incidence of esophageal disorders in MVP patients with or without chest pain. Methods: Twenty-five MVP patients with chest pain (group A) and 25 MVP patients without chest pain (group B) underwent evaluation of esophageal motility. None of the total of 50 MVP patients had significant coronary artery disease on cardiac catheterization. Esophageal motility including esophageal mean transit time (MTT), residual fraction (RF), and retrograde index (RI) was analyzed by the radionuclide esophageal transit test (RETT). Results: In comparison with 25 age and sex-matched healthy volunteers, the results showed that: (1) 19 patients in group A (76%) had abnormal RETT findings (48% of cases with prolonged MTT, 44% of cases with higher RF, and 60% of cases with higher RI); (2) 3 patients in group B (12%) had abnormal RETT findings (8% of cases with prolonged MTT, 4% of cases with higher RF, and 8% of cases with higher RI). In addition, mean values of MTT, RF, and RI in group A patients were significantly higher than in group B patients and healthy volunteers. Conclusion: We found that the chest pain in some MVP patients may be related to abnormal esophageal motility, based on the evidence from a simple and noninvasive RETT. (orig.) [German] Ziel: Die Ursache thorakaler Beschwerden bei Patienten mit Mitralklappenprolaps (MVP) wird kontrovers diskutiert. Wir bestimmten prospektiv die Haeufigkeit oesophagealer Stoerungen in MVP-Patienten mit oder ohne thorakale Beschwerden. Methode: Bei jeweils 25 MVP-Patienten mit thorakalen Beschwerden (Gruppe A) und 25 MVP-Patienten ohne thorakale Beschwerden (Gruppe B) wurde die oesophageale Motilitaet untersucht. Keiner der 50 MVP-Patienten hatte eine koronarangiographisch nachweisbare koronare Herzkrankheit. Mittels der Oesophagus-Funktionsszintigraphie (OeFZ) wurden oesophageale Motilitaet inklusive

  14. Distal esophageal spasm.

    Science.gov (United States)

    Roman, Sabine; Kahrilas, Peter J

    2015-07-01

    Distal esophageal spasm (DES) is a rare esophageal motility disorder associated with dysphagia and chest pain. In 2011, the diagnosis of DES was refined based on the occurrence of premature (rather than rapid) contractions by high-resolution manometry. New therapeutic options have also been recently proposed. Thus, a review on DES incorporating publications since 2012 is timely because of these revisions in definition and management. DES remains a heterogeneous clinical disorder. Its pathophysiology is still debated and DES might be related to achalasia. Alternatively, it might be secondary to medications, especially opiates. Endoscopic ultrasound might be informative diagnostically by demonstrating muscularis propria hypertrophy and thickening. Botulinum toxin injection in the esophageal body has been shown superior to placebo to relieve symptoms associated with DES. Finally, per oral endoscopic myotomy is a promising therapeutic approach, but may be less effective in DES than in achalasia. The diagnosis of DES should lead to a systematic search for medication that might promote the occurrence of esophageal dysmotility. Endoscopic treatment of DES (botulinum toxin injection or per oral endoscopic myotomy) should be further evaluated in controlled studies using current diagnostic criteria by high-resolution manometry.

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

    Directory of Open Access Journals (Sweden)

    Ashraf Karbasi

    2013-01-01

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

  16. Gastroesophageal Acid Reflux Control 5 Years After Antireflux Surgery, Compared With Long-term Esomeprazole Therapy.

    Science.gov (United States)

    Hatlebakk, Jan G; Zerbib, Frank; Bruley des Varannes, Stanislas; Attwood, Stephen E; Ell, Christian; Fiocca, Roberto; Galmiche, Jean-Paul; Eklund, Stefan; Långström, Göran; Lind, Tore; Lundell, Lars R

    2016-05-01

    We compared the ability of laparoscopic antireflux surgery (LARS) and esomeprazole to control esophageal acid exposure, over a 5-year period, in patients with chronic gastroesophageal reflux disease (GERD). We also studied whether intraesophageal and intragastric pH parameters off and on therapy were associated with long-term outcomes. We analyzed data from a prospective, randomized, open-label trial comparing the efficacy and safety of LARS vs esomeprazole (20 or 40 mg/d) over 5 years in patients with chronic GERD. Ambulatory intraesophageal and intragastric 24-hour pH monitoring data were compared between groups before LARS or the start of esomeprazole treatment, and 6 months and 5 years afterward. A secondary aim was to evaluate the association between baseline and 6-month pH parameters and esomeprazole dose escalation, reappearance of GERD symptoms, and treatment failure over 5 years in patients receiving LARS or esomeprazole. In the LARS group (n = 116), the median 24-hour esophageal acid exposure was 8.6% at baseline and 0.7% after 6 months and 5 years (P esomeprazole group (n = 151), the median 24-hour esophageal acid exposure was 8.8% at baseline, 2.1% after 6 months, and 1.9% after 5 years (P esomeprazole). Gastric acidity was stable in both groups. Patients who required a dose increase to 40 mg/d had more severe supine reflux at baseline, and decreased esophageal acid exposure (P esomeprazole therapy. However, patients receiving LARS had significantly greater reductions in 24-hour esophageal acid exposure after 6 months and 5 years. Esophageal and gastric pH, off and on therapy, did not predict long-term outcomes of patients. Abnormal supine acid exposure predicted esomeprazole dose escalation. ClinicalTrials.Gov identifier: NCT00251927 (available: http://clinicaltrials.gov/ct2/show/NCT00251927). Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.

  17. Congenital Abnormalities

    Science.gov (United States)

    ... Stages Ages and Stages Prenatal Baby (0-12 mos.) Toddler 1-3yrs. Preschool 3-5yrs Grade School ... Categories of Congenital Abnormalities Chromosome Abnormalities Chromosomes are structures that carry genetic material inherited from one generation ...

  18. Right pulmonary aplasia, aberrant left pulmonary artery, and bronchopulmonary sequestration with an esophageal bronchus

    International Nuclear Information System (INIS)

    Lee, Peter; McCauley, Roy; Westra, Sjirk; Baba, Timothy

    2006-01-01

    Pulmonary aplasia and bronchopulmonary foregut malformations in which a patent communication between the foregut and the pulmonary system is present are rare congenital abnormalities. Pulmonary aplasia associated with a pulmonary sling is an even rarer abnormality. We report a unique case of right pulmonary aplasia, aberrant left pulmonary artery, and bronchopulmonary sequestration with an esophageal bronchus diagnosed by multidetector helical CT. (orig.)

  19. Eosinophilic Esophagitis: an Emerging Clinicopathologic Disease of Children and Adults

    Science.gov (United States)

    Straumann, Alex

    2006-01-01

    Eosinophililc esophagitis is a clinicopathologic disease characterized clinically by dysphagia and food impaction in adults and nonspecific symptoms of gastroesophageal reflux disease in children, and histologically by large numbers of eosinophils in the proximal and distal esophageal epithelium. Importantly, these symptoms and histologic abnormalities appear to be unresponsive to proton pump inhibition. Recent clinical and basic studies suggest an allergic etiology but the precise allergen remains unknown and is likely unique for each patient. Endoscopic features suggest ongoing inflammation and range from linear furrowing with whitish exudation to long-segment stricture formation, to a fragile, crepe paper–like mucosa that is easily split open. Treatments include nutritional restrictions, medical management with topical steroids, and, in stenotic circumstances, esophageal dilation. The long-term outcome is still not certain. PMID:28289340

  20. Esophageal bypass after failed chemoradiotherapy for unresectable esophageal cancer

    International Nuclear Information System (INIS)

    Matono, Satoru; Tanaka, Toshiaki; Mori, Naoki; Nagano, Takeshi; Fujita, Hiromasa; Shirouzu, Kazuo

    2013-01-01

    Esophageal stenosis and/or fistula often occur after chemoradiotherapy (CRT) for unresectable esophageal cancer. In such patients, an esophageal stent can help achieve oral intake. However an esophageal stent cannot be inserted where there is complete stenosis or where the tumor is located. In such cases, esophageal bypass surgery may be necessary. Here, we investigated the clinical characteristics and outcomes in patients who underwent esophageal bypass surgery in our institution. We reviewed 10 cases of esophageal bypass surgery (gastric tube in 8 cases, colon in 2 cases) after CRT for unresectable esophageal cancer, between 2001 and 2009. There were 5 of stenosis-only cases, 4 fistula-only cases, and 1 case of stenosis and fistula. There were postoperative complications in 5 cases (50%), and all these were treated conservatively and healed. The median survival from surgery to peroral intake was 20 days (range 9-90 days), and the median survival after starting peroral intake was 130 days (range 48-293 days). Esophageal bypass surgery can achieve good performance status and improve peroral intake. (author)

  1. Worldwide esophageal cancer collaboration.

    Science.gov (United States)

    Rice, T W; Rusch, V W; Apperson-Hansen, C; Allen, M S; Chen, L-Q; Hunter, J G; Kesler, K A; Law, S; Lerut, T E M R; Reed, C E; Salo, J A; Scott, W J; Swisher, S G; Watson, T J; Blackstone, E H

    2009-01-01

    The aim of this study is to report assemblage of a large multi-institutional international database of esophageal cancer patients, patient and tumor characteristics, and survival of patients undergoing esophagectomy alone and its correlates. Forty-eight institutions were approached and agreed to participate in a worldwide esophageal cancer collaboration (WECC), and 13 (Asia, 2; Europe, 2; North America, 9) submitted data as of July 1, 2007. These were used to construct a de-identified database of 7884 esophageal cancer patients who underwent esophagectomy. Four thousand six hundred and twenty-seven esophagectomy patients had no induction or adjuvant therapy. Mean age was 62 +/- 11 years, 77% were men, and 33% were Asian. Mean tumor length was 3.3 +/- 2.5 cm, and esophageal location was upper in 4.1%, middle in 27%, and lower in 69%. Histopathologic cell type was adenocarcinoma in 60% and squamous cell in 40%. Histologic grade was G1 in 32%, G2 in 33%, G3 in 35%, and G4 in 0.18%. pT classification was pTis in 7.3%, pT1 in 23%, pT2 in 16%, pT3 in 51%, and pT4 in 3.3%. pN classification was pN0 in 56% and pN1 in 44%. The number of lymph nodes positive for cancer was 1 in 12%, 2 in 8%, 3 in 5%, and >3 in 18%. Resection was R0 in 87%, R1 in 11%, and R2 in 3%. Overall survival was 78, 42, and 31% at 1, 5, and 10 years, respectively. Unlike single-institution studies, in this worldwide collaboration, survival progressively decreases and is distinctively stratified by all variables except region of the world. A worldwide esophageal cancer database has been assembled that overcomes problems of rarity of this cancer. It reveals that survival progressively (monotonically) decreased and was distinctively stratified by all variables except region of the world. Thus, it forms the basis for data-driven esophageal cancer staging. More centers are needed and encouraged to join WECC.

  2. Clinical significance of abnormal high signal intensity of left ventricular myocardium by gadolinium-diethylenetriaminepenta-acetic acid enhanced magnetic resonance imaging in hypertrophic cardiomyopathy

    Energy Technology Data Exchange (ETDEWEB)

    Koito, Hitoshi; Suzuki, Junichi; Nakamori, Hisato; Ohkubo, Naohiko; Wakayama, Yuka; Iwasaka, Toshiji; Inada, Mitsuo; Katoh, Tsumotu [Kansai Medical Univ., Moriguchi, Osaka (Japan)

    1995-04-01

    The significance of abnormal high signal intensity observed in left ventricular myocardium by gadolinium-diethylenetriaminepenta-acetic acid (Gd-DTPA) enhanced magnetic resonance (MR) imaging in hypertrophic cardiomyopathy (HCM) patients was assessed by comparison with T{sub 1}-weighted MR imaging, thallium-201 ({sup 201}Tl) myocardial scintigraphy, radionuclide angiocardiography, M-mode echocardiography, electrocardiography, and chest radiography. The 16 patients were divided into three groups: 8 patients (group I) with abnormal high signal intensity before and after Gd-DTPA enhancement, 4 (group II) with abnormal high signal intensity only after enhancement and 4 (group III) without abnormal high signal intensity. Thallium-201 myocardial single photon emission computed tomography (SPECT) showed abnormalities of regional {sup 201}Tl uptake in the left ventricular myocardium in 4 patients in Group I, 3 in group II, and one in Group III. No significant difference in left ventricular ejection fraction (LVEF) was seen between groups I, II, and III (64{+-}13%, 67{+-}17% and 71{+-}7%) although 3 patients in group I had LVEF of less than 55%. Left ventricular peak filling rates (PFR) of groups I and II were significantly lower than group III (1.90{+-}0.44, 2.41{+-}0.43 and 3.37{+-}0.48 EDV/sec). Group I had larger end-diastolic left ventricular dimension (LVDd), significantly larger end-systolic left ventricular dimension (LVDs), and smaller % fractional shortening (%FS) than group III (49{+-}4 vs 42{+-}6 mm, 31{+-}5 vs 22{+-}4 mm, and 38{+-}8 vs 49{+-}4%). Abnormal high signal intensity in left ventricular myocardium in HCM seems to reflect myocardial ischemia and fibrosis due to small vessel disease, or myocardial degeneration and necrosis. We conclude that Gd-DTPA enhanced MR imaging may detect the early process of the dilated phase of HCM. (J.P.N.).

  3. Esophageal dischalasia: Serendipity during sup(99m)Tc thyroid scan. Case report

    Energy Technology Data Exchange (ETDEWEB)

    Iorio, F.; Lorenzon, D.; Giacobini, E.

    1986-04-01

    It is rare for a large amount of pooled radioactive saliva to be observed in the neck during a thyroid scan. Such a finding would imply abnormal salivation and/or esophageal kinesis. The case of esophageal dischalasia reported here suggests that a complete study of the esophagus is advisable when a large area or amount of radioactive saliva is observed in the neck during a thyroid scan.

  4. High Resolution Esophageal Manometry in Patients with Chagas Disease: A Cross-Sectional Evaluation.

    Directory of Open Access Journals (Sweden)

    Adrián Sánchez-Montalvá

    2016-02-01

    Full Text Available Gastrointestinal involvement affects 30-40% of the patients with chronic Chagas disease. Esophageal symptoms appear once the structural damage is established. Little is known about the usefulness of high resolution manometry to early identification of esophageal involvement.We performed a cross-sectional study at the Vall d'Hebron University Hospital (Barcelona, Spain between May 2011 and April 2012. Consecutive patients diagnosed with Chagas disease in the chronic phase were offered to participate. All patients underwent a structured questionnaire about digestive symptoms, a barium esophagogram (Rezende classification and an esophageal high resolution manometry (HRM. A control group of patients with heartburn who underwent an esophageal HRM in our hospital was selected.62 out of 73 patients that were included in the study fulfilled the study protocol. The median age of the Chagas disease group (CG was 37 (IQR 32-45 years, and 42 (67.7% patients were female. Twenty-seven (43.5% patients had esophageal symptoms, heartburn being the most frequent. Esophagogram was abnormal in 5 (8.77%. The esophageal HRM in the CG showed a pathological motility pattern in 14 patients (22.6%. All of them had minor disorders of the peristalsis (13 with ineffective esophageal motility and 1 with fragmented peristalsis. Hypotonic lower esophageal sphincter was found more frequently in the CG than in the control group (21% vs 3.3%; p<0.01. Upper esophageal sphincter was hypertonic in 22 (35.5% and hypotonic in 1 patient. When comparing specific manometric parameters or patterns in the CG according to the presence of symptoms or esophagogram no statistically significant association were seen, except for distal latency.The esophageal involvement measured by HRM in patients with chronic Chagas disease in our cohort is 22.6%. All the patients with esophageal alterations had minor disorders of the peristalsis. Symptoms and esophagogram results did not correlate with the HRM

  5. A randomized, comparative study of three doses of AZD0865 and esomeprazole for healing of reflux esophagitis

    DEFF Research Database (Denmark)

    Kahrilas, Peter J; Dent, John; Lauritsen, Karsten

    2007-01-01

    BACKGROUND & AIMS: AZD0865 belongs to a new class of acid-suppressing agents with rapid onset of action and potent acid inhibition. We evaluated its effectiveness for healing reflux esophagitis. METHODS: One thousand five hundred twenty-one patients with Los Angeles A-D esophagitis and heartburn ...

  6. Association between esophageal dysmotility and gastroesophaeal reflux on barium studies

    International Nuclear Information System (INIS)

    Campbell, Craig; Levine, Marc S.; Rubesin, Stephen E.; Laufer, Igor; Redfern, Gina; Katzka, David A.

    2006-01-01

    Objective: To determine whether there is an association between abnormal primary peristalsis in the esophagus and gastroesophageal reflux (GER) on barium studies. Methods: A computerized search of radiologic reports revealed 151 patients with esophageal dysmotility (characterized by intermittently decreased or absent peristalsis in the esophagus on upper gastrointestinal tract examinations) who fulfilled our study's entry criteria. These 151 patients were stratified into two groups depending on whether this dysmotility was associated with nonperistaltic contractions (NPCs): 92 patients had no NPCs (Dysmotility and No NPCs Group) and 59 had NPCs (Dysmotility and NPCs Group). An age-matched control group of 92 patients with normal motility was also generated from the radiologic reports. The reports were also reviewed for the presence and degree of GER and other complications of GER. The frequency and degree of GER were tabulated for each group, and the data were analyzed using a Pearson chi square test to determine if significant differences were present in the frequency and degree of GER or other findings among the groups. Results: The frequency of GER was significantly higher in patients with abnormal peristalsis and no NPCs than in controls (p = 0.02). When GER was stratified based on the degree of reflux, the frequency of moderate-to-marked GER was significantly higher in patients with abnormal peristalsis and no NPCs than in patients with abnormal peristalsis and NPCs (p = 0.01) or in controls (p = 0.0031). The frequency of reflux esophagitis also was significantly higher in patients with abnormal peristalsis and no NPCs than in controls (p = 0.04). Conclusion: Our findings suggest that patients with esophageal dysmotility characterized by intermittently decreased or absent peristalsis without NPCs have a significantly higher frequency and degree of GER than patients with normal motility. The presence of this specific form of esophageal dysmotility on barium

  7. Association between esophageal dysmotility and gastroesophaeal reflux on barium studies

    Energy Technology Data Exchange (ETDEWEB)

    Campbell, Craig [Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104 (United States); Levine, Marc S. [Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104 (United States)]. E-mail: marc.levine@uphs.upenn.edu; Rubesin, Stephen E. [Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104 (United States); Laufer, Igor [Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104 (United States); Redfern, Gina [Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104 (United States); Katzka, David A. [Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104 (United States)

    2006-07-15

    Objective: To determine whether there is an association between abnormal primary peristalsis in the esophagus and gastroesophageal reflux (GER) on barium studies. Methods: A computerized search of radiologic reports revealed 151 patients with esophageal dysmotility (characterized by intermittently decreased or absent peristalsis in the esophagus on upper gastrointestinal tract examinations) who fulfilled our study's entry criteria. These 151 patients were stratified into two groups depending on whether this dysmotility was associated with nonperistaltic contractions (NPCs): 92 patients had no NPCs (Dysmotility and No NPCs Group) and 59 had NPCs (Dysmotility and NPCs Group). An age-matched control group of 92 patients with normal motility was also generated from the radiologic reports. The reports were also reviewed for the presence and degree of GER and other complications of GER. The frequency and degree of GER were tabulated for each group, and the data were analyzed using a Pearson chi square test to determine if significant differences were present in the frequency and degree of GER or other findings among the groups. Results: The frequency of GER was significantly higher in patients with abnormal peristalsis and no NPCs than in controls (p = 0.02). When GER was stratified based on the degree of reflux, the frequency of moderate-to-marked GER was significantly higher in patients with abnormal peristalsis and no NPCs than in patients with abnormal peristalsis and NPCs (p = 0.01) or in controls (p = 0.0031). The frequency of reflux esophagitis also was significantly higher in patients with abnormal peristalsis and no NPCs than in controls (p = 0.04). Conclusion: Our findings suggest that patients with esophageal dysmotility characterized by intermittently decreased or absent peristalsis without NPCs have a significantly higher frequency and degree of GER than patients with normal motility. The presence of this specific form of esophageal dysmotility on

  8. Immunopathogenesis of eosinophilic esophagitis.

    Science.gov (United States)

    Simon, Hans-Uwe; Straumann, Alex

    2014-01-01

    Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus associated with dysphagia in adults and refractory reflux syndromes in children. Immunological and genetic approaches have been used to better understand the pathophysiology of the underlying inflammation. Evidence has accumulated that EoE represents a T-helper (Th) 2-type inflammatory disease, in which allergens play a role in triggering the disease. The majority of the patients suffer from concurrent allergic rhinitis, asthma, and eczema, and have a history of atopy. The chronic inflammatory response in EoE is associated with tissue damage and remodeling, both of which lead to esophageal dysfunction and bolus impaction. The new insights into the pathophysiology have resulted in the development of the first pharmacological therapies of EoE. 2014 S. Karger AG, Basel.

  9. Genetics of Eosinophilic Esophagitis

    Science.gov (United States)

    2012-03-01

    an emerging worldwide food allergic disorder associated with polysensitization to multiple food allergens, resulting in greatly restricted diets and...and methylation), and DNA methylation.77 Importantly, because these genomic al- terations can be influenced by external stimuli, such as diet and drugs...2007;133: 1342-63. 3. Liacouras CA, Furuta GT, Hirano I, Atkins D, Attwood S, Bonis PA, et al. Eosin- ophilic esophagitis: updated consensus

  10. Hypnotherapy for Esophageal Disorders

    Science.gov (United States)

    Riehl, Megan E.; Keefer, Laurie

    2015-01-01

    Hypnotherapy is an evidence based intervention for the treatment of functional bowel disorders, particularly irritable bowel syndrome. While similar in pathophysiology, less is known about the utility of hypnotherapy in the upper gastrointestinal tract. Esophageal disorders, most of which are functional in nature, cause painful and uncomfortable symptoms that impact patient quality of life and are difficult to treat from a medical perspective. After a thorough medical workup and a failed trial of proton pump inhibitor therapy, options for treatment are significantly limited. While the pathophysiology is likely multifactorial, two critical factors are believed to drive esophageal symptoms—visceral hypersensitivity and symptom hypervigilance. The goal of esophageal directed hypnotherapy is to promote a deep state of relaxation with focused attention allowing the patient to learn to modulate physiological sensations and symptoms that are not easily addressed with conventional medical intervention. Currently, the use of hypnosis is suitable for dysphagia, globus, functional chest pain/non-cardiac chest pain, dyspepsia, and functional heartburn. In this article the authors will provide a rationale for the use of hypnosis in these disorders, presenting the science whenever available, describing their approach with these patients, and sharing a case study representing a successful outcome. PMID:26046715

  11. Radiotherapy for esophageal cancer

    International Nuclear Information System (INIS)

    Oshitani, Takashi; Kuwata, Yoichiro; Kano, Kyoko

    1988-01-01

    Esophageal carcinoma were treated by high-dose-rate intracavitary irradiation using specially designed balloon application at Hyogo medical Center for Adults. 32 patients were treated from January 1982 through July 1986. According to the stage of UICC (1978), 10 patients were classified into stage I, 7 into II, 13 into III and 2 into IV. Acturial 5 year survival rate was 17.9 % in all 32 patients and that of 23 patients who received radical radiotherapy was 24 %. Local CR rate was 66 %. However, since 9 (53 %) of 17 CR patients were relapsed, local control rate for 2 years was 25 %. Mild adverse effects were experienced in 9 (47 %) of 19 CR patients. Our balloon applicator was easily fixed, could have an adequate space from esophageal mucosa and clarify the tumor site by filling with 20 % gastrografin. It is concluded that high-dose-rate intracavitary irradiation with our balloon applicator is an effective boost therapy and decline a lethal adverse effect in radiotherapy for esophageal carcinoma. (author)

  12. esophageal cancer: preliminary results

    Directory of Open Access Journals (Sweden)

    Afsaneh Maddah Safaei

    2017-01-01

    Full Text Available Purpose: Dysphagia is a common initial presentation in locally advanced esophageal cancer and negatively impacts patient quality of life and treatment compliance. To induce fast relief of dysphagia in patients with potentially operable esophageal cancer high-dose-rate (HDR brachytherapy was applied prior to definitive radiochemotherapy. Material and methods : In this single arm phase II clinical trial between 2013 to 2014 twenty patients with locally advanced esophageal cancer (17 squamous cell and 3 adenocarcinoma were treated with upfront 10 Gy HDR brachytherapy, followed by 50.4 Gy external beam radiotherapy (EBRT and concurrent chemotherapy with cisplatin/5-fluorouracil. Results : Tumor response, as measured by endoscopy and/or computed tomography scan, revealed complete remission in 16 and partial response in 4 patients (overall response rate 100%. Improvement of dysphagia was induced by brachytherapy within a few days and maintained up to the end of treatment in 80% of patients. No differences in either response rate or dysphagia resolution were found between squamous cell and adenocarcinoma histology. The grade 2 and 3 acute pancytopenia or bicytopenia reported in 4 patients, while sub-acute adverse effects with painful ulceration was seen in five patients, occurring after a median of 2 months. A perforation developed in one patient during the procedure of brachytherapy that resolved successfully with immediate surgery. Conclusions : Brachytherapy before EBRT was a safe and effective procedure to induce rapid and durable relief from dysphagia, especially when combined with EBRT.

  13. Hypnotherapy for Esophageal Disorders.

    Science.gov (United States)

    Riehl, Megan E; Keefer, Laurie

    2015-07-01

    Hypnotherapy is an evidence based intervention for the treatment of functional bowel disorders, particularly irritable bowel syndrome. While similar in pathophysiology, less is known about the utility of hypnotherapy in the upper gastrointestinal tract. Esophageal disorders, most of which are functional in nature, cause painful and uncomfortable symptoms that impact patient quality of life and are difficult to treat from a medical perspective. After a thorough medical workup and a failed trial of proton pump inhibitor therapy, options for treatment are significantly limited. While the pathophysiology is likely multifactorial, two critical factors are believed to drive esophageal symptoms--visceral hypersensitivity and symptom hypervigilance. The goal of esophageal directed hypnotherapy is to promote a deep state of relaxation with focused attention allowing the patient to learn to modulate physiological sensations and symptoms that are not easily addressed with conventional medical intervention. Currently, the use of hypnosis is suitable for dysphagia, globus, functional chest pain/non-cardiac chest pain, dyspepsia, and functional heartburn. In this article the authors will provide a rationale for the use of hypnosis in these disorders, presenting the science whenever available, describing their approach with these patients, and sharing a case study representing a successful outcome.

  14. Loss of secondary esophageal peristalsis is not a contributory pathogenetic factor in posterior laryngitis.

    Science.gov (United States)

    Ulualp, S O; Gu, C; Toohill, R J; Shaker, R

    2001-02-01

    Secondary esophageal peristalsis helps prevent the entry of gastric acid into the pharynx by clearing the refluxed gastric contents back into the stomach. Because the loss of this mechanism may contribute to the pathogenesis of reflux-induced laryngeal disorders, our aim was to study the frequency of stimulation and parameters of secondary esophageal peristalsis in patients with posterior laryngitis (PL). We studied 14 patients (45 +/- 5 years) with PL documented by videolaryngoscopy and 11 healthy controls (46 +/- 6 years). The upper esophageal sphincter (UES) pressure was monitored by a sleeve assembly incorporating an injection port 5 cm distal to the sleeve. The esophageal body and lower esophageal sphincter (LES) pressures were measured by an LES sleeve assembly. Primary esophageal peristalsis was induced by 5-mL water swallows. Secondary esophageal peristalsis was induced by abrupt injection of volumes of air, incrementally increased by 5 mL, into the esophagus. Secondary esophageal peristalsis could not be elicited by injection of any volume (up to 60 mL) in 3 PL patients and 2 controls. These 5 subjects had normal primary peristalsis. The threshold volume of air required to stimulate secondary esophageal peristalsis in PL patients (median, 15 mL) was similar to that of controls (median, 10 mL). The parameters of the secondary esophageal peristaltic pressure wave were similar in both groups, and in both groups, they were similar to those of primary peristalsis. The UES response to the injection of the threshold volume that induced secondary esophageal peristalsis in PL patients was contraction in 58% of the trials, partial relaxation in 3%, and no response in 39%. The findings were similar to those in the controls. The LES response to injection of the threshold volume was complete relaxation in both the PL patients and the controls. We conclude that the integrity of secondary esophageal peristalsis is preserved in PL patients.

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

    Directory of Open Access Journals (Sweden)

    Sung-Shuo Kao

    2013-01-01

    Full Text Available 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.

  16. Meiotic abnormalities

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1993-12-31

    Chapter 19, describes meiotic abnormalities. These include nondisjunction of autosomes and sex chromosomes, genetic and environmental causes of nondisjunction, misdivision of the centromere, chromosomally abnormal human sperm, male infertility, parental age, and origin of diploid gametes. 57 refs., 2 figs., 1 tab.

  17. Radionuclide esophageal transit of a liquid bolus: A reappraisal

    International Nuclear Information System (INIS)

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

    1984-01-01

    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 μCi /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

  18. Radionuclide esophageal transit of a liquid bolus: A reappraisal

    Energy Technology Data Exchange (ETDEWEB)

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

    1984-01-01

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

  19. Use of 111In-labeled alginate to study the pH dependence of alginic acid anti-esophageal reflux barrier

    International Nuclear Information System (INIS)

    Knight, L.C.; Maurer, A.H.; Ammar, I.A.; Siegel, J.A.; Fisher, R.S.; Malmud, L.S.; Temple Univ., Philadelphia, PA

    1988-01-01

    Mixtures of alginic acid and antacid, when given orally, react with gastric acid to form a viscous barrier (raft) which floats on the surface of the gastric contents. 111 In was used to label magnesium alginate in order to study the effect of gastric acidity on the extent of formation of the raft. In vitro, acid concentrations less than 0.05 N diminished raft formation. In vivo, raft formation was significantly better in normal subjects who ingested dilute acid with the labeled alginate/antacid than in subjects who ingested the labeled alginate/antacid with plain water. Gastric emptying of the labeled alginate was also slowed by the presence of acidified gastric contents. These results suggest that the formation of an effective alginic acid antireflux barrier requires acidic gastric contents. (author)

  20. Significance of retardation of abnormal uptake of iodine-123-beta-methyl-p-iodophenyl-pentadecanoic acid myocardial scintigraphy in patients with vasospastic angina

    Energy Technology Data Exchange (ETDEWEB)

    Inoue, Fumitaka; Hashimoto, Toshio; Uemura, Shiro; Kawamoto, Atsuhiko; Dohi, Kazuhiro [Nara Medical Univ., Kashihara (Japan); Matsushima, Akihiko

    2001-07-01

    This study investigated retardation of abnormal uptake of iodine-123-beta-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) scintigraphy in patients with vasospastic angina. Twenty-three patients with vasospastic angina showed abnormal uptake of BMIPP before medical treatment and had coronary vasospasm induced by acetylcholine. The patients were divided into two groups according to uptake of BMIPP after medical treatment: retardation of abnormal uptake of BMIPP (Group R, n=4) and normal uptake of BMIPP (Group N, n=19). Frequency of chest pain, medical treatment and autonomic nervous activity were compared between the two groups. Furthermore, the frequency of chest pain and uptake of BMIPP in group R were obtained after intensive medical treatment. Autonomic nervous activity was evaluated by heart rate variability on Holter electrocardiography. Heart rate variability contained high-frequency elements (HF; 0.15-0.4 Hz) and low-frequency elements (LF; 0.04-0.15 Hz). LF/HF was estimated for sympathetic nervous activity and HF was estimated for parasympathetic nervous activity. Daytime and nighttime autonomic nervous activity were compared between the two groups. The frequency of chest pain was higher in Group R than in Group N (p<0.05). Medical treatment was not different between the two groups. Circadian variation of sympathetic and parasympathetic nervous activity were absent in Group R. During the nighttime, Group R showed higher sympathetic nervous activity (p<0.05) and lower parasympathetic nervous activity (p<0.01) than Group N. The frequency of chest pain was significantly lower after intensive medical treatment (p<0.05), and uptake of BMIPP returned to normal in Group R. We suspected that the disorder in autonomic nervous activity was more severe in Group R, and thus induced coronary vasospasm. Retardation of abnormal uptake of BMIPP in patients with vasospastic angina indicates poor control of coronary vasospasm. Uptake of BMIPP is useful in the evaluation of

  1. Significance of retardation of abnormal uptake of iodine-123-beta-methyl-p-iodophenyl-pentadecanoic acid myocardial scintigraphy in patients with vasospastic angina

    International Nuclear Information System (INIS)

    Inoue, Fumitaka; Hashimoto, Toshio; Uemura, Shiro; Kawamoto, Atsuhiko; Dohi, Kazuhiro; Matsushima, Akihiko

    2001-01-01

    This study investigated retardation of abnormal uptake of iodine-123-beta-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) scintigraphy in patients with vasospastic angina. Twenty-three patients with vasospastic angina showed abnormal uptake of BMIPP before medical treatment and had coronary vasospasm induced by acetylcholine. The patients were divided into two groups according to uptake of BMIPP after medical treatment: retardation of abnormal uptake of BMIPP (Group R, n=4) and normal uptake of BMIPP (Group N, n=19). Frequency of chest pain, medical treatment and autonomic nervous activity were compared between the two groups. Furthermore, the frequency of chest pain and uptake of BMIPP in group R were obtained after intensive medical treatment. Autonomic nervous activity was evaluated by heart rate variability on Holter electrocardiography. Heart rate variability contained high-frequency elements (HF; 0.15-0.4 Hz) and low-frequency elements (LF; 0.04-0.15 Hz). LF/HF was estimated for sympathetic nervous activity and HF was estimated for parasympathetic nervous activity. Daytime and nighttime autonomic nervous activity were compared between the two groups. The frequency of chest pain was higher in Group R than in Group N (p<0.05). Medical treatment was not different between the two groups. Circadian variation of sympathetic and parasympathetic nervous activity were absent in Group R. During the nighttime, Group R showed higher sympathetic nervous activity (p<0.05) and lower parasympathetic nervous activity (p<0.01) than Group N. The frequency of chest pain was significantly lower after intensive medical treatment (p<0.05), and uptake of BMIPP returned to normal in Group R. We suspected that the disorder in autonomic nervous activity was more severe in Group R, and thus induced coronary vasospasm. Retardation of abnormal uptake of BMIPP in patients with vasospastic angina indicates poor control of coronary vasospasm. Uptake of BMIPP is useful in the evaluation of

  2. Walking abnormalities

    Science.gov (United States)

    ... include: Arthritis of the leg or foot joints Conversion disorder (a mental disorder) Foot problems (such as a ... injuries. For an abnormal gait that occurs with conversion disorder, counseling and support from family members are strongly ...

  3. Return of esophageal peristalsis in achalasia secondary to gastric cancer.

    Science.gov (United States)

    Menin, R; Fisher, R S

    1981-11-01

    A 69-year-old white man developed progressive symptoms of dysphagia for solids and liquids and regurgitation of undigested food accompanied by a 12-kg weight loss over a 4-month period. Initially, radiographs of the esophagus and stomach were normal, but when repeated 4 months later, a diagnosis of achalasia was suggested. Esophageal manometry performed at that time demonstrated a motor abnormality of the esophagus and lower esophageal sphincter consistent with a diagnosis of achalasia. Upper endoscopy revealed a small ulcerated tumor in the cardia of the stomach. A biopsy specimen was interpreted as adenocarcinoma of the stomach. Surgical treatment included resection of the gastric tumor along with a 4-cm segment of the distal esophagus, resection of a collar of apparently uninvolved stomach, and esophagogastrostomy. Nine months following surgery the patient was restudied. An upper gastrointestinal roentgenogram demonstrated a return of esophageal caliber and configuration to normal. Manometry showed that esophageal contractions had reverted to a normal progressive, postdeglutition pattern throughout the length of the esophagus. This is the first report in which achalasia secondary to gastric adenocarcinoma was reversed after tumor resection.

  4. Effect of morbid obesity, gastric banding and gastric bypass on esophageal symptoms, mucosa and function.

    Science.gov (United States)

    Borovicka, Jan; Krieger-Grübel, Claudia; van der Weg, Boudewijn; Thurnheer, Martin; Schultes, Bernd; Sulz, Michael Christian; Gutzwiler, Jean-Pierre; Bisang, Philipp; Pohl, Daniel; Fried, Michael; Meyenberger, Christa; Tutuian, Radu

    2017-02-01

    Obesity and gastroesophageal reflux disease (GERD) are commonly associated diseases. Bariatric surgery has been shown to have various impacts on esophageal function and GERD. Our aim was to evaluate changes in symptoms, endoscopic findings, bolus passage and esophageal function in patients after primary gastric bypass surgery as compared to patients converted from gastric banding to gastric bypass. Obese patients scheduled for laparoscopic Roux-en-Y gastric bypass (naïve-to-bypass) and patients who previously underwent gastric banding and were considered for conversion from gastric banding to gastric bypass (band-to-bypass) were included. Patients rated esophageal and epigastric symptoms (100 point VAS) and underwent upper endoscopy, impedance-manometry, and modified "timed barium swallow" before/after surgery. Data from 66 naïve-to-bypass patients (51/66, 77 % females, mean age 41.2 ± 11.1 years) and 68 band-to-bypass patients (53/68, 78 % females, mean age 43.8 ± 10.0 years) were available for analysis. Esophageal symptoms, esophagitis, esophageal motility abnormalities and impaired esophageal bolus transit were more common in patients that underwent gastric banding compared to those that underwent gastric bypass. The majority of symptoms, lesions and abnormalities induced by gastric banding were decreased by conversion to gastric bypass. Esophagitis was present in 28/68 (41 %) and 13/47 (28 %) patients in the band-to-bypass group, pre- versus postoperatively, respectively, (p symptoms and should be therefore favored over gastric banding in difficult to treat obese patients at risk of repeated bariatric surgery.

  5. Treatment Option Overview (Esophageal Cancer)

    Science.gov (United States)

    ... the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds , ... stage of the cancer being treated. External and internal radiation therapy are used to treat esophageal cancer. A plastic ...

  6. General Information about Esophageal Cancer

    Science.gov (United States)

    ... the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds , ... stage of the cancer being treated. External and internal radiation therapy are used to treat esophageal cancer. A plastic ...

  7. Prevention of Esophageal Variceal Rebleeding

    Directory of Open Access Journals (Sweden)

    Gin-Ho Lo

    2006-12-01

    Full Text Available The rate of rebleeding of esophageal varices remains high after cessation of acute esophageal variceal hemorrhage. Many measures have been developed to prevent the occurrence of rebleeding. When considering their effectiveness in reduction of rebleeding, the associated complications cannot be neglected. Due to unavoidable high incidence of complications, shunt surgery and endoscopic injection sclerotherapy are now rarely used. Transjugular intrahepatic portosystemic stent shunt was developed to replace shunt operation but is now reserved for rescue therapy. Nonselective beta-blockers alone or in combination with isosorbide mononitrate and endoscopic variceal ligation are currently the first choices in the prevention of variceal rebleeding. The combination of nonselective beta-blockers and endoscopic variceal ligation appear to enhance the efficacy. With the advent of newly developed measures, esophageal variceal rebleeding could be greatly reduced and the survival of cirrhotics with bleeding esophageal varices could thereby be prolonged.

  8. Drugs Approved for Esophageal Cancer

    Science.gov (United States)

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

  9. Dietary flax oil rich in α-linolenic acid reduces renal disease and oxylipin abnormalities, including formation of docosahexaenoic acid derived oxylipins in the CD1-pcy/pcy mouse model of nephronophthisis.

    Science.gov (United States)

    Yamaguchi, Tamio; Devassy, Jessay G; Gabbs, Melissa; Ravandi, Amir; Nagao, Shizuko; Aukema, Harold M

    2015-03-01

    The CD1-pcy/pcy mouse model of nephronophthisis displays reduced renal docosahexaenoic acid (DHA) levels and alterations in renal cyclooxygenase and lipoxygenase oxylipins derived from n-6 fatty acids. Since dietary flax oil ameliorates disease progression, its effect on renal fatty acids and oxylipins was examined. Sixteen weeks of feeding resulted in reduced disease progression and enrichment of renal phospholipid α-linolenic acid (ALA) and eicosapentaenoic acid, reduction in arachidonic acid (AA), but no change in linoleic acid (LA) or DHA. In diseased kidneys, flax oil feeding mitigated the elevated levels of renal cyclooxygenase derived oxylipins formed from AA and the lowered lipoxygenase and cytochrome P450 derived oxylipins formed from ALA and DHA. Increased DHA oxylipins occurred with flax feeding despite not altering DHA levels. Dietary flax oil may therefore reduce disease progression via mitigation of oxylipin abnormalities. This study also provides evidence of in vivo ALA conversion to DHA in amounts necessary to restore DHA oxylipin levels. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. Protruded superficial esophageal carcinoma

    International Nuclear Information System (INIS)

    Yamada, Akiyoshi; Satoh, Yuichi; Sugiyama, Akinori

    1986-01-01

    Until the end of 1985, 113 cases of superficial esophageal carcinoma had been operated on. Classified by histology, almost all cases are squamous cell carcinoma and some cases are pseudocarcinoma, adenocarcinoma, adenoid cystic carcinoma, basal cell carcinoma and so on. X-ray of the latter shows all cases except one are protruded type. Regarding the relation between X-ray findings and histology, semipeduncular tumorous type, generally speaking, belongs to pseudosarcoma. As to lymph node metastasis, there is no difference among superficial elevated, tumorous elevated and semi-peduncular tumorous types. Lymph node metastasis is less freqently seen in the cases with smooth surface. With regard to prognosis, there is no difference between early carcinoma without lymph node metastasis and superficial carcinoma with lymph node metastasis. Only two-year and more than 7-year survival rates of the one with smooth surface are superior to those of the one with irregular surface. (author)

  11. Bench-to-bedside review: treating acid-base abnormalities in the intensive care unit - the role of buffers.

    Science.gov (United States)

    Gehlbach, Brian K; Schmidt, Gregory A

    2004-08-01

    The recognition and management of acid-base disorders is a commonplace activity for intensivists. Despite the frequency with which non-bicarbonate-losing forms of metabolic acidosis such as lactic acidosis occurs in critically ill patients, treatment is controversial. This article describes the properties of several buffering agents and reviews the evidence for their clinical efficacy. The evidence supporting and refuting attempts to correct arterial pH through the administration of currently available buffers is presented.

  12. Plasma Amino Acid Abnormalities in Chronic Heart Failure. Mechanisms, Potential Risks and Targets in Human Myocardium Metabolism

    Directory of Open Access Journals (Sweden)

    Roberto Aquilani

    2017-11-01

    Full Text Available The goal of this study was to measure arterial amino acid levels in patients with chronic heart failure (CHF, and relate them to left ventricular function and disease severity. Amino acids (AAs play a crucial role for heart protein-energy metabolism. In heart failure, arterial AAs, which are the major determinant of AA uptake by the myocardium, are rarely measured. Forty-one subjects with clinically stable CHF (New York Heart Association (NYHA class II to IV were analyzed. After overnight fasting, blood samples from the radial artery were taken to measure AA concentrations. Calorie (KcalI, protein-, fat-, carbohydrate-intake, resting energy expenditure (REE, total daily energy expenditure (REE × 1.3, and cardiac right catheterization variables were all measured. Eight matched controls were compared for all measurements, with the exception of cardiac catheterization. Compared with controls, CHF patients had reduced arterial AA levels, of which both their number and reduced rates are related to Heart Failure (HF severity. Arterial aspartic acid correlated with stroke volume index (r = 0.6263; p < 0.0001 and cardiac index (r = 0.4243; p = 0.0028. The value of arterial aspartic acid (µmol/L multiplied by the cardiac index was associated with left ventricular ejection fraction (r = 0.3765; p = 0.0076. All NYHA groups had adequate protein intake (≥1.1 g/kg/day and inadequate calorie intake (KcalI < REE × 1.3 was found only in class IV patients. This study showed that CHF patients had reduced arterial AA levels directly related to clinical disease severity and left ventricular dysfunction.

  13. Promyelocytic Leukemia with No Retinoic Acid Receptor Alpha Abnormality but with RUNX1T1 Insertion to Chromosome 7q: A Classification and Management Dilemma

    Directory of Open Access Journals (Sweden)

    Kathleen Overholt

    2015-01-01

    Full Text Available A case of acute promyelocytic leukemia (APL with RUNX1T1 insertion to 7q is described and compared to reported cases of APL with negative retinoic acid receptor alpha (RARA abnormality. In this report, we describe the case of a 2-year-old boy who presented with bone pain and was found to have pancytopenia. Bone marrow examination showed morphologic and immunophenotypic findings typical of APL, but conventional cytogenetics, fluorescence in situ hybridization (FISH, and real-time polymerase chain reaction (RT-PCR showed no evidence of RARA rearrangements. The only cytogenetic abnormality found was a small insertion in 7q, and three copies of RUNX1T1. Gene sequencing results became available after initiating therapy but were not informative. We describe the rarity of such cases and discuss how the typical morphologic and immunophenotypic findings of APL, coupled with the definite absence of RARA rearrangement (by FISH and RT-PCR, present a diagnostic and classification dilemma, raising the possibility of an unknown alternative mechanism for the leukemogenesis and maturation arrest seen in other APL variants. The diagnostic challenges and urgent management issues this unusual case raises may justify including it, along with similar cases, in a separate subtype of acute myeloid leukemia (AML in future classifications.

  14. Invisible Threat In Sport Bag: Esophageal Obstruction Due To Aminoacid Tablets

    Directory of Open Access Journals (Sweden)

    Erhan Dedeoglu

    2013-10-01

    Full Text Available Although esophageal foreign bodies are mostly encountered in children, they also continue to constitute a life threatening problem in adults. Because of severe complications possibly to occur, esophageal foreign bodies should be extracted as soon as the diagnosis is made. A 30 year-old male patient who had a sense of blockage in the throat after taking two amino acid tablets and who was admitted to our emergency room and was discussed in this case report. In endoscopy performed with the initial diagnosis of esophageal foreign body, two attached tablets which completely obstruct lower lumen were removed immediately below the upper esophageal sphincter. In recent years, we wanted to share this case in order to express that increasing amino acid tablet usage will lead to serious complications.

  15. Mildly abnormal general movement quality in infants is associated with higher Mead acid and lower arachidonic acid and shows a U-shaped relation with the DHA/AA ratio.

    Science.gov (United States)

    van Goor, S A; Schaafsma, A; Erwich, J J H M; Dijck-Brouwer, D A J; Muskiet, F A J

    2010-01-01

    We showed that docosahexaenoic acid (DHA) supplementation during pregnancy and lactation was associated with more mildly abnormal (MA) general movements (GMs) in the infants. Since this finding was unexpected and inter-individual DHA intakes are highly variable, we explored the relationship between GM quality and erythrocyte DHA, arachidonic acid (AA), DHA/AA and Mead acid in 57 infants of this trial. MA GMs were inversely related to AA, associated with Mead acid, and associated with DHA/AA in a U-shaped manner. These relationships may indicate dependence of newborn AA status on synthesis from linoleic acid. This becomes restricted during the intrauterine period by abundant de novo synthesis of oleic and Mead acids from glucose, consistent with reduced insulin sensitivity during the third trimester. The descending part of the U-shaped relation between MA GMs and DHA/AA probably indicates DHA shortage next to AA shortage. The ascending part may reflect a different developmental trajectory that is not necessarily unfavorable. Copyright 2009 Elsevier Ltd. All rights reserved.

