AIM:To investigate the role of psychological characteristics as risk factors for oesophageal adenocarcinoma(OAC),as well as the reflux-mediated precursor pathway.METHODS:An all-Ireland population-based case-control st...AIM:To investigate the role of psychological characteristics as risk factors for oesophageal adenocarcinoma(OAC),as well as the reflux-mediated precursor pathway.METHODS:An all-Ireland population-based case-control study recruited 230 reflux oesophagitis(RO),224 Barrett's oesophagus(BO) and 227 OAC patients and 260 controls.Each case/control group completed measures of stress,depression,self-efficacy,self-esteem,repression and social support.A comparative analysis was undertaken using polytomous logistic regression adjusted for potential confounders.RESULTS:Compared to controls,OAC patients were almost half as likely to report high stress levels over their lifetime(P = 0.010,OR 0.51;95%CI:0.29-0.90)and 36% less likely to report having experienced depression(OR 0.64;95%CI:0.42-0.98).RO patients reported significantly higher stress than controls particularly during middle-and senior-years(P for trends < 0.001).RO patients were 37% less likely to report having been highly emotionally repressed(OR 0.63;95%CI:0.41-0.95).All case groups(OAC,RO and BO) were more likely than controls to report having had substantial amounts of social support(OR 2.84;95%CI:1.63-4.97;OR 1.97;95%CI:1.13-3.44 and OR 1.83;95%CI:1.03-3.24,respectively).CONCLUSION:The improved psychological profile of OAC patients may be explained by response shift.The role of psychological factors in the development of OAC requires further investigation.展开更多
AIM:To elucidate the effect of a proton pump inhibitor(PPI,rabeparazole)on oesophageal bile reflux in oesophagitis after total gastrectomy.METHODS:Twenty-one 8-week-old male Wistar rats were studied.They were performe...AIM:To elucidate the effect of a proton pump inhibitor(PPI,rabeparazole)on oesophageal bile reflux in oesophagitis after total gastrectomy.METHODS:Twenty-one 8-week-old male Wistar rats were studied.They were performed oesophagoduodenostomy of total gastrectomy to induce oesophageal reflux of biliary and pancreatic juice.Five rats were performed the sham operation(Sham).On post-operative day 7,they were treated with saline(Control)(n=8)or PPI(rabeprazole,30 mg/kg per day,ip)(n=8)for 2 wk.On post-operative 21,all rats were sacrificed and each oesophagus was evaluated histologically.Oesophageal injury was evaluated by macroscopic and microscopic findings as well as the expression of cyclooxygenase-2(COX2).We measured bile acid in the oesophageal lumen and the common bile duct.RESULTS:At 3 wk after surgery,a histological study analysis revealed an increase in the thickness of the epithelium,elongation of the lamina propria and basal cell hyperplasia in the oesophageal mucosa.The macroscopic ulcer score and microscopic ulcer length of the control group were significantly higher compared to those of the rabeprazole-treated group.The expression of COX2 was significantly increased according to the immunostaining in the control group compared to rabeprazole-treated group.Although there was no difference between the control and PPI groups in the total bile acid in the common bile duct,the bileacid activity in the oesophageal lumen was significantly decreased in the rabeprazole-treated group due to augmentation of the duodenal motor complex.CONCLUSION:With this model,rabeprazole is good effect for reflux esophagitis after total gastrectomy from bile reflux.Bile acid is an important factor in the mucosal lesion induced by duodenal reflux.展开更多
BACKGROUND Suppurative oesophagitis is a diffuse inflammation of the oesophagus characterized by suppurative exudate or pus formation.Suppurative infections can affect any part of the gastrointestinal tract,most commo...BACKGROUND Suppurative oesophagitis is a diffuse inflammation of the oesophagus characterized by suppurative exudate or pus formation.Suppurative infections can affect any part of the gastrointestinal tract,most commonly the stomach,with inflammation involving the entire gastric cavity.However,cases extending beyond the cardia or pylorus and involving the oesophagus,small intestine,and colon are rare.Usually such cases are discovered during surgery or autopsy.CASE SUMMARY We report a rare case of acute suppurative oesophagitis.A 57-year-old man presented at the Emergency Department of our hospital with fever and productive cough.The patient had a significant history of lower oesophageal mucosal frostbite.He was successfully diagnosed and treated with repeated gastroscopy,appropriate antibiotics,and innovative symptomatic treatment.CONCLUSION Early diagnosis and appropriate treatment of acute suppurative oesophagitis are critical.Nutritional support,postural drainage,and other symptomatic treatments must be considered.展开更多
AIM： To examine the relationship between Hpylori and gastro-oesophageal reflux disease （GORD） in Iran. METHODS： In this study 51 GORD patients （referred to endoscopy at Taleghani hospital） were compared with 49 ...AIM： To examine the relationship between Hpylori and gastro-oesophageal reflux disease （GORD） in Iran. METHODS： In this study 51 GORD patients （referred to endoscopy at Taleghani hospital） were compared with 49 age-sex matched controls. Diagnosis of H pylori was made by gastric mucosal biopsy and rapid urease test （positive if the result of one or both diagnostic methods was positive）. Updated Sydney system was used to report histopathological changes. RESULTS： The frequency of H pylori infection based on rapid urease test and histology was 88.2% （45） in patients and 77.6% （38） in controls, which showed no significant difference. The frequency of H pylori infection was significantly higher in the antrum than in the corpus and cardia. The mean activity, inflammation, and gastritis scores were also higher in the antrum of patients than in the antrum of controls. The mean scores were significantly higher in the corpus of controls than in the corpus of patients. Diffuse active gastritis was observed in a significantly larger number of controls, while the frequency of diffuse chronic gastritis was higher in patients. There in the frequency of other patients and controls. was no significant difference histological findings between.CONCLUSION： H pylori infection cannot prevent GORD in this region.展开更多
Eosinophilic oesophagitis (EoE) is a chronic,antigen mediated disease of the disease of the oesophagus that may present in both adults and children.It is characterised by intermittent dysphagia,food bolus obstruction ...Eosinophilic oesophagitis (EoE) is a chronic,antigen mediated disease of the disease of the oesophagus that may present in both adults and children.It is characterised by intermittent dysphagia,food bolus obstruction and weight loss.The pathogenesis is incompletely understood but is thought to culminate in poor compliance,or reduced distensibility.The condition is being reported and studied in the literature with increasing incidence,although equally it is highly likely that the diagnosis is being missed altogether with alarming frequency.Diagnosis of the condition requires at least one oesophageal biopsy with an eosinophil count greater than 15 per high power field.Endoscopic features include trachealisation,furrows,white exudate,narrowing and in the most severe cases stricture formation although none are pathognomonic of the condition.Therapy is often not required,but in the acute setting may take the form of dietary therapy or topical steroids.Long term maintenance therapy is usually only required in the most severe cases and the most effective treatment is the subject of ongoing research.There are a number of hurdles to be overcome in the management of patients with EoE.These include;improving our understanding of the aetiologyof the condition,investigating the individual causes,assessing the true disease severity and planning the best long term maintenance therapy.Distinguishing EoE from EoE gastro-oesophageal reflux disease is also a hurdle because the two conditions,both being common,can co-exist.In order to overcome these hurdles,a multifaceted approach is required.The management of food bolus obstruction requires a management algorithm that is accepted and endorsed by a number of specialties.National and international disease registers should be established in order to facilitate future research but more importantly to address areas where further education or increased diagnostic capabilities may be required.Assessment of disease severity should become a key goal,and the development of specific biomarkers for EoE should also be a priority.Finally,randomised controlled trials of new agents are required to assess the best treatment in both the acute and long term setting.展开更多
