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Hallazgos clínicos, endoscópicos y magnitud del reflujo de contenido gástrico y duodenal en pacientes con metaplasia intestinal cardial y esófago de Barrett corto, comparados con controles Magnitude of gastric or duodenal reflux, clinical and endoscopic findings in patients with cardial intestinal metaplasia, short Barrett esofhagus and controls  [cached]
Attila Csendes J,Patricio Burdiles P,Gladys Smok S,Jorge Rojas C
Revista médica de Chile , 1999,
Abstract: Background: The diagnosis of patients with short segments of intestinal metaplasia in the distal esophagus, has increased in recent years. Aim: To assess the clinical, pathological and functional features of patients with esophageal intestinal metaplasia. Patients and methods: A prospective study was performed in 95 control subjects, 115 patients with cardial intestinal metaplasia and 89 patients with short Barret esophagus with intestinal metaplasia. All had clinical and endoscopic assessments, esophageal manometry and determination of 24 h esophageal exposure to acid and duodenal content. Results: Control patients were younger and, in this group, the pathological findings in the mucosa distal to the squamous-columnar change, showed a preponderance of fundic over cardial mucosa. In patients with intestinal metaplasia and short Barret esophagus, there was only cardial mucosa, that is the place where intestinal metaplasia implants. Low grade dysplasia was only seen in the presence of intestinal metaplasia. Gastroesophageal sphincter pressure decreased and gastric and duodenal reflux increased along with increases in the extension of intestinal metaplasia. Conclusions: These findings confirm the need to obtain multiple biopsies from the squamous-columnar mucosal junction in all patients with gastroesophageal reflux symptoms, for the detection of early pathological changes of Barret esophagus and eventual dysplasia.
Proton Pump Inhibitors Decrease Eotaxin-3 Expression in the Proximal Esophagus of Children with Esophageal Eosinophilia  [PDF]
Jason Y. Park, Xi Zhang, Nathalie Nguyen, Rhonda F. Souza, Stuart J. Spechler, Edaire Cheng
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0101391
Abstract: Objective Besides reducing gastric acid secretion, proton pump inhibitors (PPIs) suppress Th2-cytokine-stimulated expression of an eosinophil chemoattractant (eotaxin-3) by esophageal epithelial cells through acid-independent, anti-inflammatory mechanisms. To explore acid-inhibitory and acid-independent, anti-inflammatory PPI effects in reducing esophageal eosinophilia, we studied eotaxin-3 expression by the proximal and distal esophagus of children with esophageal eosinophilia before and after PPI therapy. In vitro, we studied acid and bile salt effects on IL-13-stimulated eotaxin-3 expression by esophageal epithelial cells. Design Among 264 children with esophageal eosinophilia seen at a tertiary pediatric hospital from 2008 through 2012, we identified 10 with esophageal biopsies before and after PPI treatment alone. We correlated epithelial cell eotaxin-3 immunostaining with eosinophil numbers in those biopsies. In vitro, we measured eotaxin-3 protein secretion by esophageal squamous cells stimulated with IL-13 and exposed to acid and/or bile salt media, with or without omeprazole. Results There was strong correlation between peak eosinophil numbers and peak eotaxin-3-positive epithelial cell numbers in esophageal biopsies. Eotaxin-3 expression decreased significantly with PPIs only in the proximal esophagus. In esophageal cells, exposure to acid-bile salt medium significantly suppressed IL-13-induced eotaxin-3 secretion; omeprazole added to the acid-bile salt medium further suppressed that eotaxin-3 secretion, but not as profoundly as at pH-neutral conditions. Conclusion In children with esophageal eosinophilia, PPIs significantly decrease eotaxin-3 expression in the proximal but not the distal esophagus. In esophageal squamous cells, acid and bile salts decrease Th2 cytokine-stimulated eotaxin-3 secretion profoundly, possibly explaining the disparate PPI effects on the proximal and distal esophagus. In the distal esophagus, where acid reflux is greatest, a PPI-induced reduction in acid reflux (an effect that could increase eotaxin-3 secretion induced by Th2 cytokines) might mask the acid-independent, anti-inflammatory PPI effect of decreasing cytokine-stimulated eotaxin-3 secretion.