  16. High prevalence of esophageal involvement in lichen planus: a study using magnification chromoendoscopy

    NARCIS (Netherlands)

    Quispel, R.; van Boxel, O. S.; Schipper, M. E.; Sigurdsson, V.; Canninga-van Dijk, M. R.; Kerckhoffs, A.; Smout, A. J.; Samsom, M.; Schwartz, M. P.

    2009-01-01

    BACKGROUND AND STUDY AIMS: The first cases of squamous cell carcinoma in esophageal lichen planus were recently described. We performed a study to establish the prevalence of endoscopic and histopathologic abnormalities consistent with lichen planus and (pre-) malignancy in a cohort of patients with

  17. Eosinophilic Esophagitis in Pediatric and Adolescent Patients

    Science.gov (United States)

    ... and Adolescent Patients Eosinophilic Esophagitis in Pediatric and Adolescent Patients Basics Overview Eosinophilic esophagitis also known as ( ... children may have vomiting and abdominal pain, and adolescents may complain of the feeling of food getting ...

  18. Gallium-67 imaging in candidal esophagitis

    Energy Technology Data Exchange (ETDEWEB)

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

    1990-01-01

    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.

  19. Gallium-67 imaging in candidal esophagitis

    International Nuclear Information System (INIS)

    Rundback, J.H.; Goldfarb, C.R.; Ongseng, F.

    1990-01-01

    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

  20. 21 CFR 878.3610 - Esophageal prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Esophageal prosthesis. 878.3610 Section 878.3610...) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3610 Esophageal prosthesis. (a) Identification. An esophageal prosthesis is a rigid, flexible, or expandable tubular device made...

  1. Management of congenital esophageal stenosis associated with ...

    African Journals Online (AJOL)

    Aim The aim of this work was to study the incidence, management of congenital esophageal stenosis (CES) associated with esophageal atresia (EA) and tracheoesophageal fistula (TEF), and its impact on esophageal stricture (ES) after primary repair. Patients and methods From January 2006 to December 2014, ...

  2. Eosinophilic esophagitis: rapidly emerging disorder.

    Science.gov (United States)

    Straumann, Alex

    2012-02-03

    Eosinophilic Esophagitis (EoE), first described in the early 1990's, has rapidly evolved as distinctive chronic inflammatory esophageal disease. The diagnosis is based clinically by the presence of symptoms related to an esophageal dysfunction and histologically by an eosinophil-predominant inflammation once other conditions leading to esophageal eosinophilia are excluded. This striking male-prevalent disease has an increasing incidence and prevalence in the westernised countries. Currently, EoE represents the main cause of dysphagia and bolus impaction in adult patients. Despite the fact that EoE often occurs in atopic patients, the value of allergic testing is still under discussion. Topical corticosteroids lead to a rapid improvement of active EoE clinically and histologically; they are therefore regarded as first-line drug therapy. Elimination diets have similar efficacy as topical corticosteroids, but their long-term use is limited by practical issues. Esophageal dilation of EoE-induced strictures can also be effective in improving symptoms, but this therapy has no effect on the underlying inflammation. Neither the diagnostic nor the long-term therapeutic strategies are yet fully defined.

  3. Evaluation of esophageal intramural pseudo-diverticulosis using high-resolution manometry.

    Science.gov (United States)

    Aimi, Masahito; Mikami, Hironobu; Izumi, Daisuke; Okimoto, Eiko; Tada, Yasumasa; Mishiro, Tsuyoshi; Ishimura, Norihisa; Ishihara, Shunji; Kinoshita, Yoshikazu

    2016-10-01

    Esophageal intramural pseudo-diverticulosis (EIPD) is a rare disease characterized by multiple small flask-shaped pouches in the esophageal wall, with the predominant symptom of chronic progressive or intermittent dysphagia. However, its etiology and pathogenesis remain unknown. We present a case of EIPD evaluated with high-resolution manometry in a 75-year-old man with food impaction after eating beef, who came to our emergency department. The patient experienced similar episodes three times previously, though the cause was unknown. Computed tomography (CT) findings revealed diffuse wall thickness in the upper intrathoracic esophagus, while esophagogastroduodenoscopy showed multiple small depressions and several white plaque patches, and a barium meal esophagogram showed characteristic multiple small outpouching areas. From these findings, we diagnosed the patient with EIPD. In addition, high-resolution manometry revealed strong contractions in the distal esophagus. We started an administration of isosorbide dinitrate, because abnormal esophageal motility may have been causative of the condition and development of pseudo-diverticulosis. Thereafter, the patient had a good clinical course without food impaction. Elevated intra-esophageal luminal pressure caused by abnormal esophageal motility seems to be an important factor in the pathogenesis of EIPD in some cases.

  4. Esophageal cancer in yemen

    International Nuclear Information System (INIS)

    Samawi, A.S.A.; Aulaqi, S.M.

    2014-01-01

    To document the age and gender distribution, histopathologic type as well as grading characteristics of Esophageal Cancer (EC) in Yemen. Study Design: A case series. Place and Duration of Study: Department of Pathology, Sana'a University, Sana'a, Yemen, from January 2005 to December 2011. Methodology: Three hundred twenty five cases of EC were included for review. The diagnoses were made on hematoxylin and eosin stained sections and the cases were categorized into Squamous Cell Carcinoma (SCC) and adenocarcinoma (ADC). Results: Out of the 325 EC cases, 163 (50%) were SCC (females 67%, males 33%) and 158 (49%) were ADC (females 30%, males 70%). The rest of the cases were 2 adenosquamous carcinoma and 2 non-Hodgkin's lymphoma. The mean age, for SCC was 60 years while the mean age for ADC was 65 years. The peak incidence for SCC was found in the age groups of fifth and sixth decades for females and in fifth and seventh decades for males. The maximum number of patients with ADC was seen in sixth and seventh decades for both gender. Well-differentiated histological grading accounted for 247 (77%) for both genders and types. The moderately differentiated and poorly differentiated accounted, for 17% and 6% respectively. Conclusion: The EC in Yemen had a predominance of SCC in female patients and predominance of ADC in male patients which was usually of a well-differentiated grade. (author)

  5. Esophageal cancer in Yemen.

    Science.gov (United States)

    Al-Samawi, Abdullah S; Aulaqi, Saleh M

    2014-03-01

    To document the age and gender distribution, histopathologic type as well as grading characteristics of Esophageal Cancer (EC) in Yemen. A case series. Department of Pathology, Sana'a University, Sana'a, Yemen, from January 2005 to December 2011. Three hundred twenty five cases of EC were included for review. The diagnoses were made on hematoxylin and eosin stained sections and the cases were categorized into Squamous Cell Carcinoma (SCC) and adenocarcinoma (ADC). Out of the 325 EC cases, 163 (50%) were SCC (females 67%, males 33%) and 158 (49%) were ADC (females 30%, males 70%). The rest of the cases were 2 adenosquamous carcinoma and 2 non-Hodgkin's lymphoma. The mean age, for SCC was 60 years while the mean age for ADC was 65 years. The peak incidence for SCC was found in the age groups of fifth and sixth decades for females and in fifth and seventh decades for males. The maximum number of patients with ADC was seen in sixth and seventh decades for both gender. Well-differentiated histological grading accounted for 247 (77%) for both genders and types. The moderately differentiated and poorly differentiated accounted, for 17% and 6% respectively. The EC in Yemen had a predominance of SCC in female patients and predominance of ADC in male patients which was usually of a well-differentiated grade.

  6. Disorders of fatty acid oxidation and autosomal recessive polycystic kidney disease-different clinical entities and comparable perinatal renal abnormalities.

    Science.gov (United States)

    Hackl, Agnes; Mehler, Katrin; Gottschalk, Ingo; Vierzig, Anne; Eydam, Marcus; Hauke, Jan; Beck, Bodo B; Liebau, Max C; Ensenauer, Regina; Weber, Lutz T; Habbig, Sandra

    2017-05-01

    Differential diagnosis of prenatally detected hyperechogenic and enlarged kidneys can be challenging as there is a broad phenotypic overlap between several rare genetic and non-genetic disorders. Metabolic diseases are among the rarest underlying disorders, but they demand particular attention as their prognosis and postnatal management differ from those of other diseases. We report two cases of cystic, hyperechogenic and enlarged kidneys detected on prenatal ultrasound images, resulting in the suspected diagnosis of autosomal recessive polycystic kidney disease (ARPKD). Postnatal clinical course and work-up, however, revealed early, neonatal forms of disorders of fatty acid oxidation (DFAO) in both cases, namely, glutaric acidemia type II, based on identification of the novel, homozygous splice-site mutation c.1117-2A > G in the ETFDH gene, in one case and carnitine palmitoyltransferase II deficiency in the other case. Review of pre- and postnatal sonographic findings resulted in the identification of some important differences that might help to differentiate DFAO from ARPKD. In DFAO, kidneys are enlarged to a milder degree than in ARPKD, and the cysts are located ubiquitously, including also in the cortex and the subcapsular area. Interestingly, recent studies have pointed to a switch in metabolic homeostasis, referred to as the Warburg effect (aerobic glycolysis), as one of the underlying mechanisms of cell proliferation and cyst formation in cystic kidney disease. DFAO are characterized by the inhibition of oxidative phosphorylation, resulting in aerobic glycolysis, and thus they do resemble the Warburg effect. We therefore speculate that this inhibition might be one of the pathomechanisms of renal hyperproliferation and cyst formation in DFAO analogous to the reported findings in ARPKD. Neonatal forms of DFAO can be differentially diagnosed in neonates with cystic or hyperechogenic kidneys and necessitate immediate biochemical work-up to provide early

  7. Omeprazole blocks STAT6 binding to the eotaxin-3 promoter in eosinophilic esophagitis cells.

    Directory of Open Access Journals (Sweden)

    Xi Zhang

    Full Text Available Patients who have esophageal eosinophilia without gastroesophageal reflux disease (GERD nevertheless can respond to proton pump inhibitors (PPIs, which can have anti-inflammatory actions independent of effects on gastric acid secretion. In esophageal cell cultures, omeprazole has been reported to inhibit Th2 cytokine-stimulated expression of eotaxin-3, an eosinophil chemoattractant contributing to esophageal eosinophilia in eosinophilic esophagitis (EoE. The objective of this study was to elucidate molecular mechanisms underlying PPI inhibition of IL-4-stimulated eotaxin-3 production by esophageal cells.Telomerase-immortalized and primary cultures of esophageal squamous cells from EoE patients were treated with IL-4 in the presence or absence of acid-activated omeprazole or lansoprazole. We measured eotaxin-3 protein secretion by ELISA, mRNA expression by PCR, STAT6 phosphorylation and nuclear translocation by Western blotting, eotaxin-3 promoter activation by an exogenous reporter construct, and STAT6, RNA polymerase II, and trimethylated H3K4 binding to the endogenous eotaxin-3 promoter by ChIP assay. Omeprazole in concentrations ≥5 µM significantly decreased IL-4-stimulated eotaxin-3 protein secretion and mRNA expression. Lansoprazole also blocked eotaxin-3 protein secretion. Omeprazole had no effect on eotaxin-3 mRNA stability or on STAT6 phosphorylation and STAT6 nuclear translocation. Rather, omeprazole blocked binding of IL-4-stimulated STAT6, RNA polymerase II, and trimethylated H3K4 to the eotaxin-3 promoter.PPIs, in concentrations achieved in blood with conventional dosing, significantly inhibit IL-4-stimulated eotaxin-3 expression in EoE esophageal cells and block STAT6 binding to the promoter. These findings elucidate molecular mechanisms whereby patients with Th2 cytokine-driven esophageal eosinophilia can respond to PPIs, independent of effects on gastric acid secretion.

  8. Clinical usefulness of myocardial iodine-123-15-(p-iodophenyl)-3(R,S)-methyl-pentadecanoic acid distribution abnormality in patients with mitochondrial encephalomyopathy based on normal data file in bull's-eye polar map

    International Nuclear Information System (INIS)

    Takahashi, Nobukazu; Mitani, Isao; Sumita, Shinichi

    1998-01-01

    Visual interpretation of iodine-123-beta-15-(p-iodophenyl)-3(R,S)-methyl-pentadecanoic acid ( 123 I-BMIPP) myocardial images cannot easily detect mild reduction in tracer uptake. Objective assessment of myocardial 123 I-BMIPP maldistributions at rest was attempted using a bull's-eye map and its normal data file for detecting myocardial damage in patients with mitochondrial encephalomyopathy. Six patients, two with Kearns-Sayre syndrome and four with mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes (MELAS), and 10 normal subjects were studied. Fractional myocardial uptake of 1 23 I-BMIPP was also measured by dynamic static imaging to assess the global myocardial free fatty acid. These data were compared with the cardiothoracic ratio measured by chest radiography and left ventricular ejection fraction assessed by echocardiography. Abnormal cardiothoracic ratio and lower ejection fraction were detected in only one patient with Kearns-Sayre syndrome. Abnormal fractional myocardial uptake was detected in two patients (1.61%, 1.91%), whereas abnormal regional 123 I-BMIPP uptake assessed by the bull's-eye map was detected in five patients (83%). All patients showed abnormal uptake in the anterior portion, and one showed progressive atrioventricular conduction abnormality and systolic dysfunction with extended 123 I-BMIPP abnormal uptake. The results suggest that assessment based on the normal data file in a bull's-eye polar map is clinically useful for detection of myocardial damage in patients with mitochondrial encephalomyopathy. (author)

  9. Balloon dilatations of esophageal strictures

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Jeong Jin; Juhng, Seon Kwan; Kim, Jae Kyu; Chung, Hyon De [Chonnam National University College of Medicine, Seoul (Korea, Republic of)

    1990-04-15

    Most benign esophageal strictures can be successfully dilated with conventional bougienage technique. But occasionally strictures are so tight, lengthy, or sometimes irregular that this technique fail, and surgical intervention is required. Since 1974 Gruentzig balloon catheter has succeed when used for strictures in the cardiac and peripheral vasculatures, the biliary and urinary tracts, the colon of neonates after inflammatory disease and also in the esophagus. Fluoroscopically guided balloon catheters were used to dilate 30 esophageal strictures in 30 patients over 3 years at Department of Diagnostic Radiology, Chonnam University, College of Medicine. The distribution of age was from 7 years to 71 days and the ratio of male to female was 15:15. The causes of benign stricture (23 cases) were post-operative strictures (13), chemical (4), achalasia (3), chronic inflammation (2), esophageal rupture (1) and those of malignant stricture (7 cases) were post-radiation stricture of primary esophageal cancer (6) and metastatic esophageal cancer (1). The success rate of procedure was 93% (28/30). The causes of failure were the failure of passage of stricture due to markedly dilated proximal segment of esophagus (1 case) and too long segment of stricture (1 case). Complication of procedure was the diverticular-formation of esophagus in 3 cases, but has no clinical significance in follow-up esophagography. In conclusion, fluoroscopically guided balloon dilation of esophageal stricture appears to be safe, effective treatment and may be have theoretical advantages over conventional bougienage and also should be considered before other methods of treatment are used.

  10. Balloon dilatations of esophageal strictures

    International Nuclear Information System (INIS)

    Seo, Jeong Jin; Juhng, Seon Kwan; Kim, Jae Kyu; Chung, Hyon De

    1990-01-01

    Most benign esophageal strictures can be successfully dilated with conventional bougienage technique. But occasionally strictures are so tight, lengthy, or sometimes irregular that this technique fail, and surgical intervention is required. Since 1974 Gruentzig balloon catheter has succeed when used for strictures in the cardiac and peripheral vasculatures, the biliary and urinary tracts, the colon of neonates after inflammatory disease and also in the esophagus. Fluoroscopically guided balloon catheters were used to dilate 30 esophageal strictures in 30 patients over 3 years at Department of Diagnostic Radiology, Chonnam University, College of Medicine. The distribution of age was from 7 years to 71 days and the ratio of male to female was 15:15. The causes of benign stricture (23 cases) were post-operative strictures (13), chemical (4), achalasia (3), chronic inflammation (2), esophageal rupture (1) and those of malignant stricture (7 cases) were post-radiation stricture of primary esophageal cancer (6) and metastatic esophageal cancer (1). The success rate of procedure was 93% (28/30). The causes of failure were the failure of passage of stricture due to markedly dilated proximal segment of esophagus (1 case) and too long segment of stricture (1 case). Complication of procedure was the diverticular-formation of esophagus in 3 cases, but has no clinical significance in follow-up esophagography. In conclusion, fluoroscopically guided balloon dilation of esophageal stricture appears to be safe, effective treatment and may be have theoretical advantages over conventional bougienage and also should be considered before other methods of treatment are used

  11. Gastroesophageal reflux after esophageal surgery

    International Nuclear Information System (INIS)

    Nishimura, Osamu; Yokoi, Hideki; Maebeya, Shinji

    1989-01-01

    By means of esophageal transit scintigram using 99m Tc-DTPA, 15 patients (13 esophageal carcinomas and 2 cardia carcinomas) were studied, in whom esophagogastric anastomosis was done according to the posterior invagination anastomosis technique we had devised. In all 8 patients with anastomosis at cervical region, gastroesophageal reflux was not seen on both scintigrams before and after meals, and the average pressure gradient of high pressure zone at anastomosis was 39.8 cmH 2 O. In 2 of 7 patients with intrathoracic anastomosis, the scintigram before meals showed severe reflux. and the endoscopic findings showed diffuse and moderate erosion in the esophageal mucosa. The average pressure gradient across the anastomosis was 6.5 cmH 2 O. In these 2 patients, the new fornix with a sharp angle of His was not formed. In the remaining 5 patients with intrathoracic anastomosis, reflux was not seen on the scintigram before meals. However, in 2 of them, the scintigram after meal and endoscopic examination revealed mild reflux and mild esophagitis respectively. Furthermore in one patient very mild reflux was observed only on the scintigram after meals but the endoscopic findings showed the normal esophageal mucosa. In these 5 patients, the average pressure gradient across the anastomosis was 17.0 cmH 2 O, which was significantly higher (p<0.01) than that in 2 patients with severe reflux and was significantly lower (p<0.01) than the mean value of high pressure zone in 8 patients with cervical anastomosis. In conclusion, it is presumed that the formation of a large fornix enough to store food and a sharp angle of His are important factors in maintaining an anti-reflux mechanism. The esophageal transit scintigram was proved to be an excellent technique in detecting and evaluating quantitatively gastroesophageal reflux. (author)

  12. [Pathophysiology of reflux esophagitis in the elderly patients].

    Science.gov (United States)

    Nakamura, Toshiya; Uetake, Tomoyoshi; Fujino, Masayuki A

    2002-08-01

    Recent reports indicate an increased prevalence of reflux esophagitis(RE) in Japan. There are many factors causing RE, and many kinds of changes associating aging are important in the causes of RE in the elderly patients. Characteristic features of the causes of RE in elderly patients are summarized here. Within the elderly patients, there are cases with persistent gastric acid secretion. Aging affections lead to esophageal motor dysfunctions and to failure of LES function(presbyesophagus). The elderly are complicated by orthopedic degenerative diseases with posture change due to osteoporosis; some pharmaceutical agents such as Ca-channel blockers or NSAIDs. Hiatal hernia is also an aggravating factor. In the future, elderly people with persistent gastric acid secretion will be increased based on declining prevalence of Helicobacter pylori. Therefore further increase in the prevalence and development of RE is foreseen in our country. Pathophysiology of RE in the elderly patients is expected to show various changes in the future.

  13. Esophageal Replacement for Long-Gap Esophageal Atresia in a ...

    African Journals Online (AJOL)

    humility to know when to consider a replacement procedure (3). To replace the esophagus of a baby is a major decision in many pediatric surgical units world over. Fortunately, the need for this procedure has decreased in the recent years due to the increase in the variety of techniques of lengthening the upper esophageal ...

  14. Reflux esophagitis revisited: Prospective analysis of radiologic accuracy

    International Nuclear Information System (INIS)

    Ott, D.J.; Gelfand, D.W.; Wu, W.C.

    1981-01-01

    A prospective radiologic-endoscopic study of the esophagogastric region in 266 patients, including 206 normals and 60 with esophagitis, is reported. The endoscopic classification grading severity of esophagitis was grade 1-normal; grades 2. 3. and 4-mild, moderate, and severe esophagitis, respectively. Radiology detected 22% of patient with mild esophagitis, 83% with moderate esophagitis, and 95% with severe esophagitis. Although hiatal hernia was present in 40% of normals and 89% with esophagitis, absence of radiographic hiatal hernia excluded esophagitis with 95% accuracy. The implications of this study regarding the role of radiology in evaluating patient with suspected reflux esophagitis are discussed. (orig.) [de

  15. The effect of synthetic ceramide analogues on gastritis and esophagitis in rats.

    Science.gov (United States)

    Kim, Sung Hyo; Um, Seung In; Nam, Yoonjin; Park, Sun Young; Dong, Je Hyun; Ko, Sung Kwon; Sohn, Uy Dong; Lee, Sang Joon

    2016-09-01

    The effects of ceremide analogues on esophagitis and gastritis in rats were examined. Gastritis induced by indomethacin was significantly reduced after CY3325 and CY3723 treatment, whereas other analogues had no effect. The amount of malondialdehyde in gastritis was significantly reduced by CY3325 or CY 3723. CY3325 or CY 3723 decreased the glutathione levels in gastritis. The myeloperoxidase level in gastritis is increased, and its increment was decreased by CY3325 and CY3723. In reflux esophagitis, the ulceration was decreased by CY3325, CY3723. The gastric volume and acid output are reduced, whereas the pH value is increased by CY3325 or CY3723 after esophagitis. These results suggest that ceramide analogues, CY3325 and CY3723, can prevent the development of gastritis and reflux esophagitis in rats.

  16. Papel dos testes provocativos esofagianos na investigação de pacientes com dor torácica de origem indeterminada Role of esophageal provocative tests in the investigation of patients with chest pain of undetermined origin

    Directory of Open Access Journals (Sweden)

    Luiz J. Abrahão Jr.

    2005-09-01

    a dor era provável e em 6 dos 14 pacientes (42,8% com exames habitualmente empregados normais ou inconclusivos [ganho diagnóstico de 45% (18/40]. Dois pacientes com testes provocativos negativos apresentaram o índice de sintomas positivo à pHmetria, totalizando 25 (62,5% pacientes com dor esofagiana comprovada. CONCLUSÃO: Os testes provocativos permitiram apontar a dor como de origem esofagiana comprovada em 62,5% dos casos, o que representou um ganho diagnóstico de 45% quando comparados aos exames habitualmente empregados, constituindo ferramenta importante na investigação de pacientes com dor torácica de origem indeterminada.BACKGROUND: Traditional methods employed in esophageal investigation of patients with chest pain of undetermined origin includes upper endoscopy, esophageal manometry and pH monitoring. These methods many times disclose abnormalities that can only be enrolled as the possible cause of chest pain. Provocative tests can reproduce pain in the laboratory, establishing its esophageal origin. OBJECTIVES: Determine the positivity of acid perfusion test, edrophonium and balloon distension in patients with chest pain of undetermined origin and compare with results of traditional exams, establishing the gain for the diagnosis of esophageal pain. RESULTS: Forty patients with chest pain of undetermined origin (normal coronary angiography, 80% female, mean age of 54.7 years were submitted to traditional exams and provocative tests. Upper endoscopy disclosed erosive esophagitis in two (5% and peptic ulcer in one (2.5%, esophageal manometry was abnormal in 60%. pH monitoring was abnormal in 14 (35% with a positive symptom index in 7. Chest pain was considered of proved esophageal origin by traditional exams in 7 (17.5% patients with a positive symptom index and of probable esophageal origin in 19 (47.5% being 8 with gastroesophageal reflux disease and 11 abnormal esophageal motility. In 14 (35% an esophageal origin could not be demonstrated. The acid

  17. The genetic alteration of retinoblastoma gene in esophageal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Jae Il; Shim, Yung Mok; Kim, Chang Min [Korea Cancer Center Hospital of Korea Atomic Energy Research Institute, Taejon (Korea, Republic of)

    1994-12-01

    Retinoblastoma(RB) gene is the prototype of tumor suppressor gene and it`s alteration have been frequently observed in a large number of human tumors. To investigate the role of RB in esophageal cancer, we studied 36 esophageal cancer tissues with Southern blot analysis to detect gross LOH and PCR-SSCP method to find minute LOH and mutation, if any. In the cases with abnormalities, the nucleotide sequence analysis was performed. Allelic loss of chromosome 13q14 occurred in 20 out of 32 informative cases (62.5%) by Southern analysis. Furthermore, PCR-LOH added three positive cases. Mobility shift by PCR-SSCP was observed in one case at exon 22, which showed 1 bp deletion in codon 771 of RB gene resulting in frame shift mutation. Besides, nine PCR-band alteration in tumor tissue compared with normal tissue were observed in exon 14 and 22, but mutation was not found on sequencing analysis suggesting the epigenetic alteration in tumor tissue. Analysis of the clinical data did not show any difference depending upon RB alteration. However, the total incidence of RB gene may play an important role in the development of esophageal cancer. The main genetic alteration of RB gene was deletion detected by Southern blot and one bp deletion leading to frame shift was also observed. 8 figs, 5 tabs. (Author).

  18. Brain Abscess after Esophageal Dilatation

    DEFF Research Database (Denmark)

    Gaïni, S; Grand, M; Michelsen, J

    2007-01-01

    with malaise, progressive lethargy, fever, aphasia and hemiparesis. Six days before she had been treated with esophageal dilatation for a stricture caused by accidental ingestion of caustic soda. The brain abscess was treated with surgery and antibiotics. She recovered completely. This clinical case...

  19. Esophageal Cancer Risk Prediction Models

    Science.gov (United States)

    Developing statistical models that estimate the probability of developing esophageal cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  20. [Esophageal histoplasmosis. A case report].

    Science.gov (United States)

    Henry, M A; Mendes, E F; Saad, L H; Rodrigues, P A; Gonçalves, I

    1996-01-01

    The authors report a case of a patient with complaint of progressive disphagia. Stenoses of lower third of esophagus was revealed by radiological and endoscopic examinations. Fungi were showed in biopsy of lesion, with demonstration of Histoplasm capsulate by tissue culture. Endoscopic dilatation was performed because especific medical treatment failed but esophageal rupture was observed. Partial esophagectomy was performed with symptoms remission.

  1. Study on the treatment effect of Bx decoction on rat models of reflux esophagitis

    International Nuclear Information System (INIS)

    Liu Xiaoni; Jin Xiudong; Li Yuezhen; Liu Guilian; Sun Wei

    2008-01-01

    Objective: To explore the mechanism of BAN-XIA-XIE-XIN Decoction (Bx Decoction) treatment in rat models of reflux esophagitis. Methods: Rat models of reflux esophagitis were prepared with the method previously reported from this laboratory. Twenty-five models each were left untreated, treated with cisapride (2.5 mg/kg/d) or treated with BAN-XIA-XIE-XIN Decoction (BX) 5.78m/kg/d) respectively. All the models were sacrificed after 4 weeks, acid contents in gastric juice, cholic acid contents in duodenal juice as well as calcitonin-gene-related peptide (CGRP) (with RIA) contents in lower esophageal tissue and plasma were measured. Histologic examination of lower esophageal tissue for degree of esophagitis was also performed in all the models. Besides, 25 animals underwent sham operation only and served as controls. Results: The positive rates of pathologic changes (mucosal inflammation, squamous cell hyperplasia, lamina propria extension and mucosal erosion) were all significantly higher in the non-treated models than those in the BX treated models (P<0.01). Acid contents in gastric juice were significantly lowered with pH significantly increased in the BX treated group (P<0.01). The CGRP contents in esophageal tissue in the BX treated models, though remains lower than those in the 25 animals with sham operation only, were significantly higher than those in non-treated models (P<0.01). The plasma contents of CGRP in the BX-treated models remained significantly higher than those in sham-operation animals (P<0.01), decrease from the very high levels in untreated model was not large enough to be significant. Conclusion: BX-decoction might exert its protective effect on esophageal mucosa through lowering of gastric acidity with modulation of CGRP synthesis. (authors)

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

    Directory of Open Access Journals (Sweden)

    Ekta Arya

    2013-01-01

    Full Text Available 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.

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

    Science.gov (United States)

    2018-02-22

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

  4. Parametric imaging technique for visualization of esophageal motility and its disorders

    International Nuclear Information System (INIS)

    Tatsch, K.; Knesewitsch, P.; Moser, E.

    1987-01-01

    Fifty-eight healthy individuals and patients with esophageal dysfunction (achalasia, reflux, morphea, PSS, Sharp syndrome) were studied with esophageal parametric imaging (EPI) (acquisition of 15-20 swallows per patient; image creation by special ''space time'' matrix) and results were compared with standard esophageal function scintigraphy (EPS). We could demonstrate that normal function and motility disorders result in defined parametric image patterns. Pathologic findings on EFS always showed abnormal findings on EPI. Normal findings on EPI always showed normal findings on EFS. However, ten of 15 patients with normal EFS had pathologic EPI. Compared with EFS, evaluation of dysfunction in EPI is not referred to single but multiple swallowing and demonstrated a higher sensitivity by comparable specificity

  5. Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography

    NARCIS (Netherlands)

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

    2012-01-01

    Background The Chicago Classification of esophageal motility was developed to facilitate the interpretation of clinical high resolution esophageal pressure topography (EPT) studies, concurrent with the widespread adoption of this technology into clinical practice. The Chicago Classification has been

  6. Clinical Study of Time Optimizing of Endoscopic Photodynamic Therapy on Esophageal and/or Gastric Cardiac Cancer

    Science.gov (United States)

    2015-12-10

    Stage I Esophageal Adenocarcinoma; Stage II Esophageal Adenocarcinoma; Stage III Esophageal Adenocarcinoma; Stage I Esophageal Squamous Cell Carcinoma; Stage II Esophageal Squamous Cell Carcinoma; Stage III Esophageal Squamous Cell Carcinoma

  7. Novel methylene blue staining technique for localizing small esophageal leiomyomas during thoracoscopic enucleation.

    Science.gov (United States)

    Zhang, Z; Ai, B; Liao, Y; Liu, L; Liu, M

    2016-11-01

    The treatment of choice for leiomyoma, the most common benign esophageal tumor, is thoracoscopic enucleation. One of the most difficult aspects of thoracoscopic enucleation is the precise localization of small tumors (≤1.5 cm) and tumors without external protrusion. No simple, feasible solutions to this problem are available. We developed a novel methylene blue staining technique to localize small esophageal leiomyomas and evaluated the feasibility of our technique. Between January 2013 and July 2014, eight patients with small esophageal leiomyomas (≤1.5 cm) underwent thoracoscopic enucleation in Tongji Hospital. Preoperative endoscopic ultrasonography was performed in all patients. The leiomyomas were located in the middle (n = 5) and lower (n = 3) thirds of the esophagus. We preoperatively injected 0.5-1.0 mL methylene blue in the submucosa adjacent to the tumors under standard gastroscope guidance. The entire staining process took about 10 minutes. Staining was successful in all patients. The unstained tumor was exposed after the blue-stained mediastinal pleura, and overlying muscle were incised longitudinally. All procedures were successfully completed without conversion to open surgery. No abnormalities were detected in the esophageal mucosa. The median operating time was 60 minutes (range, 40-90 minutes). Postoperative histopathology confirmed leiomyoma in all patients. The median postoperative hospital stay was 6 days (range, 5-7 days). No major complications, such as esophageal leakage or esophageal diverticulum, occurred. Endoscopic methylene blue staining is safe and feasible for localizing small esophageal leiomyomas during thoracoscopic enucleation. This method will enable precise and easy enucleation. © 2015 International Society for Diseases of the Esophagus.

  8. The Changing Face of Esophageal Cancer

    International Nuclear Information System (INIS)

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

    2010-01-01

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

  9. The Changing Face of Esophageal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Melhado, Rachel E., E-mail: raye732001@yahoo.co.uk; Alderson, Derek; Tucker, Olga [Academic Department of Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham (United Kingdom)

    2010-06-28

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

  10. Esophageal replacement by hydroxylated bacterial cellulose patch in a rabbit model.

    Science.gov (United States)

    Zhu, Changlai; Liu, Fang; Qian, Wenbo; Wang, Yingjie; You, Qingsheng; Zhang, Tianyi; Li, Feng

    2015-01-01

    To repair esophageal defects by hydroxylated and kombucha-synthesized bacterial cellulose (HKBC) patch in a rabbit model. Semicircular esophageal defects 1 cm in length of the cervical esophagus were initially created in 18 Japanese big-ear rabbits and then repaired with HKBC patch grafts. The clinical outcomes including survival rate, weight change, food intake, and hematological and radiologic evaluation were observed. After X-ray evaluation, the rabbits were sacrificed sequentially at 1, 3, and 6 months for histopathologic analysis with light microscopy and scanning electron microscopy. Survival rate during the first month was 88.9% (n = 16). Two rabbits died from anastomotic leakage during the entire follow-up. Postoperatively, feeding function and body weight were gradually restored in the surviving animals. No hematological abnormalities were found, and no obvious anastomotic leakage, stenosis, or obstruction was observed under X-ray examination. The histopathologic results showed a progressive regeneration of the esophagus in the graft area, where the neo-esophagus tissue had characteristics similar to native esophageal tissue after 3 months of surgery. HKBC is beneficial for esophageal tissue regeneration and may be a promising material for esophageal reconstruction.

  11. Esophageal transit in patients bearing diabetes mellitus: contribution to its study with radionuclides

    International Nuclear Information System (INIS)

    Maliska, C.M.; Almeida Cruz, M.G. de; Lima, J.E.

    1991-01-01

    Among the disorders brought about by diabetes mellitus one may include the involvement of the esophageal innervation, which leads to motor disturbances of the esophagus even in non-symptomatic phases. Taking into consideration how simple and sensitive the scintigraphic method is, in the study of esophageal motility, the authors have proposed to compare the duration of esophageal transit with radionuclide in patients bearing diabetes mellitus and in normal individuals. Thirty-three diabetic patients and 26 controls were studied. The patients were divided into two groups: group A (insulin dependents, 11 patients): group B (insulin non dependents, 22 patients). The study showed that the alterations in the time of esophageal transit predominated in groups of diabetics that were insulin non dependents, having no connection with the duration of the disease. In the group of insulin dependents the abnormalities found were related to the duration of the disease. The results obtained showed the importance of this method in the study of diabetic patients with a possible involvement of esophageal motility. (author)

  12. Effects of mosapride on secondary peristalsis in patients with ineffective esophageal motility.

    Science.gov (United States)

    Chen, Chien-Lin; Yi, Chih-Hsun; Liu, Tso-Tsai; Orr, William C

    2013-12-01

    OBJECTIVE. Ineffective esophageal motility is frequently found in patients with gastroesophageal reflux diseases. Secondary peristalsis contributes to esophageal acid clearance. Mosapride improves gastrointestinal (GI) motility by acting on 5-hydroxytrypatamine4 receptors. The authors aimed to evaluate the effect of mosapride on secondary peristalsis in patients with ineffective esophageal motility. MATERIAL AND METHODS. After recording primary peristalsis baseline, secondary peristalsis was stimulated by slowly and rapidly injecting mid-esophageal air in 18 patients. Two separate experiments were randomly performed with 40 mg oral mosapride or placebo. RESULTS. Mosapride had no effect on the threshold volume of secondary peristalsis during slow air distension (9.8 ± 0.97 vs. 10.2 ± 1.0 mL; p = 0.84), but decreased the threshold volume during rapid air distension (4.1 ± 0.2 vs. 4.6 ± 0.3 mL; p = 0.001). The efficiency of secondary peristalsis during rapid air distension increased with mosapride (70% [40-95%]) compared with placebo (60% [10-85%]; p = 0.0003). Mosapride had no effect on the amplitudes of distal pressure wave of secondary peristalsis during slow (94.3 ± 9 vs. 101.9 ± 9.1 mmHg; p = 0.63) or rapid air distension (89.3 ± 9 vs. 95.2 ± 8.3 mmHg; p = 0.24). CONCLUSIONS. Mosapride improves esophageal sensitivity of secondary peristalsis by abrupt air distension but has limited effect on the motor properties of secondary peristalsis in ineffective esophageal motility patients. Despite its well-known prokinetic effect, mosapride enhances the efficiency of secondary peristalsis in patients with ineffective esophageal motility through augmenting esophageal sensitivity instead of motility.

  13. Esophageal peristaltic defects in adults with functional dysphagia.

    Science.gov (United States)

    Ratuapli, Shiva K; Hansel, Stephanie L; Umar, Sarah B; Burdick, George E; Ramirez, Francisco C; Fleischer, David E; Harris, Lucinda A; Lacy, Brian E; DiBaise, John K; Crowell, Michael D

    2014-08-01

    Functional dysphagia (FD) is characterized by the presence of dysphagia without evidence of mechanical esophageal obstruction, GERD, and histopathology-based esophageal motor disorders. Dysphagia is common in older patients; however, there is a paucity of information regarding the type and frequency of peristaltic abnormalities compared to younger patients. Based on recently validated criteria for classification of weak peristalsis using high-resolution manometry (HRM), we hypothesized that older patients with FD would have more peristaltic defects detected by HRM compared to younger FD patients. A retrospective review of our motility database yielded 65 patients that met inclusion criteria. Patients were divided into two groups based on age (younger: dysphagia, or quality of life. Dyspeptic symptoms, including nausea (p 5 cm) (p < 0.001). The mean contraction amplitude was also lower in the older group (p < 0.05). These data support the hypothesis that older patients with FD have a higher frequency of peristaltic abnormalities on HRM compared to younger patients. Older age was associated with increased frequency of weak peristalsis with small and large peristaltic defects.

  14. Acute Necrotizing Esophagitis Followed by Duodenal Necrosis

    Science.gov (United States)

    del Hierro, Piedad Magdalena

    2011-01-01

    Acute Necrotizing Esophagitis is an uncommon pathology, characterized by endoscopic finding of diffuse black coloration in esophageal mucosa and histological presence of necrosis in patients with upper gastrointestinal bleeding. The first case of acute necrotizing esophagitis followed by duodenal necrosis, in 81 years old woman with a positive history of Type 2 Diabetes Mellitus, Hypertension, and usual intake of Nonsteroidal Anti-inflammatory drugs, is reported. Although its etiology remains unknown, the duodenal necrosis suggests that ischemia could be the main cause given that the branches off the celiac axis provide common blood supply to the distal esophageal and duodenal tissue. The massive gastroesophagic reflux and NSAID intake could be involved. PMID:27957030

  15. Combined treatment of esophageal cancer: a review

    International Nuclear Information System (INIS)

    Cesas, A.; Bagajevas, A.

    2004-01-01

    While still relatively uncommon in many countries, esophageal cancer is fatal in the vast majority of cases. In the USA, estimated 13,100 of new cases were diagnosed in 2002. In Lithuania, 163 new cases were diagnosed in 2001. Evidence for an association between environment, diet and esophageal cancer comes from the profound differences in incidence observed in different parts of the world. While the overall outlook for patients diagnosed with esophageal cancer has improved in the last 30 years, most patients are still present with advanced disease and their survival remains poor. Commonly etiology and risk factors of esophageal cancer are: cigarettes and alcohol, diet and other genetics factors. Only in 50% of patients with esophageal cancer clinically localized disease is present. National Comprehensive Cancer Network guidelines state that patients with clinically localized disease may be treated with resection or chemotherapy plus radiation. The overall survival rates for either surgery alone or combined chemotherapy and radiation appear equivalent. Chemoradiation as primary management of localized esophageal cancer has been shown to be superior in radiation alone. A series of randomized trials have demonstrated that adjuvant postoperative chemoradiation does not offer a survival advantage to patients with esophageal cancer. The superiority of preoperative chemoradiation over surgery alone in esophageal cancer has been demonstrated in a prospective trials. Recently published phase I and II studies have demonstrated moderate response rates to taxanes in esophageal cancer. Taxanes and irinotecan in combinations with platinum compounds and fluoropyrimidines are being tested in regimes with radiation. (author)

  16. Enhanced recovery after esophageal resection.

    Science.gov (United States)

    Vorwald, Peter; Bruna Esteban, Marcos; Ortega Lucea, Sonia; Ramírez Rodríguez, Jose Manuel

    2018-03-21

    ERAS is a multimodal perioperative care program which replaces traditional practices concerning analgesia, intravenous fluids, nutrition, mobilization as well as a number of other perioperative items, whose implementation is supported by evidence-based best practices. According to the RICA guidelines published in 2015, a review of the literature and the consensus established at a multidisciplinary meeting in 2015, we present a protocol that contains the basic procedures of an ERAS pathway for resective esophageal surgery. The measures involved in this ERAS pathway are structured into 3areas: preoperative, perioperative and postoperative. The consensus document integrates all the analyzed items in a unique time chart. ERAS programs in esophageal resection surgery can reduce postoperative morbidity, mortality, hospitalization and hospital costs. Copyright © 2018 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Wortmannin influences hypoxia-inducible factor-1 alpha expression and glycolysis in esophageal carcinoma cells.

    Science.gov (United States)

    Zeng, Ling; Zhou, Hai-Yun; Tang, Na-Na; Zhang, Wei-Feng; He, Gui-Jun; Hao, Bo; Feng, Ya-Dong; Zhu, Hong

    2016-05-28

    To investigate the influence of phosphatidylinositol-3-kinase protein kinase B (PI3K/AKT)-HIF-1α signaling pathway on glycolysis in esophageal carcinoma cells under hypoxia. Esophageal carcinoma cell lines Eca109 and TE13 were cultured under hypoxia environment, and the protein, mRNA and activity levels of hypoxia inducible factor-1 alpha (HIF-1α), glucose transporter 1, hexokinase-II, phosphofructokinase 2 and lactate dehydrogenase-A were determined. Supernatant lactic acid concentrations were also detected. The PI3K/AKT signaling pathway was then inhibited with wortmannin, and the effects of hypoxia on the expression or activities of HIF-1α, associated glycolytic enzymes and lactic acid concentrations were observed. Esophageal carcinoma cells were then transfected with interference plasmid with HIF-1α-targeting siRNA to assess impact of the high expression of HIF-1α on glycolysis. HIF-1α is highly expressed in the esophageal carcinoma cell lines tested, and with decreasing levels of oxygen, the expression of HIF-1α and the associated glycolytic enzymes and the extracellular lactic acid concentration were enhanced in the esophageal carcinoma cell lines Eca109 and TE13. In both normoxia and hypoxic conditions, the level of glycolytic enzymes and the secretion of lactic acid were both reduced by wortmannin. The expression and activities of glycolytic enzymes and the lactic acid concentration in cells were reduced by inhibiting HIF-1α, especially the decreasing level of glycolysis was significant under hypoxic conditions. The PI3K/AKT pathway and HIF-1α are both involved in the process of glycolysis in esophageal cancer cells.

  18. Vitiligo associated with esophageal adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Ali Asilian

    2013-01-01

    Full Text Available 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.

  19. Eosinophilic esophagitis: indications for treatment.

    Science.gov (United States)

    Straumann, Alex

    2014-01-01

    At present, it is still debated whether the focus of treatment in eosinophilic esophagitis (EoE) should be directed toward a symptomatic or histological response, or even toward a combination of both. This question cannot be answered as long as we have no solid data evaluating the long-term consequences of untreated symptoms and untreated inflammation. Nevertheless, today there are at least three established reasons to treat patients with clinically and histologically active EoE. First, dysphagia has a substantial negative impact on the patient's daily life. Despite the fact that patients often cope with this symptom and accept even marked restrictions in their nutritional habits, they usually experience a marked enhancement in quality of life under treatment. Second, untreated EoE harbors the risk of long-lasting food impactions. There is evidence that this unpleasant, unforeseeable and even risky incident can be prevented by efficient treatment of the eosinophilic inflammation. Third, it has been demonstrated in several clinical studies as well as in animal models that unbridled eosinophilic inflammation leads to a so-called remodeling of the esophagus with wall thickening, stiffness of the organ and stricture. Prevention of esophageal damage caused by tissue remodeling is therefore another reason to strongly advocate a consequential treatment. Finally, there is increasing evidence that untreated EoE might be a risk factor for acute infection of the esophagus with herpes simplex virus (HSV), leading to a severe ulcerative and extremely painful esophagitis. Prevention of HSV esophagitis might therefore be a fourth indication for treating EoE. 2014 S. Karger AG, Basel.

  20. Current knowledge on esophageal atresia

    Science.gov (United States)

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

    2012-01-01

    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. PMID:22851858

  1. Pharmacologic influence on esophageal varices

    International Nuclear Information System (INIS)

    Lunderquist, A.; Owman, T.

    1983-01-01

    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. (orig.)

  2. Spontaneous circumferential esophageal dissection in a young man with eosinophilic esophagitis.

    Science.gov (United States)

    Quiroga, Jorge; Prim, José María G; Moldes, Milagros; Ledo, Ramiro

    2009-12-01

    Spontaneous esophageal dissection is a rare condition that may happen in patients with eosinophilic esophagitis. Conservative management is an important therapeutic option to be considered. We describe an unusual case of a young man with eosinophilic esophagitis who presented complaining of acute retrosternal pain, fever and vomiting. After a thorough evaluation including CT-scan and esophagogram, circumferential esophageal dissection and mediastinal abscess without visible perforation was observed. Abscess resolution and oral nutrition reintroduction was achieved with non-surgical management. Corticoid therapy was initiated for esophagitis treatment.

  3. Long-term observation and functional state of the esophagus after primary repair of spontaneous esophageal rupture.

    Science.gov (United States)

    D'Journo, Xavier Benoit; Doddoli, Christophe; Avaro, Jean Philippe; Lienne, Pascal; Giovannini, Marc A; Giudicelli, Roger; Fuentes, Pierre A; Thomas, Pascal A

    2006-05-01

    Long-term outcome of patients treated for a spontaneous esophageal rupture (Boerhaave's syndrome) is seldom reported. From 1989 to 2004, 62 esophageal perforations were treated in a single institution. Eighteen patients presented with a spontaneous esophageal rupture. Among them, 15 could be treated with a transthoracic primary repair and constituted the material of the present study. A chart review was performed with special attention to survival, residual symptoms, and anatomic and motility disorders. Three patients died postoperatively (20%). At last follow-up, 10 patients were alive and 2 had died from unrelated causes. At a median delay of 13 months (3 to 74), 7 patients accepted to undergo complementary investigations. None of them had any anatomic abnormality as checked by barium swallow. Six patients complained of mild symptoms from gastroesophageal reflux. Six patients (85%) presented with esophageal motility disorders on manometry and 4 (54%) had nocturne chronic reflux disease on pH monitoring. Two patients underwent endoscopic ultrasonography, of which one presented with a focal absence of one layer of the esophageal wall within the area of the suture. With time, no patient experienced recurrence, but one developed a cancer in the cervical esophagus. These results suggest that esophageal functional disorders are the rule after primary repair of a Boerhaave's syndrome. Whether or not these findings are causal, coincidental, or related to the surgical treatment remains unclear. However, performance of routine postoperative explorations is strongly encouraged for a better understanding of this challenging condition.