AIM: To look at the relationship between eosinophilic oesophagitis(EO) and food bolus impaction in adults. METHODS: We retrospectively analysed medical records of 100 consecutive patients who presented to our hospital...AIM: To look at the relationship between eosinophilic oesophagitis(EO) and food bolus impaction in adults. METHODS: We retrospectively analysed medical records of 100 consecutive patients who presented to our hospital with oesophageal food bolus obstruction(FBO) between 2012 and 2014. In this cohort, 96 were adults(64% male), and 4 paediatric patients were excluded from the analysis as our centre did not have paediatric gastroenterologists. Eighty-five adult patients underwent emergency gastroscopy. The food bolus was either advanced into the stomach using the push technique or retrieved using a standard retrieval net. Biopsies were obtained in 51 patients from the proximal and distal parts of the oesophagus at initial gastroscopy. All biopsy specimens were assessed and reviewed by dedicated gastrointestinal pathologists at the Department of Pathology, University Hospital Geelong. The diagnosis of EO was defined and established by the presence of the following histological features:(1) peak eosinophil counts > 20/hpf;(2) eosinophil microabscess;(3) superficial layering of eosinophils;(4) extracellular eosinophil granules;(5) basal cell hyperplasia;(6) dilated intercellular spaces; and(7) subepithelial or lamina propria fibrosis. The histology results of the biopsy specimens were accessed from the pathology database of the hospital and recorded for analysis. RESULTS: Our cohort had a median age of 60. Seventeen/51(33%) patients had evidence of EO on biopsy findings. The majority of patients with EO were male(71%). Classical endoscopic features of oesophageal rings, furrows or white plaques and exudates werefound in 59% of patients with EO. Previous episodes of FBO were present in 12/17 patients and 41% had a history of eczema, hay fever or asthma. Reflux oesophagitis and benign strictures were found in 20/34 patients who did not have biopsies. CONCLUSION: EO is present in approximately one third of patients who are admitted with FBO. Biopsies should be performed routinely at index endoscopy in order to pursue this treatable cause of long term morbidity.展开更多
Eosinophilic oesophagitis(EoE) and gastro-oesophageal reflux disease(GORD) are the most common causes of chronic oesophagitis and dysphagia associated with oesophageal mucosal eosinophilia. Distinguishing between the ...Eosinophilic oesophagitis(EoE) and gastro-oesophageal reflux disease(GORD) are the most common causes of chronic oesophagitis and dysphagia associated with oesophageal mucosal eosinophilia. Distinguishing between the two is imperative but challenging due to overlapping clinical and histological features. A diagnosis of EoE requires clinical, histological and endoscopic correlation whereas a diagnosis of GORD is mainly clinical without the need for other investigations. Both entities may exhibit oesophageal eosinophilia at a similar level making a histological distinction between them difficult. Although the term proton-pump inhibitor responsive oesophageal eosinophilia has recently been retracted from the guidelines, a relationship between Eo E and GORD still exists. This relationship is complex as they may coexist, either interacting bidirectionally or are unrelated. This review aims to outline the differences and potential relationship between the two conditions, with specific focus on histology, immunology, pathogenesis and treatment.展开更多
This letter addresses challenges in the clinical translation of BIBR1532,a promising telomerase inhibitor,for the treatment of esophageal squamous cell carcinoma(ESCC).BIBR1532 exerts its anti-cancer effect by activat...This letter addresses challenges in the clinical translation of BIBR1532,a promising telomerase inhibitor,for the treatment of esophageal squamous cell carcinoma(ESCC).BIBR1532 exerts its anti-cancer effect by activating DNA damage response(ATR/CHK1 and ATM/CHK2)pathways and downregulating telomere-binding proteins.Although its therapeutic potential is limited by poor aqueous solubility,solid dispersion(SD)technology may overcome this obstacle.Systematic analysis using PubChem-derived simplified molecular input line entry system identifiers and artificial intelligence-driven FormulationDT platform evaluation(oral formulation feasibility index:0.38)revealed that the SD technology,with superior scalability(32 approved products by 2021)and lower production risks,outperforms lipid-based formulations as an optimal dissolution strategy.Material analysis revealed hydroxypropyl methylcellulose(HPMC)as the optimal carrier with lower hygroscopicity,higher temperature and no intestinal targeting,thus enabling ESCC therapy.HPMC-based SD enhances BIBR1532 solubility and bioavailability for effective ESCC treatment.Future studies should focus on pilot tests for SD fabrication.展开更多
BACKGROUND There are few clinicopathologic characteristics and clinical results for oesophageal gastrointestinal stromal tumours(GISTs).Thus,the objective of this study was to identify the clinicopathologic characteri...BACKGROUND There are few clinicopathologic characteristics and clinical results for oesophageal gastrointestinal stromal tumours(GISTs).Thus,the objective of this study was to identify the clinicopathologic characteristics and clinical results of oesophageal GISTs.AIM To investigate endoscopic treatment effective of oesophageal GISTs.METHODS It was retrospective research that collected 32 patients with oesophageal GISTs treated by endoscopic resection(ER)between January 2012 and January 2023 in two Hospital.Clinicopathologic,endoscopic records,and follow-up data were collected and analysed.RESULTS Thirty-one patients underwent en bloc resection and 24(75.0%)lesions underwent R0 resection.The size of GISTs was 2.12±1.88 cm.The overall complication rate was 25.0%,including hydrothorax and post-endoscopic submucosal dissection electrocoagulation syndrome.The mean mitotic index was 3.34±5.04(median,1.50;range,1.00-4.00).Eighteen(56.3%),6(18.8%),2(6.3%),and 6(18.8%)patients were identified as very low,low,intermediate,and high risk,respectively.Three patients developed recurrence after a median follow-up of 64.69±33.13 months.The 5-year overall survival rate was 100%,and the disease-free survival rate was 90.6%.CONCLUSION ER is safe and effective for patients with low-risk oesophageal GISTs.Early detection of oesophageal GISTs is essential to achieve a favourable prognosis.展开更多
BACKGROUND Gastric and oesophageal cancers are among the leading causes of cancer-related mortality globally.Treatment in the form of surgical resection and neoadjuvant therapy is considered the gold standard;however,...BACKGROUND Gastric and oesophageal cancers are among the leading causes of cancer-related mortality globally.Treatment in the form of surgical resection and neoadjuvant therapy is considered the gold standard;however,these procedures are associated with significant postoperative morbidity and prolonged recovery times.Prehabilitation aims to combat this by physically and psychologically optimising patients preoperatively to handle the stress of surgery and improve postoperative outcomes.AIM To evaluate the effectiveness of prehabilitation in patients undergoing gastric or oesophageal cancer resections.METHODS Standard medical databases such as MEDLINE,EMBASE,PubMed,and Cochrane Library were searched to find randomised,controlled trials comparing prehabilitation vs no-prehabilitation in patients undergoing gastric or oesophageal cancer resections.All data were analysed using Review Manager Software 5.4,and the meta-analysis was performed with a random-effect model analysis.RESULTS A total of 16 studies were included(n=1479),recruiting adult patients undergoing gastric or oesophageal cancer resections.In the random effect model analysis,prehabilitation was associated with fewer postoperative complications compared to no prehabilitation(Odds ratio:0.43,95%CI:0.31-0.58,Z=25.28,P<0.00001).Additionally,prehabilitation was associated with a lower postoperative readmission rate(risk ratio:0.58,95%CI:0.35-0.96,Z=2.10,P=0.04)and a shorter length of stay[standardised mean difference(SMD):-0.19,95%CI:-0.37 to-0.02,Z=2.21,P=0.03]compared to no-prehabilitation.Prehabilitation was also found to improve preoperative 6-minute walking distance(6-MWD)compared to no-prehabilitation(SMD:0.72,95%CI:0.21-1.23,Z=2.75,P=0.006).No statistical difference was found in postoperative 6-MWD,mortality,and severe complications.CONCLUSION Prehabilitation was found to be effective in reducing postoperative morbidity and improving preoperative physical health in patients undergoing gastric or oesophageal cancer resections.展开更多
