Cases Of Reflux Esophagitis Research Articles

Combined thoracoscopic and laparoscopic surgery for epiphrenic diverticulum with associated gastroesophageal reflux disease: a case report

BackgroundSurgery is indicated for symptomatic epiphrenic esophageal diverticula. Based on the features of a case, thoracoscopic or laparoscopic approaches may be used. Epiphrenic diverticula are often associated with esophageal motility disorders, but cases of reflux esophagitis have rarely been reported. In this report, we describe a case of an epiphrenic esophageal diverticulum with reflux esophagitis, which was successfully treated by thoracoscopic diverticulectomy and laparoscopic fundoplication.Case presentationA 69-year-old man visited the hospital with a chief complaint of eructation and hiccup. Upper gastrointestinal endoscopy revealed a diverticulum in the left wall of the esophagus, which was 37–45 cm distal to the incisors. High-resolution manometry (HRM) showed no esophageal motility disorders. Due to the large size of the diverticulum, a thoracoscopic resection of the esophageal diverticulum was performed. Additionally, the patient had reflux esophagitis due to a hiatal hernia. The anti-reflux mechanism would be more impaired during the diverticulectomy; therefore, we decided that anti-reflux surgery should be performed simultaneously. Thoracoscopic esophageal diverticulectomy and laparoscopic Dor fundoplication were performed. The patient had an uncomplicated postoperative course and was discharged on the tenth operative day. He has been symptom-free without acid secretion inhibitors for 21 months after the surgery.ConclusionsWe described a rare case of a large epiphrenic diverticulum with reflux esophagitis. A good surgical outcome was achieved by thoracoscopic resection of the diverticulum and laparoscopic Dor fundoplication.

Esophageal Mucosal Resistance in Reflux Esophagitis: What We Have Learned So Far and What Remains to Be Learned.

Gastroesophageal reflux disease (GERD) has the highest prevalence among diseases of the digestive system and is characterized by a significant decrease in patients' quality of life, comparable to arterial hypertension and coronary heart disease. One in every ten cases of reflux esophagitis leads to the formation of Barrett's esophagus, which is associated with a high risk of esophagus adenocarcinoma. The key factors determining the progression of the disease are the frequency and duration of the reflux of the stomach's contents. As a result, refluxate, which includes hydrochloric acid, pepsin, and, in the case of concomitant duodeno-gastric reflux, bile acids and lysolecithin, is thrown into the overlying sections of the digestive tract. At the same time, in addition to aggression factors, it is necessary to take into account the state of resistance in the esophageal mucosa to the effects of aggressive refluxate molecules. This review was prepared using systematized data on the protective properties of the esophageal mucosa and modern methods to assess the mucosal barrier in reflux esophagitis. Lesions of the epithelial barrier structure in the esophagus are recognized as the main pathogenetic factor in the development of reflux esophagitis and are a potentially significant therapeutic target in the treatment of GERD and Barrett's esophagus. This article presents the characteristics of the esophageal mucosal barrier and the protective mechanisms of the esophagus's mucous membrane in conditions of gastroesophageal reflux. Diagnostic approaches for assessing the course of reflux esophagitis are described for both histological criteria and the possibility of a comprehensive assessment of the state of mucins, tight-junction proteins, and the proliferative activity of the mucosa, including under the conditions of ongoing therapy.

Functional end to end esophagojejunostomy without previous resection of esophagus and jejunum by linear stapler in the totally laparoscopic gastrectomy: Experience in 106 patients

Abstract Introduction: We aimed to evaluate the outcomes of the technique of functional end-to-end esophagojejunostomy by linear stapler without previous resection of the esophagus and jejunum in the totally laparoscopic total gastrectomy (TLTG) and report experience in 106 patients. Patients and methods: A prospective observational study on patients received technique of functional end-to-end esophagojejunostomy by linear stapler without previous resection of esophagus and jejunum in TLTG between July 2017 and July 2022. Results: We included 106 patients with a mean age of 63.2 ± 11.7 (26 – 88). 10.4% of patients having tumors in the upper third of the stomach and 88.7% of patients having tumors in the middle of the stomach. There were 4.7% of cases having incidents during the surgery and 3.6% of cases having complications after the surgery. There were 2 (1.8%) cases of technical errors in making functional end to end esophagojejunostomy during surgery. No anastomotic leakage or death was observed after the surgery. The operation time was 201.5 ± 29.0 (145 - 270) minutes. The mean hospital stay was 7.56 ± 2.23 (5 - 15) days. 04 (3.6%) cases of reflux esophagitis, and 03 (2.7%) mild stenosis of the anastomosis after surgery, and 1 (0.9%) recurrence at the anastomosis after surgery. Conclusion:The technique of functional end-to-end esophagojejunostomy by linear stapler without previous resection of esophagus and jejunum was safe and effective in TLTG. Keywords: Esophagojejunostomy in laparoscopy, The technique of functional end-to-end.