  4. Expression, localization and polymorphisms of the nuclear receptor PXR in Barrett's esophagus and esophageal adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Kusters Johannes G

    2011-10-01

    Full Text Available Abstract Background The continuous exposure of esophageal epithelium to refluxate may induce ectopic expression of bile-responsive genes and contribute to the development of Barrett's esophagus (BE and esophageal adenocarcinoma. In normal physiology of the gut and liver, the nuclear receptor Pregnane × Receptor (PXR is an important factor in the detoxification of xenobiotics and bile acid homeostasis. This study aimed to investigate the expression and genetic variation of PXR in reflux esophagitis (RE, Barrett's esophagus (BE and esophageal adenocarcinoma. Methods PXR mRNA levels and protein expression were determined in biopsies from patients with adenocarcinoma, BE, or RE, and healthy controls. Esophageal cell lines were stimulated with lithocholic acid and rifampicin. PXR polymorphisms 25385C/T, 7635A/G, and 8055C/T were genotyped in 249 BE patients, 233 RE patients, and 201 controls matched for age and gender. Results PXR mRNA levels were significantly higher in adenocarcinoma tissue and columnar Barrett's epithelium, compared to squamous epithelium of these BE patients (P P = 0.003. Immunohistochemical staining of PXR showed predominantly cytoplasmic expression in BE tissue, whereas nuclear expression was found in adenocarcinoma tissue. In cell lines, stimulation with lithocholic acid did not increase PXR mRNA levels, but did induce nuclear translocation of PXR protein. Genotyping of the PXR 7635A/G polymorphism revealed that the G allele was significantly more prevalent in BE than in RE or controls (P = 0.037. Conclusions PXR expresses in BE and adenocarcinoma tissue, and showed nuclear localization in adenocarcinoma tissue. Upon stimulation with lithocholic acid, PXR translocates to the nuclei of OE19 adenocarcinoma cells. Together with the observed association of a PXR polymorphism and BE, this data implies that PXR may have a function in prediction and treatment of esophageal disease.

  5. Candidial esophagitis - A marker for HIV infection

    Directory of Open Access Journals (Sweden)

    B Kumar

    1990-01-01

    Full Text Available A case of AIDS manifested as candidial esophagitis. In addition , he had genital herpes, frequent diarrhoea, loss of weight and generalized lymphadenopathy. The diagnosis was confirmed by endoscopy. The patient died in 3 months due to unremitting diarrhoea. This importance of candidial esophagitis in a person at risk for developing AIDS is highlighted.

  6. Iatrogenic esophageal perforation in a newborn

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jeong Mi; Yeon, Kyung Mo; Park, Won Soon; Choi, Jung Hwan [College of Medicine, Seoul National Univ., Seoul (Korea, Republic of)

    1990-07-15

    Esophagus and pharyngeal structures of newborn are very week and so vulnerable. When a parallel longitudinal tubular structure around (especially behind) the esophagus is seen, traumatic esophageal perforation must be differentiated. We report a case of esophageal perforation in a premature twin baby by nasogastric tube insertion.

  7. esophageal carcinoma complicating achalasia, 25 years post ...

    African Journals Online (AJOL)

    mine

    Achalasia was made, with marked retention and esophageal dilation seen on Barium Swallow examination (fig. ... 2.) showed moderate dilation of the esophagus with trickling of barium into the stomach and some esophageal ... patients, an incidence almost seven times that in the general population. In Nigeria, Pindiga 10.

  8. PET-CT manifestation of Candida esophagitis

    International Nuclear Information System (INIS)

    Bahk, Yong Whee; O, Joo Hyun

    2007-01-01

    Candida esophagitis (moniliasis) is the most common infection of the gullet and has generally been attributed to as a complication of immune suppressed state. However, as the current case. Holt found the disease to occur in 3 of his 13 patients without predisposing condition. Predisposing factors other than immune deficient conditions include aplastic anemia, alcoholism and Parkinson's disease and age, diabetes mellitus, and disruption of mucosal integrity. Growing prevalence of Candida esophagitis in recent years is accounted for by an increase in the number of patients with organ transplantation, malignancy and AIDS as well as populrization of endoscopy. Microorganisms that reached the esophagus in oral secretions are rarely cultured from the esophageal surface. Of many species C. albicans is the most common offender although C. tropicalis has also been isolated with high prevalence, particularly in the patients with cancer and disseminated candidiasis. Clinically, the patients with Candida esophagitis seek medical care for esophageal or retrosternal pain, dysphagia or distress. Candida esophagitis may be the extension from oropharyngeal infection but in the majority the esophagus is the sole site of infection. The middle and lower thirds of the esophagus are more typically affected than the upper third. Diagnosis can be indicated by double contrast esophagography or endoscopy and confirmed by potassium hydroxide (KOH) stain or biopsy. It is to be noted that the more presence of Candida in smear or cultured specimen cannot indict Candida as definitive offender. Differential diagnosis includes herpes simplex infection, cytomegalovirus infection, reflux esophagitis or radiation esophagitis

  9. PET-CT manifestation of Candida esophagitis

    Energy Technology Data Exchange (ETDEWEB)

    Bahk, Yong Whee [Sung-Ae Hospital, Seoul (Korea, Republic of); O, Joo Hyun [Kangnam St. Mary' s Hospital, Catholic University Medical School, Seoul (Korea, Republic of)

    2007-04-15

    Candida esophagitis (moniliasis) is the most common infection of the gullet and has generally been attributed to as a complication of immune suppressed state. However, as the current case. Holt found the disease to occur in 3 of his 13 patients without predisposing condition. Predisposing factors other than immune deficient conditions include aplastic anemia, alcoholism and Parkinson's disease and age, diabetes mellitus, and disruption of mucosal integrity. Growing prevalence of Candida esophagitis in recent years is accounted for by an increase in the number of patients with organ transplantation, malignancy and AIDS as well as populrization of endoscopy. Microorganisms that reached the esophagus in oral secretions are rarely cultured from the esophageal surface. Of many species C. albicans is the most common offender although C. tropicalis has also been isolated with high prevalence, particularly in the patients with cancer and disseminated candidiasis. Clinically, the patients with Candida esophagitis seek medical care for esophageal or retrosternal pain, dysphagia or distress. Candida esophagitis may be the extension from oropharyngeal infection but in the majority the esophagus is the sole site of infection. The middle and lower thirds of the esophagus are more typically affected than the upper third. Diagnosis can be indicated by double contrast esophagography or endoscopy and confirmed by potassium hydroxide (KOH) stain or biopsy. It is to be noted that the more presence of Candida in smear or cultured specimen cannot indict Candida as definitive offender. Differential diagnosis includes herpes simplex infection, cytomegalovirus infection, reflux esophagitis or radiation esophagitis.

  10. Esophageal Stricture Post Endoscopic Injection Sclerotherapy ...

    African Journals Online (AJOL)

    Only two patients had esophageal varices secondary to viral hepatitis B liver cirrhosis. Their presentation was commonly with difficulty in swallowing and few cases presented with food impaction. The majority of patients were treated with wire guided endoscopic Savary Gilliard dilation. Conclusion: Esophageal stricture ...

  11. Palliation of Dysphagia from Esophageal Cancer

    NARCIS (Netherlands)

    M.Y.V. Homs (Marjolein)

    2004-01-01

    textabstractThe prognosis of esophageal cancer is poor with a 5-year survival of 10-15%. In addition, over 50% of patients with esophageal cancer already have an inoperable disease at presentation. The majority of these patients require palliative treatment to relieve progressive dysphagia. Metal

  12. esophageal carcinoma complicating achalasia, 25 years post ...

    African Journals Online (AJOL)

    mine

    moderate dilation of the esophagus with trickling of barium into the stomach and some esophageal retention Flexible esophago-gastro-duodenoscopy was carried out which showed cobble stone appearance of lower esophageal mucosa plus food debris. Biopsy taken during this procedure revealed chronic oesophagitis.

  13. Prognostic yield of esophageal manometry in chronic intestinal pseudo-obstruction: a retrospective cohort of 116 adult patients.

    Science.gov (United States)

    Amiot, A; Joly, F; Cazals-Hatem, D; Merrouche, M; Jouet, P; Coffin, B; Bouhnik, Y

    2012-11-01

    Chronic intestinal pseudo-obstruction (CIPO) refers to a wide and heterogeneous group of neuromuscular disorders, which classically involve the small intestine. However, further investigation is required to determine if motility disturbances involve all parts of the gastrointestinal (GI) tract. Medical records and follow-up examinations of 116 adult CIPO patients [70F, median age 28 (0-79) years] were reviewed and performed at our institution since 1980. Manometry (esophageal, small bowel and anorectal) and gastric emptying scintigraphy reports were retrieved and analyzed. Survival, home parenteral nutrition requirement, and the inability to maintain sufficient oral feeding was analyzed using univariate and multivariate analysis. The median follow-up time was 6 (0.1-30) years. In all, 90% of patients who underwent at least one motility test, with the exception of small bowel manometry, exhibited at least one abnormal pattern. Esophageal manometry was abnormal in 73% of the cases, including 51% with severe ineffective esophageal motility. Anorectal manometry was abnormal in 59% of the cases, including only 17% with severe abnormalities. Gastric emptying was abnormal in 61% of the cases. Only esophageal motor disorders had significant predicting values for survival, home parenteral nutrition requirement, and an inability to maintain sufficient oral feeding. Our study showed that CIPO was associated with a diffuse involvement of all parts of the GI tract and was not restricted to the small intestine in 90% of the cases studied. Esophageal manometry had a significant prognostic yield and should be systematically performed in CIPO patients. © 2012 Blackwell Publishing Ltd.

  14. Abnormal Head Position

    Science.gov (United States)

    ... Frequently Asked Questions Español Condiciones Chinese Conditions Abnormal Head Position En Español Read in Chinese What is an abnormal head posture? An abnormal or compensatory head posture occurs ...

  15. A Dietary Medium-Chain Fatty Acid, Decanoic Acid, Inhibits Recruitment of Nur77 to the HSD3B2 Promoter In Vitro and Reverses Endocrine and Metabolic Abnormalities in a Rat Model of Polycystic Ovary Syndrome.

    Science.gov (United States)

    Lee, Bao Hui; Indran, Inthrani Raja; Tan, Huey Min; Li, Yu; Zhang, Zhiwei; Li, Jun; Yong, Eu-Leong

    2016-01-01

    Hyperandrogenism is the central feature of polycystic ovary syndrome (PCOS). Due to the intricate relationship between hyperandrogenism and insulin resistance in PCOS, 50%-70% of these patients also present with hyperinsulinemia. Metformin, an insulin sensitizer, has been used to reduce insulin resistance and improve fertility in women with PCOS. In previous work, we have noted that a dietary medium-chain fatty acid, decanoic acid (DA), improves glucose tolerance and lipid profile in a mouse model of diabetes. Here, we report for the first time that DA, like metformin, inhibits androgen biosynthesis in NCI-H295R steroidogenic cells by regulating the enzyme 3β-hydroxysteroid dehydrogenase/Δ5-Δ4-isomerase type 2 (HSD3B2). The inhibitory effect on HSD3B2 and androgen production required cAMP stimulation, suggesting a mechanistic action via the cAMP-stimulated pathway. Specifically, both DA and metformin reduced cAMP-enhanced recruitment of the orphan nuclear receptor Nur77 to the HSD3B2 promoter, coupled with decreased transcription and protein expression of HSD3B2. In a letrozole-induced PCOS rat model, treatment with DA or metformin reduced serum-free testosterone, lowered fasting insulin, and restored estrous cyclicity. In addition, DA treatment lowered serum total testosterone and decreased HSD3B2 protein expression in the adrenals and ovaries. We conclude that DA inhibits androgen biosynthesis via mechanisms resulting in the suppression of HSD3B2 expression, an effect consistently observed both in vitro and in vivo. The efficacy of DA in reversing the endocrine and metabolic abnormalities of the letrozole-induced PCOS rat model are promising, raising the possibility that diets including DA could be beneficial for the management of both hyperandrogenism and insulin resistance in PCOS.

  16. Esophageal strictures during treatment for acute lymphoblastic leukemia.

    LENUS (Irish Health Repository)

    Kelly, Kevin

    2012-02-01

    Esophageal stricture is a rare complication of paediatric cancer treatment that usually occurs after esophageal exposure to radiotherapy. We describe 4 cases of esophageal stricture during chemotherapy for acute lymphoblastic leukemia. All patients presented with refractory vomiting and were diagnosed with radiologic contrast studies. None of the patients had received radiotherapy. Esophageal candidiasis was seen in 2 patients but the remaining 2 patients had earlier systemic candidiasis. High-dose dexamethasone may predispose these children to both esophageal candidiasis and peptic esophagitis. The etiology of esophageal strictures during treatment for acute leukemia is likely to be multifactorial but systemic candidiasis may play a significant role.

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

    Directory of Open Access Journals (Sweden)

    Lalit Parida

    2015-01-01

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

  18. Radiation therapy for esophageal carcinoma

    International Nuclear Information System (INIS)

    Chatani, Masashi; Matayoshi, Yoshinobu; Masaki, Norie

    1992-01-01

    From 1977 through 1989, 149 patients with esophageal carcinoma were treated with external irradiation (EI) with or without high-dose rate intraluminal irradiation (HDRII) using remote afterloading system. Concerning complete response group EI alone showed higher local control rate than EI + HDRII, especially in ulcerative type. Another problem is the EI field. Fourteen of 22 patients who were salvaged by surgery due to local recurrence after EI showed marginal or out-field metastasis of the lymph node. These preliminary results suggest that HDRII is not effective for the local control of the ulcerative lesion as a boost therapy, EI should be given for the entire regional lymph nodes. (author)

  19. Epidemiologic differences in esophageal cancer between Asian and Western populations

    OpenAIRE

    Hong-Bing Shen; Guang-Fu Jin; Han-Ze Zhang

    2012-01-01

    Esophageal cancer is a common cancer worldwide and has a poor prognosis. The incidence of esophageal squamous cell cancer has been decreasing, whereas the incidence of esophageal adenocarcinoma has been increasing rapidly, particularly in Western men. Squamous cell cancer continues to be the major type of esophageal cancer in Asia, and the main risk factors include tobacco smoking, alcohol consumption, hot beverage drinking, and poor nutrition. In contrast, esophageal adenocarcinoma predomina...

  20. Proximal esophageal pH monitoring: improved definition of normal values and determination of a composite pH score.

    Science.gov (United States)

    Ayazi, Shahin; Hagen, Jeffrey A; Zehetner, Joerg; Oezcelik, Arzu; Abate, Emmanuele; Kohn, Geoffrey P; Sohn, Helen J; Lipham, John C; Demeester, Steven R; Demeester, Tom R

    2010-03-01

    Patients with respiratory and laryngeal symptoms are commonly referred for evaluation of reflux disease as a potential cause. Dual-probe pH monitoring is often performed, although data on normal acid exposure in the proximal esophagus are limited because of the small number of normal subjects and inconsistent placement of the proximal pH sensor in relation to the upper esophageal sphincter. We measured proximal esophageal acid exposure using dual-probe pH and calculated a composite pH score in a large number of asymptomatic volunteers to better define normal values. Eighty-one normal subjects free of reflux, laryngeal, or respiratory symptoms were recruited. All had video esophagraphy to exclude hiatal hernia. Esophageal pH monitoring was performed using 1 of 3 different dual-probe catheters with sensors spaced 10, 15, or 18 cm apart. The standard components of esophageal acid exposure were measured, excluding meal periods. A composite pH score for the proximal esophagus was calculated using these components. The final study population consisted of 59 (49% male) subjects, with a median age of 27 years. All had normal distal esophageal acid exposure and no hiatal hernia. The 95(th) percentile values for the percent time the pH was < 4 for the total, upright, and supine periods were 0.9%, 1.2%, and 0.4%, respectively. The 95(th) percentile for the number of reflux episodes was 24 and for the calculated proximal esophageal composite pH score was 16.4. In a large population of normal subjects, we have defined the normal values and calculated a composite pH score for proximal esophageal acid exposure. The total percent time pH < 4 was similar to previously published normal values, but the number of reflux episodes was greater. Copyright 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Effect of Severity of Esophageal Acidification on Sleep vs Wake Periods in Infants Presenting with Brief Resolved Unexplained Events.

    Science.gov (United States)

    Sankaran, Janani; Qureshi, Aslam H; Woodley, Frederick; Splaingard, Mark; Jadcherla, Sudarshan R

    2016-12-01

    To describe the pattern of gastroesophageal reflux (GER) events in wake and sleep states with increasing acid reflux index (ARI) in neonates and to test the hypothesis that GER-related symptoms are frequent in ARI >7% in wake state. Infants underwent 24-hour pH-impedance studies with 6-hour concurrent video-polysomnography studies. Data were stratified based on the 24-hour ARI (% duration that esophageal pH is 7% (abnormal). GER frequency, clearance mechanisms, and symptoms were distinguished during wake state and sleep state. Total wake and sleep duration was similar (P ≥ .2) in all ARI groups. Acidic events were frequent with increasing ARI in wake state vs sleep state (P ≤ .03). The symptom index increased with increasing ARI (P ≤ .02) in both wake state and sleep state. Acid clearance time increased with increasing ARI in wake state (P ≤ .02). In ARI > 7% vs ARI ≤ 7%, frequency of acidic GER events was higher (P ≤ .02) in wake state and sleep state; proximal migration of acid (P = .03) and acid clearance time were higher in wake state (P = .0005) only. Symptom index was higher in ARI >7% vs ARI ≤ 7% in wake state (P 7%) is associated with increased reflux-associated symptoms in wake state. Sleep state appears to be protective regardless of ARI, likely because of greater chemosensory thresholds. Attention to posture and movements during wake state can be helpful. Scrutiny for non-GER etiologies should occur for infants presenting with life-threatening symptoms. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Esomeprazole for the Treatment of Erosive Esophagitis in Children: An International, Multicenter, Randomized, Parallel-Group, Double-Blind (for Dose) Study.

    Science.gov (United States)

    Tolia, Vasundhara; Youssef, Nader N; Gilger, Mark A; Traxler, Barry; Illueca, Marta

    2015-07-01

    Acid suppression with a proton pump inhibitor is standard treatment for gastroesophageal reflux disease and erosive esophagitis in adults and increasingly is becoming first-line therapy for children aged 1-17 years. We evaluated endoscopic healing of erosive esophagitis with esomeprazole in young children with gastroesophageal reflux disease and described esophageal histology. Children aged 1-11 years with endoscopically or histologically confirmed gastroesophageal reflux disease were randomized to esomeprazole 5 or 10 mg daily (Esomeprazole (0.2-1.0 mg/kg) effectively heals macroscopic and microscopic erosive esophagitis in this pediatric population with gastroesophageal reflux disease. Dilation of intercellular space may be an important histologic marker of erosive esophagitis in children.

  3. Thoracoscopic Surgery in a Patient with Multiple Esophageal Carcinomas after Surgery for Esophageal Achalasia

    Science.gov (United States)

    Tsukada, Tomoya; Aoki, Tatsuya; Haba, Yusuke; Hirano, Katsuhisa; Watanabe, Toshifumi; Kaji, Masahide; Shimizu, Koichi

    2017-01-01

    We present a case in which we used a thoracoscopic approach for resection of multiple esophageal carcinomas diagnosed 33 years after surgery for esophageal achalasia. A 68-year-old Japanese man had been diagnosed with esophageal achalasia and underwent surgical treatment 33 years earlier. He was examined at our hospital for annual routine checkup in which upper gastrointestinal endoscopy showed a “0-IIb+IIa” lesion in the middle esophagus. Iodine staining revealed multiple irregularly shaped iodine-unstained areas, the diagnosis of which was esophageal carcinoma. Thoracoscopic subtotal esophagectomy was performed. Esophageal carcinoma may occur many years after surgery for esophageal achalasia, even if the passage symptoms have improved. So, long-term periodic follow-up is necessary for detection of carcinoma at an earlier stage. PMID:28951795

  4. A case of metachronous development of esophageal squamous cell carcinoma in the patient with esophageal carcinosarcoma.

    Science.gov (United States)

    Cha, Ra Ri; Jung, Woon Tae; Oh, Hye Won; Kim, Hee Jin; Ha, Chang Yoon; Kim, Hong Jun; Kim, Tae Hyo; Ko, Gyung Hyuck

    2014-12-01

    Esophageal carcinosarcoma is a rare malignant esophageal neoplasm consisting of both carcinomatous and sarcomatous elements, with an incidence of 0.5%. There have been only a few case reports of carcinosarcoma and squamous cell carcinoma coexisting in the esophagus. However, all of these are cases of synchronous or metachronous development of carcinosarcoma after chemoradiotherapy in patients of esophageal squamous cell carcinoma. A 53-year-old man underwent esophagogas-troduodenoscopy because of chest pain for several months. Endoscopic examination revealed a huge pedunculated esophageal polypoid mass. Endoscopic submucosal dissection (ESD) was performed and histopathologic examination confirmed spindle cell carcinoma (carcinosarcoma). He refused additional esophagectomy. After 21 months, third follow-up endoscopy showed poorly-demarcated flat, faint discolored lesions at different location from the previous ESD site and endoscopic biopsies confirmed squamous cell carcinoma. To the best of our knowledge, this is the first case of metachronous development of esophageal squamous cell carcinoma in a patient with esophageal carcinosarcoma.

  5. The potential of photodynamic therapy to treat esophageal candidiasis coexisting with esophageal cancer.

    Science.gov (United States)

    Qiu, Haixia; Mao, Yongping; Gu, Ying; Zhu, Jianguo; Wang, Ying; Zeng, Jing; Huang, Naiyan; Liu, Qingsen; Yang, Yunsheng

    2014-01-05

    Photodynamic therapy (PDT) has been used in recent years to deal with fungal infections because of the prevalence of fungi resistance to drugs. However, PDT for gastrointestinal fungal infection has not been reported. This study was conducted to assess the potential of PDT to deal with esophageal candidiasis. Two male patients with histological evidence of esophageal candidiasis coexisting with esophageal cancer were included in this retrospective study. Both patients were treated with PDT. This treatment was repeated at least 1month after the initial PDT if the patient still had residual cancer or esophageal candidiasis. Short-term efficacy was evaluated on the basis of endoscopy and histology findings. Further follow-up data were obtained from endoscopy results or telephone conversation. The esophageal candidiasis located 21-24cm and 25-28cm from the incisors of case 1 reached complete remission after one and two PDT sessions, respectively. The esophageal cancer coexisting with esophageal candidiasis located 21-24cm from the incisors reached complete remission after two PDT sessions. No recurrence was found at a 14-month follow-up. The esophageal cancer located 30-35cm from the incisors reached partial response after three PDT sessions. Both of the esophageal candidiasis and the coexisting esophageal cancer at 23-26cm from the incisors of case 2 reached complete remission and the esophageal cancer at 34-37cm from the incisors reached complete remission after one PDT session. No recurrence was found at a 24-month follow-up. There were no serious adverse events found in either of the two cases. Results of this preliminary study indicate that PDT may be a potential method to deal with esophageal candidiasis. Copyright © 2013 Elsevier B.V. All rights reserved.

  6. Pattern of food intolerance in patients with gastro-esophageal reflux symptoms.

    Science.gov (United States)

    Caselli, Michele; Lo Cascio, Natalina; Rabitti, Stefano; Eusebi, Leonardo H; Zeni, Elena; Soavi, Cecilia; Cassol, Francesca; Zuliani, Giovanni; Zagari, Rocco M

    2017-12-01

    Many food items have been involved in gastro-esophageal reflux disease pathogenesis and dietary modification has been proposed as first-line treatment. Test-based exclusion diets have shown to significantly reduce reflux symptoms. We aimed to assess the patterns of food intolerance in a series of patients with typical gastro-esophageal reflux symptoms (GERS). We retrospectively evaluated all patients with typical reflux symptoms, attending the Centre Study Association on Food Intolerance and Nutrition of Ferrara from January 2010 to October 2015, who resulted positive to at least one food item at the Leucocytotoxic Test. The presence and severity of typical GERS (heartburn and/or acid regurgitation) were assessed using the Gastro-esophageal Reflux Disease Impact Scale (GIS) questionnaire. Only individuals with a GIS Score of at least 5 points were included. Almost all patients (91.1%) were intolerant to at least 5 food items. The most frequent food intolerance (more than 33% of patients) were found for milk (55.4%), lettuce (46.4%), coffee (43.7%), brewer's yeast (42.9%), pork (42.9%), tuna (37.5%), rice (35.7%), sole (34.8%), asparagus (34.8%) and eggs (33.9%). Nine different clusters of food intolerance were detected. Patients with typical gastro-esophageal reflux symptoms seem to have intolerance to multiple food items, some of which (lettuce, brewer's yeast, tuna, rice, sole and asparagus) have not yet been associated to gastro-esophageal reflux disease.

  7. Balloon Dilatation for Corrosive Esophageal Strictures in Children: Radiologic and Clinical Outcomes

    International Nuclear Information System (INIS)

    Youn, Byung Jae; Kim, Woo Sun; Cheon, Jung Eun; Kim, Wha Young; Shin, Su Mi; Kim, In One; Yeon, Kyung Mo

    2010-01-01

    We retrospectively evaluated the effectiveness of the esophageal balloon dilatation (EBD) in children with a corrosive esophageal stricture. The study subjects included 14 patients (M:F = 8:6, age range: 17-85 months) who underwent an EBD due to a corrosive esophageal stricture. The causative agents for the condition were glacial acetic acid (n = 9) and lye (n = 5). A total of 52 EBD sessions were performed in 14 patients (range 1-8 sessions). During the mean 15-month follow-up period (range 1-79 months), 12 patients (86%) underwent additional EBD due to recurrent esophageal stricture. Dysphagia improved after each EBD session and oral feeding was possible between EBD sessions. Long-term success (defined as dysphagia relief for at least 12 months after the last EBD) was achieved in two patients (14%). Temporary success of EBD (defined as dysphagia relief for at least one month after the EBD session) was achieved in 17 out of 52 sessions (33%). A submucosal tear of the esophagus was observed in two (4%) sessions of EBD. Only a limited number of children with corrosive esophageal strictures were considered cured by EBD. However, the outcome of repeated EBD was sufficient to allow the children to eat per os prior to surgical management

  8. The feasibility and acceptability of esophageal-directed hypnotherapy for functional heartburn

    Science.gov (United States)

    Riehl, M. E.; Pandolfino, J. E.; Palsson, O. S.; Keefer, L.

    2015-01-01

    SUMMARY Functional Heartburn (FH) is a benign but burdensome condition characterized by painful, burning epigastric sensations in the absence of acid reflux or symptom-reflux correlation. Esophageal hypersensitivity and its psychological counterpart, esophageal hypervigilance (EHv) drive symptom experience. Hypnotherapy (HYP) is an established and preferred intervention for refractory symptoms in functional gastrointestinal disorders (FGIDs) and could be applied to FH. The objective of this study was to determine the feasibility, acceptability and clinical utility of 7 weekly sessions of esophageal-directed hypnotherapy (EHYP) on heartburn symptoms, quality of life and EHv. Similar to other work in FGIDs and regardless of hypnotizability, there were consistent and significant changes in heartburn symptoms, visceral anxiety and quality of life and a trend for improvement in catastrophizing. We would recommend EHYP in FH patients who are either non-responsive to medications or who would prefer a lifestyle intervention. PMID:25824436

  9. Feasibility and acceptability of esophageal-directed hypnotherapy for functional heartburn.

    Science.gov (United States)

    Riehl, M E; Pandolfino, J E; Palsson, O S; Keefer, L

    2016-07-01

    Functional heartburn (FH) is a benign but burdensome condition characterized by painful, burning epigastric sensations in the absence of acid reflux or symptom-reflux correlation. Esophageal hypersensitivity and its psychological counterpart, esophageal hypervigilance (EHv) drive symptom experience. Hypnotherapy (HYP) is an established and preferred intervention for refractory symptoms in functional gastrointestinal disorders (FGIDs) and could be applied to FH. The objective of this study was to determine the feasibility, acceptability, and clinical utility of 7 weekly sessions of esophageal-directed HYP (EHYP) on heartburn symptoms, quality of life, and EHv. Similar to other work in FGIDs and regardless of hypnotizability, there were consistent and significant changes in heartburn symptoms, visceral anxiety, and quality of life and a trend for improvement in catastrophizing. We would recommend EHYP in FH patients who are either non-responsive to medications or who would prefer a lifestyle intervention. © 2015 International Society for Diseases of the Esophagus.

  10. Gastro-esophageal reflux disease and exacerbations in chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Ingebrigtsen, Truls S; Marott, Jacob L; Vestbo, Jørgen

    2015-01-01

    (31 vs 21%, P = 0.004), more breathlessness (39 vs 22%, P history of respiratory infections (6.8 vs 1.4%, P disease. Among individuals with COPD and gastro-esophageal reflux disease, those who did......BACKGROUND AND OBJECTIVE: We tested the hypothesis that gastro-esophageal reflux disease is a risk factor for exacerbations in individuals with chronic obstructive pulmonary disease (COPD). METHODS: Among 9622 participants in the Copenhagen City Heart Study, we identified 1259 individuals with COPD...... and information on gastro-esophageal reflux disease and the regular use of acid inhibitory treatment. These individuals were followed for 5 years with regard to medically treated COPD exacerbations, which we defined as a short course treatment with oral corticosteroids alone or in combination with antibiotics. We...

  11. Palliative Treatment of Esophageal Cancer.

    Science.gov (United States)

    Ahmad; Goosenberg; Frucht; Coia

    1994-07-01

    Palliative interventions for advanced esophageal cancer include surgery, radiation therapy, chemotherapy, chemoradiation, endoscopic procedures, and combinations of the above. Palliative esophagectomy or bypass procedures are difficult to justify in these patients because their life expectancy is so short. Palliative external beam radiation to doses of 50 to 60 Gy is successful in 50% to 70% of patients. The addition of brachytherapy may improve these results. One third to one half of patients treated with radiation develop benign or maglinant stricture. Although response rates to combination chemotherapy are only 50% at best, the majority of patients do have improvement of dysphagia. These regimens are commonly used as part of a multidisciplinary approach with radiation andøor surgery, rather than as a sole modality of treatment. Chemoradiation regimens results in better survival than treatment with radiation alone, and provide palliation of dysphagia in up to 90% of patients. Although acute toxicity of chemoradiation is more severe than radiation alone, this is of limited duration. Chemoradiation may be the treatment of choice for the majority of patients with locally advanced esophageal cancer. Endoscopic techniques are available that provide palliation of dysphagia. The most commonly used technique is esophageal dilatation, either alone or before performing other palliative procedures such as laser therapy or stent placement. The most significant limitation of dilatation alone is that palliation is short-lived and most patients require repeat dilatations. Esophageal stents offer a high degree of palliation, but procedure-related morbidity and mortality rates are not insignificant. Expandable metal stents are associated with few complications but tumor ingrowth through the metallic mesh is frequent. Conventional plastic stents are not affected by tumor ingrowth but can migrate. Endoscopic laser therapy also provides symptoms relief and complication rates are

  12. Eosinophilic esophagitis: emerging therapies and future perspectives.

    Science.gov (United States)

    Straumann, Alex

    2014-06-01

    Twenty years have passed since eosinophilic esophagitis was first recognized as a new and distinct entity. Current treatment modalities for eosinophilic esophagitis include the "3 Ds": drugs, allergen avoidance with diet, and esophageal dilation. Drugs entail the limitation that only corticosteroids have a proven efficacy; most other compounds evoke only a minimal effect. Diets must be maintained continuously and they interfere markedly with the quality of life, possibly even involving some risk of malnutrition. A greater understanding of the immunopathogenesis, natural history, and disease spectrum will inevitably lead to improved therapeutic outcomes for this emerging entity. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Epidemic Trends of Upper Gastrointestinal Tract Abnormalities: Hospital-based study on Endoscopic Data Evaluation.

    Science.gov (United States)

    Mohiuddin, Mohammed Khaliq; Chowdavaram, Suman; Bogadi, Varun; Prabhakar, Boddu; Rao, Kondadasula Pandu Ranga; Devi, Suneetha; Mohan, Vasavi

    2015-01-01

    To understand the epidemiology of different upper gastrointestinal (UGI) tract related abnormalities through endoscopic data analysis. A retrospective study of three years from January 2009 to December 2011 was conducted with data from endoscopic surveillance of upper GI tract problems, collected from the Gastroenterology Unit, Osmania General Hospital, Hyderabad. MS excel and Medcalc software (comparison of proportions) were used for data analysis. A total of 10,029 (6,468 in males and 3,561 in females) endoscopies were performed during this three-year period. The male to female ratio was 1.8:1. Overall, ~30% of endoscopies evaluated showed patients with acid peptic disorders, 13.6% with vascular- related abnormalities, 10.6% showed structural abnormalities, followed by 6.3% with malignancies. Burden of malignancies was mostly observed in the older age group (60-69 years). Esophageal cancer cases decreased (p=0.0001) whereas stomach cancers increased over this period (p=0.0345). We also observed an increased incidence of acid peptic disease (APD) (p=0.0036) and gastroesophageal reflux disease (GERD) (p=0.0002) cases during this period. Endoscopic diagnosis is useful for early detection of UGI anomalies and helpful for physicians to manage and treat varied kinds of UGI disorders. Analysis of data revealed changing trends in the incidence of various pathologies of the UGI tract. Functional dyspepsia and GERD definitely reduce the quality of life of the individual. The role of our diverse dietary habits and lifestyle associated with these problems have not yet been established, though there have been reports on the effect of coffee, spicy food, wheat-based diet, screening of UGI pathologies along with collection of complete personal and medical history details, can help in correlating the patients' condition with various aspects of lifestyle and diet.

  14. Lower esophageal mucosal ring: correlation of referred symptoms with radiographic findings using a marshmallow bolus.

    Science.gov (United States)

    Smith, D F; Ott, D J; Gelfand, D W; Chen, M Y

    1998-11-01

    The purpose of this investigation was to determine the prevalence of lower esophageal mucosal rings and to correlate the relationship between these mucosal rings and the presence and anatomic level of symptoms evoked using a marshmallow bolus. Our prospective study included 130 patients who underwent barium examination of the esophagus. All patients completed a questionnaire regarding the anatomic location of their symptoms of dysphagia. In addition to a multiphasic examination of the esophagus, all patients also underwent fluoroscopic observation and videotaping while swallowing a marshmallow bolus; any symptoms that were provoked were recorded. Lower esophageal mucosal rings were shown in 26 (20%) of the 130 patients. The diameter of the rings was 9-12 mm in six patients, 13-20 mm in 18 patients, and larger than 20 mm in two patients. In 16 (62%) of the 26 patients, a marshmallow bolus became impacted at the ring; the impaction caused dysphagia in 12 (75%) of the 16 patients. In these 12 patients, dysphagia was referred to the neck in seven, the sternal angle in two, the mid chest in two, and the lower chest in one patient. None of the 12 patients had a pharyngeal or cervical esophageal abnormality that would account for their symptoms. Because proximal referral of symptoms is common in patients with lower esophageal mucosal rings, a thorough radiographic examination of the entire esophagus and esophagogastric region is required regardless of the level of their swallowing complaints.

  15. Neurological manifestations of atrio-esophageal fistulas from left atrial ablation.

    Science.gov (United States)

    Finsterer, J; Stöllberger, C; Pulgram, T

    2011-10-01

    Left atrial ablation (LAAB) is carried out as an alternative treatment of atrial fibrillation refractory to conservative measures. An increasingly recognized complication of LAAB is an atrio-esophageal fistula (AEF). Neurological manifestations usually dominate the presentation of an AEF and result from cardiac embolism of thrombi, transgressed esophageal contents, or air. AEFs have been reported after LAAB in 52 patients (23 men, age 35-76 years), described in 24 publications, so far. AEFs manifest clinically on the average 17 days (3-38 days) after ablation. Neurological manifestations include embolic strokes (n = 30), seizures (n = 9), transitory-ischaemic attacks (n = 6), coma (n = 6), or psychiatric abnormalities (n = 5). Imaging studies of the cerebrum most frequently show multiple embolic strokes or air embolism. The diagnosis is made upon thoracic computed tomography with contrast media. An act of swallowing, trans-esophageal echocardiography, gastroscopy, or esophageal stenting must be avoided not to enlarge the shunt. The only expedient therapy is surgical closure of the fistula, but even then, the prognosis is poor with a mortality of 71%. AEFs should be suspected if there is a history of LAAB followed by fever, thoracic pain, postprandial cerebral strokes, seizures, coma, or confusion with a latency of days to 5 weeks after ablation. Diagnostic work-up must avoid measures, which enlarge the fistula. Treatment is surgical exclusively. © 2011 The Author(s). European Journal of Neurology © 2011 EFNS.

  16. Neurophysiology and new techniques to assess esophageal sensory function: an update.

    Science.gov (United States)

    Brock, Christina; McCallum, Richard W; Gyawali, C Prakash; Farmer, Adam D; Frøkjaer, Jens Brøndum; McMahon, Barry P; Drewes, Asbjørn Mohr

    2016-09-01

    This review aims to discuss the neurophysiology of the esophagus and new methods to assess esophageal nociception. Pain and other symptoms can be caused by diseases in the mucosa or muscular or sphincter dysfunction, together with abnormal pain processing, either in the peripheral or central nervous systems. Therefore, we present new techniques in the assessment of esophageal function and the potential role of the mucosal barrier in the generation and propagation of pain. We discuss the assessment and role of esophageal sphincters in nociception, as well as imaging and electrophysiological techniques, with examples of their use in understanding the sensory system following noxious stimuli to the esophagus. Additionally, we discuss the mechanisms behind functional diseases of the esophagus. We conclude that the new methods have identified many of the mechanisms behind malfunction of the mucosa, disturbances of muscular and sphincter functions, and the central response to different stimuli. Taken together, this has increased our understanding of esophageal disorders and may lead to new treatment modalities. © 2016 New York Academy of Sciences.

  17. Advanced esophageal cancer and esophageal stenosis endoscopic treatment

    International Nuclear Information System (INIS)

    Piazze, A. E mail: apiazze@hc.edu.uy

    2005-01-01

    Advanced esophageal cancer (AEC) is diagnosed during those stages in which surgery is possible, it is palliative for disphagia, with high morbimortality.In inoperable or irresectable cases, resorting to alternative treatment such as radiotherapy or endoscopy may palliate dsphagia.Endoscopically it is possible to place a transtumoral nasogastric catheter (NGC) for preoperative nutrition or branchial therapy (intratumoral iridium).It is possible to dilate the tumor and place and indwelling plastic or auto expandable prosthesis or to inject absolute intratumoral alcohol.There is and evaluation of results and morbimortality of personal case material through the retrospective study of 54 patients in whom 120 procedures such as those referred to above were carried out.The series includes 41 men and 13 women (3-1), 79.5% of which were of ages between 61 and 90.Optic fiber endoscopes or video endoscopes, coaxial dilators, hydro-pneumatic balloons, metallic guides and non industrial and autoexpandable plastic prosthesis were used; 34.1% of procedures were performed under used; 34.1% of procedures were performed under radioscopy.Eleven patient (8 for nutritional purposes and 3 for brachiotherapy)form part of Groups 1 and 2 of NGC.Group 3 consist of:dilations of radicular stenosis with or without neopasic recurrence, or neoplasic infiltration of esophagus, 6 patient; Group 4: 14 patients for the purpose of dilation of esophageal neoplasm; Group 5:prosthesis, 12 patients; Group 6: 11 patients with anastomotic stenosis.In patients in Group 1-2-3 solution was achieved.In Group 3 there was 1 perforation.In Group 4, out of 14 patient 13 were dilated.In Group 5 it proved impossible to place prosthesis in 2 patient, (3.7%).The conclusion arrived at is that various endoscopic techniques may palliate disphagia in patient with AEC, collaborate with preoperative nutrition through enteral path, with brachioterapy or by treating post surgical stenosis, with low mortality

  18. Eosinophilic Esophagitis (EE) or (EoE)

    Science.gov (United States)

    ... delayed, caused primarily by immune mechanisms other than classical IgE-mediated food allergy. Once a causative food ... specific responses in allergy? » Dietary Therapy and Nutrition Management of Eosinophilic Esophagitis: A Work Group Report of ...

  19. Treatment Options by Stage (Esophageal Cancer)

    Science.gov (United States)

    ... the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds , ... stage of the cancer being treated. External and internal radiation therapy are used to treat esophageal cancer. A plastic ...

  20. Gastroesophageal reflux in cirrhotic patients with esophageal varices without endoscopic treatment Prevalência do refluxo gastroesofágico em pacientes cirróticos com varizes de esôfago sem tratamento endoscópico

    Directory of Open Access Journals (Sweden)

    Rosana Bihari Schechter

    2007-06-01

    Full Text Available BACKGROUND: Portal hypertension in patients with liver cirrhosis causes manifestations such as esophageal varices, ascites and edema. Some studies have been conducted about the role of esophageal varices in the development of esophageal motor disorders and abnormal gastroesophageal reflux in these patients. Ascites could be a factor promoting gastroesophageal reflux and it has been questioned whether reflux would favor the rupture of varices. However there are a few studies using ambulatory esophageal pH recording in the evaluation of these patients. AIMS: Evaluate gastroesophageal reflux by pH recording in cirrhotic patients with esophageal varices and possible predictors. METHODS: Fifty one patients (28 men, 23 women, mean age of 54 years with liver cirrhosis, diagnosed by clinical, laboratorial, image and histological findings were prospectively evaluated. All patients had esophageal varices confirmed by endoscopy and were submitted to a questionnaire about typical gastroesophageal reflux disease symptoms (heartburn and or acid regurgitation. pH recording was performed with the probe placed 5 cm above the superior lower esophageal sphincter limit, as determined by manometry. Abnormal reflux (% total time with pH 4.5% was related to the size of varices, congestive gastropathy, ascites, severity of cirrhosis and typical gastroesophageal reflux disease symptoms. RESULTS: The caliber of the varices was considered to be small in 30 patients (59%, medium in 17 (33% and large in 4 (8%, 21 (41% congestive gastropathy. Ascites was observed in 17 (33%, 32 patients (63% were classified as Child-Pugh A, 17 (33% Child-Pugh B and 2 (4% Child-Pugh C. Twenty seven patients (53% presented with typical gastroesophageal reflux disease symptoms. Abnormal reflux at pH recording was found in 19 patients (37%. One of them presented with erosive esophagitis at endoscopy. There was no relation between ascites, variceal size, congestive gastropathy and Child

  1. Congenital esophageal stenosis owing to tracheobronchial remnants

    OpenAIRE

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

    2013-01-01

    OBJECTIVE To emphasize the need of an accurate diagnosis of congenital esophageal stenosis due to tracheobronchial remnants, since its treatment differs from other types of congenital narrowing. CASE DESCRIPTION Four cases of lower congenital esophageal stenosis due to tracheobronchial remnants, whose definitive diagnosis was made by histopathology. Except for the last case, in which a concomitant anti-reflux surgery was not performed, all had a favorable outcome after resection and anastomos...

  2. A reproducible canine model of esophageal varices.

    Science.gov (United States)

    Jensen, D M; Machicado, G A; Tapia, J I; Kauffman, G; Franco, P; Beilin, D

    1983-03-01

    One of the most promising nonoperative techniques for control of variceal hemorrhage is sclerosis via the fiberoptic endoscope. Many questions remain, however, about sclerosing agents, guidelines for effective use, and limitations of endoscopic techniques. A reproducible large animal model of esophageal varices would facilitate the critical evaluation of techniques for variceal hemostasis or sclerosis. Our purpose was to develop a large animal model of esophageal varices. Studies in pigs and dogs are described which led to the development of a reproducible canine model of esophageal varices. For the final model, mongrel dogs had laparotomy, side-to-side portacaval shunt, inferior vena cava ligation, placement of an ameroid constrictor around the portal vein, and liver biopsy. The mean (+/- SE) pre- and postshunt portal pressure increased significantly from 12 +/- 0.4 to 23 +/- 1 cm saline. Weekly endoscopies were performed to grade the varix size. Two-thirds of animals developed medium or large sized esophageal varices after the first operation. Three to six weeks later, a second laparotomy with complete ligation of the portal vein and liver biopsy were performed in animals with varices (one-third of the animals). All dogs developed esophageal varices and abdominal wall collateral veins of variable size 3-6 wk after the first operation. After the second operation, the varices became larger. Shunting of blood through esophageal varices via splenic and gastric veins was demonstrated by angiography. Sequential liver biopsies were normal. There was no morbidity or mortality. Ascites, encephalopathy, or spontaneous variceal bleeding did not occur. We have documented the lack of size change and the persistence of medium to large esophageal varices and abdominal collateral veins in all animals followed for more than 6 mo. Variceal bleeding could be induced by venipuncture for testing endoscopic hemostatic and sclerosis methods. We suggest other potential uses of this

  3. Opportunistic esophagitis in AIDS: radiographic diagnosis.

    Science.gov (United States)

    Levine, M S; Woldenberg, R; Herlinger, H; Laufer, I

    1987-12-01

    Thirty-five of 90 patients with acquired immunodeficiency syndrome (AIDS) seen between 1983 and 1986 underwent esophagography (double contrast in all but two) to rule out opportunistic esophagitis; 20 of the 35 were found to have fungal or viral esophagitis. A radiographic diagnosis of Candida esophagitis was made in 17 patients because of varying degrees of plaque formation. Seven of those patients had a grossly irregular or "shaggy" esophagus; in four, the diagnosis of AIDS was initially suspected from this finding. In the remaining three patients, a radiographic diagnosis of viral esophagitis (herpes simplex in two and cytomegalovirus in one) was made because of discrete ulcers on a normal background mucosa. Eighteen patients had endoscopic, clinical, or autopsy findings that corroborated the radiographic diagnosis; follow-up data were not available for two patients with Candida esophagitis. This experience suggests that fungal and viral esophagitis can often be differentiated with double-contrast esophagography, enabling appropriate antifungal or antiviral therapy to be instituted without endoscopic intervention.

  4. miR-1 suppresses the proliferation and promotes the apoptosis of esophageal carcinoma cells by targeting Src.