Oesophageal gastrointestinal stromal tumours are rare,anatomically challenging lesions with higher surgical morbidity than their gastric counterparts.Emerging endoscopic resection techniques such as endoscopic submuco...Oesophageal gastrointestinal stromal tumours are rare,anatomically challenging lesions with higher surgical morbidity than their gastric counterparts.Emerging endoscopic resection techniques such as endoscopic submucosal dissection and submucosal tunnelling endoscopic resection show much promise for the management of patients who are not fit for,or wish to avoid the morbidity of,major surgical resection.These techniques require careful patient selection and advanced technical skills.We build on the recent review of such techniques by Vogli et al.Current evidence is limited to small case series with heterogeneity in patient selection,tumor size,and outcomes.Notably,long-term oncological data remain sparse,and complications such as bleeding or perforation may be life-threatening in patients unfit for surgical rescue.Nonetheless,endoscopic approaches have many potential advantages to offer such as preserved quality of life and definitive management of unfit patients.展开更多
BACKGROUND Oesophageal cancer is a significant health concern worldwide,with high inci-dence and mortality rates.In China,the disease burden is particularly high,accounting for a substantial proportion of oesophageal ...BACKGROUND Oesophageal cancer is a significant health concern worldwide,with high inci-dence and mortality rates.In China,the disease burden is particularly high,accounting for a substantial proportion of oesophageal cancer cases and related deaths worldwide.AIM To explore the relationship between the mortality rate of oesophageal cancer patients and insurance type,out-of-pocket ratio,and the joint effects of insurance type and out-of-pocket ratio.METHODS The χ^(2) test was used to analyze patients’demographic and clinical characteristics.Multivariate logistic regression,the Cox proportional hazard model,and the competitive risk model were used to calculate the cumulative hazard ratios(HRs)of all-cause death and oesophageal cancer-specific death among patients with different types of insurance and out-of-pocket ratios.RESULTS Compared with patients covered by basic medical insurance for urban and rural residents,patients covered by urban employee basic medical insurance for urban workers(UEBMI)had a 23.30%increased risk of oesophageal cancer-specific death[HR=1.233,95%confidence interval(CI):1.093-1.391,P<0.005].Compared with patients in the low out-of-pocket ratio group,patients in the high out-of-pocket ratio group had a 25.80%reduction in the risk of oesophageal cancer-specific death(HR=0.742,95%CI:0.6555-0.84,P<0.005).With each 10%increase in the out-of-pocket ratio,the risk of oesophageal cancer-specific death decreased by 10.10%in patients covered by UEBMI.However,the risk of oesophageal cancer-specific death increased by 26.90%in patients in the high out-of-pocket ratio group.CONCLUSION This study reveals the relationships of the specific mortality rate of patients with oesophageal cancer with the out-of-pocket ratio and medical insurance types as well as their combined effects.This study provides practical suggestions and guidance for the formulation of relevant policies in this area.展开更多
Benign esophageal stricture is characterized by the narrowing of the digestivetract lumen due to multiple factors. Endoscopic treatment is the first treatmentchoice and includes endoscopic dilatation, drug injection, ...Benign esophageal stricture is characterized by the narrowing of the digestivetract lumen due to multiple factors. Endoscopic treatment is the first treatmentchoice and includes endoscopic dilatation, drug injection, stenosis incision, stentimplantation, stem cell flap transplantation, etc. However, there are currently nospecific clinical standards or guidelines to quantify a series of specific parametersin the treatment of benign esophageal stricture, such as the frequency of drugadministration, dosage, dilation inner diameter, and number of treatments. Thisleads to operator bias in clinical practice and inconsistent treatment outcomesamong patients. Therefore, this article reviews the current advances and existingchallenges in the endoscopic treatment of benign esophageal stricture, with theaim of exploring the possibility of achieving precision and standardization in theendoscopic treatment of this disease.展开更多
In this letter,a commentary on the article by Xu et al has been provided.Gastrointestinal stomal tumours(GISTs)are rare tumours that originate commonly in stomach(60%-70%)and small intestine(30%-40%).The course of tre...In this letter,a commentary on the article by Xu et al has been provided.Gastrointestinal stomal tumours(GISTs)are rare tumours that originate commonly in stomach(60%-70%)and small intestine(30%-40%).The course of treatment especially oesophageal GIST is very complex and hard to diagnose because of limited availability of pathological and clinical data.Endoscopic resection(ER)is a minimally invasive approach for removing tumours from the oesophagus and digestive system that does not require open surgery and is especially successful for very small and low-risk GIST.A retrospective exami-nation of 32 patients treated with ER between 2012 and 2023 was conducted to analyse clinical and pathological characteristics,effectiveness of therapy,and long-term prognosis.The findings demonstrate en bloc resection was achieved in 96.9%of cases with an R0 resection rate of 75%with a median size of tumour was approximately 2.12 cm.Post-surgery complication like hydrothorax,post-endoscopic submucosal dissection electrocoagulation syndrome occurred in about 25%of cases which later go resolved by conservative treatment.Recurrence of GIST was approximately 9.4%primarily in high-risk cases.ER should be widely adopted in clinical practise preferably for managing low-risk oesophageal GIST because of its high success rate,low recurrence rates and excellent survival results,ensuring better patient prognosis.展开更多
In this article,we comment on the work put forth by Wu et al regarding the investigation of oesophageal cancer-specific mortality for a cohort of patients from Chongqing University Cancer Hospital.We specifically focu...In this article,we comment on the work put forth by Wu et al regarding the investigation of oesophageal cancer-specific mortality for a cohort of patients from Chongqing University Cancer Hospital.We specifically focused on the implications of public health plans such as Urban Employee Basic Medical Insurance(UEBMI)and Urban Resident Basic Medical Insurance as well as out-of-pocket ratios on patient treatment plans regarding whether they pursue surgical interventions or therapeutic treatments such as chemotherapy.While Wu et al put forth potential explanations for why patients with the UEBMI plan surprisingly had a 23.30%increased risk of oesophageal cancer-specific death,more analysis is needed to alleviate cancer burden within this group.Although it is likely that patients covered by Urban Resident Basic Medical Insurance and higher out-ofpocket ratios have stronger self-recovery awareness,more work must be done to improve outcomes for people with the UEBMI plan while simultaneously implementing international and domestic initiatives to better emphasize cancer prevention and early detection.Lastly,future research must explore the relationship between Serious Illness Medical Insurance as well as the New Rural Cooperative Medical System on the mortality rate of oesophageal cancer patients in rural China,where disease burden is significantly higher than urban areas.By unifying these public health insurance schemes,officials can significantly alleviate economic burden of treatment and better prognosis for patients with oesophageal cancer.展开更多