Does a melatonin supplement alter the course of gastro-esophageal reflux disease?  [cached]
Mariusz H Madalinski
World Journal of Gastrointestinal Pharmacology and Therapeutics , 2011, DOI: 10.4292/wjgpt.v2.i6.50
Abstract: Symptomatic gastro-esophageal reflux disease (GERD) is a very common disease. The consequence of GERD is not only erosive esophagitis, but also esophageal stricture, Barrett’s esophagus and extra-esophageal damage (including the lungs, throat, sinuses, middle ear and teeth). GERD and Barrett’s esophagus are also identified as major risk factors for esophageal carcinoma. Therapy with melatonin prevents esophageal injury from acid-pepsin and acid-pepsin-bile exposure in animals, then further studies are required in humans to establish whether a melatonin supplement is able to protect the patients with GERD from erosions, Barrett’s and neoplasia.
The influence of BMI on reflux disease severity and esophageal motility disorders
Dorota Wa?ko-Czopnik,Szymon Wieczorek,Robert Dudkowiak,Joanna Hajduczenia
Polish Gastroenterology , 2010,
Abstract: Introduction: All over the world, obesity and GERD (gastroesophaeal reflux disease) are the most common disease entities. Their prevalence is increasing, which suggests a link between them, although the exact pathophysiological correlation is incompletely understood. Aim of the study: The aim of this study was to assess the relationship between BMI and severity of GERD and esophageal manometry disorders. Material and methods: Each patient involved in the study had 24-hour pH monitoring and esophageal manometry to confirm or exclude a diagnosis of GERD. The BMI (body mass index) was calculated, the patients were divided into groups, and the results of manometry and pHmetry were compared in the groups of patients. The results of 171 consecutive subjects with typical symptoms of GERD were analyzed. Results: Differences in esophageal acid exposure and manometry parameters were assessed among different BMI groups using statistical analysis. Although no significant association between increasing BMI and GERD prevalence was demonstrated, the study showed a relationship between increasing BMI and the presence of postprandial reflux in the GERD-confirmed patients. A negative correlation between increasing BMI and the presence of nocturnal reflux was observed. Conclusion: According to these results on BMI and its influence on GERD and 24-hour pH monitoring and esophageal manometry parameters, body mass plays a doubtful role in GERD's pathogenesis. Therefore, further investigations are necessary.
Gene expression changes associated with Barrett's esophagus and Barrett's-associated adenocarcinoma cell lines after acid or bile salt exposure
Ying Hao, Sumita Sood, George Triadafilopoulos, Jong Kim, Zheng Wang, Peyman Sahbaie, M Bishr Omary, Anson W Lowe
BMC Gastroenterology , 2007, DOI: 10.1186/1471-230x-7-24
Abstract: Using previously published methods, Barrett's-associated esophageal adenocarcinoma cell lines and primary cultures of Barrett's esophageal tissue were exposed to short pulses of acid or bile salts followed by incubation in culture media at pH 7.4. A genome-wide assessment of gene expression was then determined for the samples using cDNA microarrays. Subsequent analysis evaluated for statistical differences in gene expression with and without treatment.The SEG-1 cell line showed changes in gene expression that was dependent on the length of exposure to pH 3.5. Further analysis using the Gene Ontology, however, showed that representation by genes associated with cell proliferation is not enhanced by acid exposure. The changes in gene expression also did not involve genes known to be differentially expressed in esophageal adenocarcinoma. Similar experiments using short-term primary cultures of Barrett's esophagus also did not result in detectable changes in gene expression with either acid or bile salt exposure.Short-term exposure of esophageal adenocarcinoma SEG-1 cells or primary cultures of Barrett's esophagus does not result in gene expression changes that are consistent with enhanced cell proliferation. Thus other model systems are needed that may reflect the impact of acid and bile salt exposure on the esophagus in vivo.The incidence of esophageal adenocarcinoma has increased at a rate that is among the highest of all cancers[1]. The major risk factor for esophageal adenocarcinoma is the presence of Barrett's esophagus, a premalignant neoplastic lesion that is characterized by intestinal metaplasia replacing the normal squamous esophageal epithelia[2]. The presence of Barrett's esophagus increases the overall risk of adenocarcinoma by 40-fold[3]. In addition, similarities in the gene expression profile of Barrett's esophagus to esophageal adenocarcinoma further support a close relationship between the two tissues[4].Clinical studies have identified esophageal aci