Modified Peroral Endoscopic Myotomy Technique for Type II Achalasia: A Multicenter Retrospective Study.

Aim This retrospective study is aimed at evaluating the outcomes of a modified peroral endoscopic myotomy (POEM) technique in patients with type II achalasia. Methods We performed a modified POEM procedure, which involved a shorter (total myotomy length = 4 cm), full-thickness myotomy, on 31 patients with type II achalasia. Clinical success rates, technical success rates, pre- and postoperative esophageal manometry results, complications, and reflux-related adverse events were evaluated. Results The clinical success (Eckardt score ≤ 3) rates were 100% and 88.9% within 2 years and beyond 2 years postoperatively, respectively. The median lower esophageal sphincter pressures (LESP) decreased from 31.6 (26.7-49.7) mmHg preoperatively to 13.4 (10.5-21.6) and 11.8 (7.4-16.7) mmHg (P < 0.001) at 6 and 12 months postoperatively, respectively. The median integrated relaxation pressure (IRP) decreased from 27.8 (20.6-37.5) mmHg preoperatively to 12.9 (11.3-23.4) and 11.6 (9.6-16.8) mmHg (P < 0.001) at 6 and 12 months after POEM, respectively. Only one case (3.2%) of mucosal injury, four (12.9%) cases of reflux esophagitis, and two (6.5%) cases of gastroesophageal reflux symptoms were reported. Conclusions The modified POEM technique showed excellent outcomes in patients with type II achalasia.

Severe reflux esophagitis after total gastrectomy successfully treated by transposition of the jejunojejunal anastomosis: a report of two cases

BackgroundReflux esophagitis after total gastrectomy is often difficult to treat. In this report, we describe two cases of reflux esophagitis that were refractory to medical therapy and successfully treated by transposition of the jejunojejunal anastomosis.Case presentationCase 1: A 66-year-old man underwent total gastrectomy and cholecystectomy for gastric cancer, and Roux-en-Y (RY) reconstruction was performed. The pathological diagnosis was T4aN3aM0 stage IIIC. Five months later, esophagogastroduodenoscopy identified reflux esophagitis. Although he was treated with various oral medications and was hospitalized six times, he lost 19 kg of weight. Finally, the patient was reoperated 3 years postoperatively. Intraoperative findings showed that there was no evidence of recurrence or severe adhesions that could have caused obstruction, and the anastomotic distance between the esophagojejunostomy and the jejunojejunostomy was approximately 40 cm. The jejunojejunostomy was re-anastomosed to increase the distance to 100 cm. Two years and 6 months after the reoperation, there was no recurrence of reflux esophagitis, and the patient’s weight increased by 14 kg.Case 2: A 68-year-old woman underwent total gastrectomy and cholecystectomy for gastric cancer, and RY reconstruction was performed. The pathological diagnosis was T4aN0M0 stage IIB. Similar to Case 1, the patient was diagnosed with reflux esophagitis 5 months later. She lost 23 kg of weight and was reoperated at 6 months postoperatively. Intraoperative findings showed that there was no evidence of recurrence or severe adhesions, and transposition of the jejunojejunostomy was performed to increase the distance between anastomoses from 40 to 100 cm. Two years and 8 months after the reoperation, there was no recurrence of reflux esophagitis, and her weight increased by 15 kg.ConclusionsTransposition of the jejunojejunostomy was an effective treatment for medication-resistant severe reflux esophagitis after total gastrectomy.