Feeding dysfunction is a frequent presenting symptom of eosinophilic esophagitis(EoE). Here we present 3 children of various ages whose manifestations of EoE associated feeding dysfunction led to significant and life ...Feeding dysfunction is a frequent presenting symptom of eosinophilic esophagitis(EoE). Here we present 3 children of various ages whose manifestations of EoE associated feeding dysfunction led to significant and life altering impact on their growth and development. Early identification of presenting symptoms of EoE will allow for prompt diagnosis and initiation of appropriate treatments. Recognition of salient features of dysfunction and treatment by feeding therapists and nutritionists led to symptom resolution and growth.展开更多
BACKGROUND Laparoscopic assisted total gastrectomy(LaTG)is associated with reduced nutritional status,and the procedure is not easily carried out without extensive expertise.A small remnant stomach after near-total ga...BACKGROUND Laparoscopic assisted total gastrectomy(LaTG)is associated with reduced nutritional status,and the procedure is not easily carried out without extensive expertise.A small remnant stomach after near-total gastrectomy confers no significant nutritional benefits over total gastrectomy.In this study,we developed a modified laparoscopic subtotal gastrectomy procedure,termed laparoscopicassisted tailored subtotal gastrectomy(LaTSG).AIM To evaluate the feasibility and nutritional impact of LaTSG compared to those of LaTG in patients with advanced middle-third gastric cancer(GC).METHODS We retrospectively analyzed surgical and oncological outcomes and postoperative nutritional status in 92 consecutive patients with middle-third GC who underwent radical laparoscopic gastrectomy at Department of Pancreatic Stomach Surgery,National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences,and Peking Union Medical College between 2013 and 2017.Of these 92 patients,47 underwent LaTSG(LaTSG group),and the remaining underwent LaTG(LaTG group).RESULTS Operation time(210±49.8 min vs 208±50.0 min,P>0.05)and intraoperative blood loss(152.3±166.1 mL vs 188.9±167.8 mL,P>0.05)were similar between the groups.The incidence of postoperative morbidities was lower in the LaTSG group than in the LaTG group(4.2%vs 17.8%,P<0.05).Postoperatively,nutritional indices did not significantly differ,until postoperative 12 mo.Albumin,prealbumin,total protein,hemoglobin levels,and red blood cell counts were significantly higher in the LaTSG group than in the LaTG group(P<0.05).No significant differences in Fe or C-reaction protein levels were found between the two groups.Endoscopic examination demonstrated that reflux oesophagitis was more common in the LaTG group(0%vs 11.1%,P<0.05).Kaplan–Meier analysis showed a significant improvement in the overall survival(OS)and disease free survival(DFS)in the LaTSG group.Multivariate analysis showed that LaTSG was an independent prognostic factor for OS(P=0.048)but not for DFS(P=0.054).Subgroup analysis showed that compared to LaTG,LaTSG improved the survival of patients with stage III cancers,but not for other stages.CONCLUSION For advanced GC involving the middle third stomach,LaTSG can be a good option with reduced morbidity and favorable nutritional status and oncological outcomes.展开更多
Gastroesophageal reflux disease (GORD) is highly prevalent in the general population.In the last decade,a potential relationship between Helicobacter pylori (H.pylori) eradication and GORD onset has been claimed.The m...Gastroesophageal reflux disease (GORD) is highly prevalent in the general population.In the last decade,a potential relationship between Helicobacter pylori (H.pylori) eradication and GORD onset has been claimed.The main putative mechanism is the gastric acid hypersecretion that develops after bacterial cure in those patients with corpus-predominant gastritis.We performed a critical reappraisal of the intricate pathogenesis and clinical data available in this field.Oesophagitis onset after H.pylori eradication in duodenal ulcer patients has been ascribed to a gastric acid hypersecretion,which could develop following body gastritis healing.However,the absence of an acid hypersecretive status in these patients is documented by both pathophysiology and clinical studies.Indeed,duodenal ulcer recurrence is virtually abolished followingH.pylori eradication.In addition,intra-oesophageal pH recording studies failed to demonstrated increased acid reflux following bacterial eradication.Moreover,oesophageal manometric studies suggest that H.pylori eradication would reduce-rather than favor-acid reflux into the oesophagus.Finally,data of clinical studies would suggest that H.pylori eradication is not significantly associated with eitherreflux symptoms or erosive oesophagitis onset,some data suggesting also an advantage in curing the infection when oesophagitis is already present.Therefore,the legend of "crazy acid" remains-as all the others a fascinating,but imaginary tale.展开更多
AIM. To develop a new experimental model of esophagitis that serves a complementary tool to clinical investigation in an insight into the mechanism of the damage to the esophagus mucosa by aggressive factors, and role...AIM. To develop a new experimental model of esophagitis that serves a complementary tool to clinical investigation in an insight into the mechanism of the damage to the esophagus mucosa by aggressive factors, and role of COX inhibitors in this process. METHODS： The study was conducted in 56 male mice. Animals were divided into seven groups： （1） perfused with HCI, （2） perfused with HCI and physiologic concentration of pepsin （HCI/P）, （3） perfused with similar HCI/P solution enriched with conjugated bile acids （glycho- and tauro-sodium salts） designated esophageal infusion catheter under the general anesthesia, （4） perfused as in group 2 treated with indometacin, （5） perfused as in group 2 treated with NS-398, （6） perfused as in group 3 treated with indometacin, and （7） perfused as in group 3 treated with NS-398. The esophagus was divided into 3 parts： upper, middle and lower. The PGE2 concentration was measured in all parts of esophagus using RIA method. Esophagus of sacrificed animals was macroscopically evaluated using a low power dissecting microscope （20x）. Specimeris, representing the most frequently seen changes were fixed, stained with H＆E and assessed microscopically using the damage score, and inflammatory score. RESULTS： The macroscopic changes were significantly severer in HCI/P than those in HCI animals （77%） and in HCI/P/BA group （43%）. In HCI/P NS-398 group we noticed significantly less changes than those in not treated group （42%） and in analogical group treated with indometacine （45%）. In HCI/P/BA INDO group we observed significantly severer changes than that in not treated group （52%）. We noticed less changes in HCI/P NS-398 than that in group with indometacine （46%）. In HCI/P/BA NS-398 group we had less changes than that in indometacin group （34%）. The microscopic changes observed in HCI/P/BA INDO group were severer than that in not treated group （48%）. Esophagitis index in HCI group was significantly lower than in HCI/P and also HCI/P/BA group （32% and 33 %）. In HCI/P/BA/INDO group the esophagitis surface was larger than that in not treated group （33%）. In HCL/P group the surface of esophagus with ulceration was significantly larger （10-fold） than that in HCI/P/BA group. The PGE2 concentration was significantly higher in HCI/P group than in HCI/P/BA group. The PGE2 concentration in lower part of esophagus was also significantly higher in middle than those in HCI and HCI/P/BA groups. In upper part of esophagus the PGE2 concentration was significantly higher in HCI/P/BA group than that in group treated with indometacine （46%）. We also observed higher PGE2 concentration in middle part of esophagus in HCI/P/BA group than those in group treated with indometadne and in group treated with indometacin and NS-398 （by 52% and 43% respectively）. CONCLUSION： Pepsin is the pivotal factor in the development of chronic esophageal injury. Bile acids diminish chronic esophageal injury induced by HCI/P, indicating its potential negative impact on pepsin proteolytic potential, pivotal for mucosal injury in low pH. The role of selective COX inhibitors is still unclear, and needs more investigations. This novel chronic experimental esophagitis is an excellent model for further study on the role of cytokines in genetically modified animals.展开更多