    Science.gov (United States)

    Liao, Zhicong; Wang, Xiaojun; Liang, Hongwei; Yu, Ao; Ur Rehman, Uzair; Fan, Qian; Hu, Yue; Wang, Chen; Zhou, Zhen; Wang, Tao

    2017-12-01

    Nonreceptor tyrosine kinase c-Src, also known as Src, is a potent oncogene involved in a series of biological processes including cell growth, differentiation, and apoptosis; however, its expression pattern and function in esophageal cancer is poorly addressed. In this study, abnormal overexpression of Src protein was observed in esophageal cancer tissues, which fuelled the speculation that microRNA-mediated posttranscriptional regulatory mechanism might be involved. Bioinformatic analyses were applied to identify miRNAs that could potentially target Src. miR-1 was predicted and further validated as a direct repressor of Src. Moreover, we manipulated knockdown and overexpression experiment on TE-1 and TE-10 cells to demonstrate miR-1 suppressed proliferation and promoted apoptosis in esophageal cancer cells by inhibiting Src. Taken together, this study underlines a negative regulatory mechanism in which miR-1 serves as a suppressor of Src in esophageal cancer cells and may provide insights into novel therapeutic approaches for esophageal cancer. © 2017 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

  5. How useful is esophageal high resolution manometry in diagnosing gastroesophageal junction disruption: causes affecting this disruption and its relationship with manometric alterations and gastroesophageal reflux

    Directory of Open Access Journals (Sweden)

    Constanza Ciriza-de-los-Ríos

    2014-01-01

    Full Text Available Background: High-resolution manometry (HRM is a breakthrough in the morphological study of the gastroesophageal junction (GEJ and its degrees of disruption. Objectives: a Assessment of risk factors involved in the disruption of the GEJ in patients with gastroesophageal reflux (GER symptoms; b the relationship between the type of GEJ and GER demonstrated by 24 hours pH-monitoring; and c identification of the alterations in the manometric parameters related to the morphology of the GEJ. Methods: One hundred and fifteen patients with symptoms of GER studied with HRM and classified by the type of GEJ (type I: Normal; type II: Sliding; type III: Hiatal hernia. Twenty four hour pH-monitoring without proton pump inhibitors was performed in all of them. Epidemiological aspects, manometric parameters (Chicago 2012 classification and the pH-monitoring results were evaluated. Results: Age (OR 1.033 [1.006-1.060]; p = 0.16, BMI (OR 1.097 [1.022-1.176]; p = 0. 01 and abdominal perimeter (OR 1.034 [1.005-1.063]; p = 0.0215 were independent risk factors for the GEJ type III (area under the curve 0.70. Disruption of the GEJ was associated with a lower resting pressure (p = 0.006, greater length (p < 0.001 and greater esophageal shortening (p < 0.001. Abnormal acidic reflux was found in the total period (p = 0.015, standing (p = 0.022 and supine (p = 0.001 in patients with GEJ type II and III with respect to type I. Conclusions: Increased age, overweight and central obesity pose a higher risk of GEJ type III (hiatal hernia. The greater disruption of the GEJ is associated with lower resting pressure, esophageal shortening, and higher acid exposure in the pH-monitoring.

  6. The effect of a sitting vs supine posture on normative esophageal pressure topography metrics and Chicago Classification diagnosis of esophageal motility disorders.

    Science.gov (United States)

    Xiao, Y; Read, A; Nicodème, F; Roman, S; Kahrilas, P J; Pandolfino, J E

    2012-10-01

    Although, the current protocol for high resolution manometry (HRM) using the Chicago Classification is based on the supine posture, some practitioners prefer a sitting posture. Our aims were to establish normative esophageal pressure topography data for the sitting position and to determine the effect of applying those norms to Chicago Classification diagnoses. Esophageal pressure topography studies including test swallows in both a supine and sitting position of 75 healthy volunteers and 120 patients were reviewed. Integrated relaxation pressure (IRP), distal contractile integral (DCI), contractile front velocity (CFV), and distal latency were measured and compared between postures. Normative ranges were established from the healthy volunteers and the effect of applying sitting normative values to the patients was analyzed. Normative values of IRP, DCI, and CFV all decreased significantly in the sitting posture. Applying normative sitting metrics to patient studies [27% reduction in IRP (15 to 11 mmHg), 69% reduction in DCI (8000-2500 mmHg-s-cm)] reclassified 13/120 (11%) patients as having abnormal esophagogastric junction relaxation and 26/120 (22%) as hypercontractile. Three patients with an abnormal supine IRP normalized when sitting with elimination of a vascular artifact. Clinical HRM studies should include both a supine and sitting position to minimize misdiagnoses attributable to anatomical factors. However, until outcome studies demonstrating the significance of isolated abnormalities of IRP or DCI in the sitting position are available, the Chicago Classification of esophageal motility disorders should continue to be based on supine swallows using normative data from the supine posture. © 2012 Blackwell Publishing Ltd.

  7. Alterações da motilidade esofagiana em pacientes cirróticos com varizes de esôfago não submetidos a tratamento endoscópico Esophageal motor disorders in cirrhotic patients with esophageal varices non-submitted to endoscopic treatment

    Directory of Open Access Journals (Sweden)

    Priscila Pollo Flores

    2005-12-01

    the development of esophageal varices, the possibility of a digestive hemorrhage and worsening of hepatic insufficiency. It is important to identify causal predictive or aggravating factors and if possible to prevent them. In the last years, it has been observed the association of esophageal motor disorders and gastro-esophageal reflux in cirrhotic patients with esophageal varices. AIMS: To study the prevalence of the esophageal motility disorders and among them, the ineffective esophageal motility, in patients with hepatic cirrhosis and esophageal varices, without previous endoscopic therapeutic and the predictives factors. METHODS: Prospectively, it has been evaluate 74 patients suffering from liver cirrhosis and esophagic varices, without previous endoscopic treatment. All of them were submitted to a clinical protocol, esophageal manometry and 55 patients also held the ambulatory esophageal pHmetry. RESULTS: Esophageal motility disorders have been found in 44 patients (60%. The most prevalent was the ineffective esophageal motility, observed in 28%. The abnormal reflux disease was diagnosed through the pHmetry in 35% of the patients. There were no correlation between the manometrical abnormality in general and the ineffective esophageal motility in particular and the esophageal or gastroesophageal reflux disease symptoms, the abnormal reflux, the disease seriousness, the ascites presence and the gauge of the varices. CONCLUSIONS: The majority of cirrhotic patients with non-treated esophageal varices present esophageal motor disorders. No predictive factor was found. The clinical relevance of these findings need more researches in the scope to define the real meaning of theses abnormalities.

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

    Science.gov (United States)

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

    2012-06-01

    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. Copyright © 2012 Elsevier Inc. All rights reserved.

  9. Tooth - abnormal colors

    Science.gov (United States)

    ... medlineplus.gov/ency/article/003065.htm Tooth - abnormal colors To use the sharing features on this page, please enable JavaScript. Abnormal tooth color is any color other than white to yellowish- ...

  10. Urine - abnormal color

    Science.gov (United States)

    ... medlineplus.gov/ency/article/003139.htm Urine - abnormal color To use the sharing features on this page, please enable JavaScript. The usual color of urine is straw-yellow. Abnormally colored urine ...

  11. Abnormal uterine bleeding

    Science.gov (United States)

    Anovulatory bleeding; Abnormal uterine bleeding - hormonal; Polymenorrhea - dysfunctional uterine bleeding ... ACOG committee opinion no. 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Reaffirmed 2015. ACOG. ...

  12. The diagnosis of gastro-esophageal reflux disease cannot be made with barium esophagograms.

    Science.gov (United States)

    Saleh, C M G; Smout, A J P M; Bredenoord, A J

    2015-02-01

    For over 50 years, barium studies have been used to diagnose gastro-esophageal reflux disease (GERD), but the value of this test is controversial. Our study aimed to determine if barium esophagograms can be used to diagnose GERD. Barium esophagograms and pH-impedance measurement were performed in 20 subjects with reflux symptoms. pH-impedance measurements were used as gold standard for the diagnosis of GERD. Gastro-esophageal reflux measured with the barium study was defined as a positive outcome. 50% of patients presented gastro-esophageal reflux on the barium esophagogram. No significant differences were observed in acid exposure time between subjects with (median: 7.4%; interquartile range, IQR: 8.4%) or without reflux at barium esophagography (median: 5.95%; IQR: 13.05%; p > 0.05). Nor did we find differences in median proximal extent of reflux measured with impedance monitoring between patients with a positive (median: 6.7%; IQR: 1.95%) and negative barium study (median: 7.1%; IQR: 0.68%; p > 0.05). Patients with reflux on barium esophagogram did not have a positive symptom association probability more often than those who did not have reflux at barium esophagography. Lastly, there were no differences in numbers of acid, weakly acidic or total reflux episodes between those with positive or negative barium esophagogram (p > 0.05). No correlations were found between the maximum proximal extent of gastro-esophageal reflux during esophagography and pH-impedance parameters. Presence or absence of gastro-esophageal reflux during barium esophagography does not correlate with incidence or extent of reflux observed during 24-h pH-impedance monitoring and is not of value for the diagnosis of GERD. © 2014 John Wiley & Sons Ltd.

  13. Opossum as an animal model for studying radiation esophagitis. [Gamma rays

    Energy Technology Data Exchange (ETDEWEB)

    Northway, M.G.; Libshitz, H.I.; West, J.J.; Withers, H.R.; Mukhopadhyay, A.K.; Osborne, B.M.; Szwarc, I.A.; Dodd, G.D.

    1979-06-01

    Six opossums were evaluated as a possible animal model of radiation esophagitis. In a single exposure to the esophagus, four animals received /sup 60/Co radiation of various doses; two served as controls. Pre- and postirradiation evaluations using fiberoptic endoscopy, mucosal biopsy, barium esophagography, and manometry were performed. Esophagitis developed at one week in irradiated animals. Opossums receiving 17.5, 20, and 22.5 Gy (1,750; 2,000; and 2,250 rad) became anorexic one week postirradiation, and abnormal motility subsequently developed. The controls and the animal receiving 15 Gy (1,500 rad) remained normal. Histological changes in the irradiated opossum esophagus resembled those found in humans.

  14. Chicago Classification of Esophageal Motility Disorders: Lessons Learned

    NARCIS (Netherlands)

    Rohof, W. O. A.; Bredenoord, A. J.

    2017-01-01

    High-resolution manometry (HRM) is increasingly performed worldwide, to study esophageal motility. The Chicago classification is subsequently applied to interpret the manometric findings and facilitate a diagnosis of esophageal motility disorders. This review will discuss new insights regarding the

  15. Nutrition in peri-operative esophageal cancer management

    NARCIS (Netherlands)

    Steenhagen, E.; Vulpen, J.K. van; Hillegersberg, R. van; May, A.M.; Siersema, P.D.

    2017-01-01

    INTRODUCTION: Nutritional status and dietary intake are increasingly recognized as essential areas in esophageal cancer management. Nutritional management of esophageal cancer is a continuously evolving field and comprises an interesting area for scientific research. Areas covered: This review

  16. Prenatal diagnosis of horseshoe lung and esophageal atresia

    Energy Technology Data Exchange (ETDEWEB)

    Goldberg, Shlomit; Ringertz, Hans [Stanford University School of Medicine, Radiology Department, Stanford, CA (United States); Barth, Richard A. [Stanford University School of Medicine, Radiology Department, Stanford, CA (United States); Lucile Packard Children' s Hospital, Radiology, Palo Alto, CA (United States)

    2006-09-15

    We present a case of horseshoe lung (HL) and esophageal atresia suspected prenatally on US imaging and confirmed with fetal MRI. Prenatal diagnosis of HL and esophageal atresia allowed for prenatal counseling and informed parental decisions. (orig.)

  17. Gender difference in gastro-esophageal reflux diseases.

    Science.gov (United States)

    Asanuma, Kiyotaka; Iijima, Katsunori; Shimosegawa, Tooru

    2016-02-07

    The incidence of esophageal adenocarcinoma (EAC) has risen sharply in western countries over the past 4 decades. This type of cancer is considered to follow a transitional process that goes from gastro-esophageal reflux disease (GERD) to Barrett's esophagus (BE, a metaplastic condition of the distal esophagus), a precursor lesion and ultimately adenocarcinoma. This spectrum of GERD is strongly predominant in males due to an unidentified mechanism. Several epidemiologic studies have described that the prevalence of GERD, BE and EAC in women is closely related to reproductive status, which suggests a possible association with the estrogen level. Recently, we revealed in an in vivo study that the inactivation of mast cells by the anti-inflammatory function of estrogen may account for the gender difference in the GERD spectrum. Other studies have described the contribution of female steroid hormones to the gender difference in these diseases. Estrogen is reported to modulate the metabolism of fat, and obesity is a main risk factor of GERDs. Moreover, estrogen could confer esophageal epithelial resistance to causative refluxate. These functions of estrogen might explain the approximately 20-year delay in the incidence of BE and the subsequent development of EAC in women compared to men, and this effect may be responsible for the male predominance. However, some observational studies demonstrated that hormone replacement therapy exerts controversial effects in GERD patients. Nevertheless, the estrogen-related endocrine milieu may prevent disease progression toward carcinogenesis in GERD patients. The development of innovative alternatives to conventional acid suppressors may become possible by clarifying the mechanisms of estrogen.

  18. Diagnostic yield of 24-hour esophageal manometry in non-cardiac chest pain.

    Science.gov (United States)

    Barret, M; Herregods, T V K; Oors, J M; Smout, A J P M; Bredenoord, A J

    2016-08-01

    In the past, ambulatory 24-h manometry has been shown useful for the evaluation of patients with non-cardiac chest pain (NCCP). With the diagnostic improvements brought by pH-impedance monitoring and high-resolution manometry (HRM), the contribution of ambulatory 24-h manometry to the diagnosis of esophageal hypertensive disorders has become uncertain. Our aim was to assess the additional diagnostic yield of ambulatory manometry to HRM and ambulatory pH-impedance monitoring in this patient population. All patients underwent 24-h ambulatory pressure-pH-impedance monitoring and HRM. Patients had retrosternal pain as a predominant symptom and no explanation after cardiologic and digestive endoscopic evaluations. Diagnostic measurements were analyzed by two independent physicians. Fifty-nine patients met the inclusion criteria; 37.3% of the patients had their symptoms explained by abnormalities on pH-impedance monitoring and 6.8% by ambulatory manometry. Functional chest pain was diagnosed in 52.5% of the patients. High-resolution manometry, using the Chicago Classification v3.0 criteria alone, did not identify any of the four patients with esophageal spasm on ambulatory manometry. However, taking into account other abnormalities, such as simultaneous (rapid) or repetitive contractions, HRM had a sensitivity of 75% and a specificity of 98.2% for the diagnosis of esophageal spasm. In the work-up of NCCP, ambulatory 24-h manometry has a low additional diagnostic yield. However, it remains the best technique to identify esophageal spasm as the cause of symptoms. This is particularly useful when an unequivocal diagnosis is needed before treatment. © 2016 John Wiley & Sons Ltd.

  19. High Prevalence of Barrett's Esophagus and Esophageal Squamous Cell Carcinoma After Repair of Esophageal Atresia.

    Science.gov (United States)

    Vergouwe, Floor W T; IJsselstijn, Hanneke; Biermann, Katharina; Erler, Nicole S; Wijnen, René M H; Bruno, Marco J; Spaander, Manon C W

    2018-04-01

    Esophageal atresia is rare, but improved surgical and intensive care techniques have increased rates of survival in children, so there are now many adults with this disorder. Many patients with esophageal atresia develop gastroesophageal reflux (GER), raising concerns about increased risk of Barrett's esophagus (BE; prevalence of 1.3%-1.6% in general population) and esophageal carcinoma. We assessed the prevalence of BE and esophageal carcinoma in this population. We performed a prospective study of 289 patients with esophageal atresia at the Department of Gastroenterology and Hepatology at Erasmus MC University Medical Center in The Netherlands, from May 2012 through March 2017. A total of 151 (median age, 25.4 y; age range, 16.8-68.6 y) underwent upper endoscopies as part of a surveillance program for (pre)malignant esophageal lesions. Biopsies were collected and analyzed by histology. We collected data on patients' use of medications, tobacco, and alcohol; gastrointestinal symptoms; ability to swallow; complaints of GER; and type of atresia and surgeries. Prevalence of esophageal squamous cell carcinoma (ESCC) was determined using data from The Netherlands Cancer Registry. The number of persons alive on January 1, 2016, in the esophageal atresia cohort and in the general Dutch population were used to calculate the 10-year prevalence of ESCC per 100,000 persons in both populations. Forty-seven percent of patients with esophageal atresia had a history of GER and 20.5% had undergone fundoplication surgery. Endoscopy revealed normal esophagus in 68.2% of patients, esophagitis in 7.3%, and columnar-lined esophagus in 24.5%. Histology revealed normal mucosa in 50.3% of patients, esophagitis in 23.2%, gastric metaplasia in 17.2%, and BE in 6.6% (at a median age of 31.6 years). A history of fundoplication surgery was associated with BE (P = .03). Three ESCCs developed, in 2 men, at ages 42, 44, and 60 years. This corresponded to a prevalence of 0.7% in patients with

  20. Clinical and manometric characteristics of patients with Parkinson's disease and esophageal symptoms.

    Science.gov (United States)

    Su, A; Gandhy, R; Barlow, C; Triadafilopoulos, G

    2017-04-01

    Dysphagia is a common problem in patients with Parkinson's disease (PD); its etiology is multifactorial and its management is challenging. In this retrospective cohort analysis using prospectively collected data, we aimed to objectively characterize dysphagia and/or other esophageal symptoms in patients with PD, assess the prevalence of outflow obstruction as well as major or minor disorders of esophageal peristalsis leading to impaired esophageal clearance and highlight objective parameters that can help in the current management algorithm. Thirty-three consecutive patients with PD presenting with dysphagia, odynophagia, heartburn, regurgitation, chest pain, and weight loss underwent clinical and functional evaluation by high-resolution manometry (HRM). Esophagogastric junction (EGJ) outflow obstruction and major as well as minor disorders of peristalsis were then assessed using the Chicago classification (v3). Thirty-three PD patients with esophageal symptoms were enrolled in the study; 12 of them reported weight loss that was considered as potentially reflecting underlying esophageal dysfunction. The median age of the patients was 70 years (range: 53-89 years), 24 (75%) were men. The majority (62%) experienced dysphagia, likely contributing to weight loss in 41% of patients. Odynophagia was rare (6%) while GER symptoms, such as heartburn, regurgitation, and chest pain were noted in 37%, 31%, and 28% of patients, respectively. Using the hierarchy of the Chicago classification, 12 patients (39%) exhibited EGJ outflow obstruction, 16 (48%) diffuse esophageal spasm (DES), 18 (55%), ineffective esophageal peristalsis (IEM), 16 (48%) fragmented peristalsis, and only 2 patients (6%) had normal HRM tracings. There were no patients with HRM features of achalasia. Dysphagia is common in patients with PD and is associated with a high prevalence of underlying motility disturbances as identified by HRM. The exact impact of these motility abnormalities on symptom induction

  1. Radiological evaluation of esophageal speech on total laryngectomee

    International Nuclear Information System (INIS)

    Chung, Tae Sub; Suh, Jung Ho; Kim, Dong Ik; Kim, Gwi Eon; Hong, Won Phy; Lee, Won Sang

    1988-01-01

    Total laryngectomee requires some form of alaryngeal speech for communication. Generally, esophageal speech is regarded as the most available and comfortable technique for alaryngeal speech. But esophageal speech is difficult to train, so many patients are unable to attain esophageal speech for communication. To understand mechanism of esophageal of esophageal speech on total laryngectomee, evaluation of anatomical change of the pharyngoesophageal segment is very important. We used video fluoroscopy for evaluation of pharyngesophageal segment during esophageal speech. Eighteen total laryngectomees were evaluated with video fluoroscopy from Dec. 1986 to May 1987 at Y.U.M.C. Our results were as follows: 1. Peseudoglottis is the most important factor for esophageal speech, which is visualized in 7 cases among 8 cases of excellent esophageal speech group. 2. Two cases of longer A-P diameter at the pseudoglottis have the best quality of esophageal speech than others. 3. Two cases of mucosal vibration at the pharyngoesophageal segment can make excellent esophageal speech. 4. The cases of failed esophageal speech are poor aerophagia in 6 cases, abscence of pseudoglottis in 4 cases and poor air ejection in 3 cases. 5. Aerophagia synchronizes with diaphragmatic motion in 8 cases of excellent esophageal speech.

  2. Esophageal replacement by gastric tube: is three-stage surgery ...

    African Journals Online (AJOL)

    useful alternative under a resource-limited condition, with optimal outcome. Ann Pediatr Surg 10:7–9 c 2014 Annals of Pediatric Surgery. Annals of Pediatric Surgery 2014, 10:7–9. Keywords: esophageal replacement, gastric tube, long gap esophageal atresia, pure esophageal atresia. Departments of aPediatric Surgery ...

  3. Esophageal achalasia and secondary megaesophagus in a dog

    Science.gov (United States)

    Boria, Pedro A.; Webster, Cynthia R.L.; Berg, John

    2003-01-01

    A 5-year-old, castrated male, golden retriever was presented with a history of regurgitation. An esophagram revealed normal peristalsis with failure of the lower esophageal sphincter to open, supporting the diagnosis of esophageal achalasia. Prior to surgery, the dog developed megaesophagus. Heller's esophagomyotomy resolved the clinical signs and the esophageal dilation. PMID:12677694

  4. Esophageal carcinoma. From the viewpoint of surgery

    International Nuclear Information System (INIS)

    Kawano, Tatsuyuki; Nakajima, Yasuaki; Suzuki, Tomoyoshi

    2007-01-01

    Therapeutic performance of the esophageal cancer has improved rapidly. Now in the decision of therapeutic strategy not only life prognosis but also treatments-related morbidity and late term quality of life should be considered. The most important factor of the improvement of esophageal cancer treatment is a progress in early detection of esophageal cancers and active use of treatment methods such as endoscopic mucosal resection. In addition, the role of radiotherapy and chemotherapy has improved as an arm of multidisciplinary therapy, and the establishment of chemoradiotherapy as one of the standard therapy for esophageal cancer is also very important. This shows that surgical and non-surgical approach has been getting more interactive and the relationship to one another should always be considered. Surgical therapy is very effective in patients with localized esophageal tumor and the patient's satisfaction is high. However, many problems are remained, and the improvement of diagnosis for metastasis and lessening surgical invasiveness and early/late complications are expected. Moreover, the chemoradiotherapy as an esophagus preserving method will establish more important standpoint and the salvage surgery will be applied more actively. On the other hand, a new strategy such as chemoradiotherapy immediate after esophagectomy for the patients with possible residual tumor for improving therapeutic results may be considered under the status of reliable surgical procedures. (author)

  5. Pharmacological Management of Esophageal Food Bolus Impaction

    Directory of Open Access Journals (Sweden)

    Yasir Mohammed Khayyat

    2013-01-01

    Full Text Available 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.

  6. Eosinophilic esophagitis: a bulk of mysteries.

    Science.gov (United States)

    Straumann, Alex

    2013-01-01

    Eosinophilic esophagitis (EoE), which was first described in the early 1990s, has rapidly evolved as a distinctive chronic inflammatory esophageal disease. The diagnosis is based clinically on the presence of symptoms related to esophageal dysfunction and histologically by an eosinophil-predominant inflammation once other conditions leading to esophageal eosinophilia are excluded. This striking male-prevalent disease has an increasing incidence and prevalence in the Westernized countries. Currently, EoE represents the main cause of dysphagia and bolus impaction in adult patients. Despite the fact that EoE often occurs in atopic patients, the value of allergic testing is still under discussion. Topical corticosteroids lead to a rapid improvement of active EoE clinically and histologically; they are therefore regarded as first-line drug therapy. Elimination diets have similar efficacy as topical corticosteroids, but their long-term use is limited by practical issues. Esophageal dilation of EoE-induced strictures can also be effective in improving symptoms, but this therapy has no effect on the underlying inflammation. Neither the diagnostic nor the long-term therapeutic strategies have been fully defined. Currently, the list of unsolved issues--or mysteries--is still long and a concerted effort on behalf of clinicians and scientists is required to improve the understanding and the therapeutic management of this mysterious disease. Copyright © 2013 S. Karger AG, Basel.

  7. Endoscopic treatment of esophageal achalasia

    Science.gov (United States)

    Esposito, Dario; Maione, Francesco; D’Alessandro, Alessandra; Sarnelli, Giovanni; De Palma, Giovanni D

    2016-01-01

    Achalasia is a motility disorder of the esophagus characterized by dysphagia, regurgitation of undigested food, chest pain, weight loss and respiratory symptoms. The most common form of achalasia is the idiopathic one. Diagnosis largely relies upon endoscopy, barium swallow study, and high resolution esophageal manometry (HRM). Barium swallow and manometry after treatment are also good predictors of success of treatment as it is the residue symptomatology. Short term improvement in the symptomatology of achalasia can be achieved with medical therapy with calcium channel blockers or endoscopic botulin toxin injection. Even though few patients can be cured with only one treatment and repeat procedure might be needed, long term relief from dysphagia can be obtained in about 90% of cases with either surgical interventions such as laparoscopic Heller myotomy or with endoscopic techniques such pneumatic dilatation or, more recently, with per-oral endoscopic myotomy. Age, sex, and manometric type by HRM are also predictors of responsiveness to treatment. Older patients, females and type II achalasia are better after treatment compared to younger patients, males and type III achalasia. Self-expandable metallic stents are an alternative in patients non responding to conventional therapies. PMID:26839644

  8. Airway and esophageal stenting in patients with advanced esophageal cancer and pulmonary involvement.

    Directory of Open Access Journals (Sweden)

    Fabrice Paganin

    Full Text Available 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

  9. Early esophageal carcinoma treated with intracavitary irradiation

    International Nuclear Information System (INIS)

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

    1985-01-01

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

  10. Herpetic esophagitis: a diagnosis to remember

    Directory of Open Access Journals (Sweden)

    Marina Pinheiro

    2016-02-01

    Full Text Available Introduction: Herpetic esophagitis is a well-recognized infection in immunocompromised hosts, having been rarely described in immunocompetent individuals. Case report: The authors describe a case of a 16-year-old female adolescent admitted to the emergency room with a threeday history of fever, odynophagia, dysphagia for liquid and solid food and retrosternal pain. The upper endoscopy revealed linear and round erosions in the distal esophagus and the histologic findings were compatible with herpetic esophagitis. Discussion/conclusion: Herpetic esophagitis is an underdiagnosed condition in immunocompetent children and adolescents, but it should not be overlooked. An esophagoscopy is required to make a definitive diagnosis. It is usually a selflimited infection and the mainstay of treatment is supportive care. The use of acyclovir is still controversial but its early initiation may shorten the clinical course of the disease.

  11. Esophageal Intramural Pseudodiverticulosis Complicated With Stricture

    Directory of Open Access Journals (Sweden)

    Shian-Min Liu

    2010-03-01

    Full Text Available We report a rare case of diffuse esophageal intramural pseudodiverticulosis in a 35-year-old man complaining of severe dysphagia and vomiting for several months. The advanced morphological change in the esophagus caused irregular track formation, mimicking an ulcerative lesion on esophagogram. Endoscopic examination revealed an esophageal stricture with intact mucosa. Endoscopic ultrasonography and chest computed tomography showed multiple hyperechoic lesions of unknown nature and multiple air collection sites in the esophageal wall, respectively, making diagnosis difficult. The patient finally received a subtotal esophagectomy because of severe symptoms. The lesion was pathologically proven to be intramural pseudodiverticulosis with marked submucosal fibrosis. Our experience suggests that awareness of this rare pathology and the related image changes will be helpful for early diagnosis and treatment in the future.

  12. Dietary Omega-3 Fatty Acid Deficiency and High Fructose Intake in the Development of Metabolic Syndrome, Brain Metabolic Abnormalities, and Non-Alcoholic Fatty Liver Disease

    Directory of Open Access Journals (Sweden)

    Artemis P. Simopoulos

    2013-07-01

    Full Text Available Western diets are characterized by both dietary omega-3 fatty acid deficiency and increased fructose intake. The latter found in high amounts in added sugars such as sucrose and high fructose corn syrup (HFCS. Both a low intake of omega-3 fatty acids or a high fructose intake contribute to metabolic syndrome, liver steatosis or non-alcoholic fatty liver disease (NAFLD, promote brain insulin resistance, and increase the vulnerability to cognitive dysfunction. Insulin resistance is the core perturbation of metabolic syndrome. Multiple cognitive domains are affected by metabolic syndrome in adults and in obese adolescents, with volume losses in the hippocampus and frontal lobe, affecting executive function. Fish oil supplementation maintains proper insulin signaling in the brain, ameliorates NAFLD and decreases the risk to metabolic syndrome suggesting that adequate levels of omega-3 fatty acids in the diet can cope with the metabolic challenges imposed by high fructose intake in Western diets which is of major public health importance. This review presents the current status of the mechanisms involved in the development of the metabolic syndrome, brain insulin resistance, and NAFLD a most promising area of research in Nutrition for the prevention of these conditions, chronic diseases, and improvement of Public Health.

  13. Reproducibility of esophageal scintigraphy using semi-solid yoghurt

    Energy Technology Data Exchange (ETDEWEB)

    Imai, Yukinori; Kinoshita, Manabu; Asakura, Yasushi; Kakinuma, Tohru; Shimoji, Katsunori; Fujiwara, Kenji; Suzuki, Kenji; Miyamae, Tatsuya [Saitama Medical School, Moroyama (Japan)

    1999-10-01

    Esophageal scintigraphy is a non-invasive method which evaluate esophageal function quantitatively. We applied new technique using semi-solid yoghurt, which can evaluate esophageal function in a sitting position. To evaluate the reproducibility of this method, scintigraphy were performed in 16 healthy volunteers. From the result of four swallows except the first one, the mean coefficients of variation in esophageal transit time and esophageal emptying time were 12.8% and 13.4% respectively (interday variation). As regards the interday variation, this method had also good reproducibility from the result on the 2 separate days. (author)

  14. Endoscopic ultrasonography in the management of esophageal cancer

    Science.gov (United States)

    Trowers, Eugene A.

    2000-05-01

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

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

    Science.gov (United States)

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

    2011-03-01

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

  16. Asymptomatic Esophageal Varices Should Be Endoscopically Treated

    Directory of Open Access Journals (Sweden)

    Nib Soehendra

    1998-01-01

    Full Text Available Endoscopic treatment has generally been accepted in the management of bleeding esophageal varices. Both the control of acute variceal bleeding and elective variceal eradication to prevent recurrent bleeding can be achieved via endoscopic methods. In contrast to acute and elective treatment, the role of endoscopic therapy in asymptomatic patients who have never had variceal bleeding remains controversial because of the rather disappointing results obtained from prophylactic sclerotherapy. Most published randomized controlled trials showed that prophylactic sclerotherapy had no effect on survival. In some studies, neither survival rate nor bleeding risk was improved. In this article, the author champions the view that asymptomatic esophageal varices should be endoscopically treated.

  17. Monometric and scintiscanning evaluation of esophageal function after endoscopic sclerosis of esophageal varices. Controlled prospective study

    International Nuclear Information System (INIS)

    Bastos, J.L.A.

    1990-01-01

    Esophageal function was studied in twenty-one patients with esophageal varices of different etiology submitted to endoscopic sclerosis for the detection of possible alterations in the functional pattern of the organ after this treatment. The endoscopic injection sclerosis (EIS) was performed electively in 14 patients (Group I) and in the presence of bleeding in 07 (Group II). The sclerotizing agent used was a solution of equal parts of ethanolamine oleate (Ethamolin R ) and 50% glucose. The injections were preferentially performed by the perivascular technique at weekly intervals. Esophageal function was studied by manometry, and esophageal transit time by scintillography. Group I patients were evaluated before and two to three months and five to nine months after EIS, and Group II patients were only evaluated six to nine months after EIS. The manometry and scintillography procedures were performed in sequence on the same day. The scintillographic examinations were performed with the patient in the supine and sitting positions. (author)

  18. Involvement of nitric oxide in human transient lower esophageal sphincter relaxations and esophageal primary peristalsis

    NARCIS (Netherlands)

    Hirsch, D. P.; Holloway, R. H.; Tytgat, G. N.; Boeckxstaens, G. E.

    1998-01-01

    BACKGROUND & AIMS: Nitric oxide (NO) is well accepted as an inhibitory neurotransmitter in the gastrointestinal tract; however, its role in the triggering of transient lower esophageal sphincter relaxations (TLESRs) in humans remains to be determined. Therefore, the effect of

  19. Acute Herpes Simplex Viral Esophagitis Occurring in 5 Immunocompetent Individuals With Eosinophilic Esophagitis.

    Science.gov (United States)

    Zimmermann, Dorothee; Criblez, Dominique H; Dellon, Evan S; Bussmann, Christian; Pfeifer, David; Froh, Matthias; Straumann, Alex

    2016-04-01

    Herpes simplex esophagitis (HSE) is an acute, severe viral infection of the esophagus, rarely occurring in immunocompetent individuals. Eosinophilic esophagitis (EoE) is a rare immune-mediated esophageal disorder. We recently observed 5 severe HSE cases in diagnosed EoE patients. Four of the 5 patients had active, untreated EoE at the time of infection, so HSE is not likely a side effect of swallowed topical corticosteroids, the first-line medical treatment of EoE. However, this coincidence of these 2 rare conditions raises the question of a causal relationship between these 2 forms of esophagitis, and whether active EoE might predispose to HSE infection.

  20. Use of "Gore-Tex surgical membrane" to minimize surgical adhesions in multistaged extrathoracic esophageal elongation for esophageal atresia.

    Science.gov (United States)

    Dessanti, A; Caccia, G; Iannuccelli, M; Dettori, G

    2000-04-01

    The procedure of choice in the surgical correction of "long gap" esophageal atresia should, when possible, preserve the native esophagus. We present a modification of "the multistaged extrathoracic esophageal elongation method," designed to facilitate esophageal elongation and use of a Gore-Tex (W.L. Gore and Associates, Flagstaff, AZ) surgical membrane to minimize surgical adhesions. We used this technique to successfully treat a 1-kg infant, with type A esophageal atresia, associated aortic coartation, and severe necrotizing enterocolitis with multiple perforations. Multistaged extrathoracic esophageal elongation was begun at the age of 9 months and concluded at 17 months.

  1. Gastroesophageal junction adenocarcinoma displays abnormalities in homologous recombination and nucleotide excision repair

    Directory of Open Access Journals (Sweden)

    Dewalt RI

    2014-02-01

    Full Text Available Robin I Dewalt,1 Kenneth A Kesler,2 Zane T Hammoud,3 LeeAnn Baldridge,4 Eyas M Hattab,4 Shadia I Jalal1,5 1Division of Hematology/Oncology, Department of Medicine, 2Cardiothoracic Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA; 3Henry Ford Hospital, Detroit, MI, USA; 4Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; 5Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA Objective: Esophageal adenocarcinoma (EAC continues to be a disease associated with high mortality. Among the factors leading to poor outcomes are innate resistance to currently available therapies, advanced stage at diagnosis, and complex biology. Platinum and ionizing radiation form the backbone of treatment for the majority of patients with EAC. Of the multiple processes involved in response to platinum chemotherapy or ionizing radiation, deoxyribonucleic acid (DNA repair has been a major player in cancer sensitivity to these agents. DNA repair defects have been described in various malignancies. The purpose of this study was to determine whether alterations in DNA repair are present in EAC compared with normal gastroesophageal tissues. Methods: We analyzed the expression of genes involved in homologous recombination (HR, nonhomologous end-joining, and nucleotide excision repair (NER pathways in 12 EAC tumor samples with their matched normal counterparts. These pathways were chosen because they are the main pathways involved in the repair of platinum- or ionizing-radiation-induced damage. In addition, abnormalities in these pathways have not been well characterized in EAC. Results: We identified increased expression of at least one HR gene in eight of the EAC tumor samples. Alterations in the expression of EME1, a structure-specific endonuclease involved in HR, were the most prevalent, with messenger (mRNA overexpression in six of the EAC samples

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

    OpenAIRE

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

    2014-01-01

    Gastroesophageal reflux (GER) is a common gastrointestinal process that can generate symptoms of heartburn and chest pain. Proton pump inhibitors (PPIs) are the gold standard for the treatment of GER; however, a substantial group of GER patients fail to respond to PPIs. In the past, it was believed that acid reflux into the esophagus causes all, or at least the majority, of symptoms attributed to GER, with both erosive esophagitis and nonerosive outcomes. However, with modern testing techniqu...

  3. Eosinophilic Esophagitis-Associated Chemical and Mechanical Microenvironment Shapes Esophageal Fibroblast Behavior.

    Science.gov (United States)

    Muir, Amanda B; Dods, Kara; Henry, Steven J; Benitez, Alain J; Lee, Dale; Whelan, Kelly A; DeMarshall, Maureen; Hammer, Daniel A; Falk, Gary; Wells, Rebecca G; Spergel, Jonathan; Nakagawa, Hiroshi; Wang, Mei-Lun

    2016-08-01

    Eosinophilic esophagitis (EoE) is an immune-mediated allergic disease characterized by progressive esophageal dysmotility and fibrotic stricture associated with chronic esophageal fibroblast activation. It remains unknown how esophageal fibroblasts respond to EoE-relevant matrix stiffness or inflammatory cytokines. Immunofluorescence was used to evaluate α-smooth muscle actin (α-SMA) expression in endoscopic esophageal biopsies. Primary esophageal fibroblasts from adult and pediatric patients with or without EoE were exposed to transforming growth factor (TGF)β to determine gene expression, collagen-matrix contractility, and cytoskeletal organization. The influence of matrix stiffness upon fibroblast behavior was assessed on the engineered surface of polyacrylamide gels with varying stiffness. Fibroblast traction forces were measured using microfabricated-post-array-detectors. EoE esophageal fibroblasts had enhanced α-SMA expression. TGFβ not only stimulated enhanced fibroblast-specific gene expression but also promoted fibroblast-mediated collagen-matrix contraction, despite disease state or age of patients as the origin of cells. Unlike conventional monolayer cell, culture conditions using plastic surface (1 GPa) that activates fibroblasts constitutively, our engineered platforms recapitulating physiologically relevant stiffness (1-20 kPa) revealed that matrix stiffness defines the extent of α-SMA expression, intracellular collagen fibril organization, SMAD3 phosphorylation, and fibroblast traction force. Matrix stiffness may critically influence TGFβ-mediated gene expression and functions of esophageal fibroblasts ex vivo independent of age and disease conditions. These findings provide a novel insight into the pathogenesis of fibrostenotic disease in EoE.

  4. The Correlation between Endoscopic Reflux Esophagitis and Combined Multichannel Intraluminal Impedance-pH Monitoring in Children

    OpenAIRE

    Yu-Wen Liu; Jia-Feng Wu; Huey-Ling Chen; Hong-Yuan Hsu; Mei-Hwei Chang; Wei-Chung Hsu; Ping-Huei Tseng; Hsiu-Po Wang; Yen-Hsuan Ni

    2016-01-01

    Gastroesophageal reflux (GER) is the retrograde flow of gastric contents into the esophagus and may induce a variety of complications. Endoscopically visible breaks in the distal esophageal mucosa are the most reliable evidence of reflux esophagitis. Combined multichannel intraluminal impedance and pH-metry (MII-pH) is a technique that enables monitoring of GER independent of its acidity. The aim of this study is to investigate the GER patterns in children with the aid of MII-pH monitoring an...

  5. Occurrence of chronic esophageal ulcer after high dose rate intraluminal radiation therapy for esophageal cancer

    International Nuclear Information System (INIS)

    Soejima, Toshinori; Hirota, Saeko; Okamoto, Yoshiaki; Obayashi, Kayoko; Takada, Yoshiki

    1995-01-01

    Ninety-eight patients with esophageal cancer were treated by high dose rate intraluminal radiation therapy at the Department of Radiology of the Hyogo Medical Center for Adults between January 1982 and December 1993. Twenty patients with complete response after intraluminal radiation therapy, who were followed up with esophageal fiberscopy in our institute, were reviewed. The one-year cumulative rate of occurrence of esophageal ulcers was 81%, and in 69% of the cases the ulcers occurred from 4 to 8 months after completion of intraluminal radiation therapy. We graded esophageal ulcer by fiberscopic findings. Grade 0 was defined as no ulcer, grade 1 as superficial ulcer, grade 2 as deep ulcer, grade 3 as circumferencial ulcer, and severe stenosis. Factors related to grade were studied, and shorter distances from the source to the surface of the mucosa and lower surface doses of intraluminal radiation therapy appear to reduce the severity as graded on the above scale, of the esophageal ulcer. Four of the five 2-year recurrence-free patients suffered esophageal ulcers, which were cured from 15 to 22 months after intraluminal radiation therapy. However ulcers recurred in two patients, ong term care was thought to be necessary. (author)

  6. Defining Abnormally Low Tenders

    DEFF Research Database (Denmark)

    Ølykke, Grith Skovgaard; Nyström, Johan

    2017-01-01

    The concept of an abnormally low tender is not defined in EU public procurement law. This article takes an interdisciplinary law and economics approach to examine a dataset consisting of Swedish and Danish judgments and verdicts concerning the concept of an abnormally low tender. The purpose...

  7. Association between swallow perception and esophageal bolus clearance in patients with globus sensation.

    Science.gov (United States)

    Chen, Chien-Lin; Yi, Chih-Hsun; Liu, Tso-Tsai

    2013-04-01

    Globus sensation is common, but its pathogenesis is not yet clear. Our purpose was to investigate subjective perception of swallowing and esophageal motility by combined multichannel intraluminal impedance and manometry (MII-EM) for patients with globus sensation. Combined MII-EM was performed for 25 globus patients and 15 healthy controls. Swallows were abnormal if hypocontractivity or simultaneous contractions occurred. Esophageal bolus transit was incomplete if bolus exit was not found at one or more of all measurement sites. Perception of each swallow was assessed by use of a standardized scoring system, and was enhanced if the score was >1. Few globus patients reported enhanced perception during viscous or solid swallows. Incomplete bolus transit and enhanced perception occurred similarly between viscous and solid boluses. Agreement between enhanced perception and proximal bolus clearance was greater during solid swallows (κ = 0.45, 95 % CI: 0.32-0.58) than during viscous swallows (κ = 0.13, 95 % CI: 0-0.25) (P perception and total bolus clearance was greater during solid swallows (κ = 0.46, 95 % CI: 0.34-0.58) than during viscous swallows (κ = 0.11, 95 % CI: 0-0.22) (P perception is uncommon in patients with globus sensation, although there is a significant association between enhanced esophageal perception and solid bolus clearance. Application of a solid bolus may help better delineation of the interrelationship between the subjective perception of bolus passage and the objective measurement of bolus clearance.

  8. [Five cases of severe radiation pneumonitis after chemoradiotherapy for esophageal cancer].

    Science.gov (United States)

    Sakurai, Katsunobu; Kubo, Naoshi; Shibutani, Masatsune; Yamazoe, Sadaaki; Kimura, Kenjiro; Nagahara, Hisashi; Toyokawa, Takahiro; Amano, Ryosuke; Tanaka, Hiroaki; Muguruma, Kazuya; Ohtani, Hiroshi; Yashiro, Masakazu; Maeda, Kiyoshi; Ohira, Masaichi; Hirakawa, Kosei

    2013-11-01

    Chemoradiotherapy( CRT) for esophageal cancer is a useful modality for both locally advanced and resectable cases. Among adverse events related to CRT, radiation pneumonitis( RP) requires special attention because it has been shown to be occasionally associated with a worse acute prognosis. We report 5 cases of severe RP after CRT. All patients were male, and their mean age was 72 years (range: 66-76 years). The clinical stage of esophageal cancer was I in 1 case, II in 2 cases, and IVa in 2 cases. The mean total radiation dose was 51.8 Gy (range: 43.4-61.4). Initial symptoms and first abnormal findings were a high fever in 4 cases and elevated serum C-reactive protein( CRP) levels in 1 case. No patients presented with respiratory symptoms, including dyspnea and coughing, as initial symptoms. All cases were diagnosed as RP by chest computed tomography examination, an average of 6.8 days after the completion of RT. Four patients required intensive care and were put on ventilator support. All patients received steroid pulse therapy. Two patients recovered from RP; however, 3 died( 1 attributable to multi-organ failure and 2 to respiratory failure). It is important to consider RP caused by CRT when patients present with high fever or elevated CRP levels after the completion of RT for esophageal cancer.

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

    Science.gov (United States)

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

    2014-01-01

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

  10. Once-daily omeprazole/sodium bicarbonate heals severe refractory reflux esophagitis with morning or nighttime dosing.

    Science.gov (United States)

    Orbelo, Diana M; Enders, Felicity T; Romero, Yvonne; Francis, Dawn L; Achem, Sami R; Dabade, Tushar S; Crowell, Michael D; Geno, Debra M; DeJesus, Ramona S; Namasivayam, Vikneswaran; Adamson, Steven C; Arora, Amindra S; Majka, Andrew J; Alexander, Jeffrey A; Murray, Joseph A; Lohse, Matthew; Diehl, Nancy N; Fredericksen, Mary; Jung, Kee Wook; Houston, Margaret S; O'Neil, Angela E; Katzka, David A

    2015-01-01

    Morning dose or twice-daily proton pump inhibitor (PPI) use is often prescribed to heal severe reflux esophagitis. Compare the effect of single dose morning (control arm) versus nighttime (experimental arm) omeprazole/sodium bicarbonate (Zegerid(®)) (IR-OME) on esophagitis and gastroesophageal reflux symptoms. Adult outpatients with Los Angeles grade C or D esophagitis were allocated to open-label 40 mg IR-OME once a day for 8 weeks in a prospective, randomized, parallel design, single center study. Esophagogastroduodenoscopy (EGD) and validated self-report symptom questionnaires were completed at baseline and follow-up. Intention-to-treat and per-protocol analyses were performed. Ninety-two of 128 (72 %) eligible subjects participated [64 (70 %) male, mean age 58 (range 19-86), median BMI 29 (range 21-51), 58 C:34 D]. Overall, 81 (88 %) subjects healed [n = 70 (76 %)] or improved [n = 11 (12 %)] erosions. There was no significant difference (morning vs. night) in mucosal healing [81 vs. 71 %, (p = 0.44)] or symptom resolution [heartburn (77 vs. 65 %, p = 0.12), acid regurgitation (82 vs. 73 %, p = 0.28)]. Prevalence of newly identified Barrett's esophagus was 14 % with half diagnosed only after treatment. Once-daily IR-OME (taken morning or night) effectively heals severe reflux esophagitis and improves GERD symptoms. Results support the clinical practice recommendation to repeat EGD after 8 weeks PPI therapy in severe esophagitis patients to assure healing and exclude Barrett's esophagus.

  11. [Use of corticosteroids after esophageal dilations on patients with corrosive stenosis: prospective, randomized and double-blind study].

    Science.gov (United States)

    Camargo, Marcelo Amade; Lopes, Luiz Roberto; Grangeia, Tiago de Araújo Guerra; Andreollo, Nelson Adami; Brandalise, Nelson Ary

    2003-01-01

    To determine triancinolone intralesional injections effects in association with esophageal dilations in corrosive stenosis cases, by means of a double-blind and randomized study. Fourteen adults patients (6 men and 8 women) with severe esophageal corrosive stenosis were randomized in two groups: Group A: treated by esophageal dilations and posterior triancinolone 10 mg/ml intralesional injection; Group B: treated by esophageal injections and posterior saline solution 0,9% injection (placebo). New applications were made based on the patient symptomatology. It had been analysed dilation frequency, obtained diameters and dysphagia before and after the research, for 12 months. Eleven patients had ingested sodium hydroxide, two had ingested ammoniac and one had taken muriatic acid. There was no statistic difference (p > 0.05) in dilation frequency and dysphagia between the groups. However, an improvement in obtained diameter was observed in the corticosteroids group in comparison with control group (p < 0.05). By comparing groups before and after steroids, the final results were very favorable in group A CONCLUSION: Multiple intralesional injections of triancinolone hexacetonide 10 mg/ml in association with esophageal dilations increase obtained diameters in succeeding sessions.

