History Of Reflux Esophagitis Research Articles

A comparative analysis of the distribution of the high-risk population of upper gastrointestinal cancer and endoscopic screening compliance in two urban areas and two rural areas in China

Objective: To analyze and compare the distribution of the high-risk population of upper gastrointestinal (UGI) cancer and the factors influencing the compliance rate of endoscopic screening in urban China and rural China. Methods: From 2015 to 2017, an epidemiological survey was conducted on residents aged 40-69 in two rural areas (Luoshan county of Henan province, Sheyang county of Jiangsu province) and two urban areas (Changsha city of Hunan province, Harbin city of Heilongjiang province). As a result, high-risk individuals were recommended for endoscopic screening. Chi-square χ(2) test was used to compare the high-risk rate of UGI cancer between urban and rural residents. In addition, the multivariate logistic regression model was used to analyze the factors influencing the compliance rate of endoscopic screening. Results: A total of 48, 310 residents aged 40-69 were enrolled in this study, including 22 870 (47.34%) residents from rural areas and 25 440 (52.66%) residents from urban areas. A total of 23 532 individuals were assessed with a high risk of UGI cancer, with an overall risk rate of 48.71%. A higher proportion of participants with high risk was observed in rural China (56.17%, 12 845/22 870) than in urban China (42.01%, 10 687/25 440). A total of 10 971 high-risk individuals with UGI cancer participated in endoscopic screening, with an overall compliance rate of 46.62% (10 971/23 532), 45.15% (5 799/12 845) in rural China, and 48.40% (5 172/10 687) in urban China. In rural population, the compliance rate of endoscopic screening was higher in those of females, aged 50-69 years, primary school education or above, high income, a family history of UGI cancer, history of gastric and duodenal ulcer, history of reflux esophagitis, and history of superficial gastritis, but lower in smokers (P<0.05). Among the urban population, the compliance rate of endoscopic screening was higher in those aged 40-49 years, uneducated, low income, family history of UGI cancer, history of reflux esophagitis, history of superficial gastritis, but lower in smokers (P<0.05). Conclusions: The proportion of participants with high risk of UGI cancer in rural areas is higher than that of urban areas. The compliance rates of endoscopic screening in urban and rural areas are low, and influencing factors of endoscopic screening exhibit some differences in rural China and urban China.

Analysis of endoscopic screening compliance and related factors among high risk population of upper gastrointestinal cancer in urban areas of Henan Province from 2013 to 2017

Objective: To study the compliance of endoscopic screening for high-risk population of upper gastrointestinal cancer and relevant factors in urban areas of Henan Province, 2013-2017. Methods: The study participants were from the Cancer Screening Program in Urban Henan Province, China. From October 2013 to October 2017, 43 423 residents, who were evaluated as high-risk population for upper gastrointestinal cancer, were recruited from Zhengzhou, Zhumadian and Anyang. The cancer risk assessment questionnaire was used to collect basic demographic characteristics, dietary habits, living environment and habits, psychology and emotions, disease history and family history of cancer, and women's physiological and reproductive history. The data of endoscopic screening was obtained from hospitals participating in the Cancer Screening Program. Multivariate logistic regression model was applied to explore potential factors related to the compliance of endoscopic screening. Results: The age of study participants was(55.49±8.15) years old, and 44.00% (19 105) were male. About 18.41% of study subjects (7 996) took the endoscopic screening. The multivariate logistic regression analysis showed that females, individuals aged 45-64 years old, with junior high school education or above, unmarried/divorced/widowed, previous smoking, alcohol drinking, infrequent physical exercise, history of reflux esophagitis, history of superficial gastritis, history of gastric ulcer, history of duodenal ulcer, history of gastric polyps and family history of upper gastrointestinal cancer were more likely to accept endoscopic screening. Conclusion: The overall participation rate of endoscopic screening among high-risk population of upper gastrointestinal cancer was still low in urban areas of Henan Province. Gender, age, education, marital status, smoking, alcohol consumption, physical activity, history of upper gastrointestinal disease and family history of upper gastroin testinal cancer were associated with the compliance of endoscopic screening.

Independent and combined effects of environmental factors and CYP2C19 polymorphisms on the risk of esophageal squamous cell carcinoma in Fujian Province of China.