Esophageal cancer is one of the most unknown and deadliest cancers worldwide,mainly because of its extremely aggressive nature and poor survival rate.Esophageal cancer is the 6th leading cause of death from cancer and...Esophageal cancer is one of the most unknown and deadliest cancers worldwide,mainly because of its extremely aggressive nature and poor survival rate.Esophageal cancer is the 6th leading cause of death from cancer and the 8th most common cancer in the world.The 5-year survival is around 15%-25%.There are clear differences between the risk factors of both histological types that affect their incidence and distribution worldwide.There are areas of high incidence of squamous cell carcinoma(some areas in China) that meet the requirements for cost-effectiveness of endoscopy for early diagnosis in the general population of those areas.In Europe and United States the predominant histologic subtype is adenocarcinoma.The role of early diagnosis of adenocarcinoma in Barrett's esophagus remains controversial.The differences in the therapeutic management of early esophageal carcinoma(high-grade dysplasia,T1 a,T1 b,N0) between different parts of the world may be explained by the number of cancers diagnosed at an early stage.In areas where the incidence is high(China and Japan among others) early diagnoses is more frequent and has led to the development of endoscopic techniques for definitive treatment that achieve very effective results with a minimum number of complications and preserving the functionality of the esophagus.展开更多
文摘AIM:To investigate the role of psychological characteristics as risk factors for oesophageal adenocarcinoma(OAC),as well as the reflux-mediated precursor pathway.METHODS:An all-Ireland population-based case-control study recruited 230 reflux oesophagitis(RO),224 Barrett's oesophagus(BO) and 227 OAC patients and 260 controls.Each case/control group completed measures of stress,depression,self-efficacy,self-esteem,repression and social support.A comparative analysis was undertaken using polytomous logistic regression adjusted for potential confounders.RESULTS:Compared to controls,OAC patients were almost half as likely to report high stress levels over their lifetime(P = 0.010,OR 0.51;95%CI:0.29-0.90)and 36% less likely to report having experienced depression(OR 0.64;95%CI:0.42-0.98).RO patients reported significantly higher stress than controls particularly during middle-and senior-years(P for trends < 0.001).RO patients were 37% less likely to report having been highly emotionally repressed(OR 0.63;95%CI:0.41-0.95).All case groups(OAC,RO and BO) were more likely than controls to report having had substantial amounts of social support(OR 2.84;95%CI:1.63-4.97;OR 1.97;95%CI:1.13-3.44 and OR 1.83;95%CI:1.03-3.24,respectively).CONCLUSION:The improved psychological profile of OAC patients may be explained by response shift.The role of psychological factors in the development of OAC requires further investigation.
文摘AIM:To elucidate the effect of a proton pump inhibitor(PPI,rabeparazole)on oesophageal bile reflux in oesophagitis after total gastrectomy.METHODS:Twenty-one 8-week-old male Wistar rats were studied.They were performed oesophagoduodenostomy of total gastrectomy to induce oesophageal reflux of biliary and pancreatic juice.Five rats were performed the sham operation(Sham).On post-operative day 7,they were treated with saline(Control)(n=8)or PPI(rabeprazole,30 mg/kg per day,ip)(n=8)for 2 wk.On post-operative 21,all rats were sacrificed and each oesophagus was evaluated histologically.Oesophageal injury was evaluated by macroscopic and microscopic findings as well as the expression of cyclooxygenase-2(COX2).We measured bile acid in the oesophageal lumen and the common bile duct.RESULTS:At 3 wk after surgery,a histological study analysis revealed an increase in the thickness of the epithelium,elongation of the lamina propria and basal cell hyperplasia in the oesophageal mucosa.The macroscopic ulcer score and microscopic ulcer length of the control group were significantly higher compared to those of the rabeprazole-treated group.The expression of COX2 was significantly increased according to the immunostaining in the control group compared to rabeprazole-treated group.Although there was no difference between the control and PPI groups in the total bile acid in the common bile duct,the bileacid activity in the oesophageal lumen was significantly decreased in the rabeprazole-treated group due to augmentation of the duodenal motor complex.CONCLUSION:With this model,rabeprazole is good effect for reflux esophagitis after total gastrectomy from bile reflux.Bile acid is an important factor in the mucosal lesion induced by duodenal reflux.
基金Supported by the Fund of Spring Wind Plan of Tianjin First Central Hospital,No.TFCHCF201814.
文摘BACKGROUND Suppurative oesophagitis is a diffuse inflammation of the oesophagus characterized by suppurative exudate or pus formation.Suppurative infections can affect any part of the gastrointestinal tract,most commonly the stomach,with inflammation involving the entire gastric cavity.However,cases extending beyond the cardia or pylorus and involving the oesophagus,small intestine,and colon are rare.Usually such cases are discovered during surgery or autopsy.CASE SUMMARY We report a rare case of acute suppurative oesophagitis.A 57-year-old man presented at the Emergency Department of our hospital with fever and productive cough.The patient had a significant history of lower oesophageal mucosal frostbite.He was successfully diagnosed and treated with repeated gastroscopy,appropriate antibiotics,and innovative symptomatic treatment.CONCLUSION Early diagnosis and appropriate treatment of acute suppurative oesophagitis are critical.Nutritional support,postural drainage,and other symptomatic treatments must be considered.
基金the Research Center of Gastroenterology and Liver Diseases, Shaheed Beheshti University of Medical Sciences, grant No. EPS/00/114
文摘AIM： To examine the relationship between Hpylori and gastro-oesophageal reflux disease （GORD） in Iran. METHODS： In this study 51 GORD patients （referred to endoscopy at Taleghani hospital） were compared with 49 age-sex matched controls. Diagnosis of H pylori was made by gastric mucosal biopsy and rapid urease test （positive if the result of one or both diagnostic methods was positive）. Updated Sydney system was used to report histopathological changes. RESULTS： The frequency of H pylori infection based on rapid urease test and histology was 88.2% （45） in patients and 77.6% （38） in controls, which showed no significant difference. The frequency of H pylori infection was significantly higher in the antrum than in the corpus and cardia. The mean activity, inflammation, and gastritis scores were also higher in the antrum of patients than in the antrum of controls. The mean scores were significantly higher in the corpus of controls than in the corpus of patients. Diffuse active gastritis was observed in a significantly larger number of controls, while the frequency of diffuse chronic gastritis was higher in patients. There in the frequency of other patients and controls. was no significant difference histological findings between.CONCLUSION： H pylori infection cannot prevent GORD in this region.