  12. Histopathologic profile of esophageal atresia and ...

    African Journals Online (AJOL)

    tissue were observed in only three LP specimens. Gastric- .... with gastric alternating with esophageal epithelium (Fig. 1) and three with ... Table 1 Histologic profile in seven control cases. Histopathologic features. Upper esophagus. (n = 7). Lower esophagus. (n = 7). Lining epithelium. Stratified squamous. 4. 4. Not seen. 3.

  13. Esophageal achalasia in adolescence - two case reports

    Directory of Open Access Journals (Sweden)

    Inês Vaz Silva

    2016-02-01

    Full Text Available Introduction: Achalasia is a rare disorder, particularly in pediatrics, characterized by esophageal aperistalsis and inadequate relaxation of the lower esophageal sphincter. Its etiology remains unclear. Cases: We describe two adolescents with dysphagia for solids and liquids, vomiting, weight loss and nocturnal cough for a few months. Initially it was considered to be an eating disorder, and the diagnosis of achalasia was reached later by esophageal manometry in one case and by intraoperative biopsy in another. The patients were submitted to Heller myotomy with an antireflux procedure, laparoscopically in one case, and by laparotomy in another, both with a favorable outcome. Discussion/Conclusions: We emphasize the rarity and diagnostic challenge of these cases. The nonspecific symptoms often lead to the diagnosis of an eating disorder, delaying the correct treatment. If symptoms persist achalasia must be considered and the esophageal manometry is the diagnostic test of choice. The gold standard in treatment is surgical, and we highlight the effectiveness of the techniques applied.

  14. Esophageal leiomyoma arising in an epiphrenic diverticulum

    International Nuclear Information System (INIS)

    Hamilton, S.

    1988-01-01

    A 32-year old woman was found at surgery to have an esophageal leiomyoma arising within an epiphrenic diverticulum. These uncommon conditions may rarely occur together, causing difficulty in diagnosis of the leiomyoma. Other neoplasms may also arise in an epiphrenic diverticulum and should be borne in mind in this situation. (orig.)

  15. Neoadjuvant chemoradiotherapy for advanced esophageal cancer

    International Nuclear Information System (INIS)

    Natsugoe, Shoji; Matsumoto, Masataka; Okumura, Hiroshi

    2011-01-01

    The limitations of surgical treatment for advanced esophageal cancer have been clarified, although esophagectomy with extended lymph node dissection has been widespread in Japan. Preoperative adjuvant therapy has been investigated in Western countries, and recently preoperative chemoradiotherapy (CRT) has been introduced for the treatment of resectable esophageal cancer. There are several reports of randomized controlled trials (RCTs) comparing CRT followed by surgery and surgery alone. According to the results of a meta-analysis, preoperative CRT is considered to be the standard therapy in Western countries. However, problems in the clinical heterogeneity of meta-analyses include: small number of patients in each RCT; differences in stage grouping; presence of both squamous cell carcinoma and adenocarcinoma; various surgical techniques used; and differences in the amount of radiation administered. Preoperative CRT appears to be a promising method for the treatment of potentially resectable advanced esophageal cancer patients with nodal metastasis. Currently, phase I and II trials of new anticancer agents or molecular targeting agents are ongoing. However, since the surgical procedure in the Western method is still being debated, well-designed RCTs are necessary, especially in esophageal squamous cell carcinoma. The effectiveness of CRT followed by surgery should be clarified based on excellent Japanese surgical techniques. (author)

  16. Preoperative Chemoradiotherapy for Esophageal or Junctional Cancer

    NARCIS (Netherlands)

    van Hagen, P.; Hulshof, M. C. C. M.; van Lanschot, J. J. B.; Steyerberg, E. W.; van Berge Henegouwen, M. I.; Wijnhoven, B. P. L.; Richel, D. J.; Nieuwenhuijzen, G. A. P.; Hospers, G. A. P.; Bonenkamp, J. J.; Cuesta, M. A.; Blaisse, R. J. B.; Busch, O. R. C.; ten Kate, F. J. W.; Creemers, G.-J.; Punt, C. J. A.; Plukker, J. T. M.; Verheul, H. M. W.; Spillenaar Bilgen, E. J.; van Dekken, H.; van der Sangen, M. J. C.; Rozema, T.; Biermann, K.; Beukema, J. C.; Piet, A. H. M.; van Rij, C. M.; Reinders, J. G.; Tilanus, H. W.; van der Gaast, A.; Bergman, J. J. G. H. M.; Bartelsman, J. F.; Bissumbar, A.; Blom, R. L.; Geijsen, E. D.; van Heijl, M.; Obertop, H.; Koning, C. C. E.; Offerhaus, G. J.; Omloo, J. M.; Wilmink, H.; Aparicio Pages, M. N.; van den Nieuwenhof-Biesheuvel, L.; Eijkenboom, W. M. H.; Koppert, L. B.; Meijer, D. A.; Siersema, P. D.; Spaander, M. C. V.; Verheij, C.; Vollebregt, C.; van Krieken, J. H. J. M.; van Mansum, W.; van Dam, G.; van Dullemen, H. M.; Eerens, A.; van der Jagt, E.; Karnebeld, A.; Kluin, Ph; Mul, V. E. M.; Pruim, J.; Siemerink, E.; Weersma, R. K.; Fraikin, T.; Peters, C. W. A. H.

    2012-01-01

    BACKGROUND The role of neoadjuvant chemoradiotherapy in the treatment of patients with esophageal or esophagogastric-junction cancer is not well established. We compared chemoradiotherapy followed by surgery with surgery alone in this patient population. METHODS We randomly assigned patients with

  17. Epidemiology and histopathological features of esophageal cancer ...

    African Journals Online (AJOL)

    Introduction: Esophageal cancer is the 6th most common cause of cancer death in the world. During the past two decades some changes have occurred in histologic type and primary tumor location in some parts of the world but there is a little information about histopathological aspect of disease in Iran. The purpose of the ...

  18. Esophageal atresia with tracheoesophageal fistula and early ...

    African Journals Online (AJOL)

    Background: Several recent reports showed that associated anomalies represent the main cause of postoperative mortality in infants born with esophageal atresia (EA) and/or tracheoesophageal fistula (TEF). Our observations present additional causes of mortality to the above mentioned. The aim of this study is to identify ...

  19. Preoperative therapy in locally advanced esophageal cancer

    Science.gov (United States)

    Garg, Pankaj Kumar; Sharma, Jyoti; Jakhetiya, Ashish; Goel, Aakanksha; Gaur, Manish Kumar

    2016-01-01

    Esophageal cancer is an aggressive malignancy associated with dismal treatment outcomes. Presence of two distinct histopathological types distinguishes it from other gastrointestinal tract malignancies. Surgery is the cornerstone of treatment in locally advanced esophageal cancer (T2 or greater or node positive); however, a high rate of disease recurrence (systemic and loco-regional) and poor survival justifies a continued search for optimal therapy. Various combinations of multimodality treatment (preoperative/perioperative, or postoperative; radiotherapy, chemotherapy, or chemoradiotherapy) are being explored to lower disease recurrence and improve survival. Preoperative therapy followed by surgery is presently considered the standard of care in resectable locally advanced esophageal cancer as postoperative treatment may not be feasible for all the patients due to the morbidity of esophagectomy and prolonged recovery time limiting the tolerance of patient. There are wide variations in the preoperative therapy practiced across the centres depending upon the institutional practices, availability of facilities and personal experiences. There is paucity of literature to standardize the preoperative therapy. Broadly, chemoradiotherapy is the preferred neo-adjuvant modality in western countries whereas chemotherapy alone is considered optimal in the far East. The present review highlights the significant studies to assist in opting for the best evidence based preoperative therapy (radiotherapy, chemotherapy or chemoradiotherapy) for locally advanced esophageal cancer. PMID:27818590

  20. [Eosinophilic esophagitis: increasing incidence in paediatric population].

    Science.gov (United States)

    Braga-Tavares, Hugo; Teles, Andreia; Nogueira, Rosete; Cardoso Rodrigues, Fernando; Costa, Cristina

    2009-01-01

    Eosinophilic Esophagitis has been increasingly diagnosed and results from a chronic esophagic inflammation with eosinophilic infiltrate. Evaluation of the diagnosed paediatric cases in our centre between 2004 and 2008 and revision of current literature on this subject. Four caucasian boys, aged eight to fifteen years old, were diagnosed with Eosinophilic Esophagitis. They presented with disphagia and food impaction and endoscopic findings included multiple concentric rings (pseudo-trachea pattern) and friable mucosa. All of them had mucosal eosinophil counts higher than 20 eosinophils/high-powered field and were given corticosteroids, either topic or systemic (one case) with therapeutic success. The diagnosis of Eosinophilic Esophagitis must be considered in presence of disphagia, food impaction or gastroesophageal reflux symptoms refractory to treatment. Endoscopic evaluation may be normal and the diagnosis is based on histological findings, making biopsy mandatory whenever clinically suspected. The increasing incidence of the last years associated with the high recurrence rate will lead to future prevalence increased both in child and adulthood.

  1. Stent placement for esophageal strictures : an update

    NARCIS (Netherlands)

    Hirdes, Meike Madeleine Catharine; Vleggaar, Frank Paul; Siersema, Peter Derk

    2011-01-01

    The use of stents for esophageal strictures has evolved rapidly over the past 10 years, from rigid plastic tubes to flexible self-expanding metal (SEMS), plastic (SEPS) and biodegradable stents. For the palliative treatment of malignant dysphagia both SEMS and SEPS effectively provide a rapid relief

  2. Upper esophageal sphincter pressure in patients with Chagas' disease and primary achalasia

    Directory of Open Access Journals (Sweden)

    Dantas R.O.

    2000-01-01

    Full Text Available The most important component of the upper esophageal sphincter (UES is the cricopharyngeal muscle. During the measurement of sphincter pressure the catheter passed through the sphincter affects the pressure value. In Chagas' disease and primary achalasia there is an esophageal myenteric plexus denervation which may affect UES pressure. We measured the UES pressure of 115 patients with Chagas' disease, 28 patients with primary achalasia and 40 healthy volunteers. We used a round manometric catheter with continuous perfusion and the rapid pull-through method, performed in triplicate during apnea. Pressures were measured in four directions, and the direction with the highest pressure (anterior/posterior and the average of the four directions were measured. The highest UES pressure in Chagas' disease patients without abnormalities upon radiologic esophageal examination (N = 63 was higher than in normal volunteers (142.8 ± 47.4 mmHg vs 113.0 ± 46.0 mmHg, mean ± SD, P<0.05. There was no difference in UES pressure between patients with primary achalasia and patients with Chagas' disease and similar esophageal involvement and normal volunteers (P>0.05. There was no difference between patients with or without esophageal dilation. In the group of subjects less than 50 years of age the UES pressure of primary achalasia (N = 21 was lower than that of Chagas' disease patients with normal radiologic esophageal examination (N = 41, measured at the site with the highest pressure (109.3 ± 31.5 mmHg vs 149.6 ± 45.3 mmHg, P<0.01 and as the average of the four directions (64.2 ± 17.1 mmHg vs 83.5 ± 28.6 mmHg, P<0.05. We conclude that there is no difference in UES pressure between patients with Chagas' disease, primary achalasia and normal volunteers, except for patients with minor involvement by Chagas' disease, for whom the UES pressure at the site with the highest pressure was higher than the pressure of normal volunteers and patients with primary

  3. Histomorphological and Immunophenotypic Features of Pill-Induced Esophagitis.

    Directory of Open Access Journals (Sweden)

    Ji Won Kim

    Full Text Available The aim of this study was to investigate histomorphological and immunophenotypic features in pill-induced esophagitis. We comparatively evaluated the histomorphological, immunophenotypic features of pill-induced esophagitis vs. reflux esophagitis, as well as clinical information and endoscopic findings. Fifty-two tissue pieces from 22 cases of pill-induced esophagitis, 46 pieces from 20 reflux esophagitis, and 16 pieces from 14 control samples were subjected to immunohistochemistry for inflammatory infiltrates (CD3 for T lymphocyte, CD20 for B lymphocyte, CD56 for NK cell, CD68 for macrophage, CD117 for mast cell and eosinophil chemotaxis-associated proteins (Erk, leptin, leptin receptor, pSTAT3, phospho-mTOR. As a result, Histomorphology showed that a diffuse pattern of dilated intercellular spaces was more frequently observed in pill-induced esophagitis, while reactive atypia and subepithelial papillary elongation were more often found in reflux esophagitis (P < 0.05, respectively. Interestingly, intraepithelial eosinophilic microabscess, intraepithelial pustule and diffuse pattern of dilated intercellular spaces were observed in 14% (3 cases, 9% (2 cases and 32% (7 cases of pill-induced esophagitis, respectively, but in no cases of reflux esophagitis. Regarding intraepithelial inflammatory infiltrates in pill-induced esophagitis, T lymphocytes were the most common cells, followed by eosinophil; 11 and 7 in one x400 power field, respectively. Intraepithelial pSTAT3-positive pattern was more frequently observed in pill-induced esophagitis than in reflux esophagitis, at 45% (10 cases versus 10% (2 cases, respectively (P < 0.05. Considering the distal esophageal lesion only, intraepithelial pustule, diffuse dilated intercellular spaces and stromal macrophages were more frequently found in distal pill-induced esophagitis, whereas reactive atypia and intraepithelial mast cells in reflux esophagitis (P < 0.05, respectively. In conclusion, diffuse

  4. with esophageal squamous cell cancer

    Directory of Open Access Journals (Sweden)

    Tao Li

    2017-02-01

    Full Text Available Purpose: The aim of this study was to retrospectively observe and analyze the long-term treatment outcomes of 191 elderly patients with esophageal squamous cell cancer (ESCC who were treated with californium-252 (252Cf neutron brachytherapy (NBT in combination with external beam radiotherapy (EBRT. Material and methods : From January 2002 to November 2012, 191 patients with ESCC underwent NBT in combination with EBRT. The total radiation dose to the reference point via NBT was 8-25 Gy-eq in two to five fractions with one fraction per week. The total dose via EBRT was 50-60 Gy, which was delivered over a period of 5 to 6 weeks with normal fractionation. Results : The median survival time for the 191 patients was 23.6 months, and the 5-year rates for overall survival (OS and local-regional control (LRC were 28.7% and 54.2%, respectively. The patients’ age was a factor that was significantly associated with OS (p = 0.010, according to univariate analysis. The 5-year OS (LRC was 37.3% (58.6% for patients aged 70-74 years and 14.5% (47.9% for patients aged > 74 years (p = 0.010 and p = 0.038. In multivariate analysis, age and clinical N stage were associated with OS and LRC (p = 0.011 [0.041] and p = 0.005 [0.005]. From the time of treatment completion to the development of local-regional recurrence or death, 5 (2.6% patients experienced fistula and 15 (7.9% experienced massive bleeding. The incidence of severe late complications was related to older age (p = 0.027, higher NBT dose/fraction (20-25 Gy/5 fractions, and higher total dose (> 66 Gy. Conclusions : The clinical data indicated that NBT in combination with EBRT produced favorable local control and long-term survival rates for elderly patients with ESCC, and that the side effects were tolerable. Patient’s age, clinical stage N status, and radiation dose could be used to select the appropriate treatment for elderly patients.

  5. Esophageal Cancer in Iran: A Review

    Directory of Open Access Journals (Sweden)

    Siavosh Nasseri-Moghaddam

    2010-01-01

    Full Text Available Esophageal cancer is the second and third most common malignancy in Iranian malesand females, respectively, claiming lives of approximately 5800 Iranians each year.Squamous cell carcinoma (SCC is presently the most common type accounting forabout 90% of all esophageal cancers in Iran. Recent studies have shown that there isa gradual increase in the incidence of adenocarcinoma of the distal esophagus alongwith gastric cardia adenocarcinoma. Thirty-five years ago, the age standardizied rate (ASR of esophageal SCC in thecity of Gonbad (Golestan Province, northeast of Iran was found to be one of the highestrates for any single cancer that had been reported worldwide (ASR >100/105/year.Recent studies have shown that the incidence of SCC in Gonbad has declined to lessthan half of what it was in the past. This decline in the incidence of esophageal SCCparallels an improvement in the socioeconomic situation of people living in thisregion. According to recent cancer registry data in Iran there is still an obviousintracountry variability between the incidence of esophageal cancer in the south withan ASR of 3 for males and 2 for females in Kerman and 43 and 36 in the northeasternprovince of Golestan. The reasons for this very high rate of SCC in northeastern Iranhave been the subject of several studies during the past 35 years. According to resultsof these studies the suspected risk factors are: low intake of fruits and vegetables, drinkinghot tea, consumption of opium products and tobacco, H.pyloriinfection in the stomach,using unhealthy drinking water from cisterns and genetic susceptibility. The mainsuspected mutagens are polycyclic aromatic hydrocarbons (PAH and N-nitrosocompounds. In order to embark primary and secondary prevention of this fatal cancer,further prospective studies are presently underway in the region. The Golestanesophageal cancer cohort study which follows of 50,000 subjects is on going. We expectsimple and feasible evidence based

  6. Twenty-four-hour esophageal pH monitoring in children and adolescents with chronic and/or recurrent rhinosinusitis

    Directory of Open Access Journals (Sweden)

    V.R.S.G. Monteiro

    2005-02-01

    Full Text Available Gastroesophageal reflux (GER disorder was studied in children and adolescents with chronic and/or recurrent rhinosinusitis not associated with bronchial asthma. Ten children with a clinical and radiological diagnosis of chronic and/or recurrent rhinosinusitis, consecutively attended at the Pediatric Otolaryngology Outpatient Clinic, Federal University of São Paulo, were evaluated. Prolonged esophageal pH monitoring was used to investigate GER disorder. The mean age of the ten patients evaluated (eight males was 7.4 ± 2.4 years. Two patients presented vomiting as a clinical manifestation and one patient presented retrosternal pain with a burning sensation. Twenty-four-hour esophageal pH monitoring was performed using the Sandhill apparatus. An antimony probe electrode was placed in the lower third of the esophagus, confirmed by fluoroscopy and later by a chest X-ray. The parameters analyzed by esophageal pH monitoring included: total percent time of the presence of acid esophageal pH, i.e., pH below 4 (<4.2%; total number of acid episodes (<50 episodes; number of reflux episodes longer than 5 min (3 or less, and duration of the longest reflux episode (<9.2 min. One patient (1/10, 10% presented a 24-h esophageal pH profile compatible with GER disorder. This data suggest that an association between chronic rhinosinusitis not associated with bronchial asthma and GER disorder may exist in children and adolescents, especially in those with compatible GER disorder symptoms. In these cases, 24-h esophageal pH monitoring should be performed before indicating surgery, since the present data suggest that 10% of chronic rhinosinusitis surgeries can be eliminated.

  7. Effect of age on proximal esophageal response to swallowing

    Directory of Open Access Journals (Sweden)

    Roberto Oliveira Dantas

    2010-12-01

    Full Text Available CONTEXT: It has been demonstrated that the ageing process affects esophageal motility. OBJECTIVES: To evaluate the effect of the age on the proximal esophageal response to wet swallows. METHOD: We measured the proximal esophageal response to swallows of a 5 mL bolus of water in 69 healthy volunteers, 20 of them aged 18-30 years (group I, 27 aged 31-50 years (group II, and 22 aged 51-74 years (group III. We used the manometric method with continuous perfusion. The proximal esophageal contractions were recorded 5 cm from a pharyngeal recording site located 1 cm above the upper esophageal sphincter. The time between the onset of the pharyngeal and of the proximal esophageal recording (pharyngeal-esophageal time and the amplitude, duration and area under the curve of the proximal esophageal contraction were measured. RESULTS: The pharyngeal-esophageal time was shorter in group I subjects than in group II and III subjects (P<0.05. The duration of proximal esophageal contractions was longer in group I than in groups II and III (P<0.001. There was no differences between groups in the amplitude or area under the curve of contractions. There were no differences between groups II and III for any of the measurements. CONCLUSION: We conclude that the age may affects the response of the proximal esophagus to wet swallows.

  8. Magnetic compression anastomosis as a nonsurgical treatment for esophageal atresia

    Energy Technology Data Exchange (ETDEWEB)

    Zaritzky, Mario [Hospital de Ninos de La Plata, Department of Radiology, Buenos Aires (Argentina); University of Chicago Medical Center, Department of Radiology, Chicago, IL (United States); Ben, Ricardo [Hospital de Ninos de La Plata, Department of Gastroenterology, Buenos Aires (Argentina); Zylberg, Gaston I.; Yampolsky, Brian [Hospital de Ninos de La Plata, Department of Radiology, Buenos Aires (Argentina)

    2009-09-15

    We describe a unique technique to promote a nonsurgical esophageal anastomosis with magnets in children with esophageal atresia. To evaluate the efficacy of magnetic lengthening of atretic esophageal ends to produce an anastomosis and to communicate our results after more than 2 years of follow-up. Between September 2001 and March 2004, five children were selected for treatment. Two of the children had esophageal atresia without fistula (type A) and three had atresia with fistula converted to type A surgically; however, surgeons failed to achieve an anastomosis because of the width of the gap. Neodymium-iron-boron magnets were used. Daily chest radiographs were taken until union of the magnets was observed. They were then replaced with an orogastric tube. Anastomosis was achieved in all patients in an average of 4.8 days. One patient, with signs of early sepsis, was successfully treated with antibiotics. In four of the five patients, esophageal stenosis developed. At the time of this report, two patients were free of treatment and on an oral diet (after 26 months), two patients required periodic balloon dilatation, and one patient had recently undergone surgery due to recurrent esophageal stenosis not amenable to balloon dilatation. Magnetic esophageal anastomosis is a feasible method in selected patients with esophageal atresia. Esophageal anastomosis was achieved in all patients. The only observed complication of significance was esophageal stenosis. One patient needed surgery because of stenosis. (orig.)

  9. Plant abnormality diagnosis device

    International Nuclear Information System (INIS)

    Saeki, Akira.

    1992-01-01

    The device of the present invention diagnose an abnormal event occurred in a large-scaled plant, such as a nuclear power plant. The device comprises the following four functions. (1) Abnormality candidates are estimated based on an intelligence base storing characteristics established between the characteristics/functions and physical amounts of the plant components, and detected abnormality and measured values. Among the candidates, one which coincidents with the measured value such as an actual process amount is judged as a first cause. (2) In addition, a real time plant behavior is estimated based on parameters determining a plant operation mode. The candidate for the abnormality cause is estimated by the comparison between the result of the estimation and the measured value such as a process amount. (3) Characteristics established between the characteristics/functions and the physical amount of the plant components are structured stepwise thereby identifying the first abnormality cause. (4) Inactuated or failed portions of the components for restoring the abnormality to normal state are identified based on the intelligence base simultaneously with the estimation for the first abnormality cause. (I.S.)

  10. Distal contraction latency: a measure of propagation velocity optimized for esophageal pressure topography studies.

    Science.gov (United States)

    Roman, Sabine; Lin, Zhiyue; Pandolfino, John E; Kahrilas, Peter J

    2011-03-01

    A defining feature of peristalsis is propagation velocity, which determines the timing of the distal contraction relative to the swallow. This study aimed to exploit a coordinate-based strategy to quantify the normal latency of the distal esophageal contraction as a measure of propagation velocity optimized for high-resolution esophageal pressure topography (EPT) studies. EPT studies for 75 healthy volunteers were merged in a computer simulation. Swallows were synchronized and analyzed as a 100 × 200 pixel grid that normalized esophageal length from the pharynx to the stomach for a 20-s period to first calculate a composite for each individual and then to establish normative values for the morphology and latency of the distal contraction among individuals. Stereotyped landmarks in composite EPT studies were pressure troughs in the proximal and distal esophagus isolating the distal segment and the contractile deceleration point (CDP) localizing the termination of peristalsis in the distal segment. Distal contractile latency was timed to the CDP (median 6.0 s, 95% confidence interval 4.8-7.6 s) and to lower esophageal sphincter (LES) contraction (median 9.2 s, 95% confidence interval 6.5-11.5 s). Illustrative examples are shown of rapidly conducted contractions with normal or short latency, suggesting short latency to be the preferable EPT metric of rapid propagation. The proposed scheme, utilizing the topographic coordinates of contraction relative to the swallow as an alternative to conventional measures of peristaltic velocity, lays the foundation for a physiologically grounded classification of peristaltic abnormalities in EPT. Future studies will test the clinical utility of this scheme.

  11. 5.9 Mb microdeletion in chromosome band 17q22-q23.2 associated with tracheo-esophageal fistula and conductive hearing loss.

    Science.gov (United States)

    Puusepp, Helen; Zilina, Olga; Teek, Rita; Männik, Katrin; Parkel, Sven; Kruustük, Katrin; Kuuse, Kati; Kurg, Ants; Ounap, Katrin

    2009-01-01

    Only eight cases involving deletions of chromosome 17 in the region q22-q24 have been reported previously. We describe an additional case, a 7-year-old boy with profound mental retardation, severe microcephaly, facial dysmorphism, symphalangism, contractures of large joints, hyperopia, strabismus, bilateral conductive hearing loss, genital abnormality, psoriasis vulgaris and tracheo-esophageal fistula. Analysis with whole-genome SNP genotyping assay detected a 5.9 Mb deletion in chromosome band 17q22-q23.2 with breakpoints between 48,200,000-48,300,000 bp and 54,200,000-54,300,000 bp (according to NCBI 36). The aberration was confirmed by real-time quantitative PCR analysis. Haploinsufficiency of NOG gene has been implicated in the development of conductive hearing loss, skeletal anomalies including symphalangism, contractures of joints, and hyperopia in our patient and may also contribute to the development of tracheo-esophageal fistula and/or esophageal atresia.

  12. Achalasia and Esophageal Motility Disorders

    Science.gov (United States)

    ... the muscles in the esophagus stop working (no peristalsis), and the valve at the bottom of the ... Achalasia Dysphagia Difficulty swallowing Reflux Backing up of stomach acids that may taste sour or bitter Pressure ...

  13. Antigen presentation and MHC class II expression by human esophageal epithelial cells: role in eosinophilic esophagitis.

    Science.gov (United States)

    Mulder, Daniel J; Pooni, Aman; Mak, Nanette; Hurlbut, David J; Basta, Sameh; Justinich, Christopher J

    2011-02-01

    Professional antigen-presenting cells (APCs) play a crucial role in initiating immune responses. Under pathological conditions, epithelial cells at mucosal surfaces act as nonprofessional APCs, thereby regulating immune responses at the site of exposure. Epithelial cells in the esophagus may contribute to the pathogenesis of eosinophilic esophagitis (EoE) by presenting antigens on the major histocompatibility complex (MHC) class II. Our goal was to demonstrate the ability of esophageal epithelial cells to process and present antigens on the MHC class II system and to investigate the contribution of epithelial cell antigen presentation to EoE. Immunohistochemistry detected HLA-DR, CD80, and CD86 expression and enzyme-linked immunosorbent assay detected interferon-γ (IFNγ) in esophageal biopsies. Antigen presentation was studied using the human esophageal epithelial cell line HET-1A by reverse transcriptase-PCR, flow cytometry, and confocal microscopy. T helper cell lymphocyte proliferation was assessed by flow cytometry and IL-2 secretion. IFNγ and MHC class II were increased in mucosa of patients with EoE. IFNγ increased mRNA of HLA-DP, HLA-DQ, HLA-DR, and CIITA in HET-1A cells. HET-1A engulfed cell debris and processed ovalbumin. HET-1A cells expressed HLA-DR after IFNγ treatment. HET-1A stimulated T helper cell activation. In this study, we demonstrated the ability of esophageal epithelial cells to act as nonprofessional APCs in the presence of IFNγ. Esophageal epithelial cell antigen presentation may contribute to the pathophysiology of eosinophilic esophagitis. Copyright © 2011 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

  14. Chromosomal Abnormalities in ADHD

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2002-07-01

    Full Text Available The prevalence of fragile X syndrome, velocardiofacial syndrome (VCFS, and other cytogenetic abnormalities among 100 children (64 boys with combined type ADHD and normal intelligence was assessed at the NIMH and Georgetown University Medical Center.

  15. "Jeopardy" in Abnormal Psychology.

    Science.gov (United States)

    Keutzer, Carolin S.

    1993-01-01

    Describes the use of the board game, Jeopardy, in a college level abnormal psychology course. Finds increased student interaction and improved application of information. Reports generally favorable student evaluation of the technique. (CFR)

  16. Chromosomal abnormalities and autism

    Directory of Open Access Journals (Sweden)

    Farida El-Baz

    2016-01-01

    Conclusion: Chromosomal abnormalities were not detected in the studied autistic children, and so the relation between the genetics and autism still needs further work up with different study methods and techniques.

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

    Science.gov (United States)

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

    2014-07-16

    Our previous finding of a fractal pattern for gastric pH and esophageal pH plus the statistical association of sequential pH values for up to 2 h led to our hypothesis that the fractal pattern encodes information regarding gastric acidity and that depending on the value of gastric acidity, the esophagus can signal the stomach to alter gastric acidity by influencing gastric secretion of acid or bicarbonate. Under our hypothesis values of gastric pH should provide information regarding values of esophageal pH and vice versa. We used vector autoregression, a theory-free set of inter-related linear regressions used to measure relationships that can change over time, to analyze data from 24-h recordings of gastric pH and esophageal pH. We found that in pH records from normal subjects, as well as from subjects with gastroesophageal reflux disease alone and after treatment with a proton pump inhibitor, gastric pH values provided important information regarding subsequent values of esophageal pH and values of esophageal pH provided important information regarding subsequent values of gastric pH. The ability of gastric pH and esophageal pH to provide information regarding subsequent values of each other was reduced in subjects with gastroesophageal reflux disease compared to normal subjects. Our findings are consistent with the hypothesis that depending on the value of gastric acidity, the esophagus can signal the stomach to alter gastric acidity, and that this ability is impaired in subjects with gastroesophageal reflux disease. © 2014 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society.

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

    International Nuclear Information System (INIS)

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

    1986-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1986-07-01

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

  20. Epidemiologic differences in esophageal cancer between Asian and Western populations.

    Science.gov (United States)

    Zhang, Han-Ze; Jin, Guang-Fu; Shen, Hong-Bing

    2012-06-01

    Esophageal cancer is a common cancer worldwide and has a poor prognosis. The incidence of esophageal squamous cell cancer has been decreasing, whereas the incidence of esophageal adenocarcinoma has been increasing rapidly, particularly in Western men. Squamous cell cancer continues to be the major type of esophageal cancer in Asia, and the main risk factors include tobacco smoking, alcohol consumption, hot beverage drinking, and poor nutrition. In contrast, esophageal adenocarcinoma predominately affects the whites, and the risk factors include smoking, obesity, and gastroesophageal reflux disease. In addition, Asians and Caucasians may have different susceptibilities to esophageal cancer due to different heritage backgrounds. However, comparison studies between these two populations are limited and need to be addressed in the near future. Ethnic differences should be taken into account in preventive and clinical practices.

  1. Dysmotility in Esophageal Atresia: Pathophysiology, Characterization, and Treatment

    Science.gov (United States)

    Faure, Christophe; Righini Grunder, Franziska

    2017-01-01

    Esophageal dysmotility is almost universal after esophageal atresia (EA) repair and is mainly related to the developmental anomaly of the esophagus. Esophageal dysmotility is involved in the pathophysiology of numerous symptoms and comorbidities associated with EA such as gastroesophageal reflux disease, aspiration and respiratory complications, and symptoms of dysphagia and feeding disorders. High-resolution esophageal manometry (HREM) has facilitated the characterization of the dysmotility, but there is an incomplete correlation between symptoms and manometrical patterns. Impedance coupled to HREM should help to predict the clinical outcome and therefore personalize patient management. Nowadays, the management of esophageal dysmotility in patients with EA is essentially based on treatment of associated inflammation related to peptic or eosinophilic esophagitis. PMID:28620599

  2. Esophageal eosinophilia in pediatric patients with cerebral palsy.

    Science.gov (United States)

    Nápolis, Ana Carolina Ramos de; Alves, Flavia Araujo; Rezende, Erica Rodrigues Mariano de Almeida; Segundo, Gesmar Rodrigues Silva

    2015-01-01

    To describe the clinical picture, test results, and clinical evolution of patients with cerebral palsy associated with diagnosis of eosinophilic esophagitis, monitored at tertiary centre. Cross-sectional, retrospective and descriptive study that evaluated the medical records data of pediatric patients with diagnosis of cerebral palsy and eosinophilic esophagitis in a tertiary center of pediatric gastroenterology between August 2005 and August 2013. Seven out of 131 patients with cerebral palsy had the diagnosis of eosinophilic esophagitis. The mean age at diagnosis of eosinophilic esophagitis was 52.3 months and the mean number of eosinophils in esophagus was 35 per high-power field. Symptoms more frequent were recurrent vomiting and disphagia. Endoscopic alterations found were mucosal thickening, vertical lines, mucosal opacificacion and white plaques. The frequency of eosinophilic esophagitis found was higher than in general pediatric population. The investigation of eosinophilic esophagitis should be done regularly in those patients, once this entity could overlap other gastrointestinal diseases.

  3. (R)-(3-amino-2-fluoropropyl) phosphinic acid (AZD3355), a novel GABAB receptor agonist, inhibits transient lower esophageal sphincter relaxation through a peripheral mode of action

    DEFF Research Database (Denmark)

    Lehmann, Anders; Antonsson, Madeleine; Holmberg, Ann Aurell

    2009-01-01

    recombinant human GABA transporters. AR-H061719 [(R/S)-(3-amino-2-fluoropropyl)phosphinic acid], (the racemate of AZD3355) inhibited the response of ferret mechanoreceptors to gastric distension, further supporting its peripheral site of action on TLESR. In summary, AZD3355 probably inhibits TLESR through...

  4. Abnormal sound detection device

    International Nuclear Information System (INIS)

    Yamada, Izumi; Matsui, Yuji.

    1995-01-01

    Only components synchronized with rotation of pumps are sampled from detected acoustic sounds, to judge the presence or absence of abnormality based on the magnitude of the synchronized components. A synchronized component sampling means can remove resonance sounds and other acoustic sounds generated at a synchronously with the rotation based on the knowledge that generated acoustic components in a normal state are a sort of resonance sounds and are not precisely synchronized with the number of rotation. On the other hand, abnormal sounds of a rotating body are often caused by compulsory force accompanying the rotation as a generation source, and the abnormal sounds can be detected by extracting only the rotation-synchronized components. Since components of normal acoustic sounds generated at present are discriminated from the detected sounds, reduction of the abnormal sounds due to a signal processing can be avoided and, as a result, abnormal sound detection sensitivity can be improved. Further, since it is adapted to discriminate the occurrence of the abnormal sound from the actually detected sounds, the other frequency components which are forecast but not generated actually are not removed, so that it is further effective for the improvement of detection sensitivity. (N.H.)

  5. Esophageal motility disorders; Motilitaetsstoerungen des Oesophagus

    Energy Technology Data Exchange (ETDEWEB)

    Hannig, C.; Rummeny, E. [Klinikum rechts der Isar der Technischen Universitaet Muenchen, Institut fuer Roentgendiagnostik, Muenchen (Germany); Wuttge-Hannig, A. [Gemeinschaftspraxis fuer Radiologie, Nuklearmedizin und Strahlentherapie, Muenchen (Germany)

    2007-02-15

    For the better understanding of esophageal motility, the muscle texture and the distribution of skeletal and smooth muscle fibers in the esophagus are of crucial importance. Esophageal physiology will be shortly mentioned as far as necessary for a comprehensive understanding of peristaltic disturbances. Besides the pure depiction of morphologic criteria, a complete esophageal study has to include an analysis of the motility. New diagnostic tools with reduced radiation for dynamic imaging (digital fluoroscopy, videofluoroscopy) at 4-30 frames/s are available. Radiomanometry is a combination of a functional pressure measurement and a simultaneous dynamic morphologic analysis. Esophageal motility disorders are subdivided by radiologic and manometric criteria into primary, secondary, and nonclassifiable forms. Primary motility disorders of the esophagus are achalasia, diffuse esophageal spasm, nutcracker esophagus, and the hypertonic lower esophageal sphincter. The secondary motility disorders include pseudoachalasia, reflux-associated motility disorders, functionally caused impactions, Boerhaave's syndrome, Chagas' disease, scleroderma, and presbyesophagus. The nonclassificable motility disorders (NEMD) are a very heterogeneous collective. (orig.) [German] Zum Verstaendnis der Motilitaet des Oesophagus sind muskulaere Architektur und Verteilung der quergestreiften und glatten Muskelfasern von Bedeutung. Die Physiologie des Oesophagus wird in soweit kurz dargestellt, als sie fuer das Verstaendnis von peristaltischen Stoerungen notwendig ist. Neben der Erfassung rein morphologischer Kriterien ist bei der Untersuchung der Speiseroehre eine diagnostische Bewertung der Motilitaet erforderlich. Es stehen uns heute strahlungsarme dynamische Aufzeichnungsverfahren (digitale dynamische Aufzeichnung, Videofluoroskopie) mit Bildsequenzen von 4-30 Bildern/s zur Verfuegung. Die Kombination einer funktionellen Methode zur Darstellung der Morphologie und der

  6. Percutaneous endoscopic gastrostomy for nutritional palliation of upper esophageal cancer unsuitable for esophageal stenting

    Directory of Open Access Journals (Sweden)

    Ana Grilo

    2012-09-01

    Full Text Available CONTEXT: Esophageal cancer is often diagnosed at an advanced stage and has a poor prognosis. Most patients with advanced esophageal cancer have significant dysphagia that contributes to weight loss and malnutrition. Esophageal stenting is a widespread palliation approach, but unsuitable for cancers near the upper esophageal sphincter, were stents are poorly tolerated. Generally, guidelines do not support endoscopic gastrostomy in this clinical setting, but it may be the best option for nutritional support. OBJECTIVE: Retrospective evaluation of patients with dysphagia caused advanced esophageal cancer, no expectation of resuming oral intake and with percutaneous endoscopic gastrostomy for comfort palliative nutrition. METHOD: We selected adult patients with unresecable esophageal cancer histological confirmed, in whom stenting was impossible due to proximal location, and chemotherapy or radiotherapy were palliative, using gastrostomy for enteral nutrition. Clinical and nutritional data were evaluated, including success of gastrostomy, procedure complications and survival after percutaneous endoscopic gastrostomy, and evolution of body mass index, albumin, transferrin and cholesterol. RESULTS: Seventeen males with stage III or IV squamous cell carcinoma fulfilled the inclusion criteria. Mean age was 60.9 years. Most of the patients had toxic habits. All underwent palliative chemotherapy or radiotherapy. Gastrostomy was successfully performed in all, but nine required prior dilatation. Most had the gastrostomy within 2 months after diagnosis. There was a buried bumper syndrome treated with tube replacement and four minor complications. There were no cases of implantation metastases or procedure related mortality. Two patients were lost and 12 died. Mean survival of deceased patients was 5.9 months. Three patients are alive 6, 14 and 17 months after the gastrostomy procedure, still increasing the mean survival. Mean body mass index and laboratory

  7. The effect of a sitting versus supine posture on normative esophageal pressure topography metrics and Chicago Classification diagnosis of esophageal motility disorders

    Science.gov (United States)

    Xiao, Yinglian; Read, Andrew; Nicodème, Frédéric; Roman, Sabine; Kahrilas, Peter J.; Pandolfino, John E.

    2013-01-01

    Background and aims Although, the current protocol for high resolution manometry (HRM) using the Chicago Classification is based on the supine posture, some practitioners prefer a sitting posture. Our aims were to establish normative esophageal pressure topography (EPT) data for the sitting position and to determine the effect of applying those norms to Chicago Classification diagnoses. Method EPT studies including test swallows in both a supine and sitting position of 75 healthy volunteers and 120 patients were reviewed. Integrated relaxation pressure (IRP), distal contractile integral (DCI), contractile front velocity (CFV) and distal latency (DL) were measured and compared between postures. Normative ranges were established from the healthy volunteers and the effect of applying sitting normative values to the patients was analyzed. Result Normative values of IRP, DCI and CFV all decreased significantly in the sitting posture. Applying normative sitting metrics to patient studies (27% reduction in IRP (15 to 11 mmHg), 69% reduction in DCI (8,000 to 2500 mmHg-s-cm)) reclassified 13/120 (11%) patients as having abnormal EGJ relaxation and 26/120 (22%) as hypercontractile. Three patients with an abnormal supine IRP normalized when sitting with elimination of a vascular artifact. Conclusion Clinical HRM studies should include both a supine and sitting position to minimize misdiagnoses attributable to anatomical factors. However, until outcome studies demonstrating the significance of isolated abnormalities of IRP or DCI in the sitting position are available, the Chicago Classification of esophageal motility disorders should continue to be based on supine swallows using normative data from the supine posture. PMID:22897486

  8. The differences in esophageal motility and its clinical significance between the patients with typical and atypical symptoms of non-erosive reflux disease

    Directory of Open Access Journals (Sweden)

    Ling LIN

    2016-01-01

    Full Text Available Objective  To study the characteristics of esophageal motility in the patients with different symptoms of nonerosive reflux disease (non-erosive reflux disease, NERD. Methods  Eighty-six patients with NERD who visited the Department of Gastroenterology in our hospital from August 2012 to December 2014 were selected. They were all evaluated with upper gastrointestinal endoscopy and high resolution esophageal manometry. Those who had neither definite esophageal mucosal erosion nor Barrett's esophagus at endoscopy were diagnosed as NERD. According to the presence or absence of typical acid reflux and/or heartburn symptoms, patients with NERD were divided into two groups: the typical symptom group (47 cases, and the atypical symptom group (39 cases. High resolution measurement of esophageal pressure was used to evaluate the differences in esophageal dynamic characteristics between patients with different symptoms of NERD. The final results were analyzed with t test and chi-square test. Results  Compared with atypical symptom group, both the resting pressure (20.68±1.64mmHg vs 15.79±1.21mmHg respectively, P0.05. Conclusion  There is a difference in esophageal motility characteristics between the patients with typical and atypical symptoms of NERD, and the main differences are changes in the resting pressure and residual pressure of LES. DOI: 10.11855/j.issn.0577-7402.2015.12.12

  9. Tracheo-esophageal fistula in children: a diagnosis to keep in mind. Two case reports and review of the literature = Fístula traqueoesofágica en niños: un diagnóstico para tener en cuenta. Reporte de dos casos y revisión de la literatura

    Directory of Open Access Journals (Sweden)

    Olga Lucía Morales Múnera

    2013-07-01

    Full Text Available The tracheo-esophageal fistula without esophageal atresia is a rare type esophageal malformation. It has a multifactorial etiology including environmental and genetic factors. Common clinical manifestations are coughing and choking after meals, cyanosis and/or recurrent pneumonia. Diagnosis requires a high clinical suspicion index. Fistula confirmation is done with imaging studies including upper digestive series, video-fluoroscopy or with the use of bronchoscopy wich allows direct visualization of the fistula or methylene blue passage through the abnormal communication. Fistula closure can be done endoscopically or surgically, in both cases with good results.

  10. Role of fluoroscopic guided self expandable metallic stents in the management of malignant esophageal strictures

    Directory of Open Access Journals (Sweden)

    Mohamed Shaker

    2016-09-01

    Conclusion: Fluoroscopic guided esophageal stenting is a highly effective and safe method for palliating dysphagia in patients with obstructing esophageal cancer with significant clinical improvement.

  11. Endoscopic polypectomy: A promising therapeutic choice for esophageal carcinosarcoma

    Science.gov (United States)

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

    2009-01-01

    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 literature. PMID:19610152

  12. HER2 amplification, overexpression and score criteria in esophageal adenocarcinoma

    Science.gov (United States)

    Hu, Yingchuan; Bandla, Santhoshi; Godfrey, Tony E.; Tan, Dongfeng; Luketich, James D.; Pennathur, Arjun; Qiu, Xing; Hicks, David G.; Peters, Jeffrey; Zhou, Zhongren

    2011-01-01

    The HER2 oncogene was recently reported to be amplified and overexpressed in esophageal adenocarcinoma. However, the relationship of HER2 amplification in esophageal adenocarcinoma with prognosis has not been well defined. The scoring systems for clinically evaluating HER2 in esophageal adenocarcinoma are not established. The aims of the study were to establish a HER2 scoring system and comprehensively investigate HER2 amplification and overexpression in esophageal adenocarcinoma and its precursor lesion. Using a tissue microarray, containing 116 cases of esophageal adenocarcinoma, 34 cases of BE, 18 cases of low grade dysplasia and 15 cases of high grade dysplasia, HER2 amplification and overexpression were analyzed by HercepTest and CISH methods. The amplification frequency in an independent series of 116 esophageal adenocarcinoma samples was also analyzed using Affymetrix SNP 6.0 microarrays. In our studies, we have found that HER2 amplification does not associate with poor prognosis in total 232 esophageal adenocarcinoma patients by CISH and high density microarrays. We further confirm the similar frequency of HER2 amplification by CISH (18.10%; 21/116) and SNP 6.0 microarrays (16.4%, 19/116) in esophageal adenocarcinoma. HER2 protein overexpression was observed in 12.1 % (14/116) of esophageal adenocarcinoma and 6.67% (1/15) of HGD. No HER2 amplification or overexpression was identified in BE or LGD. All HER2 protein overexpression cases showed HER2 gene amplification. Gene amplification was found to be more frequent by CISH than protein overexpression in esophageal adenocarcinoma (18.10% vs 12.9%). A modified two-step model for esophageal adenocarcinoma HER-2 testing is recommend for clinical esophageal adenocarcinoma HER-2 trial. PMID:21460800

  13. Whole greater than the parts: integrated esophageal centers (IEC) and advanced training in esophageal diseases.

    Science.gov (United States)

    Triadafilopoulos, G; Clarke, J; Hawn, M

    2017-10-01

    An integrated esophageal center (IEC) is a multidisciplinary team with expertise, skill, range, and facilities necessary to achieve optimal outcomes in patients with esophageal diseases efficiently and expeditiously. Within IEC, patients presenting with esophageal symptoms undergo a detailed clinical, functional and structural evaluation of their esophagus prior to implementation of tailored medical, endoscopic or surgical therapy. Serving as a core, the IEC clinical practice also supports research and innovation in esophageal diseases as well as public and physician education. Referrals to the unit may be primary, either from primary care or self-initiated, or secondary from other specialty practices, to reassess patients who have previously failed therapies and to manage complex or complicated cases. The fundamental goals of the IEC are to provide value for patients with esophageal diseases, streamlining complex diagnostic investigations and expediting therapies aiming at reducing costs while improving clinical outcomes, and to accelerate knowledge generation through robust interaction and cross-training across disciplines. The organization of the IEC goes beyond traditional academic and clinical silos and involves a director and administrative team coordinating faculty and fellows from both medical and surgical disciplines and supported by other clinical lines, such as radiology, pathology, etc., while it interfaces with physicians, the public, basic, translational and clinical research groups, and related industry partners. © The Authors 2017. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  14. Sarcopenia and Visceral Obesity in Esophageal and Gastric Cancer

    Science.gov (United States)

    2017-02-17

    Esophageal Cancer; Gastric Cancer; Sarcopenia; Sarcopenic Obesity; Obesity; Visceral Obesity; Quality of Life; Surgery; Complication of Treatment; Chemotherapeutic Toxicity; Physical Activity; Oncology

  15. Congenital esophageal stenosis in 3 children: A case series

    Directory of Open Access Journals (Sweden)

    Mackenzie C. Lees

    2017-08-01

    Full Text Available Congenital esophageal stenosis (CES is rare condition found in 1 per 25,000 to 50,000 live births. It is characterized by intrinsic narrowing of the esophagus secondary to congenital malformation of the esophageal wall architecture. Diagnosis is often difficult to definitively establish as the symptoms are often initially attributed to esophageal strictures secondary to reflux, or occur within the context of a tracheo-esophageal fistula (TEF in the newborn. Endoscopic dilation and surgical repair are the mainstays of treatment. We report a series of three cases seen recently at our institution, the University of Alberta/Stollery Children's Hospital.