BackgroundThe purpose of this study was to explore the effects of CYP2C19 gene polymorphisms and various environmental factors and their interactions on the risk of esophageal squamous cell carcinoma (ESCC) in a Chinese Han population.MethodsA 1:2 frequency-matched case control study of 285 patients and 570 controls was conducted from June 2010 to May 2011 in AnXi of Fujian province, China. Environmental factors were investigated using a self-administered questionnaire and genotypes were determined using polymerase chain reaction restriction fragment length polymorphism based methods. Unconditional logistic regression models were used for statistical evaluation.ResultsCurrent or former smoking, consumption of pickled vegetables or hot beverages/food, having a first degree relative with ESCC and history of reflux esophagitis were significantly associated with increased ESCC risk, whereas tea drinking and consumption of fresh vegetables and fruits were significantly associated with decreased risk. The CYP2C19*2 GA/AA genotype was significantly more prevalent in ESCC patients and individuals with at least one copy of the CYP2C19*2 A allele had a 3.19-fold increased risk (adjusted 95% confidence interval (CI): 2.21–4.61, P < 0.001) of ESCC compared with those without this allele. We found no significant associations between CYP2C19*3 genotypes and ESCC. The Cyp2C19*2 polymorphism appeared to have a multiplicative joint effect with tea drinking and hot beverage/food consumption (gene–tea drinking: Pinteraction = 0.042; hot beverage/food consumption: Pinteraction = 6.98 × 10−6) and an additive joint effect with pickled vegetable consumption (interaction contrast ratio = 1.96, 95% CI: 0.12–3.80).ConclusionsOur findings suggest that the CYP2C19*2 polymorphism plays an important role in the development of ESCC in the Chinese population, modified by tea drinking and consumption of pickled vegetables or hot beverages/food. Further studies are warranted to confirm our results.Electronic supplementary materialThe online version of this article (doi:10.1186/s12881-015-0156-3) contains supplementary material, which is available to authorized users.

Fatal Esophageal Squamous Cell Carcinoma at a Young Age as a Complication of Autoimmune Polyendocrinopathy-Candidiasis-Ectodermal Dystrophy

ABSTRACT Objective: To report a rare case of esophageal squamous cell carcinoma (SCC) complicated by chronic mucocutaneous candidiasis (CMC) in a patient with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) to increase awareness of this association and to optimize CMC control in an effort to prevent this fatal complication. Methods: We report a case of fatal esophageal SCC in a young patient with APECED and CMC and the literature pertaining to this association. Results: A 34-year-old female with known APECED and oral CMC diagnosed in infancy presented with a 4-week history of progressive dysphagia and odynophagia on a background history of reflux esophagitis. Esophagogastroscopy revealed a diffusely necrotic esophagus with exudates. Biopsy revealed a poorly differentiated SCC and fungal spores compatible with Candida species. She was treated with micafungin for 4 weeks. Repeat endoscopy and biopsy confirmed esophageal SCC. The initial metastatic work-up was negative; however, she p...

The Use of Acetylcystine in Esophageal Food Impaction

Esophageal food impaction is a problem that faces the gastroenterologists in people with underlying esophageal strictures or altered esophageal anatomy. The only effective treatment so far is endoscopic removal of the food impacted or surgical intervention if the previous modalities failed. We describe here the use of acetylcystine in dissolving food impaction after failure of endoscopic treatment Case 1: Mrs. K.E is 40 year old female with previous history of multiple esophageal surgeries. Presented to the ER with food impaction after chicken meal. On exam there was a large soft lump in her neck suggestive of the food bolus, emergency EGD was performed which showed large food bolus impacted in the mid third of her esophagus, multiple attempts to remove it was unsuccessful. Termination of the procedure was decided, patient was sent back to the floor and was started on 15 cc of acetylcystine in 50 cc of water to give 5 cc every 5 min till finished every 8 hours. after 24 hour, repeat EGD showed complete resolution of the food bolus and patent esophagus Case 2: Mr. J.H is 50 year old male patient with old history of reflux esophagitis, presented with history of food impaction turkey sandwich, he was complaining of chest pain and difficulty to swallow. Emergency EGD showed large food bolus impacted in the distal esophagus that was difficult to remove secondary for being cement-like which made difficult to be grasped by forceps and was large for a snare to hold. After termination of the procedure, the patient was sent to the telemetry unit for close observation and surgery consult was obtained for possible surgical intervention, meanwhile the patient was started on acetylcystine with the same previous regimen. Repeat EGD in 24 hour showed complete clearance of his esophagus with evidence of underlying esophageal peptic stricture. Discussion: Food impaction in the esophagus is not uncommon problem that we face in our institution however, endoscopic treatment is usually sufficient and result in quick recovery and discharge from the hospital. Recently, we had more cases of food impaction that is difficult to treat secondary for being large in size or cement like structure. There was few reported cases of using acetylcystine in the treatment of stomach bezoar with success, using its mucolytic characteristics in dissolving the food bolus. The acetylcysteine softens the bezoars allowing an easier and faster fragmentation by mechanical means. Depending on this theory, we used it in treating difficult cases of food impaction of the esophagus with success so far. However more studies are needed to prove or disprove the efficacy of acetylcystine in this settings.