文摘Eosinophilic oesophagitis (EoE) is a chronic,antigen mediated disease of the disease of the oesophagus that may present in both adults and children.It is characterised by intermittent dysphagia,food bolus obstruction and weight loss.The pathogenesis is incompletely understood but is thought to culminate in poor compliance,or reduced distensibility.The condition is being reported and studied in the literature with increasing incidence,although equally it is highly likely that the diagnosis is being missed altogether with alarming frequency.Diagnosis of the condition requires at least one oesophageal biopsy with an eosinophil count greater than 15 per high power field.Endoscopic features include trachealisation,furrows,white exudate,narrowing and in the most severe cases stricture formation although none are pathognomonic of the condition.Therapy is often not required,but in the acute setting may take the form of dietary therapy or topical steroids.Long term maintenance therapy is usually only required in the most severe cases and the most effective treatment is the subject of ongoing research.There are a number of hurdles to be overcome in the management of patients with EoE.These include;improving our understanding of the aetiologyof the condition,investigating the individual causes,assessing the true disease severity and planning the best long term maintenance therapy.Distinguishing EoE from EoE gastro-oesophageal reflux disease is also a hurdle because the two conditions,both being common,can co-exist.In order to overcome these hurdles,a multifaceted approach is required.The management of food bolus obstruction requires a management algorithm that is accepted and endorsed by a number of specialties.National and international disease registers should be established in order to facilitate future research but more importantly to address areas where further education or increased diagnostic capabilities may be required.Assessment of disease severity should become a key goal,and the development of specific biomarkers for EoE should also be a priority.Finally,randomised controlled trials of new agents are required to assess the best treatment in both the acute and long term setting.
文摘AIM: To look at the relationship between eosinophilic oesophagitis(EO) and food bolus impaction in adults. METHODS: We retrospectively analysed medical records of 100 consecutive patients who presented to our hospital with oesophageal food bolus obstruction(FBO) between 2012 and 2014. In this cohort, 96 were adults(64% male), and 4 paediatric patients were excluded from the analysis as our centre did not have paediatric gastroenterologists. Eighty-five adult patients underwent emergency gastroscopy. The food bolus was either advanced into the stomach using the push technique or retrieved using a standard retrieval net. Biopsies were obtained in 51 patients from the proximal and distal parts of the oesophagus at initial gastroscopy. All biopsy specimens were assessed and reviewed by dedicated gastrointestinal pathologists at the Department of Pathology, University Hospital Geelong. The diagnosis of EO was defined and established by the presence of the following histological features:(1) peak eosinophil counts > 20/hpf;(2) eosinophil microabscess;(3) superficial layering of eosinophils;(4) extracellular eosinophil granules;(5) basal cell hyperplasia;(6) dilated intercellular spaces; and(7) subepithelial or lamina propria fibrosis. The histology results of the biopsy specimens were accessed from the pathology database of the hospital and recorded for analysis. RESULTS: Our cohort had a median age of 60. Seventeen/51(33%) patients had evidence of EO on biopsy findings. The majority of patients with EO were male(71%). Classical endoscopic features of oesophageal rings, furrows or white plaques and exudates werefound in 59% of patients with EO. Previous episodes of FBO were present in 12/17 patients and 41% had a history of eczema, hay fever or asthma. Reflux oesophagitis and benign strictures were found in 20/34 patients who did not have biopsies. CONCLUSION: EO is present in approximately one third of patients who are admitted with FBO. Biopsies should be performed routinely at index endoscopy in order to pursue this treatable cause of long term morbidity.
文摘Eosinophilic oesophagitis(EoE) and gastro-oesophageal reflux disease(GORD) are the most common causes of chronic oesophagitis and dysphagia associated with oesophageal mucosal eosinophilia. Distinguishing between the two is imperative but challenging due to overlapping clinical and histological features. A diagnosis of EoE requires clinical, histological and endoscopic correlation whereas a diagnosis of GORD is mainly clinical without the need for other investigations. Both entities may exhibit oesophageal eosinophilia at a similar level making a histological distinction between them difficult. Although the term proton-pump inhibitor responsive oesophageal eosinophilia has recently been retracted from the guidelines, a relationship between Eo E and GORD still exists. This relationship is complex as they may coexist, either interacting bidirectionally or are unrelated. This review aims to outline the differences and potential relationship between the two conditions, with specific focus on histology, immunology, pathogenesis and treatment.
基金Supported by“Continuation”Project of Excellent Doctors,Guangdong Basic and Applied Basic Research Foundation,No.2025A04J5082Guangdong Basic and Applied Basic Research Foundation,No.2024A1515011236.
文摘This letter addresses challenges in the clinical translation of BIBR1532,a promising telomerase inhibitor,for the treatment of esophageal squamous cell carcinoma(ESCC).BIBR1532 exerts its anti-cancer effect by activating DNA damage response(ATR/CHK1 and ATM/CHK2)pathways and downregulating telomere-binding proteins.Although its therapeutic potential is limited by poor aqueous solubility,solid dispersion(SD)technology may overcome this obstacle.Systematic analysis using PubChem-derived simplified molecular input line entry system identifiers and artificial intelligence-driven FormulationDT platform evaluation(oral formulation feasibility index:0.38)revealed that the SD technology,with superior scalability(32 approved products by 2021)and lower production risks,outperforms lipid-based formulations as an optimal dissolution strategy.Material analysis revealed hydroxypropyl methylcellulose(HPMC)as the optimal carrier with lower hygroscopicity,higher temperature and no intestinal targeting,thus enabling ESCC therapy.HPMC-based SD enhances BIBR1532 solubility and bioavailability for effective ESCC treatment.Future studies should focus on pilot tests for SD fabrication.
基金Supported by National Natural Science Foundation of China,No.82002515,No.82273025 and No.82203460China Postdoctoral Science Foundation,No.2022TQ0070 and No.2022M710759Shanghai Municipal Commission of Science and Technology,No.22JC1403003,No.22XD1402200,No.19140901902 and No.22S31903800.
文摘BACKGROUND There are few clinicopathologic characteristics and clinical results for oesophageal gastrointestinal stromal tumours(GISTs).Thus,the objective of this study was to identify the clinicopathologic characteristics and clinical results of oesophageal GISTs.AIM To investigate endoscopic treatment effective of oesophageal GISTs.METHODS It was retrospective research that collected 32 patients with oesophageal GISTs treated by endoscopic resection(ER)between January 2012 and January 2023 in two Hospital.Clinicopathologic,endoscopic records,and follow-up data were collected and analysed.RESULTS Thirty-one patients underwent en bloc resection and 24(75.0%)lesions underwent R0 resection.The size of GISTs was 2.12±1.88 cm.The overall complication rate was 25.0%,including hydrothorax and post-endoscopic submucosal dissection electrocoagulation syndrome.The mean mitotic index was 3.34±5.04(median,1.50;range,1.00-4.00).Eighteen(56.3%),6(18.8%),2(6.3%),and 6(18.8%)patients were identified as very low,low,intermediate,and high risk,respectively.Three patients developed recurrence after a median follow-up of 64.69±33.13 months.The 5-year overall survival rate was 100%,and the disease-free survival rate was 90.6%.CONCLUSION ER is safe and effective for patients with low-risk oesophageal GISTs.Early detection of oesophageal GISTs is essential to achieve a favourable prognosis.