Caracteristicas clínicas, endoscópicas, manométricas y magnitud de reflujo gastroesofágico ácido patológico en pacientes con esófago en cascanueces: Análisis prospectivo de 80 pacientes Nutcracker esophagus: Analysis of 80 patients  [cached]
Attila Csendes,Carlos Cárcamo,Ana Henríquez
Revista médica de Chile , 2004,
Abstract: Background: The nutcracker esophagus, a primary motor disorder, is frequently associated with noncardic chest pain. Aim: To study the clinical, endoscopic, manometric, and pathological features and 24 h acid reflux in patients with nutcracker esophagus. Patients and methods: Eighty patients (63 females, aged 26 to 70 years) with nutcracker esophagus, defined as the presence of contraction waves of more than 180 mmHg in the esophageal manometry, were studied. All were subjected to an upper gastrointestinal endoscopy, 24 h esophageal pH monitoring and a new manometric study. Results: Eighty percent of patients had symptoms suggestive of gastroesophageal reflux, 31% had retrosternal pain and 25% had dysphagia. Upper endoscopy was normal in 41% and showed erosive esophagitis or Barrett esophagus in 27%. Fifty percent of patients had an abnormal acid reflux. There were no significant differences in manometric parameters between patients with and without acid reflux. Conclusions: Symptoms of gastroesophageal reflux not necessarily mean that a pathological reflux is present. Primary motor disorders of the esophagus may cause similar symptoms (Rev Méd Chile 2004; 132: 160-4)
Esophageal manometry and vectorcardiography study of asymptomatic patients with Chagas' disease
Moraes-Filho, Joaquim Prado P.;Moraes, Thelma A. Bombonatti P. P.;Felix, Valter N.;Pereira-Barreto, Antonio Carlos;Bettarello, Agostinho;
Revista do Instituto de Medicina Tropical de S?o Paulo , 1988, DOI: 10.1590/S0036-46651988000600003
Abstract: the indeterminate form of chagas' disease is characterized by positive serology for the disease in the absence of clinical findings and in the presence of both normal esophagogram and electrocardiogram. when more sensitive methods were used, abnormalities have been described either in the esophagus or in the heart. the authors have studied simultaneously the esophagus and the heart in the same subjects. in thirteen adults with diagnosis of indeterminate form and nine adult controls, the esophageal manometry both in basal conditions and after stimulus (bethanecol) and vectorcardiogram were performed. in the control group none of the subjects presented concomitant esophageal and cardiac alterations while in the chagasic group 92,3% of the patients presented results simultaneously altered. it is concluded that the studied patients showed indications of parasympathetic denervation manifested by simultaneously esophageal and heart alterations.
Hallazgos clínicos, endoscópicos y magnitud del reflujo de contenido gástrico y duodenal en pacientes con metaplasia intestinal cardial y esófago de Barrett corto, comparados con controles
Csendes J,Attila; Burdiles P,Patricio; Smok S,Gladys; Rojas C,Jorge; Flores M,Noé; Domic P,Sergio; Quiroz G,Juan; Henríquez G,Ana;
Revista médica de Chile , 1999, DOI: 10.4067/S0034-98871999001100005
Abstract: background: the diagnosis of patients with short segments of intestinal metaplasia in the distal esophagus, has increased in recent years. aim: to assess the clinical, pathological and functional features of patients with esophageal intestinal metaplasia. patients and methods: a prospective study was performed in 95 control subjects, 115 patients with cardial intestinal metaplasia and 89 patients with short barret esophagus with intestinal metaplasia. all had clinical and endoscopic assessments, esophageal manometry and determination of 24 h esophageal exposure to acid and duodenal content. results: control patients were younger and, in this group, the pathological findings in the mucosa distal to the squamous-columnar change, showed a preponderance of fundic over cardial mucosa. in patients with intestinal metaplasia and short barret esophagus, there was only cardial mucosa, that is the place where intestinal metaplasia implants. low grade dysplasia was only seen in the presence of intestinal metaplasia. gastroesophageal sphincter pressure decreased and gastric and duodenal reflux increased along with increases in the extension of intestinal metaplasia. conclusions: these findings confirm the need to obtain multiple biopsies from the squamous-columnar mucosal junction in all patients with gastroesophageal reflux symptoms, for the detection of early pathological changes of barret esophagus and eventual dysplasia.