  16. Comparative study of omeprazole, lansoprazole, pantoprazole and esomeprazole for symptom relief in patients with reflux esophagitis

    Science.gov (United States)

    Zheng, Ri-Nan

    2009-01-01

    AIM: To clarify whether there is any difference in the symptom relief in patients with reflux esophagitis following the administration of four Proton pump inhibitors (PPIs). METHODS: Two hundred and seventy-four patients with erosive reflux esophagitis were randomized to receive 8 wk of 20 mg omeprazole (n = 68), 30 mg of lansoprazole (n = 69), 40 mg of pantoprazole (n = 69), 40 mg of esomeprazole (n = 68) once a day in the morning. Daily changes in heartburn and acid reflux symptoms in the first 7 d of administration were assessed using a six-point scale (0: none; 1: mild; 2: mild-moderate; 3: moderate; 4: moderate-severe; 5: severe). RESULTS: The mean heartburn score in patients treated with esomeprazole more rapidly decreased than those receiving other PPI. Complete resolution of heartburn was also more rapid in patients treated with esomeprazole for 5 d compared with omeprazole (P = 0.0018, P = 0.0098, P = 0.0027, P = 0.0137, P = 0.0069, respectively), lansoprazole (P = 0.0020, P = 0.0046, P = 0.0037, P = 0.0016, P = 0.0076, respectively), and pantoprazole (P = 0.0006, P = 0.0005, P = 0.0009, P = 0.0031, P = 0.0119, respectively). There were no significant differences between the four groups in the rate of endoscopic healing of reflux esophagitis at week 8. CONCLUSION: Esomeprazole may be more effective than omeprazole, lansoprazole, and pantoprazole for the rapid relief of heartburn symptoms and acid reflux symptoms in patients with reflux esophagitis. PMID:19248200

  17. Columnar Metaplasia in Three Types of Surgical Mouse Models of Esophageal RefluxSummary

    Directory of Open Access Journals (Sweden)

    Fabio Terabe

    2017-07-01

    Full Text Available Background and Aims: Esophageal adenocarcinoma develops in the setting of gastroesophageal reflux and columnar metaplasia in distal esophagus. Columnar metaplasia arising in gastroesophageal reflux models has developed in rat; however, gastroesophageal reflux models in mice have not been well-characterized. Methods: One hundred thirty-five C57Bl/6J mice aged 8 weeks old were divided into the following operations: esophagogastrojejunostomy (side-to-side (EGJ, esophageal separation and esophagojejunostomy (end-to-side (EJ, and EJ and gastrectomy (end-to-side (EJ/TG. The animals were euthanized after 40 weeks and the histology of the junction was examined. Immunohistochemistry for p53, PDX-1, and CDX-2 was performed. Results: Metaplasia developed in 15/33 (45.5% of EGJ, 0/38 (0% of EJ, and 6/39 (15.4% of EJ/TG (P < .05 and dysplasia developed 7/33 (21.2% of EGJ, 0% of EJ, and 1/39 (2.6% of EJ/TG. p53 was positive in all of the dysplastic regions, 12/15 (80% metaplasias in the EGJ model, and 1/6 (16.7% metaplasia in the EJ/TG model. CDX-2 was positive in all cases of metaplasias, but decreased in some cases of dysplasia. PDX-1 was positive in 7/8 (88% cases of dysplasia and in 15/21 (71% cases of metaplasia (P < .05. Conclusions: The EGJ model, which causes reflux of gastric acid and duodenal content, developed metaplasia and dysplasia most frequently. No metaplasia developed in the EJ model in which gastric juice and duodenal content mixed before reflux. Thus, duodenal contents alone can induce columnar metaplasia and dysplasia; however, the combination of gastric acid with duodenal content reflux can cause metaplasia and dysplasia more efficiently. Keywords: GERD, Esophageal Reflux, Barrett’s Esophagus, Esophageal Adenocarcinoma

  18. Gallium tomoscintigraphic imaging of esophageal cancer using emission computed tomography

    International Nuclear Information System (INIS)

    Hattori, Takao; Nakagawa, Tsuyoshi; Takeda, Kan; Maeda, Hisato; Taguchi, Mitsuo

    1983-01-01

    Emission computed tomography (ECT) was clinically evaluated in 67 Ga imaging of esophageal cancer. ECT system used in this study is equipped with opposed dual large-field-of-view cameras (GCA 70A-S, Toshiba Co.). Data were acquired by rotating the two cameras 180 0 about the longitudinal axis of the patient. Total acquisition time was about 12 minutes. Multiple slices of transaxial, sagittal and coronal sections were reconstructed in a 64 x 64 matrix form using convolution algorithms. In three out of six cases studied the tumor uptake was not detected on conventional images, because the lesion was small, concentration of activity was poor or the lesion activity was overlapped with the neighbouring activities distributed to normal organs such as sternum, vertebra, liver and hilus. On ECT images, by contrast, abnormal uptake of the tumors was definitively detected in all the six cases. ECT imaging was also useful in estimating the effect of treatment by the decrease in 67 Ga concentration. We have devised a special technique to repeat ECT scan with a thin tube filled with 67 Ga solution inserted through the esophagus. By this technique, comparing paired images with and without the tube activity, exact location of the uptake against the esophagus and extraesophageal extension of the disease could be accurately evaluated in a three-dimensional field of view. ECT in gallium scanning is expected to be of great clinical value to elevate the confidence level of diagnosis in detecting, localizing and following up the diseases. (author)

  19. Esophageal Foreign Body Causing Direct Aortic Injury

    Directory of Open Access Journals (Sweden)

    ECS Lam

    2003-01-01

    Full Text Available Foreign bodies in the esophagus are uncommon causes of esophageal perforation. Many nonperforating cases are successfully managed by flexible gastroscopy. However, complicated foreign bodies such as those that result in esophageal perforation and vascular injury are best managed surgically. Gastroscopy remains the primary method of diagnosis. A case of a 59-year-old woman who developed retrosternal and intrascapular pain, odynophagia and hematemesis after eating fish is reported. Flexible gastroscopy showed arterial bleeding from the midthoracic esophagus. Computed tomography scan localized a 3 cm fish bone perforating the esophagus with surrounding hematoma. An aortogram did not reveal an actively bleeding aortoesophageal fistula. The fish bone was surgically removed and the patient recovered with no postoperative complications. This case illustrates the importance of early consideration for surgical intervention when confronted with a brisk arterial bleed from the esophagus with suggestive history of foreign body ingestion.

  20. Surgical risk for patients with Chagasic achalasia and its correlation with the degree of esophageal dilation

    Science.gov (United States)

    Neto, José Garcia; de Cleva, Roberto; Zilberstein, Bruno; Gama-Rodrigues, Joaquim José

    2005-01-01

    AIM: To analyze the risk of cardiovascular complications in patients with indication for surgical treatment of Chagasic esophageal achalasia and to correlate the surgical risks with the degree of esophageal dilation, thereby proposing a risk scale index. METHODS: One hundred and twenty-four patients with Chagasic esophageal achalasia, who received surgical treatment at the Hospital das Clinicas of the Federal University of Goiás, were included in this study. The patients were mostly related to the postoperative complications due to the cardiovascular system. All the patients were submitted to: (1) clinical history to define the cardiac functional class (New York Heart Association); (2) conventional 12-lead electrocardiogram at rest; and (3) contrast imaging of the esophagus to determine esophageal dilatation according to Rezende’s classification of Chagasic megaesophagus. RESULTS: An assessment of the functional classification (FC) of heart failure during the preoperative period determined that 67 patients (54.03%) were assigned functional class I (FC I), 46 patients (37.09%) were assigned functional class II (FC II), and 11 patients (8.87%) were assigned functional class III (FC III). None of the patients were assigned to functional class IV (FC IV). There was a positive correlation between the functional class and the postoperative complications (FC I×FC II:P < 0.001; FC I×FC III: P < 0.001). The ECG was normal in 44 patients (35.48%) and presented abnormalities in 80 patients (64.52%). There was a significant statistical correlation between abnormal ECG (arrhythmias and primary change in ventricular repolarization) and postoperative complications (P < 0.001). With regard to the classification of the Chagasic esophageal achalasia, the following distribution was observed: group II, 53 patients (42.74%); group III, 37 patients (29.83%); and group IV, 34 patients (27.41%). There was a positive correlation between the degree of esophageal dilation and the

  1. [Clinical application features of Fufang Kushen injection in treating malignant esophageal tumor: real world study based on hospital information system].

    Science.gov (United States)

    Liu, Ya-Xin; Wang, Zhi-Fei; Xie, Yan-Ming; Zhang, Yin; Chen, Cen; Zhuang, Yan

    2017-08-01

    To analyze the clinical application features of Fufang Kushen injection in treating malignant esophageal tumors in the real world by using hospital information system database, and provide reference for clinical application of Fufang Kushen injection. The electronic medical data from 2 550 patients with malignant esophageal tumors using Fufang Kushen injection from 22 large-scale hospitals nationwide were extracted based on the hospital information system (HIS) established by Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences. Then the descriptive analysis based on frequency and rate was conducted for general characteristics, diagnostic characteristics, characteristics of dosage and medication information, characteristics of drug combination, and discharge outcome characteristics. The results showed that the average age of patients treated with Fufang Kushen injection for malignant esophageal tumors was 62.3 years old; more males than females; admitted to hospital mainly in department of cardiology, oncology and digestology first. The total efficiency was 47.15% based on the discharge outcome characteristics; the most common dosage was 10-20 mL for single use; the course of treatment was mainly 4-7 d; and the common drugs in drug combinations included dexamethasone, tropisetron injection, thymosin injection, compound amino acid injection, pantoprazole sodium injection, fluorouracil, et al. The characteristics of the crowd using Fufang Kushen injection to treat the malignant esophageal tumors were clear and in line with the general rule of malignant esophageal tumors; its clinical dosage and scope of treatment for malignant esophageal tumors in the real world were basically consistent with the specification; and the types of clinical drug use combinations were more extensive. Copyright© by the Chinese Pharmaceutical Association.

  2. Embedded esophageal foreign body. A diagnostic challenge

    International Nuclear Information System (INIS)

    Bhat, Venkatraman S.; AlSaadi, Khalid A.; Bessiouni, Ibrahim E.; Tuffaha, Amjad S.

    2009-01-01

    Esophageal foreign body (EFB) ingestion is of ubiquitous occurrence in pediatric population. Diagnosis and precise localization of non-radio opaque FB poses considerable challenge. Delayed presentation, poor history, and inconclusive esophagoscopic findings often lead to diagnostic delay. Multidetector computed tomography (MDCT) could be a great option in these situations. We present a case of EFB in a child who presented with failure to thrive, had negative fibreoptic endoscopy, ultimately diagnosed conclusively on MDCT examination. (author)

  3. Double balloon esophageal catheter for diagnosis of tracheo-esophageal fistula

    International Nuclear Information System (INIS)

    Kiyan, Guersu; Dagli, Tolga E.; Tugtepe, Halil; Kodalli, Nihat

    2003-01-01

    Congenital H-type and recurrent tracheo-esophageal fistulas (TEF) are always difficult to diagnose. For a more accurate diagnosis we designed a new double balloon catheter, which is a modification of esophageal dilatation balloon. The catheter has two balloons to occlude the esophagus proximal and distal to the fistula. The fistula can be identified by passing of the contrast material to the tracheal tree, which was injected into the esophageal segment between the inflated balloons. To prove the efficiency of this catheter, a TEF was created surgically in a New Zealand rabbit. On the postoperative fourteenth day the catheter was tried and the fistula could be visualized easily by injecting the contrast material. We think this technique may be of use in the diagnosis of TEF in children. (orig.)

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

    Directory of Open Access Journals (Sweden)

    Di Simone MP

    2012-06-01

    Full Text Available Massimo P Di Simone,1 Fabio Baldi,2,3 Valentina Vasina,4 Fabrizio Scorrano,5 Maria Laura Bacci,5 Antonella Ferrieri,6 Gilberto Poggioli11Department of General Surgery and Transplants, 2Centre for the Study and Therapy of the Esophageal Diseases, 3GVM Care and Research, MCH Cotignola (RA, 4Department of Pharmacology, Alma Mater Studiorum, University of Bologna, Bologna, 5Department of Veterinary Medical Science – DMSVET – University of Bologna, Bologna, 6Clinical Research Department, Alfa Wassermann Spa, Bologna, ItalyAbstract: 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.Keywords: bioadhesion, hyaluronic acid, Evans blue dye, animal model, esophagus, reflux esophagitis

  5. Esophageal button battery ingestion in children.

    Science.gov (United States)

    Şencan, Arzu; Genişol, İncinur; Hoşgör, Münevver

    2017-07-01

    Button battery lodged in the esophagus carries a high risk of morbidity and mortality. The purpose of this study was to present cases of patients with esophageal button battery ingestion treated at our clinic and to emphasize the importance of early diagnosis and treatment. Records of patients admitted to our hospital for foreign body ingestion between January 2010 and May 2015 were retrospectively reviewed. Cases with button battery lodged in the esophagus were included in the study. Patient data regarding age, sex, length of time after ingestion until admission, presenting clinical symptoms, type and localization of the battery, management, and prognosis were analyzed. Among 1891 foreign body ingestions, 71 were localized in the esophagus, and 8 of those (11.2%) were cases of button battery ingestion. Mean age was 1.7 years. Admission was within 6 hours of ingestion in 5 cases, after 24 hours had elapsed in 2, and 1 month after ingestion in 1 case. All patients but 1 knew the history of ingestion. Prompt endoscopic removal was performed for all patients. Three patients developed esophageal stricture, which responded to dilatation. Early recognition and timely endoscopic removal is mandatory in esophageal button battery ingestion. It should be suspected in the differential diagnosis of patients with persistent respiratory and gastrointestinal symptoms.

  6. Esophageal Cancer: Associations with pN+

    Science.gov (United States)

    Rice, Thomas W.; Ishwaran, Hemant; Hofstetter, Wayne L.; Schipper, Paul H.; Kesler, Kenneth A.; Law, Simon; Lerut, Toni E.M.R.; Denlinger, Chadrick E.; Salo, Jarmo A.; Scott, Walter J.; Watson, Thomas J.; Allen, Mark S.; Chen, Long-Qi; Rusch, Valerie W.; Cerfolio, Robert J.; Luketich, James D.; Duranceau, Andre; Darling, Gail E.; Pera, Manuel; Apperson-Hansen, Carolyn; Blackstone, Eugene H.

    2017-01-01

    Objectives 1) To identify the association of positive lymph node metastases (pN+), number of positive nodes, and pN subclassification with cancer, treatment, patient, geographic, and institutional variables, and 2) to recommend extent of lymphadenectomy needed to accurately detect pN+ for esophageal cancer. Summary Background Data Limited data and traditional analytic techniques have precluded identifying intricate associations of pN+ with other cancer, treatment, and patient characteristics. Methods Data on 5,806 esophagectomy patients from the Worldwide Esophageal Cancer Collaboration (WECC) were analyzed by Random Forest machine learning techniques. Results pN+, number of positive nodes, and pN subclassification were associated with increasing depth of cancer invasion (pT), increasing cancer length, decreasing cancer differentiation (G), and more regional lymph nodes resected. Lymphadenectomy necessary to accurately detect pN+ is 60 for shorter, well-differentiated cancers (<2.5 cm) and 20 for longer, poorly differentiated ones. Conclusions In esophageal cancer, pN+, increasing number of positive nodes, and increasing pN classification are associated with deeper invading, longer, and poorly differentiated cancers. Consequently, if the goal of lymphadenectomy is to accurately define pN+ status of such cancers, few nodes need to be removed. Conversely, superficial, shorter, and well-differentiated cancers require a more extensive lymphadenectomy to accurately define pN+ status. PMID:28009736

  7. Preoperative embolization therapy for esophageal operation.

    Science.gov (United States)

    Akiyama, S; Kodera, Y; Sekiguchi, H; Kasai, Y; Kondo, K; Ito, K; Takagi, H

    1998-12-01

    Since 1993, we have performed preoperative embolization therapy (PET) in an attempt to augment the blood flow of the gastric tube and prevent anastomotic leakage after esophageal resection. The clinical effects and complications associated with PET are reported. The femoral artery was punctured and the left gastric artery, right gastric artery, and splenic artery underwent embolization, leaving the right gastroepiploic artery as the only patent feeding artery for the stomach. PET was performed in 54 patients, and data concerning blood flow of the stomach before and after the construction of the gastric tube were available in 51 patients. Of the 25 patients who were operated in the same period without undergoing PET, similar data were available in 20 patients. In the group of patients who underwent PET, the blood flow of the gastric tube after its construction was 67% of the value measured at the upper part of the stomach just after opening the abdominal cavity. For those who were not pretreated by PET, it declined to 33%. PET for esophageal cancer is a safe procedure that contributes to the decrease in the frequency of anastomotic dehiscence after esophageal operation, owing to the augmented tissue blood flow of the upper portion of the stomach following the construction of gastric tubes.

  8. Fluoroscopic extraction of esophageal foreign body

    Energy Technology Data Exchange (ETDEWEB)

    Chon, Su Bin; Han, Young Min; Chung, Gyung Ho; Sohn, Myung Hee; Kim, Chong Soo; Choi, Ki Chul [Chonbuk National University College of Medicine, Chungju (Korea, Republic of); Song, Young Ho [Asan Medical Center, Ulsan Universty College of Medicine, Seoul (Korea, Republic of); Choi, Yeon Wha [Chungju Ri-Rha Hospital, Chungju (Korea, Republic of)

    1993-09-15

    The purpose of this study is to report our 5 year experience with fluoroscopic removal of blunt esophageal foreign body or impacted food in 15 consecutive patients who were referred by endoscopists because they couln't remove it endoscopically. The foreign body or impacted food was a piece of meat, a bean, a badug stone or a beef bone. Thirteen patients had underlying disease (11 of corrosive stricture, 2 of postopertive stricture) but 2 patient did not. We removed the object using one of the following 4 techniques: Basket extraction technique. Foley catheter technique, single balloon technique (dilatation of stenosis for passing the food into the stomach and for the treatment of the stricture as well), double balloon technique (removal of the foregin body by trapping it with two valvuloplasty balloons). Removal was successful in all patients. Esophageal performation occurred in one patient using the sibgle balloon technique, who treated nonoperatively by means of fasting, antibiotics and parenteral alimentation. No procedure related death occurred in these series. In conclusion, fliuroscopic removal of blunt esophageal foreign bodies of impacted food with various techniques is promising alternative to esophagoscopic removal.

  9. Fluoroscopic extraction of esophageal foreign body

    International Nuclear Information System (INIS)

    Chon, Su Bin; Han, Young Min; Chung, Gyung Ho; Sohn, Myung Hee; Kim, Chong Soo; Choi, Ki Chul; Song, Young Ho; Choi, Yeon Wha

    1993-01-01

    The purpose of this study is to report our 5 year experience with fluoroscopic removal of blunt esophageal foreign body or impacted food in 15 consecutive patients who were referred by endoscopists because they couln't remove it endoscopically. The foreign body or impacted food was a piece of meat, a bean, a badug stone or a beef bone. Thirteen patients had underlying disease (11 of corrosive stricture, 2 of postopertive stricture) but 2 patient did not. We removed the object using one of the following 4 techniques: Basket extraction technique. Foley catheter technique, single balloon technique (dilatation of stenosis for passing the food into the stomach and for the treatment of the stricture as well), double balloon technique (removal of the foregin body by trapping it with two valvuloplasty balloons). Removal was successful in all patients. Esophageal performation occurred in one patient using the sibgle balloon technique, who treated nonoperatively by means of fasting, antibiotics and parenteral alimentation. No procedure related death occurred in these series. In conclusion, fliuroscopic removal of blunt esophageal foreign bodies of impacted food with various techniques is promising alternative to esophagoscopic removal

  10. Diagnosis and Treatment of Eosinophilic Esophagitis.

    Science.gov (United States)

    Straumann, Alex; Katzka, David A

    2018-01-01

    Eosinophilic esophagitis (EoE) is a new disease. It is caused by a T-helper type 2 cell response to food antigens in contact with the esophageal mucosa. Although no single feature defines EoE, a constellation of compatible demographic, clinical, endoscopic, and histologic findings establish the diagnosis. Children present with symptoms and endoscopic patterns characteristic of inflammation, whereas adolescents and adults have manifestations of fibrosis and gross esophageal strictures. Clinical and endoscopic scoring systems have helped to standardize diagnosis. There is controversy in EoE research over the optimal endpoint for treatment. Although the most common endpoint is a reduced number of eosinophils in biopsies, changes in symptoms and endoscopic features are becoming important targets of therapy. We should improve our understanding of EoE progression and the need for maintenance therapy, and continue development of diagnostic tools that avoid endoscopy and biopsy analyses to more easily monitor disease activity. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

  11. [Laparoscopic Heller myotomy for esophageal achalasia].

    Science.gov (United States)

    Ibáñez, Luis; Butte, Jean Michel; Pimentel, Fernando; Escalona, Alex; Pérez, Gustavo; Crovari, Fernando; Guzmán, Sergio; Llanos, Osvaldo

    2007-04-01

    Achalasia is characterized by an incomplete relaxation of the lower esophageal sphincter. The best treatment is surgical and the laparoscopic approach may have good results. To assess the results of laparoscopic Heller myotomy among patients with achalasia. Prospective study of patients subjected to a laparoscopic Heller myotomy between 1995 and 2004. Clinical features, early and late operative results were assessed. Twenty seven patients aged 12 to 74 years (12 females) were operated. All had disphagia lasting for a mean of 32 months. Mean lower esophageal sphincter pressure ranged from 18 to 85 mmHg. Eight patients received other treatments prior to surgery but symptoms persisted or reappeared. The preoperative clinical score was 7. No patient died and no procedure had to be converted to open surgery. In a follow up of 21 to 131 months, all patients are satisfied with the surgical results and the postoperative clinical score is 1. Only one patient with a mega esophagus maintained a clinical score of six. In this series of patients, laparoscopic Heller myotomy was an effective and safe treatment for esophageal achalasia.

  12. Family history of esophageal cancer increases the risk of esophageal squamous cell carcinoma

    Science.gov (United States)

    Chen, Tiantian; Cheng, Hongwei; Chen, Xingdong; Yuan, Ziyu; Yang, Xiaorong; Zhuang, Maoqiang; Lu, Ming; Jin, Li; Ye, Weimin

    2015-01-01

    A population-based case-control was performed to explore familial aggregation of esophageal squamous cell carcinoma (ESCC). Family history of cancer was assessed by a structured questionnaire, and from which 2 cohorts of relatives of cases and controls were reconstructed. Unconditional logistic regression and Cox proportional hazards regression were applied for case-control design and reconstructed cohort design, respectively. We observed a close to doubled risk of ESCC associated with a positive family history of esophageal cancer among first degree relatives (odds ratio [OR] = 1.85, 95% confidence interval [CI]: 1.42–2.41), after adjusting age, sex, family size and other confounders. The excess risks of ESCC increased with the increasing of first-degree relatives affected by esophageal cancer (p < 0.001). In particular, those individuals whose both parents with esophageal cancer had an 8-fold excess risk of ESCC (95% CI: 1.74–36.32). The reconstructed cohort analysis showed that the cumulative risk of esophageal cancer to age 75 was 12.2% in the first-degree relatives of cases and 7.0% in those of controls (hazard ratio = 1.91, 95% CI: 1.54–2.37). Our results suggest family history of esophageal cancer significantly increases the risk for ESCC. Future studies are needed to understand how the shared genetic susceptibility and/or environmental exposures contribute to the observed excess risk. PMID:26526791

  13. Congenital esophageal stenosis associated with esophageal atresia/tracheoesophageal fistula: clinical and radiologic features

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, Hye Jin; Kim, Woo Sun; Cheon, Jung-Eun; Shin, Su-Mi; Kim, In-One; Yeon, Kyung Mo [Seoul National University College of Medicine and the Institute of Radiation Medicine, Department of Radiology, Seoul (Korea); Yoo, So-Young [Seoul National University College of Medicine and the Institute of Radiation Medicine, Department of Radiology, Seoul (Korea); Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Seoul (Korea); Park, Kwi-Won; Jung, Sung-Eun [Seoul National University Children' s Hospital, Department of Pediatric Surgery, Seoul (Korea)

    2010-08-15

    Congenital esophageal stenosis (CES) can be associated with esophageal atresia/tracheoesophageal fistula (EA/TEF). Because there are a variety of degrees of obstruction and symptoms of CES, it is frequently difficult to make a pre- and post-operative diagnosis of the distal CES associated with EA/TEF. To evaluate the clinical and radiologic features of congenital esophageal stenosis associated with esophageal atresia/tracheoesophageal fistula. We retrospectively reviewed postoperative esophagograms and medical records of 187 children (107 boys, 80 girls) who had primary repair of EA/TEF from 1992 to 2009 at our institution. We evaluated the incidence of CES, clinical findings, radiologic features and management of CES in these children. CES was diagnosed in 22 of 187 EA/TEF children (12%); one child had double CES lesions, for a total of 23 lesions. Ten of those 22 children (45%) had presented with significant symptoms of esophageal obstruction. The diagnosis of CES was delayed in 10 children (45%) until 1-10 years of age. On esophagogram, CES (n = 23) was located in the distal esophagus (n = 20, 87%) or mid-esophagus (n = 3, 13%). The degree of stenosis was severe (n = 6, 26%), moderate (n = 10, 43%), or mild (n = 7, 30%). Eight children, including two with unsuccessful esophageal balloon dilatation of CES, were treated surgically. Histologic examination revealed tracheobronchial remnant (n = 7) or fibromuscular hyperplasia (n = 1). One child with surgically treated CES developed achalasia at the age of 3 years 9 months. Esophagography after EA/TEF repair should be performed with a high index of suspicion for the presence of distal CES, because the diagnosis and adequate management of CES can often be delayed. (orig.)

  14. Gastroesophageal reflux after esophageal surgery. Evaluation by means of esophageal transit scintigram

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, Osamu; Yokoi, Hideki; Maebeya, Shinji and others

    1989-04-01

    By means of esophageal transit scintigram using /sup 99m/Tc-DTPA, 15 patients (13 esophageal carcinomas and 2 cardia carcinomas) were studied, in whom esophagogastric anastomosis was done according to the posterior invagination anastomosis technique we had devised. In all 8 patients with anastomosis at cervical region, gastroesophageal reflux was not seen on both scintigrams before and after meals, and the average pressure gradient of high pressure zone at anastomosis was 39.8 cmH/sub 2/O. In 2 of 7 patients with intrathoracic anastomosis, the scintigram before meals showed severe reflux. and the endoscopic findings showed diffuse and moderate erosion in the esophageal mucosa. The average pressure gradient across the anastomosis was 6.5 cmH/sub 2/O. In these 2 patients, the new fornix with a sharp angle of His was not formed. In the remaining 5 patients with intrathoracic anastomosis, reflux was not seen on the scintigram before meals. However, in 2 of them, the scintigram after meal and endoscopic examination revealed mild reflux and mild esophagitis respectively. Furthermore in one patient very mild reflux was observed only on the scintigram after meals but the endoscopic findings showed the normal esophageal mucosa. In these 5 patients, the average pressure gradient across the anastomosis was 17.0 cmH/sub 2/O, which was significantly higher (p<0.01) than that in 2 patients with severe reflux and was significantly lower (p<0.01) than the mean value of high pressure zone in 8 patients with cervical anastomosis. In conclusion, it is presumed that the formation of a large fornix enough to store food and a sharp angle of His are important factors in maintaining an anti-reflux mechanism. The esophageal transit scintigram was proved to be an excellent technique in detecting and evaluating quantitatively gastroesophageal reflux. (author).

  15. Randomized clinical trial: efficacy and safety of PPC-5650 on experimental esophageal pain and hyperalgesia in healthy volunteers

    DEFF Research Database (Denmark)

    Olesen, Anne Estrup; Nielsen, Lecia Møller; Larsen, Isabelle Myriam

    2015-01-01

    OBJECTIVE: Gastroesophageal reflux disease (GERD) is a common condition associated with symptoms as heart burn, regurgitation, chest pain, and gastrointestinal discomfort. PPC-5650 is a new pharmacological agent that can modulate acid-sensing ion channel activity, potentially leading to reduction...... in the pain signal. In healthy volunteers the esophagus was sensitized with acid to mimic GERD with the aims: 1) to assess the efficacy of a single bolus of PPC-5650 locally applied to the esophagus using multimodal pain stimulations, and 2) to assess the safety profile of PPC-5650. MATERIALS AND METHODS......: The study was a randomized, double-blinded, placebo-controlled, crossover trial in healthy males. Esophageal electrical, thermal, mechanical, and chemical stimulations were performed, pain perception was rated, and referred pain areas were drawn. Sensitization was induced by intraluminal esophageal acid...

  16. Esophageal Perforation: A Rare Complication of Transesophageal Echocardiography in a Patient with Asymptomatic Esophagitis

    Directory of Open Access Journals (Sweden)

    Kabir Ahmed

    2012-12-01

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

  17. Increased Risk of Esophageal Eosinophilia and Eosinophilic Esophagitis in Patients With Active Celiac Disease on Biopsy.

    Science.gov (United States)

    Jensen, Elizabeth T; Eluri, Swathi; Lebwohl, Benjamin; Genta, Robert M; Dellon, Evan S

    2015-08-01

    The possible association between eosinophilic esophagitis (EoE) and celiac disease is controversial because prior results have been contradictory. We aimed to determine the relationship between EoE and celiac disease among patients with concomitant esophageal and duodenal biopsies. We conducted a cross-sectional study in a U.S. national pathology database by using data from January 2009 through June 2012. Our primary case definition was defined by the presence of esophageal eosinophilia with ≥15 eosinophils per high-power field. The crude and adjusted (for age and sex) odds of esophageal eosinophilia for patients with active celiac disease were compared with those without celiac disease. Sensitivity analyses were performed by using more stringent case definitions and by estimating the associations between celiac disease and reflux esophagitis and celiac disease and Barrett's esophagus. Of 292,621 patients in the source population, 88,517 with both esophageal and duodenal biopsies were studied. Four thousand one hundred one (4.6%) met criteria for EoE, and 1203 (1.4%) met criteria for celiac disease. Odds of EoE were 26% higher in patients with celiac disease than in patients without celiac disease (adjusted odds ratio [aOR], 1.26; 95% confidence interval [CI], 0.98-1.60). The magnitude of association varied according to EoE case definition, but all definitions showed a weak positive association between the 2 conditions. There was no association between celiac disease and reflux esophagitis (aOR, 0.95; 95% CI, 0.85-1.07) or Barrett's esophagus (aOR, 0.89; 95% CI, 0.69-1.14) and celiac disease. There is a weak increase in EoE in patients with celiac disease. This association strengthened with increasingly stringent definitions of EoE and was not observed for other esophageal conditions. In patients with celiac disease, concomitant EoE should be considered in the correct clinical setting. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights

  18. Attributable causes of esophageal cancer incidence and mortality in China.

    Directory of Open Access Journals (Sweden)

    Jian-Bing Wang

    Full Text Available To estimate the contribution of tobacco smoking, alcohol drinking, low vegetable intake and low fruit intake to esophageal cancer mortality and incidence in China.We calculated the proportion of esophageal cancer attributable to four known modifiable risk factors [population attributable fraction (PAF]. Exposure data was taken from meta-analyses and large-scale national surveys of representative samples of the Chinese population. Data on relative risks were also from meta-analyses and large-scale prospective studies. Esophageal cancer mortality and incidence came from the 3(rd national death cause survey and population-based cancer registries in China. We estimated that 87,065 esophageal cancer deaths (men 67,686; women: 19,379 and 108,206 cases (men: 83,968, women: 24,238 were attributable to tobacco smoking, alcohol drinking, low vegetable intake and low fruit intake in China in 2005. About 17.9% of esophageal cancer deaths among men and 1.9% among women were attributable to tobacco smoking. About 15.2% of esophageal cancer deaths in men and 1.3% in women were caused by alcohol drinking. Low vegetable intake was responsible for 4.3% esophageal cancer deaths in men and 4.1% in women. The fraction of esophageal cancer deaths attributable to low fruit intake was 27.1% in men and 28.0% in women. Overall, 46% of esophageal cancers (51% in men and 33% in women were attributable to these four modifiable risk factors.Tobacco smoking, alcohol drinking, low vegetable intake and low fruit intake were responsible for 46% of esophageal cancer mortality and incidence in China in 2005. These findings provide useful data for developing guidelines for esophageal cancer prevention and control in China.

  19. Aberrant nuclear localization of β-catenin without genetic alterations in β-catenin or Axin genes in esophageal cancer

    Directory of Open Access Journals (Sweden)

    Shinoda Noriyuki

    2007-02-01

    Full Text Available Abstract Background β-catenin is a multifunctional protein involved in two apparently independent processes: cell-cell adhesion and signal transduction. β-catenin is involved in Wnt signaling pathway that regulates cellular differentiation and proliferation. In this study, we investigated the expression pattern of β-catenin and cyclin D1 using immunohistochemistry and searched for mutations in exon 3 of the β-catenin gene and Axin gene in esophageal squamous cell carcinoma. Materials and methods Samples were obtained from 50 esophageal cancer patients. Immunohistochemical staining for β-catenin and cyclin D1 was done. Mutational analyses of the exon3 of the β-catenin gene and Axin gene were performed on tumors with nuclear β-catenin expression. Results Four (8% esophageal cancer tissues showed high nuclear β-catenin staining. Overexpression of cyclin D1 was observed in 27 out of 50 (54% patients. All four cases that showed nuclear β-catenin staining overexpressed cyclin D1. No relationship was observed between the expression pattern of β-catenin and cyclin D1 and age, sex, tumor size, stage, differentiation grade, lymph node metastasis, response to chemotherapy, or survival. No mutational change was found in β-catenin exon 3 in the four cases with nuclear β-catenin staining. Sequencing analysis of the Axin cDNA revealed only a splicing variant (108 bp deletion, position 2302–2409 which was present in the paired normal mucosa. Conclusion A fraction of esophageal squamous cell carcinomas have abnormal nuclear accumulation of β-catenin accompanied with increased cyclin D1 expression. Mutations in β-catenin or axin genes are not responsible for this abnormal localization of β-catenin.

  20. Esophageal dysphagia and reflux symptoms before and after oral IQoro(R) training.

    Science.gov (United States)

    Hägg, Mary; Tibbling, Lita; Franzén, Thomas

    2015-06-28

    To examine whether muscle training with an oral IQoro(R) screen (IQS) improves esophageal dysphagia and reflux symptoms. A total of 43 adult patients (21 women and 22 men) were consecutively referred to a swallowing center for the treatment and investigation of long-lasting nonstenotic esophageal dysphagia. Hiatal hernia was confirmed by radiologic examination in 21 patients before enrollment in the study (group A; median age 52 years, range: 19-85 years). No hiatal hernia was detected by radiologic examination in the remaining 22 patients (group B; median age 57 years, range: 22-85 years). Before and after training with an oral IQS for 6-8 mo, the patients were evaluated using a symptom questionnaire (esophageal dysphagia and acid chest symptoms; score 0-3), visual analogue scale (ability to swallow food: score 0-100), lip force test (≥ 15 N), velopharyngeal closure test (≥ 10 s), orofacial motor tests, and an oral sensory test. Another twelve patients (median age 53 years, range: 22-68 years) with hiatal hernia were evaluated using oral IQS traction maneuvers with pressure recordings of the upper esophageal sphincter and hiatus canal as assessed by high-resolution manometry. Esophageal dysphagia was present in all 43 patients at entry, and 98% of patients showed improvement after IQS training [mean score (range): 2.5 (1-3) vs 0.9 (0-2), P < 0.001]. Symptoms of reflux were reported before training in 86% of the patients who showed improvement at follow-up [1.7 (0-3) vs 0.5 (0-2), P < 0.001). The visual analogue scale scores were classified as pathologic in all 43 patients, and 100% showed improvement after IQS training [71 (30-100) vs 22 (0-50), P < 0.001]. No significant difference in symptom frequency was found between groups A and B before or after IQS training. The lip force test [31 N (12-80 N) vs 54 N (27-116), P < 0.001] and velopharyngeal closure test values [28 s (5-74 s) vs 34 s (13-80 s), P < 0.001] were significantly higher after IQS training. The

  1. Hereditary urea cycle abnormality

    Science.gov (United States)

    ... into amino acids. Ammonia is produced from leftover amino acids, and it must be removed from the body. The liver produces several chemicals (enzymes) that change ammonia into a form called urea, which the body can remove in ...

  2. Nitrofurantoin and congenital abnormalities

    DEFF Research Database (Denmark)

    Czeizel, A.E.; Rockenbauer, M.; Sørensen, Henrik Toft

    2001-01-01

    Objective: To study human teratogenic potential of oral nitrofurantoin treatment during pregnancy. Materials and Methods: Pair analysis of cases with congenital abnormalities and matched population controls in the population-based dataset of the Hungarian Case-Control Surveillance of Congenital...

  3. CT of pleural abnormalities

    International Nuclear Information System (INIS)

    Webb, W.R.

    1995-01-01

    Briefly discussed were CT diagnosis of pleural thickening, CT technique for examining the pleura or pleuro-pulmonary disease, diagnosis of pleural collections, diagnosis of pleural fluid abnormalities in patients with pneumonia, pleural neoplasms, malignant (diffuse) mesothelioma, metastases, local fibrous tumor of the pleura (benign mesothelioma) (21 refs.)

  4. Chromosomal abnormalities and autism

    African Journals Online (AJOL)

    Farida El-Baz

    2015-06-19

    Jun 19, 2015 ... ORIGINAL ARTICLE. Chromosomal abnormalities and autism. Farida El-Baz a. , Mohamed Saad Zaghloul a. , Ezzat El Sobky a. ,. Reham M Elhossiny a,. *, Heba Salah a. , Neveen Ezy Abdelaziz b a Pediatric Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt b Children with Special ...

  5. High Prevalence of Esophageal Dysmotility in Asymptomatic Obese Patients

    Directory of Open Access Journals (Sweden)

    Justin Côté-Daigneault

    2014-01-01

    Full Text Available BACKGROUND: Obesity is an important health problem affecting >500 million people worldwide. Esophageal dysmotility is a gastrointestinal pathology associated with obesity; however, its prevalence and characteristics remain unclear. Esophageal dysmotilities have a high prevalence among obese patients regardless of gastrointestinal symptoms.

  6. Challenges in oral drug delivery in patients with esophageal dysphagia

    NARCIS (Netherlands)

    Kappelle, W.F.; Siersema, P.D.; Bogte, A.; Vleggaar, F.P.

    2016-01-01

    INTRODUCTION: Esophageal dysphagia is a commonly reported symptom with various benign and malignant causes. Esophageal dysphagia can impede intake of oral medication, which often poses a major challenge for both patients and physicians. The best way to address this challenge depends of the cause of

  7. Acute esophageal necrosis: a case report and review | Lahbabi ...

    African Journals Online (AJOL)

    Acute esophageal necrosis, commonly referred to as "black esophagus" or "acute necrotizing esophagitis", is a rare clinical disorder with an unclear etiology. The definition excludes patients with a history of recent caustic ingestion. Oesophageal necrosis can be diagnosed at endoscopy by the presence of black necroting ...

  8. The changing epidemiology of esophageal cancer in sub-Saharan ...

    African Journals Online (AJOL)

    Introduction: Esophageal cancer portends a grim prognosis. Most patients present with incurable disease. Scanty epidemiologic data on the disease has contributed to its low priority on the national. We sought to evaluate the current national trend in the presentation and outcome of esophageal cancer using our institutional ...

  9. Jejunum for bridging long-gap esophageal atresia

    NARCIS (Netherlands)

    Bax, Klaas (N) M. A.

    OBJECTIVE: Exploring pros and cons of bridging long-gap esophageal atresia with an orthotopic jejunal pedicle graft. Retrospective series of 19 patients. METHODS: From 1988 through 2005, 19 patients with long-gap esophageal atresia received a jejunal graft. Median age at reconstruction was 76 days.

  10. Esophageal atresia: our experiences in a university hospital ...

    African Journals Online (AJOL)

    Introduction and aim Esophageal atresia is a relatively common congenital malformation occurring one in 2500–3000 live births. The aim of this study was to determine the frequency, type of anomaly, and mortality and to detect the associated anomaly in patients with esophageal atresia. Patients and methods All neonates ...

  11. External beam radiotherapy combined with intraluminal brachytherapy in esophageal carcinoma

    NARCIS (Netherlands)

    Muijs, Christina T.; Beukema, Jannet C.; Mul, Veronique E.; Plukker, John Th; Sijtsema, Nanna M.; Langendijk, Johannes A.

    Purpose: To assess the effectiveness of definitive radiation therapy in patients with potentially curable esophageal cancer and to evaluate the side-effects of this treatment. Methods and materials: Sixty-two patients with esophageal cancer, who were treated with definitive, curatively intended

  12. Incidence of Biliary Reflux Esophagitis After Laparoscopic Omega Loop Gastric Bypass in Morbidly Obese Patients.

    Science.gov (United States)

    Salama, Tamer M Said; Hassan, Mohamed Ibrahim

    2017-06-01

    Omega loop gastric bypass is a successful bariatric surgery with numerous favorable circumstances as being basic, effective on weight reduction and treatment of obesity associated metabolic disorder, the short expectation to learn and adapt, and the simplicity of correction and inversion. However, there are arguments about the possibility of biliary reflux and/or the potential danger of gastroesophageal malignancy after the procedure. Fifty patients experiencing morbid obesity with body mass index >40 or >35 kg/m 2 with two related comorbidities, for example, diabetes type II, hypertension, or dyslipidemia, underwent omega loop gastric bypass with a follow-up period up to 18 months, investigating for any symptom of reflux infection by upper gastrointestinal tract endoscopy and pH metry. Reflux esophagitis (a gastroesophageal reflux disease) was detected in 3 patients (6%); 2 cases (4%) showed (Grade A) acidic reflux esophagitis at 6 and 12 months postoperatively. Just 1 case (2%) had experienced gastroesophageal biliary reflux esophagitis (Grade A) at 12 months. No metaplasia or dysplasia was detected in the endoscopic biopsies. Omega loop gastric bypass is a safe and effective bariatric procedure with low incidence of postoperative biliary reflux, metaplasia, or dysplasia at the esophagogastric junction, confirmed 18 months after the operation.

  13. Optimization and Evaluation Strategy of Esophageal Tissue Preparation Protocols for Metabolomics by LC-MS.

    Science.gov (United States)

    Wang, Huiqing; Xu, Jing; Chen, Yanhua; Zhang, Ruiping; He, Jiuming; Wang, Zhonghua; Zang, Qingce; Wei, Jinfeng; Song, Xiaowei; Abliz, Zeper

    2016-04-05

    Sample preparation is a critical step in tissue metabolomics. Therefore, a comprehensive and systematic strategy for the screening of tissue preparation protocols is highly desirable. In this study, we developed an Optimization and Evaluation Strategy based on LC-MS to screen for a high-extractive efficiency and reproducible esophageal tissue preparation protocol for different types of endogenous metabolites (amino acids, carnitines, cholines, etc.), with a special focus on low-level metabolites. In this strategy, we first selected a large number of target metabolites based on literature survey, previous work in our lab, and known metabolic pathways. For these target metabolites, we tested different solvent extraction methods (biphasic solvent extraction, two-step [TS], stepwise [SW], all-in one [AO]; single-phase solvent extraction, SP) and esophageal tissue disruption methods (homogenized wet tissue [HW], ground wet tissue [GW], and ground dry tissue [GD]). A protocol involving stepwise addition of solvents and a homogenized wet tissue protocol (SWHW) was superior to the others. Finally, we evaluated the stability of endogenous metabolites in esophageal tissues and the sensitivity, reproducibility, and recovery of the optimal protocol. The results proved that the SWHW protocol was robust and adequate for bioanalysis. This strategy will provide important guidance for the standardized and scientific investigation of tissue metabolomics.

  14. Mediastinal abscess and esophageal stricture following voice prosthesis insertion.

    Science.gov (United States)

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

    2014-04-01

    The use of a tracheo-esophageal voice prosthesis is a well-established procedure to restore the voice in total laryngectomees. The insertion of the prosthesis is not a risk-free procedure, various complications having been reported especially in irradiated patients. Here described is a case of an esophageal rupture after secondary tracheo-esophageal puncture with mediastinal abscess in a patient previously treated with pharyngo-laryngectomy and subsequent radiotherapy for a left pyriform sinus carcinoma, which required immediate surgical drainage through a left cervical approach. Few weeks after surgical drainage an esophageal stricture at the site of the rupture developed, which was only temporarily resolved after the insertion of biodegradable esophageal stents, followed by re-stenosis once the reabsorption of the stent took place. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  15. Esophageal-gastric anastomosis in radical resection of esophageal cancer under thoracoscopy combined with laparoscopy.

    Science.gov (United States)

    Hao, Zhang; Zhenya, Shen; Lei, Wang

    2014-10-01

    To determine the feasibility of esophagogastric anastomosis in esophageal cancer radical resection under thoracoscopy combined with laparoscopy in terms of complications and operation time. Experimental study. Department of Thoracic Surgery, Affiliated with The First Hospital, Suzhou University, from June 2008 to June 2012. Clinical data of 136 patients operated for esophageal cancer by radical resection under thoracoscopy combined with laparoscopy was analyzed. Eighty one superior and middle segment esophageal carcinoma patients were operated through right thoracoscope, abdominoscope, and neck incision. The esophagogastric anastomosis was completed in the left side of neck by handiwork. Fifty five inferior segment esophageal carcinoma were operated through right thoracoscope, abdominoscope and the esophagogastric anastomosis was completed with stapler in right thoracic cavity through superior belly incision and diaphragmatic hiatus. The operation time and the intra-operative blood loss in patients with intrathoracic mechanical anastomosis was significantly lower than that of cervical anastomosis. Other variables were not significantly different. The practicability of this method of anastomosis that completed with stapler in right thoracic cavity through superior belly incision and diaphragmatic hiatus had been well confirmed.

  16. Esophageal - Gastric Anastomosis in Radical Resection of Esophageal Cancer under Thoracoscopy Combined with Laparoscopy

    International Nuclear Information System (INIS)

    Hao, Z.; Lei, W.; Zhenya, S.