文摘BACKGROUND Gastric and oesophageal cancers are among the leading causes of cancer-related mortality globally.Treatment in the form of surgical resection and neoadjuvant therapy is considered the gold standard;however,these procedures are associated with significant postoperative morbidity and prolonged recovery times.Prehabilitation aims to combat this by physically and psychologically optimising patients preoperatively to handle the stress of surgery and improve postoperative outcomes.AIM To evaluate the effectiveness of prehabilitation in patients undergoing gastric or oesophageal cancer resections.METHODS Standard medical databases such as MEDLINE,EMBASE,PubMed,and Cochrane Library were searched to find randomised,controlled trials comparing prehabilitation vs no-prehabilitation in patients undergoing gastric or oesophageal cancer resections.All data were analysed using Review Manager Software 5.4,and the meta-analysis was performed with a random-effect model analysis.RESULTS A total of 16 studies were included(n=1479),recruiting adult patients undergoing gastric or oesophageal cancer resections.In the random effect model analysis,prehabilitation was associated with fewer postoperative complications compared to no prehabilitation(Odds ratio:0.43,95%CI:0.31-0.58,Z=25.28,P<0.00001).Additionally,prehabilitation was associated with a lower postoperative readmission rate(risk ratio:0.58,95%CI:0.35-0.96,Z=2.10,P=0.04)and a shorter length of stay[standardised mean difference(SMD):-0.19,95%CI:-0.37 to-0.02,Z=2.21,P=0.03]compared to no-prehabilitation.Prehabilitation was also found to improve preoperative 6-minute walking distance(6-MWD)compared to no-prehabilitation(SMD:0.72,95%CI:0.21-1.23,Z=2.75,P=0.006).No statistical difference was found in postoperative 6-MWD,mortality,and severe complications.CONCLUSION Prehabilitation was found to be effective in reducing postoperative morbidity and improving preoperative physical health in patients undergoing gastric or oesophageal cancer resections.
文摘Oesophageal gastrointestinal stromal tumours are rare,anatomically challenging lesions with higher surgical morbidity than their gastric counterparts.Emerging endoscopic resection techniques such as endoscopic submucosal dissection and submucosal tunnelling endoscopic resection show much promise for the management of patients who are not fit for,or wish to avoid the morbidity of,major surgical resection.These techniques require careful patient selection and advanced technical skills.We build on the recent review of such techniques by Vogli et al.Current evidence is limited to small case series with heterogeneity in patient selection,tumor size,and outcomes.Notably,long-term oncological data remain sparse,and complications such as bleeding or perforation may be life-threatening in patients unfit for surgical rescue.Nonetheless,endoscopic approaches have many potential advantages to offer such as preserved quality of life and definitive management of unfit patients.
基金Supported by the Chongqing Science and Health Joint Medical Research Project,No.2024MSXM065.
文摘BACKGROUND Oesophageal cancer is a significant health concern worldwide,with high inci-dence and mortality rates.In China,the disease burden is particularly high,accounting for a substantial proportion of oesophageal cancer cases and related deaths worldwide.AIM To explore the relationship between the mortality rate of oesophageal cancer patients and insurance type,out-of-pocket ratio,and the joint effects of insurance type and out-of-pocket ratio.METHODS The χ^(2) test was used to analyze patients’demographic and clinical characteristics.Multivariate logistic regression,the Cox proportional hazard model,and the competitive risk model were used to calculate the cumulative hazard ratios(HRs)of all-cause death and oesophageal cancer-specific death among patients with different types of insurance and out-of-pocket ratios.RESULTS Compared with patients covered by basic medical insurance for urban and rural residents,patients covered by urban employee basic medical insurance for urban workers(UEBMI)had a 23.30%increased risk of oesophageal cancer-specific death[HR=1.233,95%confidence interval(CI):1.093-1.391,P<0.005].Compared with patients in the low out-of-pocket ratio group,patients in the high out-of-pocket ratio group had a 25.80%reduction in the risk of oesophageal cancer-specific death(HR=0.742,95%CI:0.6555-0.84,P<0.005).With each 10%increase in the out-of-pocket ratio,the risk of oesophageal cancer-specific death decreased by 10.10%in patients covered by UEBMI.However,the risk of oesophageal cancer-specific death increased by 26.90%in patients in the high out-of-pocket ratio group.CONCLUSION This study reveals the relationships of the specific mortality rate of patients with oesophageal cancer with the out-of-pocket ratio and medical insurance types as well as their combined effects.This study provides practical suggestions and guidance for the formulation of relevant policies in this area.
文摘Benign esophageal stricture is characterized by the narrowing of the digestivetract lumen due to multiple factors. Endoscopic treatment is the first treatmentchoice and includes endoscopic dilatation, drug injection, stenosis incision, stentimplantation, stem cell flap transplantation, etc. However, there are currently nospecific clinical standards or guidelines to quantify a series of specific parametersin the treatment of benign esophageal stricture, such as the frequency of drugadministration, dosage, dilation inner diameter, and number of treatments. Thisleads to operator bias in clinical practice and inconsistent treatment outcomesamong patients. Therefore, this article reviews the current advances and existingchallenges in the endoscopic treatment of benign esophageal stricture, with theaim of exploring the possibility of achieving precision and standardization in theendoscopic treatment of this disease.
文摘In this letter,a commentary on the article by Xu et al has been provided.Gastrointestinal stomal tumours(GISTs)are rare tumours that originate commonly in stomach(60%-70%)and small intestine(30%-40%).The course of treatment especially oesophageal GIST is very complex and hard to diagnose because of limited availability of pathological and clinical data.Endoscopic resection(ER)is a minimally invasive approach for removing tumours from the oesophagus and digestive system that does not require open surgery and is especially successful for very small and low-risk GIST.A retrospective exami-nation of 32 patients treated with ER between 2012 and 2023 was conducted to analyse clinical and pathological characteristics,effectiveness of therapy,and long-term prognosis.The findings demonstrate en bloc resection was achieved in 96.9%of cases with an R0 resection rate of 75%with a median size of tumour was approximately 2.12 cm.Post-surgery complication like hydrothorax,post-endoscopic submucosal dissection electrocoagulation syndrome occurred in about 25%of cases which later go resolved by conservative treatment.Recurrence of GIST was approximately 9.4%primarily in high-risk cases.ER should be widely adopted in clinical practise preferably for managing low-risk oesophageal GIST because of its high success rate,low recurrence rates and excellent survival results,ensuring better patient prognosis.
文摘In this article,we comment on the work put forth by Wu et al regarding the investigation of oesophageal cancer-specific mortality for a cohort of patients from Chongqing University Cancer Hospital.We specifically focused on the implications of public health plans such as Urban Employee Basic Medical Insurance(UEBMI)and Urban Resident Basic Medical Insurance as well as out-of-pocket ratios on patient treatment plans regarding whether they pursue surgical interventions or therapeutic treatments such as chemotherapy.While Wu et al put forth potential explanations for why patients with the UEBMI plan surprisingly had a 23.30%increased risk of oesophageal cancer-specific death,more analysis is needed to alleviate cancer burden within this group.Although it is likely that patients covered by Urban Resident Basic Medical Insurance and higher out-ofpocket ratios have stronger self-recovery awareness,more work must be done to improve outcomes for people with the UEBMI plan while simultaneously implementing international and domestic initiatives to better emphasize cancer prevention and early detection.Lastly,future research must explore the relationship between Serious Illness Medical Insurance as well as the New Rural Cooperative Medical System on the mortality rate of oesophageal cancer patients in rural China,where disease burden is significantly higher than urban areas.By unifying these public health insurance schemes,officials can significantly alleviate economic burden of treatment and better prognosis for patients with oesophageal cancer.
文摘Feeding dysfunction is a frequent presenting symptom of eosinophilic esophagitis(EoE). Here we present 3 children of various ages whose manifestations of EoE associated feeding dysfunction led to significant and life altering impact on their growth and development. Early identification of presenting symptoms of EoE will allow for prompt diagnosis and initiation of appropriate treatments. Recognition of salient features of dysfunction and treatment by feeding therapists and nutritionists led to symptom resolution and growth.