Estudio mamométrico del esófago en pacientes con dolor torácico no cardíaco Esophageal manometry in patients with non cardiac chest pain  [cached]
Guillermo Rencoret,Attila Csendes,Ana Henríquez
Revista médica de Chile , 2006,
Abstract: Background: Non cardiac chest pain can be caused by esophageal problems such as gastroesophageal reflux or smooth muscle motor disorders. Aim: To perform esophageal manometry in patients with non cardiac chest pain. Material and methods: One hundred patients with chest pain in whom coronary problems were discarded, were studied. A computerized esophageal manometry was performed in all and 24 hours esophageal pH measurement was done in 21 patients. Results: Esophageal manometry was normal in eight patients. Nutcracker esophagus was the most common finding, in 36 patients. Twenty eight had a hypotensive sphincter, 16 had unspecific motor disorders, nine had diffuse esophageal spasm, two had a non achalasic esophageal aperistalsis and one had a hypertensive sphincter. Conclusions: Only eight of 100 patients referred to esophageal manometry for non cardiac chest pain, had a normal study
Critical Analysis of Esophageal Multichannel Intraluminal Impedance Monitoring 20 Years Later  [PDF]
Fernando A. M. Herbella
ISRN Gastroenterology , 2012, DOI: 10.5402/2012/903240
Abstract: Multichannel intraluminal impedance (MII) for the evaluation of esophageal diseases was created in 1991 trying to solve previous limitations of esophageal function test. MII-pH is able to determine the physical characteristics of the refluxate (liquid, gas, or mixed) and nonacidic GER. MII-manometry can determine the presence of bolus and its relation with peristalsis. This paper makes a critical analysis of the clinical applications of MII 20 years after its creation. Literature review shows that MII made great contributions for the understanding of esophageal physiology; however, direct clinical applications are few. MII-pH was expected to identify patients with normal acid reflux and abnormal nonacidic reflux. These patients are rarely found off therapy, that is, nonacidic reflux parallels acid reflux. Furthermore, the significance of isolated nonacidic reflux is unclear. Contradictory MII-manometry and conventional manometry findings lack better understanding and clinical implication as well as the real significance of bolus transit. 1. Introduction Esophageal manometry and pH monitoring are ambulatory techniques for detection of gastroesophageal reflux (GER) and esophageal motility disorders that were introduced into clinical practice in the 1970s; however, significant improvement was achieved over the last decades [1], including the development of multichannel intraluminal impedance (MII) in 1991 [2]. These new achievements try to solve previous limitations of esophageal function test, such as the lack of ability to detect bolus transit and nonacid reflux. A great enthusiasm came when MII was applied to esophageal physiology. First of all, the expectation that patients with suspected GER and a negative pH monitoring would have the disease objectively diagnosed came into mind. Second, the detection of bolus transport through the esophagus brought hope to the treatment of patients with dysphagia and normal manometry. This initial enthusiasm; however, subsided along time. This paper will focus on the critical analysis of the clinical applications of MII, 20 years after its creation. 2. MII Technique Impedance is the measurement in Ohms of the electrical resistance between 2 points. In simple words, 2 consecutive sensors are in contact with the esophageal mucosa that has specific impedance value, but when the lumen is filled with any substance and this substance bridges these 2 sensors, the equipment will detect this variance. Because of their differential conductivity, gas, liquid, or a mixture of the two can be distinguished independent of the pH of
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