    2014-01-01

    Objective: To determine the feasibility of esophagogastric anastomosis in esophageal cancer radical resection under thoracoscopy combined with laparoscopy in terms of complications and operation time. Study Design: Experimental study. Place and Duration of Study: Department of Thoracic Surgery, Affiliated with The First Hospital, Suzhou University, from June 2008 to June 2012. Methodology: Clinical data of 136 patients operated for esophageal cancer by radical resection under thoracoscopy combined with laparoscopy was analyzed. Eighty one superior and middle segment esophageal carcinoma patients were operated through right thoracoscope, abdominoscope, and neck incision. The esophagogastric anastomosis was completed in the left side of neck by handiwork. Fifty five inferior segment esophageal carcinoma were operated through right thoracoscope, abdominoscope and the esophagogastric anastomosis was completed with stapler in right thoracic cavity through superior belly incision and diaphragmatic hiatus. Results: The operation time and the intra-operative blood loss in patients with intrathoracic mechanical anastomosis was significantly lower than that of cervical anastomosis. Other variables were not significantly different. Conclusion: The practicability of this method of anastomosis that completed with stapler in right thoracic cavity through superior belly incision and diaphragmatic hiatus had been well confirmed. (author)

  17. Comparative evaluation of esophageal Barrett's epithelium through esophageal capsule endoscopy and methylene blue chromoendoscop

    Directory of Open Access Journals (Sweden)

    T.A. Domingos

    2013-04-01

    Conclusions: ECE appears to be a good method for detecting lesions in which there is suspicion of esophageal cancer and it had modest results in regard to the accurate identification of BE length and pattern. ECE is not a good method for detecting hiatal hernia. Further studies are needed in order to define the definitive role of ECE in BE monitoring.

  18. Prevalence of extra-esophageal cancers in patients with Barrett's esophagus and esophageal adenocarcinoma.

    Science.gov (United States)

    Talukdar, Anjan; Chak, Amitabh; Lee, Tommy; Fang, Xiang; Watson, Patrice; Lynch, Henry; Mittal, Sumeet

    2012-01-01

    To compare the prevalence of extra-esophageal cancers in patients diagnosed with Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC) with SEER database. Patients with BE and EAC are part of a NIH supported Familial Barrett's investigation involving personal and family history and pathology correlation recorded in the database. Data pertaining to extra-esophageal cancers in the proband was extracted into an excel datasheet for analysis. Expected prevalence obtained from SEER (Surveillance, Epidemiology and End Results) NIH database (1973-2006) for the general population, matched for age, was compared with our cohort. Chi-square test was used for statistical analysis. There were 1091 probands in the database of whom 876 had complete personal history. The mean age was 57.6 (5-84 years) with 807 Caucasians and 710 males. Overall incidence of extra-esophageal cancers was higher in our cohort when compared with the general population. There is a strong association of certain cancer types in patients with BE and EAC. However, further epidemiologic and genetic research is needed for investigation and development of genetic fingerprints.

  19. ESOPHAGEAL HYPOMOTILITY IN PRIMARY AND SECONDARY RAYNAUDS-PHENOMENON - COMPARISON OF ESOPHAGEAL SCINTIGRAPHY WITH MANOMETRY

    NARCIS (Netherlands)

    LIMBURG, A.J.; Beekhuis, H; Smit, A.J; Kallenberg, Cees; Piers, D.A; Kleibeuker, Jan

    Esophageal motility was assessed by manometry and scintigraphy in 25 patients with primary Raynaud's phenomenon and 24 patients with secondary Raynaud's phenomenon as part of a connective tissue disorder. Methods: For each scintigraphic study, transit time was evaluated after three separate

  20. Esomeprazole tablet vs omeprazole capsule in treating erosive esophagitis

    Science.gov (United States)

    Chen, Chih-Yen; Lu, Ching-Liang; Luo, Jiing-Chyuan; Chang, Full-Young; Lee, Shou-Dong; Lai, Yung-Ling

    2005-01-01

    AIM: Esomeprazole, an oral S-form of omeprazole, has been a greater acid inhibitor over omeprazole in treating acid-related diseases. Only less published data is available to confirm its efficacy for Asian people. Therefore, a perspective, double-blind, randomized comparison of esomeprazole tablets 40 mg (Nexium®) vs omeprazole capsules 20 mg (Losec®) in treating Chinese subjects with erosive/ulcerative reflux esophagitis (EE) was conducted. METHODS: A total of 48 EE patients were enrolled and randomized into two treatment groups under 8-wk therapy: 25 receiving esomeprazole, while another 23 receiving omeprazole treatment. Finally, 44 completed the whole 8-wk therapy. RESULTS: The difference in healing EE between two groups was 22.7% (72.7% vs 50.0%), not reaching significant value (P = 0.204). The median of the first time needed in relieving heartburn sensation was 1 d for both groups and the remission rates for heartburn on the 1st d after treatment were 77.3% and 65%, respectively (NS). The scores of various reflux relieving symptoms evaluated either by patients or by investigators were not different. Regarding drug safety, 28% of esomeprazole group and 26.1% of omeprazole group reported at least one episode of adverse effects, while constipation and skin dryness were the common side effects in both groups (NS). CONCLUSION: Esomeprazole 40 mg is an effective and safe drug at least comparable to omeprazole in treating Chinese EE patients. PMID:15918199

  1. Inflammation-Related Carcinogenesis and Prevention in Esophageal Adenocarcinoma Using Rat Duodenoesophageal Reflux Models

    Energy Technology Data Exchange (ETDEWEB)

    Fujimura, Takashi, E-mail: tphuji@staff.kanazawa-u.ac.jp; Oyama, Katsunobu; Sasaki, Shozo; Nishijima, Koji; Miyashita, Tomoharu; Ohta, Tetsuo [Gastroenterologic Surgery, Kanazawa University Hospital, Kanazawa, Japan, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641 (Japan); Koichi, Miwa [Houju Memorial Hospital, Nomi, Japan, 11-71 Midorigaoka, Nomi, Ishikawa 923-1226 (Japan); Takanori, Hattori [Division of Molecular and Diagnostic Pathology, Shiga University of Medical Science, Otsu, Japan, Seta Tsukinowa-cho, Otsu, Shiga 520-2192 (Japan)

    2011-08-10

    Development from chronic inflammation to Barrett's adenocarcinoma is known as one of the inflammation-related carcinogenesis routes. Gastroesophageal reflux disease induces regurgitant esophagitis, and esophageal mucosa is usually regenerated by squamous epithelium, but sometimes and somewhere replaced with metaplastic columnar epithelium. Specialized columnar epithelium, so-called Barrett's epithelium (BE), is a risk factor for dysplasia and adenocarcinoma in esophagus. Several experiments using rodent model inducing duodenogastroesophageal reflux or duodenoesophageal reflux revealed that columnar epithelium, first emerging at the proliferative zone, progresses to dysplasia and finally adenocarcinoma, and exogenous carcinogen is not necessary for cancer development. It is demonstrated that duodenal juice rather than gastric juice is essential to develop esophageal adenocarcinoma in not only rodent experiments, but also clinical studies. Antireflux surgery and chemoprevention by proton pump inhibitors, nonsteroidal anti-inflammatory drugs, selective cyclooxygenase-2 inhibitors, green tea, retinoic acid and thioproline showed preventive effects on the development of Barrett's adenocarcinoma in rodent models, but it remains controversial whether antireflux surgery could regress BE and prevent esophageal cancer in clinical observation. The Chemoprevention for Barrett's Esophagus Trial (CBET), a phase IIb, multicenter, randomized, double-masked study using celecoxib in patients with Barrett's dysplasia failed to prove to prevent progression of dysplasia to cancer. The AspECT (Aspirin Esomeprazole Chemoprevention Trial), a large multicenter phase III randomized trial to evaluate the effects of esomeprazole and/or aspirin on the rate of progression to high-grade dysplasia or adenocarcinoma in patients with BE is now ongoing.

  2. Diagnosis of Esophageal Motility Disorders: Esophageal Pressure Topography vs. Conventional Line Tracing.

    Science.gov (United States)

    Carlson, Dustin A; Ravi, Karthik; Kahrilas, Peter J; Gyawali, C Prakash; Bredenoord, Arjan J; Castell, Donald O; Spechler, Stuart J; Halland, Magnus; Kanuri, Navya; Katzka, David A; Leggett, Cadman L; Roman, Sabine; Saenz, Jose B; Sayuk, Gregory S; Wong, Alan C; Yadlapati, Rena; Ciolino, Jody D; Fox, Mark R; Pandolfino, John E

    2015-07-01

    Enhanced characterization of esophageal peristaltic and sphincter function provided by esophageal pressure topography (EPT) offers a potential diagnostic advantage over conventional line tracings (CLT). However, high-resolution manometry (HRM) and EPT require increased equipment costs over conventional systems and evidence demonstrating a significant diagnostic advantage of EPT over CLT is limited. Our aim was to investigate whether the inter-rater agreement and/or accuracy of esophageal motility diagnosis differed between EPT and CLT. Forty previously completed patient HRM studies were selected for analysis using a customized software program developed to perform blinded independent interpretation in either EPT or CLT (six pressure sensors) format. Six experienced gastroenterologists with a clinical focus in esophageal disease (attendings) and six gastroenterology trainees with minimal manometry experience (fellows) from three academic centers interpreted each of the 40 studies using both EPT and CLT formats. Rater diagnoses were assessed for inter-rater agreement and diagnostic accuracy, both for exact diagnosis and for correct identification of a major esophageal motility disorder. The total group agreement was moderate (κ=0.57; 95% CI: 0.56-0.59) for EPT and fair (κ=0.32; 0.30-0.33) for CLT. Inter-rater agreement between attendings was good (κ=0.68; 0.65-0.71) for EPT and moderate (κ=0.46; 0.43-0.50) for CLT. Inter-rater agreement between fellows was moderate (κ=0.48; 0.45-0.50) for EPT and poor to fair (κ=0.20; 0.17-0.24) for CLT. Among all raters, the odds of an incorrect exact esophageal motility diagnosis were 3.3 times higher with CLT assessment than with EPT (OR: 3.3; 95% CI: 2.4-4.5; PCLT than with EPT (OR: 3.4; 2.4-5.0; PCLT among our selected raters. On the basis of these findings, EPT may be the preferred assessment modality of esophageal motility.

  3. Recovery of normal esophageal function in a kitten with diffuse megaesophagus and an occult lower esophageal stricture.

    Science.gov (United States)

    Schneider, Jaycie; Ames, Marisa; DiCicco, Michael; Savage, Mason; Atkins, Clarke; Wood, Michael; Gookin, Jody L

    2015-06-01

    An 8-week-old male domestic shorthair was presented to the Internal Medicine Service at North Carolina State University for regurgitation. Radiographic diagnosis of generalized esophageal dilation and failure of esophageal peristalsis were compatible with diagnosis of congenital megaesophagus. Endoscopic examination of the esophagus revealed a fibrous stricture just orad to the lower esophageal sphincter. Conservative management to increase the body condition and size of the kitten consisted of feeding through a gastrostomy tube, during which time the esophagus regained normal peristaltic function, the stricture orifice widened in size and successful balloon dilatation of the stricture was performed. Esophageal endoscopy should be considered to rule out a stricture near the lower esophageal sphincter in kittens with radiographic findings suggestive of congenital megaesophagus. Management of such kittens by means of gastrostomy tube feeding may be associated with a return of normal esophageal motility and widening of the esophageal stricture, and facilitate subsequent success of interventional dilation of the esophageal stricture. © ISFM and AAFP 2014.

  4. Clinical features of refractory radiation esophageal ulcer after proton beam therapy and its management in a patient with esophageal cancer

    International Nuclear Information System (INIS)

    Hisakura, Katsuji; Terashima, Hideo; Nagai, Kentaro

    2012-01-01

    It has been reported that proton beam therapy is an effective treatment method for patients with locally confined esophageal cancer. However, there seems to be serious problems related to post-radiotherapy (RT) esophageal ulcers. We treated 7 patients who developed post-RT esophageal ulcers with the earliest symptom of esophageal stenosis, which was observed 7-17 months (median, 10.0) after completion of RT. Five of the patients had unhealed ulcers leading to lethal events such as perforation or penetration. The mean time between the appearance of the earliest symptom and lethal episode was no more than 2 months (mean, 2.1). The first 3 patients who underwent conservative therapies died from severe complications caused by perforation or penetration of post-RT esophageal ulcers. In the case of 2 consecutive patients, we performed surgical treatment as soon as possible since there were indications of penetration in post-RT developed esophageal ulcers. Therefore, they could be cured by a salvage operation which was subtotal esophagectomy using the stomach for esophageal replacement. Through the above-mentioned experience, we discussed surgical management for esophageal ulcers after proton beam therapy. (author)

  5. Pulmonary Function Impairment After Trachea-Esophageal Fistula: A Minor Role for Gastro-Esophageal Reflux Disease

    NARCIS (Netherlands)

    Peetsold, M. G.; Heij, H. A.; Nagelkerke, A. F.; Deurloo, J. A.; Gemke, R. J. B. J.

    2011-01-01

    Background: Long-term impairment of pulmonary function in trachea-esophageal fistula (TEF) patients is, at least in part, commonly ascribed to gastro-esophageal reflux disease (GERD). The objective of this study was to examine the independent effects of the underlying condition and GERD on

  6. Esophageal dysfunction in different stages of Parkinson's disease.

    Science.gov (United States)

    Suttrup, I; Suttrup, J; Suntrup-Krueger, S; Siemer, M-L; Bauer, J; Hamacher, C; Oelenberg, S; Domagk, D; Dziewas, R; Warnecke, T

    2017-01-01

    Dysphagia is a clinically relevant symptom in patients with Parkinson's disease (PD) leading to pronounced reduction in quality of life and other severe complications. Parkinson's disease-related dysphagia may affect the oral and pharyngeal, as well as the esophageal phase of swallowing. To examine the nature and extend of esophageal dysphagia in different stages of PD and their relation to oropharyngeal dysfunction, we examined 65 PD patients (mean age 66.3±9.7 years, mean disease duration 7.9±5.8 years, mean Hoehn & Yahr [H&Y] stage 2.89±0.91) and divided into three groups (early [H&Y I+II; n=21], intermediate [H&Y III; n=25], and advanced stadium [H&Y IV+V; n=19]), using esophageal high-resolution manometry (HRM) to detect esophageal motor disorders. Oropharyngeal impairment was assessed using fiberoptic endoscopic evaluation of swallowing. Major esophageal motor disorders were detected in nearly one third of the PD patients. Minor impairment of the esophageal body was present in 95% of participants and throughout all disease stages with pathological findings especially in peristalsis and intrabolus pressure (IBP). The IBP was found to significantly increase in the advanced stadium. Although dysfunction of the upper and lower esophageal sphincters was observed in individual patients, alterations in these esophageal segments revealed no statistical significance compared with normative data. No clear association was found between the occurrence of oropharyngeal dysphagia and esophageal impairment. Esophageal body impairment in PD is a frequent phenomenon during all disease stages, which possibly reflects α-synucleinopathy in the enteric nervous system. © 2016 John Wiley & Sons Ltd.

  7. Temporal Change in Brain Natriuretic Peptide After Radiotherapy for Thoracic Esophageal Cancer

    International Nuclear Information System (INIS)

    Jingu, Keiichi; Nemoto, Kenji; Kaneta, Tomohiro; Oikawa, Minako; Ogawa, Yoshihiro; Ariga, Hisanori; Takeda, Ken; Sakayauchi, Toru; Fujimoto, Keisuke; Narazaki, Kakutaro; Takai, Yoshihiro; Nakata, Eiko; Fukuda, Hiroshi; Takahashi, Shoki; Yamada, Shogo

    2007-01-01

    Purpose: To investigate the relationships of plasma levels of brain natriuretic peptide (BNP) with abnormal 18 F-fluorodeoxyglucose (FDG) accumulation in the myocardium corresponding to irradiated fields and temporal changes in BNP, which is used as an index of heart remodeling, after radiotherapy for the mediastinum. Materials and Methods: Brain natriuretic peptide concentrations were measured before and after radiotherapy for thoracic esophageal cancer, and the change in BNP concentration after radiotherapy was investigated. Moreover, FDG accumulation in the myocardium was investigated in patients who had undergone FDG positron emission tomography less than 14 days before or after measurement of BNP concentration, and the Mann-Whitney U test was used to detect significant difference between BNP concentrations in patients with and without abnormal FDG accumulation corresponding to the irradiated field. Results: There was significant difference between the levels of BNP in patients without abnormal FDG accumulation in the irradiated myocardium and in patients with abnormal FDG accumulation (p 24 months after radiotherapy group were significantly higher than the levels in the before radiotherapy group, immediately after radiotherapy group, 1-2 months after radiotherapy group, and control group. Conclusions: The level of BNP was significantly increased more than 9 months after the start of radiotherapy and was significantly higher in patients who had high FDG accumulation corresponding to the irradiated field. The results of this study indicate that BNP concentration might be an early indicator of radiation-induced myocardial damage

  8. Epigastric Distress Caused by Esophageal Candidiasis in 2 Patients Who Received Sorafenib Plus Radiotherapy for Hepatocellular Carcinoma: Case Report.

    Science.gov (United States)

    Chen, Kuo-Hsin; Weng, Meng-Tzu; Chou, Yueh-Hung; Lu, Yueh-Feng; Hsieh, Chen-Hsi

    2016-03-01

    Sorafenib followed by fractionated radiotherapy (RT) has been shown to decrease the phagocytic and candidacidal activities of antifungal agents due to radiosensitization. Moreover, sorafenib has been shown to suppress the immune system, thereby increasing the risk for candida colonization and infection. In this study, we present the 2 hepatocellular carcinoma (HCC) patients suffered from epigastric distress caused by esophageal candidiasis who received sorafenib plus RT. Two patients who had received sorafenib and RT for HCC with bone metastasis presented with hiccups, gastric ulcer, epigastric distress, anorexia, heart burn, and fatigue. Empiric antiemetic agents, antacids, and pain killers were ineffective at relieving symptoms. Panendoscopy revealed diffuse white lesions in the esophagus. Candida esophagitis was suspected. Results of periodic acid-Schiff staining were diagnostic of candidiasis. Oral fluconazole (150 mg) twice daily and proton-pump inhibitors were prescribed. At 2-weak follow-up, esophagitis had resolved and both patients were free of gastrointestinal symptoms. Physicians should be aware that sorafenib combined with RT may induce an immunosuppressive state in patients with HCC, thereby increasing their risk of developing esophagitis due to candida species.

  9. Antioxidant and Anti-Inflammatory Effects of Rhei Rhizoma and Coptidis Rhizoma Mixture on Reflux Esophagitis in Rats

    Directory of Open Access Journals (Sweden)

    O Jun Kwon

    2016-01-01

    Full Text Available The purpose of this study was to investigate the antioxidant and anti-inflammatory effects of the combined extract of Rhei rhizoma and Coptidis rhizoma (RC-mix in experimental model of acute reflux esophagitis. The antioxidant activity was assessed by in vitro 2,2-diphenyl-1-picrylhydrazyl (DPPH and 2,2′-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid (ABTS assays. RC-mix was given at 100, 200, and 400 mg/kg body weight 2 h prior to induction of reflux esophagitis (RE. After 5 h, the effects of RC-mix treated rats were compared with those of normal and control rats. The representative flavonoid contents of RC-mix, such as sennoside A, epiberberine, coptisine, palmatine, and berberine, were detected using HPLC. The elevated esophageal mucosa damage was markedly ameliorated by RC-mix treatment in a dose-dependent manner. Furthermore, the administration of RC-mix reduced the increase of serum reactive oxygen species (ROS and peroxynitrite (ONOO−. The improvement of superoxide dismutase (SOD and heme oxygenase-1 (HO-1 levels were marked in the group given RC-mix. Moreover, the elevation of inflammatory mediators and cytokines by nuclear factor-kappa B (NF-κB activation in control rats decreased by RC-mix pretreatment. These results indicate that RC-mix treatment reduces the pathological states of esophagitis via regulating NF-κB mediated inflammation related to oxidative stress.

  10. Rare esophageal ulcers related to Behçet disease: A case report.

    Science.gov (United States)

    Jia, Ning; Tang, Yanping; Liu, Huayi; Li, Yang; Liu, Simiao; Liu, Lei

    2017-11-01

    The fundamental pathogenesis of Behçet disease (BD) is still unclear and controversial. Many cases of oral aphthous ulcers and genital ulcers related to BD are reported; nevertheless, idiopathic giant esophageal ulcers related to BD are rare. A rare case for esophageal ulcers related to BD is presented. In China, BD is represented with esophageal involvement which is called esophageal BD (EBD). A 56-year-old man diagnosed to the Gastroenterology Department of Integrated Traditional Chinese and Western Medicine Hospital, for multiple discrete, elliptical esophageal ulcers related to BD. The esophageal ulcers were treated with corticosteroid treatment for 12 weeks. The esophageal ulcers were cured. Our report might give further strength to avoiding the erroneous diagnosis or missed diagnosis for EBD, which is different from esophageal carcinoma, esophageal tuberculosis and esophageal Crohns disease.

  11. Neurological abnormalities predict disability

    DEFF Research Database (Denmark)

    Poggesi, Anna; Gouw, Alida; van der Flier, Wiesje

    2014-01-01

    To investigate the role of neurological abnormalities and magnetic resonance imaging (MRI) lesions in predicting global functional decline in a cohort of initially independent-living elderly subjects. The Leukoaraiosis And DISability (LADIS) Study, involving 11 European centres, was primarily aimed...... at evaluating age-related white matter changes (ARWMC) as an independent predictor of the transition to disability (according to Instrumental Activities of Daily Living scale) or death in independent elderly subjects that were followed up for 3 years. At baseline, a standardized neurological examination.......0 years, 45 % males), 327 (51.7 %) presented at the initial visit with ≥1 neurological abnormality and 242 (38 %) reached the main study outcome. Cox regression analyses, adjusting for MRI features and other determinants of functional decline, showed that the baseline presence of any neurological...

  12. Esophageal stenosis after radiation for laryngeal carcinoma

    International Nuclear Information System (INIS)

    Takeuchi, Kazuhiko; Majima, Yuichi; Nomoto, Yoshito; Okamoto, Yasunori; Sakakura, Yasuo

    1995-01-01

    A 57-year-old female received radiation with 60 Gy, delivered by Cobalt 60 unit for laryngeal carcinoma in 1989. Several months later she complained of dyspnea, and fiberscopic observation revealed fixation of bilateral vocal cords and a swelling of bilateral arytenoid portions. In 1990, she developed difficulty swallowing. Further examinations showed that the cervical esophagus was extremely narrowed but no malignancy was found either in the larynx or in the esophagus. We suspected that the esophageal stenosis was caused by post-radiation fibrosis. (author)

  13. Esophageal stenosis after radiation for laryngeal carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Takeuchi, Kazuhiko; Majima, Yuichi; Nomoto, Yoshito; Okamoto, Yasunori; Sakakura, Yasuo [Mie Univ., Tsu (Japan). School of Medicine

    1995-10-01

    A 57-year-old female received radiation with 60 Gy, delivered by Cobalt 60 unit for laryngeal carcinoma in 1989. Several months later she complained of dyspnea, and fiberscopic observation revealed fixation of bilateral vocal cords and a swelling of bilateral arytenoid portions. In 1990, she developed difficulty swallowing. Further examinations showed that the cervical esophagus was extremely narrowed but no malignancy was found either in the larynx or in the esophagus. We suspected that the esophageal stenosis was caused by post-radiation fibrosis. (author).

  14. Axial force measurement for esophageal function testing

    DEFF Research Database (Denmark)

    Gravesen, Flemming Holbæk; Funch-Jensen, Peter; Gregersen, Hans

    2009-01-01

    force (force in radial direction) whereas the bolus moves along the length of esophagus in a distal direction. Force measurements in the longitudinal (axial) direction provide a more direct measure of esophageal transport function. The technique used to record axial force has developed from external...... documented using imaging modalities such as radiography and scintigraphy. This inconsistency using manometry has also been documented by axial force recordings. This underlines the lack of information when diagnostics are based on manometry alone. Increasing the volume of a bag mounted on a probe...

  15. Misdiagnosed Chest Pain: Spontaneous Esophageal Rupture

    Science.gov (United States)

    Inci, Sinan; Gundogdu, Fuat; Gungor, Hasan; Arslan, Sakir; Turkyilmaz, Atila; Eroglu, Atila

    2013-01-01

    Chest pain is one of themost common complaints expressed by patients presenting to the emergency department, and any initial evaluation should always consider life-threatening causes. Esophageal rupture is a serious condition with a highmortality rate. If diagnosed, successful therapy depends on the size of the rupture and the time elapsed between rupture and diagnosis.We report on a 41-year-old woman who presented to the emergency department complaining of left-sided chest pain for two hours. PMID:27122690

  16. Suspected esophageal coin--look again.

    Science.gov (United States)

    Frumkin, Kenneth; Lanker, Michael

    2016-03-01

    A 4-year-old presented to the emergency department, asymptomatic, with the strong suspicion (by history, physical examination, and initial radiographic interpretation by the emergency physician) of an esophageal coin. Closer inspection revealed radiographic signs associated with disk battery ingestion, a surgical emergency. In the operating room superimposed coins, mimicking the radiographic appearance of a disk (button) battery, were extracted. This case highlights the important management differences between ingested coins and batteries, the need for cautious interpretation of radiographs, and presents a rare mimic of a serious ingestion.

  17. Endoscopic and surgical palliation of esophageal cancer.

    Science.gov (United States)

    Ferrante, G; De Palma, G; Elia, S; Catanzano, C; Cecere, C; Griffo, S; Sivero, L; Costabile, R

    1999-12-01

    Esophageal carcinoma is frequently diagnosed at an advanced stage. Therefore for most patients either surgical or endoscopic palliation with or without radiochemotherapy may be taken into consideration. This retrospective study analyzes immediate and long term results of perendoscopic treatment in patients with unresectable esophageal cancer. Moreover a comparative analysis has been made with a group of patients who underwent palliation surgery. From 1982 to 1998 458 patients with esophageal cancer underwent palliation perendoscopic disobstructive treatment (427 patients), palliation surgery (29 patients) and dis-obstruction followed by perendoscopic gastrostomy (2 patients). Among patients treated by perendoscopic procedures, 18 underwent dilation, 53 dilation and radiotherapy, 236 stent implantation, respectively of the plastic (102) and self-expandable metallic (134) type. 120 patients underwent NdYAG laser treatment. The results for patients who underwent perendoscopic procedures are referred to as regards the first 30 days after treatment and on the long run in terms of grade of dysphagia according to Visick's scale. For the group of patients undergoing simple dilation we had an improvement (from Visick III-IV to I-II) in 33% of cases and in 54.7% when radiotherapy was added. Far better results were achieved in all groups undergoing stent implantation, with or without brachytherapy, and NdYAG laser treatment with or without previous chemical necrolysis (range 90.3-100%). Most frequent complications were obstruction and stent displacement. Mean survival was better for patients undergoing laser recanalisation (7.2 months) while among stents the metallic type has given better results than plastic ones both for survival (6.2 vs 5.9 months) and mortality (2.4 vs 4.9%). Comparison with the group undergoing palliation surgery has shown that mean survival is the same for patients undergoing jejunostomy or gastrostomy while it is significantly better for patients

  18. Predictive factors of esophageal stenosis associated with tumor regression in radiation therapy for locally advanced esophageal cancer

    International Nuclear Information System (INIS)

    Atsumi, Kazushige; Shioyama, Yoshiyuki; Nakamura, Katsumasa

    2010-01-01

    The purpose of this retrospective study was to clarify the predictive factors correlated with esophageal stenosis within three months after radiation therapy for locally advanced esophageal cancer. We enrolled 47 patients with advanced esophageal cancer with T2-4 and stage II-III who were treated with definitive radiation therapy and achieving complete response of primary lesion at Kyushu University Hospital between January 1998 and December 2005. Esophagography was performed for all patients before treatment and within three months after completion of the radiation therapy, the esophageal stenotic ratio was evaluated. The stenotic ratio was used to define four levels of stenosis: stenosis level 1, stenotic ratio of 0-25%; 2, 25-50%; 3, 50-75%; 4, 75-100%. We then estimated the correlation between the esophageal stenosis level after radiation therapy and each of numerous factors. The numbers and total percentages of patients at each stenosis level were as follows: level 1: n=14 (30%); level 2: 8 (17%); level 3: 14 (30%); and level 4: 11 (23%). Esophageal stenosis in the case of full circumference involvement tended to be more severe and more frequent. Increases in wall thickness tended to be associated with increases in esophageal stenosis severity and frequency. The extent of involved circumference and wall thickness of tumor region were significantly correlated with esophageal stenosis associated with tumor regression in radiation therapy (p=0.0006, p=0.005). For predicting the possibility of esophageal stenosis with tumor regression within three months in radiation therapy, the extent of involved circumference and esophageal wall thickness of the tumor region may be useful. (author)

  19. Equipment abnormality monitoring device

    International Nuclear Information System (INIS)

    Ando, Yasumasa

    1991-01-01

    When an operator hears sounds in a plantsite, the operator compares normal sounds of equipment which he previously heard and remembered with sounds he actually hears, to judge if they are normal or abnormal. According to the method, there is a worry that abnormal conditions can not be appropriately judged in a case where the number of objective equipments is increased and in a case that the sounds are changed gradually slightly. Then, the device of the present invention comprises a plurality of monitors for monitoring the operation sound of equipments, a recording/reproducing device for recording and reproducing the signals, a selection device for selecting the reproducing signals among the recorded signals, an acoustic device for converting the signals to sounds, a switching device for switching the signals to be transmitted to the acoustic device between to signals of the monitor and the recording/reproducing signals. The abnormality of the equipments can be determined easily by comparing the sounds representing the operation conditions of equipments for controlling the plant operation and the sounds recorded in their normal conditions. (N.H.)

  20. Folate metabolism abnormalities in autism: potential biomarkers.

    Science.gov (United States)

    Frye, Richard E; Slattery, John C; Quadros, Edward V

    2017-08-03

    Autism spectrum disorder (ASD) has been linked to abnormalities in folate metabolism. Polymorphisms in folate genes may act in complex polygenic ways to increase the risk of developing ASD. Autoantibodies that block folate transport into the brain have been associated with ASD and children with ASD and these autoantibodies respond to high doses of a reduced form of folate known as folinic acid (leucovorin calcium). Some of the same abnormalities are also found in mothers of children with ASD and supplementing folate during preconception and gestational periods reduces the risk to the offspring from developing ASD. These data suggest that folate pathway abnormalities may be a major metabolic disturbance underlying ASD that can be leveraged as biomarkers to improve symptoms and prevent ASD.

  1. Porcine Esophageal Submucosal Gland Culture Model Shows Capacity for Proliferation and DifferentiationSummary

    Directory of Open Access Journals (Sweden)

    Richard J. von Furstenberg

    2017-11-01

    Full Text Available Background & Aims: Although cells comprising esophageal submucosal glands (ESMGs represent a potential progenitor cell niche, new models are needed to understand their capacity to proliferate and differentiate. By histologic appearance, ESMGs have been associated with both overlying normal squamous epithelium and columnar epithelium. Our aim was to assess ESMG proliferation and differentiation in a 3-dimensional culture model. Methods: We evaluated proliferation in human ESMGs from normal and diseased tissue by proliferating cell nuclear antigen immunohistochemistry. Next, we compared 5-ethynyl-2′-deoxyuridine labeling in porcine ESMGs in vivo before and after esophageal injury with a novel in vitro porcine organoid ESMG model. Microarray analysis of ESMGs in culture was compared with squamous epithelium and fresh ESMGs. Results: Marked proliferation was observed in human ESMGs of diseased tissue. This activated ESMG state was recapitulated after esophageal injury in an in vivo porcine model, ESMGs assumed a ductal appearance with increased proliferation compared with control. Isolated and cultured porcine ESMGs produced buds with actively cycling cells and passaged to form epidermal growth factor–dependent spheroids. These spheroids were highly proliferative and were passaged multiple times. Two phenotypes of spheroids were identified: solid squamous (P63+ and hollow/ductal (cytokeratin 7+. Microarray analysis showed spheroids to be distinct from parent ESMGs and enriched for columnar transcripts. Conclusions: Our results suggest that the activated ESMG state, seen in both human disease and our porcine model, may provide a source of cells to repopulate damaged epithelium in a normal manner (squamous or abnormally (columnar epithelium. This culture model will allow the evaluation of factors that drive ESMGs in the regeneration of injured epithelium. The raw microarray data have been uploaded to the National Center for

  2. Porcine Esophageal Submucosal Gland Culture Model Shows Capacity for Proliferation and Differentiation.

    Science.gov (United States)

    von Furstenberg, Richard J; Li, Joy; Stolarchuk, Christina; Feder, Rachel; Campbell, Alexa; Kruger, Leandi; Gonzalez, Liara M; Blikslager, Anthony T; Cardona, Diana M; McCall, Shannon J; Henning, Susan J; Garman, Katherine S

    2017-11-01

    Although cells comprising esophageal submucosal glands (ESMGs) represent a potential progenitor cell niche, new models are needed to understand their capacity to proliferate and differentiate. By histologic appearance, ESMGs have been associated with both overlying normal squamous epithelium and columnar epithelium. Our aim was to assess ESMG proliferation and differentiation in a 3-dimensional culture model. We evaluated proliferation in human ESMGs from normal and diseased tissue by proliferating cell nuclear antigen immunohistochemistry. Next, we compared 5-ethynyl-2'-deoxyuridine labeling in porcine ESMGs in vivo before and after esophageal injury with a novel in vitro porcine organoid ESMG model. Microarray analysis of ESMGs in culture was compared with squamous epithelium and fresh ESMGs. Marked proliferation was observed in human ESMGs of diseased tissue. This activated ESMG state was recapitulated after esophageal injury in an in vivo porcine model, ESMGs assumed a ductal appearance with increased proliferation compared with control. Isolated and cultured porcine ESMGs produced buds with actively cycling cells and passaged to form epidermal growth factor-dependent spheroids. These spheroids were highly proliferative and were passaged multiple times. Two phenotypes of spheroids were identified: solid squamous (P63+) and hollow/ductal (cytokeratin 7+). Microarray analysis showed spheroids to be distinct from parent ESMGs and enriched for columnar transcripts. Our results suggest that the activated ESMG state, seen in both human disease and our porcine model, may provide a source of cells to repopulate damaged epithelium in a normal manner (squamous) or abnormally (columnar epithelium). This culture model will allow the evaluation of factors that drive ESMGs in the regeneration of injured epithelium. The raw microarray data have been uploaded to the National Center for Biotechnology Information Gene Expression Omnibus (accession number: GSE100543).

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

    Science.gov (United States)

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

    2014-04-01

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

  4. Identification of intramural metastasis in esophageal cancer using multiphoton microscopy

    Science.gov (United States)

    Xu, Jian; Kang, Deyong; Zhuo, Shuangmu; Zhu, Xiaoqin; Lin, jiangbo; Chen, Jianxin

    2017-02-01

    Intramural metastasis (IM) of esophageal cancer is defined as metastasis from a primary lesion to the esophageal wall without intraepithelial cancer extension. Esophageal cancer with IM is more common and such cases indicate a poor prognosis. In esophageal surgery, if curative resection is possible, the complete removal of both primary tumor and associated IMs is required. Therefore, accurate diagnosis of IMs in esophageal cancer prior to surgery is of particular importance. Multiphoton microscopy (MPM) with subcellular resolution is well-suited for deep tissue imaging since many endogenous fluorophores of fresh biological tissues are excited through two-photon excited fluorescence (TPEF) and second harmonic generation (SHG). Here, a study to identify IM in fresh tissue section using MPM is reported. In this study, the morphological and spectral differences between IM and surrounding tissue are described. These results show that MPM has the ability to accurately identify IM in esophageal tissues. With improvement of the penetration depth of MPM and the development of multiphton microendoscope, MPM may be a promising imaging technique for preoperative diagnosis of IMs in esophageal cancer in the future.

  5. Effect of aging on the secondary esophageal peristalsis: presbyesophagus revisited.

    Science.gov (United States)

    Ren, J; Shaker, R; Kusano, M; Podvrsan, B; Metwally, N; Dua, K S; Sui, Z

    1995-05-01

    In this study we determined the effect of aging on the capability of the human esophagus to generate secondary peristalsis. We studied nine healthy young (35 +/- 2 yr, 25-45 yr) and nine healthy elderly (74 +/- 3 yr, 70-83 yr) volunteers. We stimulated secondary peristalsis by intraesophageal air injection and balloon distension. All young volunteers exhibited secondary esophageal peristalsis. In four elderly volunteers, secondary peristalsis could not be elicited with injection of any of the tested air volumes. Frequency of stimulation of secondary peristalsis and lower esophageal sphincter (LES) relaxation in response to intraesophageal air distension in the elderly was significantly lower than that in the young (P < 0.01). Stimulation of secondary peristalsis by balloon distension was less consistent compared with the air injection. In conclusion, 1) in the elderly, compared with the young, secondary esophageal peristalsis is either absent or is evoked less frequently after esophageal distension, and complete LES relaxation in response to esophageal air distension is less frequent, and 2) in both young and elderly, secondary esophageal peristalsis is induced more frequently after generalized esophageal distension by air than its segmental distension by a balloon.

  6. Feeling Abnormal: Simulation of Deviancy in Abnormal and Exceptionality Courses.

    Science.gov (United States)

    Fernald, Charles D.

    1980-01-01

    Describes activity in which student in abnormal psychology and psychology of exceptional children classes personally experience being judged abnormal. The experience allows the students to remember relevant research, become sensitized to the feelings of individuals classified as deviant, and use caution in classifying individuals as abnormal.…

  7. Abnormal glucose tolerance and lipid abnormalities in Indian ...

    African Journals Online (AJOL)

    Discussion. Regardless of varying diagnostic classification, abnormal glucose tolerance is a well-documented risk factor. 16 Abnormalities in. Because ofthe small number offemale MI survivors, the effect of obesity and abnormal glucose tolerance on lipid levels was studied in the male patients only. There was no significant.

  8. RELATIONSHIP BETWEEN ESOPHAGITIS GRADES AND HELICOBACTER PYLORI.

    Science.gov (United States)

    Ribeiro, Patrícia Fernanda Saboya; Kubrusly, Luiz Fernandao; Nassif, Paulo Afonso Nunes; Ribeiro, Irma Cláudia Saboya; Bertoldi, Andressa de Souza; Batistão, Venessa Caroline

    2016-01-01

    The Helicobacter pylori infection (HP) is related to the development of gastric lesions and lymphoma; however, it is not known if there is a relation with gastroesophageal reflux disease and reflux esophagitis. To evaluate HP's relationship with esophagitis in patients undergoing upper endoscopy. Observational, retrospective and cross-sectional study, being evaluated 9576 patients undergoing outpatient endoscopic examination during the period between January and December 2015. Were included patients with any esophageal alteration at the examination; greater than 18; of both genders; independent of the complaint or the reason for the examination, illness or drug use. Were excluded those with active bleeding during the examination and in use of anticoagulants. The variables gender, age, esophagitis and result of the urease test, were studied. For statistical analysis was used the Epi Info software 7.1.5.2. Most of the samples consisted of women and the overall average age was 46.54±16.32 years. The presence of infection was balanced for gender: 1204 (12.56%) women and 952 (13.92%) men. Relating degree of esophagitis HP- and HP+ was observed that the type A was the most common (58.79%, n=1460); 604 (24.32%) had grade B; 334 (13.45%) grade C, and 85 (3.42%) grade D. In the relation between the grade of esophagitis with gender, esophagitis A was predominant in women and present in 929 (63.33%), followed by type B, 282 (46.68%), 136 C (40.71%) and D 30 (35.29%). In men 531 (36.36%) showed type A, 322 (53.31%) B, 198 (59.28%) C, and 55 (64.70%) D. Among the groups 40-50 and over 60 years there was a significant difference in whether have or not have HP+. There is no significant difference between HP infection and the different grades of esophagitis. A infecção pelo Helicobacter pylori (HP) é relacionada com o desenvolvimento de lesões e linfoma gástricos; porém, ainda não se sabe ao certo se há relação dele com a doença do refluxo gastroesofágico e esofagite

  9. Esophageal hiatus surgery: video laparoscopic approach

    International Nuclear Information System (INIS)

    Rodriguez, G.; Fernandez, G.; Gatti, A.; Balboa, O.

    2003-01-01

    Since the early nineties,surgery of esophageal hiatus(treatment of disease due to gastroesophageal reflux,gastric denervation surgery in treatment of duodenal chronic ulcer)through video laparoscopic approach,has gained broad dissemination and acceptance at world level.This phenomenon is explained by the excellent exposure and visualization of an anatomic region which is deeply situated in the upper hemi abdomen, added to the advantages of an approach which, while minimally invasive, attains short and medium term results comparable to those of conventional surgery.The describes the initial experience of the authors with this type of surgery as well as a review of literature, with special emphasis on the surgical technique employed.Case material covers 23 patient: fourteen had Nissen Rossetti fun duplication, 4 suffered from miotomies associated with fun duplications of varying type and 5 were gastric denervation surgeries by reason of duodenal ulcer.There were 2 conversions, both due to esophageal perforation.There were no major postoperative complications and mortality was nil. while functional results were highly satisfactory.The authors therefore conclude that since results which they obtained were coincidental with those of international bibliography, work along these lines should continue

  10. Rare cause of odynophagia: Giant esophageal ulcer.

    Science.gov (United States)

    Veroux, Massimiliano; Aprile, Giuseppe; Amore, Francesca F; Corona, Daniela; Giaquinta, Alessia; Veroux, Pierfrancesco

    2016-04-14

    Gastrointestinal complications are a frequent cause of morbidity after transplantation and may affect up to 40% of kidney transplant recipients. Here we report a rare case of idiopathic giant esophageal ulcer in a kidney transplant recipient. A 37-year-old female presented with a one-week history of odynophagia and weight loss. Upon admission, the patient presented cold sores, and a quantitative cytomegalovirus polymerase chain reaction was positive (10(5) copies/mL). An upper endoscopy demonstrated the presence of a giant ulcer. Serological test and tissue biopsies were unable to demonstrate an infectious origin of the ulcer. Immunosuppression was reduced and everolimus was introduced. An empirical i.v. therapy with acyclovir was started, resulting in a dramatic improvement in symptoms and complete healing of the ulcer. Only two cases of idiopathic giant esophageal ulcer in kidney transplant recipients have been reported in the literature; in both cases, steroid therapy was successful without recurrence of symptoms or endoscopic findings. However, this report suggests that correction of immune imbalance is mandatory to treat such a rare complication.

  11. Quality Management and Key Performance Indicators in Oncologic Esophageal Surgery.

    Science.gov (United States)

    Gockel, Ines; Ahlbrand, Constantin Johannes; Arras, Michael; Schreiber, Elke Maria; Lang, Hauke

    2015-12-01

    Ranking systems and comparisons of quality and performance indicators will be of increasing relevance for complex "high-risk" procedures such as esophageal cancer surgery. The identification of evidence-based standards relevant for key performance indicators in esophageal surgery is essential for establishing monitoring systems and furthermore a requirement to enhance treatment quality. In the course of this review, we analyze the key performance indicators case volume, radicality of resection, and postoperative morbidity and mortality, leading to continuous quality improvement. Ranking systems established on this basis will gain increased relevance in highly complex procedures within the national and international comparison and furthermore improve the treatment of patients with esophageal carcinoma.

  12. Esophageal Perforation with Unilateral Fluidothorax Caused by Nasogastric Tube

    Directory of Open Access Journals (Sweden)

    Lukas P. Mileder

    2016-01-01

    Full Text Available Preterm infants are highly susceptible to injuries following necessary and often life-saving medical interventions. Esophageal perforation is a rare, yet serious complication that can be caused by aerodigestive tract suction, endotracheal intubation, or nasogastric tube placement. We present the case of a neonate born at 23 weeks plus three days of gestation with chest radiography showing malposition of the nasogastric feeding tube and massive right-sided effusion of Iopamidol in the pleural cavity due to esophageal perforation. In addition, the article summarizes common signs and symptoms associated with esophageal perforation in infants and discusses diagnostic approaches.

  13. Acute esophageal necrosis: an uncommon cause of hematemesis.

    Science.gov (United States)

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

    2014-07-01

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

  14. Acute Esophageal Necrosis: An Uncommon Cause of Hematemesis

    Directory of Open Access Journals (Sweden)

    George Sarin Zacharia

    2014-07-01

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

  15. Esophageal replacement in patients under 3 months of age.

    Science.gov (United States)

    Vargas Gomez, M

    1994-04-01

    From 1985 to 1991, esophageal replacement was performed in seven patients with esophageal atresia without fistula. In four, the operation was performed in the neonatal period; three of these patients are alive. The other three patients were operated on between 2 and 3 months of age; two of them are alive. Six of the patients had colonic interposition, and the other had gastric interposition. Of the two patients who died, one had multiple associated malformations; the other one had a massive barium bronchoaspiration before the esophageal replacement.

  16. Esophageal Gastrointestinal Stromal Tumor: Diagnostic Complexity and Management Pitfalls

    Directory of Open Access Journals (Sweden)

    Charalampos G. Markakis

    2013-01-01

    Full Text Available 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.

  17. The impact of bariatric surgery on esophageal function.

    Science.gov (United States)

    Tolone, Salvatore; Savarino, Edoardo; Yates, Robert B

    2016-10-01

    Obesity is a worldwide epidemic. There is increasing evidence that obesity is associated with benign gastroesophageal disease, including gastroesophageal reflux disease (GERD) and esophageal dysmotility. Bariatric surgery-including sleeve gastrectomy, gastric bypass, and adjustable gastric band placement-can effectively result in weight loss and control of obesity-related conditions, including GERD. However, there is increasing evidence that bariatric surgery itself can have a deleterious effect on esophageal function. In this review, we address the effect of obesity and bariatric surgery on esophageal dysfunction. © 2016 New York Academy of Sciences.

  18. Eosinophilic Esophagitis in Children from Western Saudi Arabia: Relative Frequency, Clinical, Pathological, Endoscopic, and Immunological Study

    Directory of Open Access Journals (Sweden)

    Omar I. Saadah

    2012-01-01

    Full Text Available Background and Purpose. Eosinophilic esophagitis (EE is an evolving allergic disease with an accelerated incidence. The purpose of this study was to delineate the relative frequency and clinicopathological characteristics of EE in children from western Saudi Arabia. Methods. Children with EE were studied retrospectively between October 2002 and December 2011 at King Abdulaziz University Hospital and International Medical Center. Results. The relative frequency of EE was 0.85% of 2127 upper gastrointestinal endoscopies performed during the study period. Eighteen patients were identified with EE. The median age was 8.6 years (range, 1.5–18 years. Thirteen (72.2% were males. Dysphagia and vomiting were the most common symptoms. Ten (55.6% children had history of atopy. Testing for food allergy by skin prick test was positive in 11 (61.1%. The most common endoscopic abnormalities were mucosal longitudinal furrow and loss of vascular pattern followed by patchy specks and strictures. The histopathological findings included increased intraepithelial eosinophils, eosinophilic degranulation, lamina propria fibrosis, and eosinophilic microabscesses. Treatment was initiated by swallowed topical corticosteroids in 12 (66.7% and oral prednisolone in 6 (33% patients, followed by low dose of topical corticosteroids and dietary elimination. Conclusions. Eosinophilic esophagitis is an uncommon but evolving problem. A high index of suspicion is required for early identifications and intervention to avoid possible complications.