基金Supported by National Natural Science Foundation of China,No.81772642Beijing Municipal Science and Technology Commission,No.Z161100000116045Capital’s Funds for Health Improvement and Research,No.CFH 2018-2-4022。
文摘BACKGROUND Laparoscopic assisted total gastrectomy(LaTG)is associated with reduced nutritional status,and the procedure is not easily carried out without extensive expertise.A small remnant stomach after near-total gastrectomy confers no significant nutritional benefits over total gastrectomy.In this study,we developed a modified laparoscopic subtotal gastrectomy procedure,termed laparoscopicassisted tailored subtotal gastrectomy(LaTSG).AIM To evaluate the feasibility and nutritional impact of LaTSG compared to those of LaTG in patients with advanced middle-third gastric cancer(GC).METHODS We retrospectively analyzed surgical and oncological outcomes and postoperative nutritional status in 92 consecutive patients with middle-third GC who underwent radical laparoscopic gastrectomy at Department of Pancreatic Stomach Surgery,National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences,and Peking Union Medical College between 2013 and 2017.Of these 92 patients,47 underwent LaTSG(LaTSG group),and the remaining underwent LaTG(LaTG group).RESULTS Operation time(210±49.8 min vs 208±50.0 min,P>0.05)and intraoperative blood loss(152.3±166.1 mL vs 188.9±167.8 mL,P>0.05)were similar between the groups.The incidence of postoperative morbidities was lower in the LaTSG group than in the LaTG group(4.2%vs 17.8%,P<0.05).Postoperatively,nutritional indices did not significantly differ,until postoperative 12 mo.Albumin,prealbumin,total protein,hemoglobin levels,and red blood cell counts were significantly higher in the LaTSG group than in the LaTG group(P<0.05).No significant differences in Fe or C-reaction protein levels were found between the two groups.Endoscopic examination demonstrated that reflux oesophagitis was more common in the LaTG group(0%vs 11.1%,P<0.05).Kaplan–Meier analysis showed a significant improvement in the overall survival(OS)and disease free survival(DFS)in the LaTSG group.Multivariate analysis showed that LaTSG was an independent prognostic factor for OS(P=0.048)but not for DFS(P=0.054).Subgroup analysis showed that compared to LaTG,LaTSG improved the survival of patients with stage III cancers,but not for other stages.CONCLUSION For advanced GC involving the middle third stomach,LaTSG can be a good option with reduced morbidity and favorable nutritional status and oncological outcomes.
文摘Gastroesophageal reflux disease (GORD) is highly prevalent in the general population.In the last decade,a potential relationship between Helicobacter pylori (H.pylori) eradication and GORD onset has been claimed.The main putative mechanism is the gastric acid hypersecretion that develops after bacterial cure in those patients with corpus-predominant gastritis.We performed a critical reappraisal of the intricate pathogenesis and clinical data available in this field.Oesophagitis onset after H.pylori eradication in duodenal ulcer patients has been ascribed to a gastric acid hypersecretion,which could develop following body gastritis healing.However,the absence of an acid hypersecretive status in these patients is documented by both pathophysiology and clinical studies.Indeed,duodenal ulcer recurrence is virtually abolished followingH.pylori eradication.In addition,intra-oesophageal pH recording studies failed to demonstrated increased acid reflux following bacterial eradication.Moreover,oesophageal manometric studies suggest that H.pylori eradication would reduce-rather than favor-acid reflux into the oesophagus.Finally,data of clinical studies would suggest that H.pylori eradication is not significantly associated with eitherreflux symptoms or erosive oesophagitis onset,some data suggesting also an advantage in curing the infection when oesophagitis is already present.Therefore,the legend of "crazy acid" remains-as all the others a fascinating,but imaginary tale.
文摘AIM. To develop a new experimental model of esophagitis that serves a complementary tool to clinical investigation in an insight into the mechanism of the damage to the esophagus mucosa by aggressive factors, and role of COX inhibitors in this process. METHODS： The study was conducted in 56 male mice. Animals were divided into seven groups： （1） perfused with HCI, （2） perfused with HCI and physiologic concentration of pepsin （HCI/P）, （3） perfused with similar HCI/P solution enriched with conjugated bile acids （glycho- and tauro-sodium salts） designated esophageal infusion catheter under the general anesthesia, （4） perfused as in group 2 treated with indometacin, （5） perfused as in group 2 treated with NS-398, （6） perfused as in group 3 treated with indometacin, and （7） perfused as in group 3 treated with NS-398. The esophagus was divided into 3 parts： upper, middle and lower. The PGE2 concentration was measured in all parts of esophagus using RIA method. Esophagus of sacrificed animals was macroscopically evaluated using a low power dissecting microscope （20x）. Specimeris, representing the most frequently seen changes were fixed, stained with H＆E and assessed microscopically using the damage score, and inflammatory score. RESULTS： The macroscopic changes were significantly severer in HCI/P than those in HCI animals （77%） and in HCI/P/BA group （43%）. In HCI/P NS-398 group we noticed significantly less changes than those in not treated group （42%） and in analogical group treated with indometacine （45%）. In HCI/P/BA INDO group we observed significantly severer changes than that in not treated group （52%）. We noticed less changes in HCI/P NS-398 than that in group with indometacine （46%）. In HCI/P/BA NS-398 group we had less changes than that in indometacin group （34%）. The microscopic changes observed in HCI/P/BA INDO group were severer than that in not treated group （48%）. Esophagitis index in HCI group was significantly lower than in HCI/P and also HCI/P/BA group （32% and 33 %）. In HCI/P/BA/INDO group the esophagitis surface was larger than that in not treated group （33%）. In HCL/P group the surface of esophagus with ulceration was significantly larger （10-fold） than that in HCI/P/BA group. The PGE2 concentration was significantly higher in HCI/P group than in HCI/P/BA group. The PGE2 concentration in lower part of esophagus was also significantly higher in middle than those in HCI and HCI/P/BA groups. In upper part of esophagus the PGE2 concentration was significantly higher in HCI/P/BA group than that in group treated with indometacine （46%）. We also observed higher PGE2 concentration in middle part of esophagus in HCI/P/BA group than those in group treated with indometadne and in group treated with indometacin and NS-398 （by 52% and 43% respectively）. CONCLUSION： Pepsin is the pivotal factor in the development of chronic esophageal injury. Bile acids diminish chronic esophageal injury induced by HCI/P, indicating its potential negative impact on pepsin proteolytic potential, pivotal for mucosal injury in low pH. The role of selective COX inhibitors is still unclear, and needs more investigations. This novel chronic experimental esophagitis is an excellent model for further study on the role of cytokines in genetically modified animals.
文摘Esophageal cancer is one of the most unknown and deadliest cancers worldwide,mainly because of its extremely aggressive nature and poor survival rate.Esophageal cancer is the 6th leading cause of death from cancer and the 8th most common cancer in the world.The 5-year survival is around 15%-25%.There are clear differences between the risk factors of both histological types that affect their incidence and distribution worldwide.There are areas of high incidence of squamous cell carcinoma(some areas in China) that meet the requirements for cost-effectiveness of endoscopy for early diagnosis in the general population of those areas.In Europe and United States the predominant histologic subtype is adenocarcinoma.The role of early diagnosis of adenocarcinoma in Barrett's esophagus remains controversial.The differences in the therapeutic management of early esophageal carcinoma(high-grade dysplasia,T1 a,T1 b,N0) between different parts of the world may be explained by the number of cancers diagnosed at an early stage.In areas where the incidence is high(China and Japan among others) early diagnoses is more frequent and has led to the development of endoscopic techniques for definitive treatment that achieve very effective results with a minimum number of complications and preserving the functionality of the esophagus.