Bleeding reflux esophagitis: a prospective 1-year study in a university hospital

OBJECTIVES: The prevalence of bleeding from reflux esophagitis has not been studied. The aim of the study was to evaluate the 1-yr prevalence of bleeding from reflux esophagitis, as well as the independent factors associated with bleeding. METHODS: All patients with reflux esophagitis diagnosed with upper digestive tract endoscopy in Reims Hospital in 1996 were included. Studied parameters were prospectively recorded and compared between patients with bleeding and nonbleeding reflux esophagitis. RESULTS: Endoscopy was performed in 1983 patients of whom 219 (11.0%) had overt upper digestive tract hemorrhage. Reflux esophagitis was the cause of bleeding in 32 patients (14.6%). Reflux esophagitis was diagnosed in 391 patients during the same period of time. Bleeding reflux esophagitis accounted for 8.2% of them. Independent factors associated with bleeding were grade 3 or 4 (Savary-Miller) esophagitis (odds ratio [OR]: 25.5, 95% confidence interval [CI]: 9.6–67.9), cirrhosis (OR: 5.7, 95% CI: 1.7–18.9), Eastern Cooperative Oncology Group performance status ≥3 (OR: 4.6, 95% CI: 1.5–14.2), and anticoagulant therapy (OR: 3.9, 95% CI: 1.2–12.5). A history of reflux esophagitis or heartburn was noted in only 28.1% or 37.5% of the patients with bleeding reflux esophagitis, respectively. CONCLUSIONS: In this population of patients with reflux esophagitis, the prevalence of bleeding esophagitis was high (8.2%). Bleeding esophagitis occurred primarily in patients with severe esophagitis and was the revealing clinical form of gastroesophageal reflux disease in the majority of cases, suggesting that bleeding prevention would hardly be effective.

Gastrojejunal and gastroesophageal fistulae following placement of an Angelchik prosthesis

<h3>To the Editor.—</h3> The Angelchik prosthesis for treatment of gastroesophageal reflux and hiatal hernia was first described by Angelchik and Cohen¹in 1979. Since that time, it is estimated that more than 9,000 have been employed, with estimates of complications—primarily migration of the device and obstruction—ranging up to 10%.²These devices have eroded into the stomach and migrated to other sites.^2-5A patient treated with an Angelchik prosthesis following failure of two previous antireflux procedures, in whom a gastrojejunal fistula and gastroesophageal fistulae from the device developed, is described herein. <h3>Report of a Case.—</h3> A 51-year-old woman with a long history of reflux esophagitis had undergone an Allison procedure without splenectomy and a Nissen fundoplication with splenectomy. In November 1982, the patient underwent endoscopy for recurrent symptoms, revealing reflux esophagitis and a fundoplication defect but no other gastric abnormality. Shortly after, an Angelchik prosthesis was placed. In

Gastrojejunal and Gastroesophageal Fistulae Following Placement of an Angelchik Prosthesis

To the Editor.— The Angelchik prosthesis for treatment of gastroesophageal reflux and hiatal hernia was first described by Angelchik and Cohen1in 1979. Since that time, it is estimated that more than 9,000 have been employed, with estimates of complications—primarily migration of the device and obstruction—ranging up to 10%.2These devices have eroded into the stomach and migrated to other sites.2-5A patient treated with an Angelchik prosthesis following failure of two previous antireflux procedures, in whom a gastrojejunal fistula and gastroesophageal fistulae from the device developed, is described herein. Report of a Case.— A 51-year-old woman with a long history of reflux esophagitis had undergone an Allison procedure without splenectomy and a Nissen fundoplication with splenectomy. In November 1982, the patient underwent endoscopy for recurrent symptoms, revealing reflux esophagitis and a fundoplication defect but no other gastric abnormality. Shortly after, an Angelchik prosthesis was placed. In