  19. High-resolution manometric characteristics help differentiate types of distal esophageal obstruction in patients with peristalsis

    Science.gov (United States)

    GYAWALI, C. P.; KUSHNIR, V. M.

    2013-01-01

    Background High-resolution manometry (HRM) can identify obstructive motor features at the esophagogastric junction and abnormalities in esophageal bolus transit. We sought to determine if HRM patterns can differentiate functional from organic mechanical lower esophageal sphincter (LES) obstruction. Methods Segmental characteristics of peristalsis were examined using HRM in symptomatic subjects with elevated postdeglutitive residual pressure gradients across the LES (≥5 mmHg). Sixteen consecutive patients with non-achalasic mechanical fixed obstruction were compared with 13 patients with elevated pressure gradients yet no mechanical obstruction and 14 asymptomatic controls. Pressure volumes were determined in mmHg cm s for peristaltic segments defined on HRM Clouse plots using an on-screen pressure volume measurement tool. Key Results Residual pressure gradients were similarly elevated in both patient groups. A visually conspicuous and distinctive shift in the proportionate pressure strengths of the second and third peristaltic segments was apparent across groups. Whereas the ratios of peak pressures and pressure volumes between second and third segments approached 1 in controls (0.92, 0.98), pressures shifted to the second segment in mechanical obstruction (peak pressure ratio: 1.2 ± 0.4; pressure volume ratio: 1.8 ± 0.9) and to the third segment in functional obstruction (peak ratio: 0.7 ± 0.2; volume ratio: 0.5 ± 0.2; P peristalsis can differentiate fixed mechanical obstruction from functional obstruction. PMID:21303431

  20. [Psycho-autonomic aspects in patients with gastroesophageal reflux disease, and functional esophageal disorders].

    Science.gov (United States)

    Pogromov, A P; Diukova, G M; Rykova, S M; Bein, A M

    2005-01-01

    The subjects of the study were 79 patients (35 with functional esophageal disorders (FED), 24 with nonerosive reflux disease (NERD), and 20 with erosive reflux disease (ERD), who were selected on the basis of clinical complaints, 24-hour ph-study, and esophagogastroduodenoscopy. All the subjects were evaluated by means of clinical questionnaires and psychological tests: Beck depression test, Spielberg State-Trait Anxiety inventory (STAI), and Toronto alexithymia test (TAS). In FED and NERD patients vs. ERD patients the following abnormalities were observed more frequently: autonomic and functional somatic symptoms (apart from gastrointestinal tract (GIT) complaints) (p eating behavior disorders (DEBQ) (p < 0.05), maternal overprotection in childhood (p < 0.05), psychophysioligical GIT reaction in childhood (p < 0.05), higher levels of state and trait anxiety (p < 0.05), and hypochondria (p < 0.05). The clinical symptom index (CSI) (the sum of stomach and bowel complaints to the sum of esophageal complaints ratio) was calculated. CSI in FED and NERD patients was 1.8, while CSI in ERD patients--0.1 (p < 0). Thus, compared to ERD patients, patients with FED and NERD were characterized by more pronounced emotional, motivational, and autonomic disorders. Besides, CSI demonstrated that the character of gastrointestinal dysfunction was more diffuse in NERD and FED and more local--in ERD patients.

  1. Exercises to Improve Gait Abnormalities

    Science.gov (United States)

    ... Articles Directories Videos Resources Contact Exercises to Improve Gait Abnormalities Home » Article Categories » Exercise and Fitness Font Size: A A A A Exercises to Improve Gait Abnormalities Next Page The manner of how a ...

  2. Abnormal activity of default mode network in GERD patients.

    Science.gov (United States)

    Sun, Huihui; Chen, Ying; Zhao, Xiaohu; Wang, Xiangbin; Jiang, Yuanxi; Wu, Ping; Tang, Yinhan; Meng, Qingwei; Xu, Shuchang

    2013-07-11

    Abnormal processing of esophageal sensation at the level of the central nervous system has been proven to be involved in gastroesophageal reflux disease (GERD). However, most studies were focused on the possible functions of perceptual processing related network during task status, little attention has been paid to default mode network, which has been manifested to be important in the pathogenesis of many diseases. In our study, we compared the brain activity characteristic in GERD patients with the healthy subjects (HS) at baseline, looking for whether activities of default mode network were abnormal in GERD patients and attempting to identify their possible roles in GERD. In present study, fractional amplitude of low-frequency fluctuation was adopted to detect the brain activities at baseline. Group-level analyses were conducted by one-sample t test within groups (voxel thresholds were p42, corrected P90, corrected Pdefault mode network such as medial superior frontal gyrus, precuneus, posterior cingulate gyrus, etc. However, the activities of precuneus and posterior cingulate gyrus were significantly lower in GERD patients than those in the HS. The activities of precuneus and posterior cingulate gyrus of default mode network in GERD patients were significantly lower compared to the HS, suggesting abnormal activities of brain regions in default mode network may be involved in pathophysiology of GERD symptom generation.

  3. [Penile congenital abnormalities].

    Science.gov (United States)

    Boillot, B; Teklali, Y; Moog, R; Droupy, S

    2013-07-01

    Congenital abnormalities of the penis are usually diagnosed at birth and pose aesthetic and functional problems sometimes requiring surgical management. A literature review was conducted on Medline considering the articles listed until January 2012. Hypospadias is the most common malformation (1 in 250 boys. Familial forms: 7%). The causes remain hypothetical but the doubling of the incidence in 30 years could be linked to fetal exposure to endocrine disruptors "estrogen-like" used in the food industry in particular. Surgical treatment is usually intended to improve the aesthetic appearance but sometimes, in case of significant curvature or posterior meatus, necessary for normal sexual life and fertility. Other malformations (epispades, buried penis, transpositions, twists and preputial abnormalities) as well as management for functional or aesthetic consequences of these malformations in adulthood require complex surgical care in a specialized environment. The improvement of surgical techniques and pediatric anesthesia allows an early and effective specialized surgical approach of penile malformations. Management of sequelae in adulthood must be discussed and requires experience of surgical techniques on pediatric and adult penis. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  4. Impact of sarcopenia on outcome in patients with esophageal resection following neoadjuvant chemotherapy for esophageal cancer.

    Science.gov (United States)

    Paireder, M; Asari, R; Kristo, I; Rieder, E; Tamandl, D; Ba-Ssalamah, A; Schoppmann, S F

    2017-02-01

    Nutritional status and body composition parameters such as sarcopenia are important risk factors for impaired outcome in patients with esophageal cancer. This study was conducted to evaluate the effect of sarcopenia on long-term outcome after esophageal resection following neoadjuvant treatment. Skeletal muscle index (SMI) and body composition parameters were measured in patients receiving neoadjuvant treatment for locally advanced esophageal cancer. Endpoints included relapse-free survival (RFS) and overall survival (OS). The study included 130 patients. Sarcopenia was found in 80 patients (61.5%). Patients with squamous-cell cancer (SCC) showed a decreased median SMI of 48 (range 28.4-60.8) cm/m 2 compared with that of patients with adenocarcinoma (AC) of 52 (range 34.4-74.2) cm/m 2 , P sarcopenia had a significant impact on patient outcome: HR 1.69 (1.04-2.75), P = 0.036. Median OS was 20.5 (7.36-33.64) versus 52.1 (13.55-90.65) months in sarcopenic and non-sarcopenic patients, respectively. Sarcopenia was identified as an independent risk factor: HR 1.72 (1.049-2.83), P = 0.032. Our data provide evidence that sarcopenia impacts long-term outcome after esophageal resection in patients who have undergone neoadjuvant therapy. Assessment of the body composition parameter can be a reasonable part of patient selection and may influence treatment methods. Copyright © 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  5. From reflux esophagitis to Barrett’s esophagus and esophageal adenocarcinoma

    Science.gov (United States)

    Wang, Rui-Hua

    2015-01-01

    The occurrence of gastroesophageal reflux disease is common in the human population. Almost all cases of esophageal adenocarcinoma are derived from Barrett’s esophagus, which is a complication of esophageal adenocarcinoma precancerous lesions. Chronic exposure of the esophagus to gastroduodenal intestinal fluid is an important determinant factor in the development of Barrett’s esophagus. The replacement of normal squamous epithelium with specific columnar epithelium in the lower esophagus induced by the chronic exposure to gastroduodenal fluid could lead to intestinal metaplasia, which is closely associated with the development of esophageal adenocarcinoma. However, the exact mechanism of injury is not completely understood. Various animal models of the developmental mechanisms of disease, and theoretical and clinical effects of drug treatment have been widely used in research. Recently, animal models employed in studies on gastroesophageal reflux injury have allowed significant progress. The advantage of using animal models lies in the ability to accurately control the experimental conditions for better evaluation of results. In this article, various modeling methods are reviewed, with discussion of the major findings on the developmental mechanism of Barrett’s esophagus, which should help to develop better prevention and treatment strategies for Barrett’s esophagus. PMID:25954094

  6. Intestinal and gastric permeability in children with eosinophilic esophagitis and reflux esophagitis.

    Science.gov (United States)

    Leung, Aldrich J T; Persad, Sujata; Slae, Mordechai; Abdelradi, Amr; Kluthe, Cheryl; Shirton, Leanne; Danchuk, Ronda; Persad, Rabin; Meddings, Jon; Huynh, Hien Q

    2015-02-01

    Eosinophilic esophagitis (EoE) is an allergic and immune-mediated entity that leads to a characteristic inflammation of esophageal mucosa. Patients complain of dysphagia and reflux-like symptoms. As many as 80% of patients with EoE may also have a history of atopy, and patients with asthma and eczema have previously been shown to have increased intestinal permeability. This study was designed to assess small intestinal and gastric permeability in patients with EoE and to see whether it differed from healthy individuals and patients with reflux esophagitis (RE). Gastric and small intestinal permeability was measured using sugar probe tests containing lactulose, mannitol, and sucrose. Lactulose-to-mannitol (L/M) ratios in the patient's urine were a measure for intestinal permeability, and total sucrose was a measure for gastric permeability. We analyzed samples from 23 patients with EoE, 20 RE, 14 normal upper endoscopy with gastrointestinal symptoms, and 26 healthy controls. All of the 4 groups had L/M ratios less than the upper limit of normal (<0.025). There was no statistically significant difference in gastric permeability between the 4 groups (L/M P = 0.26, sucrose P = 0.46). Our data suggest that an alteration in gastric and intestinal permeability does not play a role in EoE or RE pathogenesis.

  7. Partially covered esophageal stents cause bowel injury when used to treat complications of bariatric surgery.

    Science.gov (United States)

    Wei, Wei; Ramaswamy, Archana; de la Torre, Roger; Miedema, Brent W

    2013-01-01

    We hypothesized that an esophageal nitinol stent that is mainly silicone-covered but partially uncovered may allow tissue ingrowth and decrease the migration rate seen with fully covered stents and still allow safe stent removal. The aim of this study was to evaluate the first human results of using partially covered stents for anastomotic complications of bariatric surgery. This was a retrospective evaluation of all patients with staple-line complications after bariatric surgery who received a partly covered stent at a single tertiary-care bariatric center. The stents varied in length from 10 to 15 cm and in diameter from 18 to 23 mm. From April 2009 to April 2010, eight patients received partially covered stents on 14 separate occasions. The indications were gastrojejunal stricture in four, acute leak in two, acute leak followed by a later stricture in one, and a perforated anastomotic ulcer in one patient. Single stents were placed in 12 sessions and two overlapping stents in two sessions. At the time of stent deployment, one patient had the uncovered proximal end of the stent in the stomach, with all others in the distal esophagus. Immediate symptom improvement occurred in 12/14 stent placements. Oral nutrition was initiated for 10/14 stent treatments within 48 h. Stents were removed after 25 ± 10 days. Minor stent displacement occurred with 9/13 stents, with the proximal end of the stent moving into the stomach, though the site of pathology remained covered. The stents were difficult to remove when tissue ingrowth was present. One patient required laparoscopic removal and one required two endoscopy sessions for removal. At the time of removal of ten stents, where the proximal end was found in the stomach, four had gastric ulceration, three had gastric mucosa replaced by granulation tissue, and three had normal gastric mucosa. In four cases where the proximal portion of the stent stayed in the esophagus, the esophageal deployment zone had abnormalities: three

  8. Vegetables and fruits consumption and risk of esophageal and gastric cancer subtypes in the Netherlands Cohort Study

    NARCIS (Netherlands)

    Steevens, J.; Schouten, L.J.; Goldbohm, R.A.; Brandt, P.A. van den

    2011-01-01

    Prospective epidemiologic data on vegetables and fruits consumption and risk of subtypes of esophageal and gastric cancer are sparse. We studied the association between vegetables and fruits consumption and risk of esophageal squamous cell carcinoma (ESCC), esophageal adenocarcinoma (EAC), gastric

  9. [Polyps esophageal cardio-conversion in children: causes, clinical picture, management and prognosis of tactics].

    Science.gov (United States)

    Sergeeva, T N

    2009-01-01

    105 children with polyps of esophago-gastric junction region, detected by gastroscopy, were under follow up during 1-9 years. 55 children with polyp size less than 5 mm were followed up without endoscopic polypectomy (EP) and 50 children with polyp size more than 5 mm and another indications underwent EP. Polyps were more frequently encountered in males aged 7-15 years without specific clinical symptoms; histologically, there were hyperplastic polyps. The majority of children (94.5%) treated conservatively were found to have absence of growth or polyp regression. Risk factors of reappearing of polyps after EP were progress of esophagitis and abnormal gastroesophageal flap valve. According to results of 24-hour pH monitoring of esophagus, alkaline gastroesophageal reflux was diagnosed only in patients with polyps in comparison with children without polyps with chronic diseases of upper floor of digestive tract (p = 0.04).

  10. The Multifactorial Origin of Respiratory Morbidity in Patients Surviving Neonatal Repair of Esophageal Atresia

    Science.gov (United States)

    Fragoso, Ana Catarina; Tovar, Juan A.

    2014-01-01

    Esophageal atresia with or without tracheoesophageal fistula (EA ± TEF) occurs in 1 out of every 3000 births. Current survival approaches 95%, and research is therefore focused on morbidity and health-related quality of life issues. Up to 50% of neonates with EA ± TEF have one or more additional malformations including those of the respiratory tract that occur in a relatively high proportion of them and particularly of those with vertebral, anal, cardiac, tracheoesophageal, renal, and limb association. Additionally, a significant proportion of survivors suffer abnormal pulmonary function and chronic respiratory tract disease. The present review summarizes the current knowledge about the nature of these symptoms in patients treated for EA ± TEF, and explores the hypothesis that disturbed development and maturation of the respiratory tract could contribute to their pathogenesis. PMID:24829898

  11. Assessment of esophageal transit of liquid: Comparison of several data processing methods

    International Nuclear Information System (INIS)

    Ham, H.R.; Georges, B.; Dobbeleir, A.; Guillaume, M.; Erbsmann, F.

    1984-01-01

    The choice of data processing technique to be applied in assessing esophageal transit depends on the information sought. For some particular purposes, the method of choice is obvious. The minimal transit time for example is best obtained by the time of arrival (Ta) while the mean duration of stay of the bolus inside a given region is best given by the mean transit time (MTT). Concerning the optimal method to detect transit abnormalities for which this study has been conducted, the following conclusion can be drawn: 1. A quantitative technique should always be used together with a qualitative technique in order to detect sources of errors in the quantitation. 2. The best methods are the simultaneous used of condensed image and the ratio of moments or the mean time from decay if an ultra-short half-time radiotracer is used. (orig.)

  12. Essential role of STX6 in esophageal squamous cell carcinoma growth and migration

    Energy Technology Data Exchange (ETDEWEB)

    Du, Jin [Department of Cardiothoracic Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029 (China); Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028 (China); Liu, Xiang [Department of Cardiothoracic Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029 (China); Wu, Yanhu, E-mail: wuyanhu@njmu.edu.cn [Department of Cardiothoracic Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029 (China); Zhu, Jinfu; Tang, Yihu [Department of Cardiothoracic Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029 (China)

    2016-03-25

    Abnormalities in endosomes, or dysregulation in their trafficking, play an important role directly in many diseases including oncogenesis. Syntaxin-6 (STX6) is involved in diverse cellular functions in a variety of cell types and has been shown to regulate many intracellular membrane trafficking events such as endocytosis, recycling and anterograde and retrograde trafficking. However, its expression pattern and biological functions in esophageal squamous cell carcinoma (ESCC) remained unknown. Here, we have found that the expression of STX6 was up-regulated in ESCC samples, its expression was significantly correlated with tumor size, histological differentiation, lymph node metastasis and depth. On one hand, STX6 silencing inhibited ESCC cells viability and proliferation in a p53-dependent manner. On the other hand, STX6 effect integrin trafficking and regulate ESCC cells migration. Taken together, our study revealed the oncogenic roles of STX6 in the progression of ESCC, and it might be a valuable target for ESCC therapy.

  13. Esofagomanometria e pHmetria esofágica de 24 h em uma ampla amostra de pacientes com manifestações respiratórias Esophageal manometry and 24-h esophageal pH-metry in a large sample of patients with respiratory symptoms

    Directory of Open Access Journals (Sweden)

    Mirna da Mota Machado

    2008-12-01

    manometry and 24-h esophageal pH-metry were analyzed.The inclusion criterion was presenting respiratory symptoms, with or without accompanying digestive symptoms. RESULTS: Of the 1,170 patients included in the study, 602 (51.5% reported having digestive and respiratory symptoms (DRS group, and 568 (48.5% reported having only respiratory symptoms (RS group. Asthma was diagnosed in 142 patients in the RS group (RS-A subgroup and in 201 of those in the DRS group (DRS-A. Of the 346 cases of esophageal dysmotility, hypomotility was found in 175 (14.3% and 15.6% in the DRS and RS groups, respectively, and lower esophageal sphincter (LES hypotonia was found in 411 (40.3% and 30.2%, respectively. Hypotonia correlated with GERD. Exposure of the distal esophagus to acid was markedly abnormal in the supine position. The prevalence of GERD in the sample as a whole, the RS-A/DRS-A subgroups and the RS-A subgroup alone was 39.8%, 44.0% and 35.2%, respectively CONCLUSIONS: Hypotonic LES was the most common abnormality and correlated with GERD. Although GERD was more evident in the DRS group, approximately one third of the patients in the RS group also presented GERD (silent GERD. The findings suggest that GERD can be an extrapulmonary cause of chronic respiratory symptoms unresponsive to conventional therapy.

  14. Objectively Quantifying Radiation Esophagitis With Novel Computed Tomography–Based Metrics

    International Nuclear Information System (INIS)

    Niedzielski, Joshua S.; Yang, Jinzhong; Stingo, Francesco; Martel, Mary K.; Mohan, Radhe; Gomez, Daniel R.; Briere, Tina M.; Liao, Zhongxing; Court, Laurence E.

    2016-01-01

    Purpose: To study radiation-induced esophageal expansion as an objective measure of radiation esophagitis in patients with non-small cell lung cancer (NSCLC) treated with intensity modulated radiation therapy. Methods and Materials: Eighty-five patients had weekly intra-treatment CT imaging and esophagitis scoring according to Common Terminlogy Criteria for Adverse Events 4.0, (24 Grade 0, 45 Grade 2, and 16 Grade 3). Nineteen esophageal expansion metrics based on mean, maximum, spatial length, and volume of expansion were calculated as voxel-based relative volume change, using the Jacobian determinant from deformable image registration between the planning and weekly CTs. An anatomic variability correction method was validated and applied to these metrics to reduce uncertainty. An analysis of expansion metrics and radiation esophagitis grade was conducted using normal tissue complication probability from univariate logistic regression and Spearman rank for grade 2 and grade 3 esophagitis endpoints, as well as the timing of expansion and esophagitis grade. Metrics' performance in classifying esophagitis was tested with receiver operating characteristic analysis. Results: Expansion increased with esophagitis grade. Thirteen of 19 expansion metrics had receiver operating characteristic area under the curve values >0.80 for both grade 2 and grade 3 esophagitis endpoints, with the highest performance from maximum axial expansion (MaxExp1) and esophageal length with axial expansion ≥30% (LenExp30%) with area under the curve values of 0.93 and 0.91 for grade 2, 0.90 and 0.90 for grade 3 esophagitis, respectively. Conclusions: Esophageal expansion may be a suitable objective measure of esophagitis, particularly maximum axial esophageal expansion and esophageal length with axial expansion ≥30%, with 2.1 Jacobian value and 98.6 mm as the metric value for 50% probability of grade 3 esophagitis. The uncertainty in esophageal Jacobian calculations can be reduced

  15. [Management of the esophageal candidiasis by the primary care physician].

    Science.gov (United States)

    Behrens, Garance; Bocherens, Astrid; Senn, Nicolas

    2014-05-14

    Esophageal candidiasis is one of the most common opportunistic infections in patients infected by human immunodeficiency virus (HIV). This pathology is also found in patients without overt immunodeficiency. Other risk factors are known to be associated with this disease like inhaled or systemic corticosteroid treatment or proton-pump inhibitors and H2 receptor antagonists. In the absence of identified risk factors, a primary immune deficiency should be sought. Prevention of esophageal candidiasis is based primarily on the identification of risk factors, and a better control of them. This article presents a review of the physiopathology, clinical presentation and management of esophageal candidiasis by primary care physicians. We will also discuss ways of preventing esophageal candidiasis when necessary.

  16. Esophageal and gastric cancer incidence and mortality in alendronate users

    DEFF Research Database (Denmark)

    Abrahamsen, Bo; Pazianas, Michael; Eiken, Pia Agnete

    2012-01-01

    Recent studies have reached conflicting conclusions regarding the risk of esophageal cancer with oral bisphosphonates. Prior studies did not record the number of cancer deaths or endoscopy rates, which could be higher in bisphosphonate users and lead to more cancers being diagnosed at a stage when...... their esophageal or gastric location could be accurately distinguished. We conducted a register-based, open cohort study using national healthcare data for Denmark. Upper endoscopy frequency, cancer incidence and mortality was examined in 30,606 alendronate users (female, age 50¿+¿) and 122,424 matched controls....... Primary outcomes were esophageal cancer incidence and death due to esophageal cancer. The analysis showed that alendronate users were more likely to have undergone recent upper endoscopy (4.1 vs 1.7%, p¿...

  17. Esophageal carcinosarcoma: management and prognosis at a single Italian series.

    Science.gov (United States)

    Cavallin, Francesco; Scarpa, Marco; Alfieri, Rita; Cagol, Matteo; Ruol, Alberto; Rugge, Massimo; Ancona, Ermanno; Castoro, Carlo

    2014-12-01

    Esophageal carcinosarcoma (ESC) is a rare malignant lesion of the esophagus with controversial characteristics and prognostic factors. Seventeen consecutive patients with esophageal carcinosarcoma were referred to the Center for Esophageal Diseases located in Padua from January 1, 1980 to December 31, 2011. Clinical characteristics, pathological features, treatment and outcome were retrospectively analyzed in a prospectively collected database. Five patients received palliative treatment and one refused surgery; they died of unresected tumor or progression of disease within 0.6-43.5 months after diagnosis. Eleven patients underwent surgical treatment with complete tumor resection; recurrence rate was 80%, leading to death within 2 years after surgery. Only two resected patients are currently alive and free of disease over 20 years after surgery. Our results did not support the better prognosis concept of esophageal carcinosarcoma and suggested the importance of radical esophagectomy with adequate lymph node dissection. Copyright© 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  18. A comparison of multimodal therapy and surgery for esophageal adenocarcinoma.

    LENUS (Irish Health Repository)

    Walsh, T N

    1996-08-15

    Uncontrolled studies suggest that a combination of chemotherapy and radiotherapy improves the survival of patients with esophageal adenocarcinoma. We conducted a prospective, randomized trial comparing surgery alone with combined chemotherapy, radiotherapy, and surgery.

  19. Preoperative Chemotherapy, Radiation Improve Survival in Esophageal Cancer (Updated)

    Science.gov (United States)

    Patients with esophageal cancer who received chemotherapy and radiation before surgery survived, on average, nearly twice as long as patients treated with surgery alone, according to results of a randomized clinical trial published May 31, 2012, in NEJM.

  20. [Lugol's solution in endoscopic diagnosis of early esophageal cancer].

    Science.gov (United States)

    Wang, G; Zhou, M; Cong, Q

    1995-07-01

    About 1500 high-risk subjects of esophageal cancer were found during screening by balloon cytology and all of them were examined endoscopically. Among them, 120 were considered as having early esophageal cancer and precancerous lesions. During the examination, Lugol's solution staining was used and guiding biopsy was taken. 98 subjects with unstained lesions were found, and biopsy showed early esophageal cancer in 60 (61.2%) and moderate and severe dysplasia in 38 (38.8%). It is usually extremely difficult to detect and localize the very early esophageal mucosal and submucosal carcinoma. But endoscopic examination and using Lugol's solution staining with multiple spots biopsy from unstained area are of great assistance. Minute malignant lesions may not be overlooked.

  1. Characterization of esophageal physiology using mechanical state analysis

    Directory of Open Access Journals (Sweden)

    Richard Eduard Leibbrandt

    2016-02-01

    Full Text Available The esophagus functions to transport swallowed fluids and food from the pharynx to the stomach. The esophageal muscles governing bolus transport comprise circular striated muscle of the proximal esophagus and circular smooth muscle of the distal esophagus. Longitudinal smooth muscle contraction provides a mechanical advantage to bolus transit during circular smooth muscle contraction. Esophageal striated muscle is directly controlled by neural circuits originating in the central nervous system, resulting in coordinated contractions. In contrast, the esophageal smooth muscle is controlled by enteric circuits modulated by extrinsic central neural connections resulting in neural relaxation and contraction. The esophageal muscles are modulated by sensory information arising from within the lumen. Contraction or relaxation, which changes the diameter of the lumen, alters the intraluminal pressure and ultimately inhibits or promotes flow of content. This relationship that exists between the changes in diameter and concurrent changes in intraluminal pressure has been used previously to identify the ‘mechanical states’ of the circular muscle; that is when the muscles are passively or actively, relaxing or contracting. Detecting these changes in the mechanical state of the muscle has been difficult and, as the current interpretation of esophageal motility is based largely upon pressure measurement (manometry, subtle changes in the muscle function during peristalsis can be missed. We hypothesized that quantification of mechanical states of the esophageal circular muscles and the pressure-diameter properties that define them, would allow objective characterization of the mechanisms that govern esophageal peristalsis. To achieve this we analyzed barium swallows captured by simultaneous videofluoroscopy and pressure with impedance recording. From these data we demonstrated that intraluminal impedance measurements could be used to determine changes in the

  2. High prevalence of esophageal dysmotility in asymptomatic obese patients

    OpenAIRE

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

    2014-01-01

    Obesity has emerged as a major health problem in the developed world and has been found to be associated with several respiratory, cardiovascular, neurological and digestive diseases. Few studies have investigated esophageal dysmotility in obese populations; however, they have reported conflicting results, primarily due to varying measures and classification systems. This prospective study aimed to determine the prevalence of esophageal motor disorders in a group of obese patients in Montreal...

  3. [Endoscopic implantation of endoprostheses in incurable esophageal and cardia cancer].

    Science.gov (United States)

    Wiesenhaken, U; Rogos, R

    1990-03-01

    The palliative treatment of tumorous stenosis of the esophagus and cardio-esophageal region by intubation with an endoprosthesis leads to an improved quality of life. The used endoscopic positioning provides better results than the surgical procedure. This method is easy in handling and has only few complications. The endoscopic positioning of endoprosthesis is also a really alternative of alimentary fistula. The positioning of plastic prosthesis under endoscopic control should be given preference in the palliative treatment of obstructing cardio-esophageal malignancy.

  4. [A case of esophageal cancer with a funnel chest].

    Science.gov (United States)

    Takemura, Manabu; Matsuyama, Takeshi; Nishibeppu, Keiji; Matsumura, Atsushi; Ogino, Shiro; Mugitani, Tatsuro; Akami, Toshikazu; Shimode, Yoshikazu

    2013-11-01

    Esophageal cancer is a disease that is difficult to manage before and after surgery and is associated with a high in-hospital mortality rate despite there being reports of improved outcomes after multidisciplinary treatment. Meanwhile, although funnel chest is generally a subclinical condition, patients with this deformity may sometimes present with cardiac failure and chest pain. We report a case of advanced esophageal cancer with a funnel chest deformity that was very difficult to reconstruct after thoracoscopy-assisted resection.

  5. Darier disease with oral and esophageal involvement: A case report

    Directory of Open Access Journals (Sweden)

    Magesh Karuppur Thiagarajan

    2011-01-01

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

  6. Chronic Cough and Eosinophilic Esophagitis: An Uncommon Association

    OpenAIRE

    Orizio, Paolo; Cinquini, Massimo; Minetti, Stefano; Alberti, Daniele; Paolo, Camilla Di; Villanacci, Vincenzo; Torri, Fabio; Crispino, Paola; Facchetti, Susanna; Rizzini, Fabio Lodi; Bassotti, Gabrio; Tosoni, Cinzia

    2011-01-01

    An increasing number of children, usually with gastrointestinal symptoms, is diagnosed with eosinophilic esophagitis (EE), and a particular subset of these patients complains of airway manifestations. We present the case of a 2-year-old child with chronic dry cough in whom EE was found after a first diagnosis of gastroesophageal reflux disease (GERD) due to pathological 24-hour esophageal pH monitoring. Traditional allergologic tests were negative, while patch tests were diagnostic for cow’s ...

  7. Esophago-pleural fistula with multiple esophageal ulcers in human immunodeficiency virus infected patients: A case report

    International Nuclear Information System (INIS)

    Kwon, Soo Hee; Lee, Young Kyung; Choi, Jae Phil; Son, Jin Sung

    2014-01-01

    Esophagitis is a common complication in patients with human immunodeficiency virus (HIV) infection. Esophagitis in HIV infected patient is caused by candidiasis, cytomegalovirus, herpes simplex virus, or idiopathic esophagitis with no detectable etiology. Esophagitis in HIV infected patient is occasionally combined with esophageal ulcers. We report chest CT findings and clinical manifestation of esophago-pleural fistula with pneumothorax in a HIV infected patient, who was treated for aspiration pneumonia and esophageal ulcers.

  8. Esophago-pleural fistula with multiple esophageal ulcers in human immunodeficiency virus infected patients: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Soo Hee; Lee, Young Kyung; Choi, Jae Phil; Son, Jin Sung [Seoul Medical Center, Seoul(Korea, Republic of)

    2014-03-15

    Esophagitis is a common complication in patients with human immunodeficiency virus (HIV) infection. Esophagitis in HIV infected patient is caused by candidiasis, cytomegalovirus, herpes simplex virus, or idiopathic esophagitis with no detectable etiology. Esophagitis in HIV infected patient is occasionally combined with esophageal ulcers. We report chest CT findings and clinical manifestation of esophago-pleural fistula with pneumothorax in a HIV infected patient, who was treated for aspiration pneumonia and esophageal ulcers.

  9. A Rare Stapes Abnormality

    Directory of Open Access Journals (Sweden)

    Hala Kanona

    2015-01-01

    Full Text Available The aim of this study is to increase awareness of rare presentations, diagnostic difficulties alongside management of conductive hearing loss and ossicular abnormalities. We report the case of a 13-year-old female reporting progressive left-sided hearing loss and high resolution computed tomography was initially reported as normal. Exploratory tympanotomy revealed an absent stapedius tendon and lack of connection between the stapes superstructure and footplate. The footplate was fixed. Stapedotomy and stapes prosthesis insertion resulted in closure of the air-bone gap by 50 dB. A review of world literature was performed using MedLine. Middle ear ossicular discontinuity can result in significant conductive hearing loss. This can be managed effectively with surgery to help restore hearing. However, some patients may not be suitable or decline surgical intervention and can be managed safely conservatively.

  10. Tracheal Penetration and Tracheoesophageal Fistula Caused by an Esophageal Self-Expanding Metallic Stent

    Science.gov (United States)

    Madan, Karan; Venuthurimilli, Arun; Ahuja, Vineet; Mohan, Anant; Guleria, Randeep

    2014-01-01

    Tracheal penetration of esophageal self-expanding metallic stents (SEMS) with/without tracheoesophageal fistula (TEF) formation is a rare occurrence. We report the case of a 66-year-old female patient with advanced esophageal squamous cell carcinoma who had undergone palliative esophageal stenting on three occasions for recurrent esophageal stent obstruction. On evaluation of symptoms of breathing difficulty and aspiration following third esophageal stent placement, tracheal erosion and TEF formation due to the tracheal penetration by esophageal stent were diagnosed. The patient was successfully managed by covered tracheal SEMS placement under flexible bronchoscopy. PMID:25276461

  11. Tracheal Penetration and Tracheoesophageal Fistula Caused by an Esophageal Self-Expanding Metallic Stent

    Directory of Open Access Journals (Sweden)

    Karan Madan

    2014-01-01

    Full Text Available Tracheal penetration of esophageal self-expanding metallic stents (SEMS with/without tracheoesophageal fistula (TEF formation is a rare occurrence. We report the case of a 66-year-old female patient with advanced esophageal squamous cell carcinoma who had undergone palliative esophageal stenting on three occasions for recurrent esophageal stent obstruction. On evaluation of symptoms of breathing difficulty and aspiration following third esophageal stent placement, tracheal erosion and TEF formation due to the tracheal penetration by esophageal stent were diagnosed. The patient was successfully managed by covered tracheal SEMS placement under flexible bronchoscopy.

  12. Esophageal motility after laparoscopic sleeve gastrectomy

    Directory of Open Access Journals (Sweden)

    Sioka E

    2017-07-01

    Full Text Available Eleni Sioka,1 George Tzovaras,1 Fotios Tsiopoulos,2 Dimitris Papamargaritis,1 Spyros Potamianos,2 Constantine Chatzitheofilou,1 Dimitris Zacharoulis1 1Department of Surgery, 2Department of Gastroenterology, University Hospital of Larissa, University of Thessaly, Larissa, Greece Background: Laparoscopic sleeve gastrectomy (LSG modifies the upper gastrointestinal tract motility. Controversial data currently exist. The aim of the study was to evaluate esophageal motility before and after LSG.Patients and methods: Morbid obese patients scheduled for LSG underwent reflux symptoms evaluation and manometry preoperatively and postoperatively. The preoperative and postoperative results were compared and analyzed.Results: Eighteen patients were enrolled. Heartburn and regurgitation improved in 38.9% and 11.1% of the patients, but deteriorated in 11.1% and 27.8% of the patients, respectively. Lower esophageal sphincter (LES total length decreased postoperatively (p=0.002. Resting and residual pressures tended to decrease postoperatively (mean difference [95% confidence interval]: −4 [−8.3/0.2] mmHg, p=0.060; −1.4 [−3/0.1] mmHg, p=0.071, respectively. Amplitude pressure decreased from 95.7±37.3 to 69.8±26.3 mmHg at the upper border of LES (p=0.014, and tended to decrease at the distal esophagus from 128.5±30.1 to 112.1±35.4 mmHg (p=0.06 and mid-esophagus from 72.7±34.5 to 49.4±16.7 mmHg (p=0.006. Peristaltic normal swallow percentage increased from 47.2±36.8 to 82.8±28% (p=0.003. Postoperative regurgitation was strongly negatively correlated with LES total length (Spearman’s r=−0.670. When groups were compared according to heartburn status, statistical significance was observed between the groups of improvement and deterioration regarding postoperative residual pressure and postoperative relaxation (p<0.002, p<0.002, respectively. With regard to regurgitation status, there was statistically significant difference between groups regarding

  13. Anomalous Right Subclavian Artery-Esophageal Fistulae

    Directory of Open Access Journals (Sweden)

    Courtney Brooke Shires

    2018-01-01

    Full Text Available An aberrant right subclavian artery (ARSA is the most common aortic arch anomaly, but only 19 previous cases of ARSA-esophageal fistula have been reported. Six patients have survived their bleeding episode. We describe the case of a 44-year-old woman who developed massive hemoptysis. Laryngoscopy, bronchoscopy, head and neck angiogram, and median sternotomy did not reveal what was presumed initially to be a tracheoinnominate fistula. Contrasted CT showed an anomalous subclavian artery posterior to the esophagus. Given the technical challenge of approaches for this pathology, the patient was unfit for open surgical repair. Therefore, endovascular covered stent grafts were deployed spanning the segment of the subclavian artery in continuity with the esophagus, via a right brachial artery approach. Unfortunately, the patient died after successful placement of the grafts.

  14. Augment clinical measurement using a constraint-based esophageal model

    Science.gov (United States)

    Kou, Wenjun; Acharya, Shashank; Kahrilas, Peter; Patankar, Neelesh; Pandolfino, John

    2017-11-01

    Quantifying the mechanical properties of the esophageal wall is crucial to understanding impairments of trans-esophageal flow characteristic of several esophageal diseases. However, these data are unavailable owing to technological limitations of current clinical diagnostic instruments that instead display esophageal luminal cross sectional area based on intraluminal impedance change. In this work, we developed an esophageal model to predict bolus flow and the wall property based on clinical measurements. The model used the constraint-based immersed-boundary method developed previously by our group. Specifically, we first approximate the time-dependent wall geometry based on impedance planimetry data on luminal cross sectional area. We then fed these along with pressure data into the model and computed wall tension based on simulated pressure and flow fields, and the material property based on the strain-stress relationship. As examples, we applied this model to augment FLIP (Functional Luminal Imaging Probe) measurements in three clinical cases: a normal subject, achalasia, and eosinophilic esophagitis (EoE). Our findings suggest that the wall stiffness was greatest in the EoE case, followed by the achalasia case, and then the normal. This is supported by NIH Grant R01 DK56033 and R01 DK079902.

  15. External beam radiotherapy combined with intraluminal brachytherapy in esophageal carcinoma

    International Nuclear Information System (INIS)

    Muijs, Christina T.; Beukema, Jannet C.; Mul, Veronique E.; Plukker, John Th.; Sijtsema, Nanna M.; Langendijk, Johannes A.

    2012-01-01

    Purpose: To assess the effectiveness of definitive radiation therapy in patients with potentially curable esophageal cancer and to evaluate the side-effects of this treatment. Methods and materials: Sixty-two patients with esophageal cancer, who were treated with definitive, curatively intended radiotherapy consisting of external radiotherapy (60 Gy in 30 fractions), preceded and followed by LDR or HDR intraluminal brachy (12 Gy in 2 fractions) were retrospectively analyzed. Results: Recurrences were reported in 38 patients (61%), of which 25 (64%) failed locally first. The overall survival rates at 1, 2 and 5 years were 57%, 34% and 11%, respectively. The median overall survival was 15 months. No prognostic factors could be identified. Most frequently reported treatment related toxicities were esophagitis, ulcerations, (11%) and strictures (16%). In 10 patients (16%) severe toxicities, were reported including grade III ulceration (2 cases), stricture (1 case), radiation pneumonitis (1 case), perforation (1 case), esophageal-pleural-tracheal fistula (1 case), and acute esophageal bleeding (4 cases). A history of gastrectomy was significantly associated with the development of severe toxicity. Conclusion: Curatively intended radiotherapy alone can be offered to esophageal cancer patients, even when surgery and/or chemotherapy are not feasible. However, we observed severe toxicity in a substantial part of the patients. Given the relatively high rate of severe complications and the uncertainties regarding dose escalation, the addition of brachytherapy, with consequently high surface doses, should be limited to well-selected patients.

  16. Expression of cystatin C in human esophageal cancer.

    Science.gov (United States)

    Zeng, Qinghong; Zhao, Yonggang; Yang, Yuxian; Zheng, Guiyu; Wang, Gefei; Zhang, Peng; Cui, Youhong; Su, Shaobo; Li, Kangsheng

    2011-01-01

    Cystatin C is a member of the cysteine protease inhibitors and its function is to decrease protease activity. A recent study showed that it was aberrantly expressed in many malignant tumors in association with tumor invasion and metastasis. We attempted to detect its expression in esophageal cancer tissues and adjacent reparative normal tissues. Samples of cancers and non-cancerous esophageal tissues were obtained as matched pairs from 30 surgery patients with esophageal cancer and paraffin embedded. The expression of cystatin C in tissues was investigated by immunohistochemistry. Fisher's exact test was used to analyze the relationship between esophageal cancer tissues and adjacent normal tissues. Furthermore, mRNA was extracted, and reverse transcriptase polymerase chain reaction was performed. The intensity of cystatin C immunostaining in tumor tissues was increased compared to that of adjacent normal tissues. mRNA expression of the cystatin C gene was greater in esophageal cancer than in normal tissues (P cystatin C may play an important role in the pathogenesis and metastasis of esophageal cancer.

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

    International Nuclear Information System (INIS)

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

    1982-01-01

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

  18. Radiologic placement of metallic esophageal stents: preliminary experience

    International Nuclear Information System (INIS)

    Good, S.; Asch, M.R.; Jaffer, N.; Casson, A.G.

    1997-01-01

    To assess the usefulness of covered, self expanding metallic stents for alleviating stricture associated with malignant esophageal lesions. Patients and methods: Self-expanding metallic stents were placed in 10 patients with dysphagia related to stricture caused by malignant esophageal lesions. The stents were placed fluoroscopically with local anesthesia, and patency of the esophageal lumen was assessed by barium study after the procedure. The patients were then followed clinically. Results: In all 10 cases patency of the lumen was renewed after stent placement. After the procedure 9 of the patients could tolerate a normal or near-normal diet; in the other patient esophageal perforation occurred, and clinical deterioration prevented oral intake of food. In one patient, 2 stents were needed because of the length of the stricture. Two patients experienced reflux after placement of the stent across the gastro-esophageal junction. Another patient had asymptomatic aspiration after stent placement in the proximal esophagus. In 2 patients, symptoms associated with tracheoesophageal fistula were relieved after placement of the stents. Six of the 10 patients died; mean survival after the procedure was 12 (range 1 to 56) weeks. The other 4 patients were alive at the time of writing, having survived for a mean of 7.5 (range 2 to 13) weeks; all of these patients tolerated a near-normal diet. Conclusions: The placement of covered, self-expanding metallic stents is a quick, effective method of palliating dysphagia related to stricture caused by malignant esophageal lesions. (author)

  19. Worldwide Esophageal Cancer Collaboration: clinical staging data.

    Science.gov (United States)

    Rice, T W; Apperson-Hansen, C; DiPaola, L M; Semple, M E; Lerut, T E M R; Orringer, M B; Chen, L-Q; Hofstetter, W L; Smithers, B M; Rusch, V W; Wijnhoven, B P L; Chen, K N; Davies, A R; D'Journo, X B; Kesler, K A; Luketich, J D; Ferguson, M K; Räsänen, J V; van Hillegersberg, R; Fang, W; Durand, L; Allum, W H; Cecconello, I; Cerfolio, R J; Pera, M; Griffin, S M; Burger, R; Liu, J-F; Allen, M S; Law, S; Watson, T J; Darling, G E; Scott, W J; Duranceau, A; Denlinger, C E; Schipper, P H; Ishwaran, H; Blackstone, E H

    2016-10-01

    To address uncertainty of whether clinical stage groupings (cTNM) for esophageal cancer share prognostic implications with pathologic groupings after esophagectomy alone (pTNM), we report data-simple descriptions of patient characteristics, cancer categories, and non-risk-adjusted survival-for clinically staged patients from the Worldwide Esophageal Cancer Collaboration (WECC). Thirty-three institutions from six continents submitted data using variables with standard definitions: demographics, comorbidities, clinical cancer categories, and all-cause mortality from first management decision. Of 22,123 clinically staged patients, 8,156 had squamous cell carcinoma, 13,814 adenocarcinoma, 116 adenosquamous carcinoma, and 37 undifferentiated carcinoma. Patients were older (62 years) men (80%) with normal body mass index (18.5-25 mg/kg 2 , 47%), little weight loss (2.4 ± 7.8 kg), 0-1 ECOG performance status (67%), and history of smoking (67%). Cancers were cT1 (12%), cT2 (22%), cT3 (56%), cN0 (44%), cM0 (95%), and cG2-G3 (89%); most involved the distal esophagus (73%). Non-risk-adjusted survival for squamous cell carcinoma was not distinctive for early cT or cN; for adenocarcinoma, it was distinctive for early versus advanced cT and for cN0 versus cN+. Patients with early cancers had worse survival and those with advanced cancers better survival than expected from equivalent pathologic categories based on prior WECC pathologic data. Thus, clinical and pathologic categories do not share prognostic implications. This makes clinically based treatment decisions difficult and pre-treatment prognostication inaccurate. These data will be the basis for the 8th edition cancer staging manuals following risk adjustment for patient characteristics, cancer categories, and treatment characteristics and should direct 9th edition data collection. © 2016 International Society for Diseases of the Esophagus.

  20. Worldwide Esophageal Cancer Collaboration: pathologic staging data.

    Science.gov (United States)

    Rice, T W; Chen, L-Q; Hofstetter, W L; Smithers, B M; Rusch, V W; Wijnhoven, B P L; Chen, K L; Davies, A R; D'Journo, X B; Kesler, K A; Luketich, J D; Ferguson, M K; Räsänen, J V; van Hillegersberg, R; Fang, W; Durand, L; Cecconello, I; Allum, W H; Cerfolio, R J; Pera, M; Griffin, S M; Burger, R; Liu, J-F; Allen, M S; Law, S; Watson, T J; Darling, G E; Scott, W J; Duranceau, A; Denlinger, C E; Schipper, P H; Lerut, T E M R; Orringer, M B; Ishwaran, H; Apperson-Hansen, C; DiPaola, L M; Semple, M E; Blackstone, E H

    2016-10-01

    We report data-simple descriptions of patient characteristics, cancer categories, and non-risk-adjusted survival-for patients with pathologically staged cancer of the esophagus and esophagogastric junction after resection or ablation with no preoperative therapy from the Worldwide Esophageal Cancer Collaboration (WECC). Thirty-three institutions from six continents submitted de-identified data using standard definitions: demographics, comorbidities, clinical cancer categories, and all-cause mortality from first management decision. Of 13,300 patients, 5,631 had squamous cell carcinoma, 7,558 adenocarcinoma, 85 adenosquamous carcinoma, and 26 undifferentiated carcinoma. Patients were older (62 years) men (80%) with normal body mass index (51%), little weight loss (1.8 kg), 0-2 ECOG performance status (83%), and a history of smoking (70%). Cancers were pT1 (24%), pT2 (15%), pT3 (50%), pN0 (52%), pM0 (93%), and pG2-G3 (78%); most involved distal esophagus (71%). Non-risk-adjusted survival for both squamous cell carcinoma and adenocarcinoma was monotonic and distinctive across pTNM. Survival was more distinctive for adenocarcinoma than squamous cell carcinoma when pT was ordered by pN. Survival for pTis-1 adenocarcinoma was better than for squamous cell carcinoma, although monotonic and distinctive for both. WECC pathologic staging data is improved over that of the 7th edition, with more patients studied and patient and cancer variables collected. These data will be the basis for the 8th edition cancer staging manuals following risk adjustment for patient, cancer, and treatment characteristics, and should direct 9th edition data collection. However, the role of pure pathologic staging as the principal point of reference for esophageal cancer staging is waning. © 2016 International Society for Diseases of the Esophagus.