Relationship between Histomorphological Profile and Endoscopic Pictures of Reflux Esophagitis in Adults

BackgroundEarly diagnosis of GERD is very important because chronic reflux esophagitis is a major risk factor for Barrett esophagus, which is aprecursor lesion for esophageal adenocarcinoma. The aim of this study is to determine the frequency, demographic characteristics,histomorphological profile based on Esohisto criteria and endoscopic features of reflux esophagitis in FKUI/RSCM in 2016-2018.MethodsA cross-sectional study was conducted in Anatomical Pathology Department, Cipto Mangunkusumo General Hospital from January2016 to December 2018. Assessment criteria include demographic characteristics, histomorphological profiles, and endoscopicfeatures. Histomorphological assessment of reflux esophagitis in this study used the Esohisto criteria, by assessing basal cellhyperplasia, elevated papillae, dilated intercellular spaces and intraepithelial eosinophils. Assessment of the lesion severity isclassified as normal mucosa, mild lesion and severe lesion.ResultsThere were 65 cases of reflux esophagitis in adults over a period of 3 years in the Department of Anatomical PathologyFKUI/RSCM. Reviewing demographic data in January 2016-December 2018. The assessment criteria included demographiccharacteristics, histomorphological profiles, and endoscopic features. Histomorphological assessment of reflux esophagitis in thisstudy used the Esohisto criteria, by assessing basal cell hyperplasia, elevated papillae, dilated intercellular spaces in 65 casesfound 33 cases (50.8%) in men and 32 cases (49.2%) in women, with an average sample age of 56 years. The location of the mostlesions was distal esophagus in 30 cases (46.2%). Clinical manifestations in 13 cases (20%) were esophagitis. The most commonclinical symptoms were dysphagia in 21 cases (32.3%). Most endoscopic features were laryngopharyngeal reflux in 12 cases(18.5%), followed by grade C esophagitis in 9 cases (13.8%). The lesion severity of reflux esophagitis lesions based on Esohistocriteria found 37 cases (56.9%) mild lesion followed by severe lesion as many as 28 cases (43.1%)ConclusionThe Esohisto criteria can be used to help diagnose the lesion severity of reflux esophagitis with endoscopic pictures

Can tissue nitric oxide synthesis 2 (iNOS) levels play a role in the pathophysiology of reflux esophagitis?

Objective: Nitric oxide (NO) is a strong dilatator, playing an important role in inflammatory events. Its production is regulated by NO synthase 2 (NOS2/iNOS). Our aim was to compare iNOS in esophageal tissues of patients with erosive or non-erosive reflux esophagitis to that of normal cases.&#x0D; Materials and Methods: The study was conducted in 2019–2020 on patients undergoing upper gastrointestinal (UGI) endoscopy. Study included 30 patients who had no reflux symptoms and were not diagnosed with reflux esophagitis in the UGI endoscopy (control), 22 who had pronounced reflux symptoms but could not be diagnosed with reflux esophagitis in the endoscopy (non-erosive reflux), and 51 who had reflux esophagitis in the endoscopy (erosive reflux esophagitis). Using the enzyme-linked immunosorbent assay, tissue iNOS levels were assessed on samples from the lower end of the esophagus.&#x0D; Results: Average iNOS level was 5.02±1.51 picogram/milliliter (pg/mL) in the normal group and 5.04±1.68 pg/mL in all reflux esophagitis cases. iNOS levels were higher in non-erosive reflux and lower in erosive reflux than in controls. In erosive reflux A, B, and C, iNOS levels were 5.03±1.64, 5.10±2.23, and 4.06±0.02 pg/mL, respectively. The level in erosive reflux C is considerably lower than in the normal group. However, none of the differences between the groups was significant.&#x0D; Conclusions: NO synthase was higher in patients with non-erosive reflux esophagitis and considerably lower in those with erosive reflux C, compared to the normal cases. Although not significant, the differences suggest that NO and iNOS levels may be important in reflux physiopathology.

The effect on the gastrointestinal tract of various forms of alendronate in comorbid patients taking NSAIDs

Introduction. The use of bisphosphonates is associated with some risk of side effects. Gastrointestinal tract complications are particularly important in clinical practice, as they constitute the main reason for refusing bisphosphonate therapy.Objective: To evaluate the effect of various forms of alendronate on the gastrointestinal tract in comorbid patients taking NSAIDs.Materials and methods. The study included 88 women aged 58–65 years (mean age 61.5 ± 3.5 years) with polyosteoarthrosis combined with postmenopausal osteoporosis, who received NSAIDs at medium therapeutic doses to manage a pain syndrome for a long time (3–5 years). The patients were divided into two groups: a group of patients receiving alendronate in the form of a buffered solution (n = 45), and a group of patients receiving alendronate in the form of non-dissolving tablets (n = 43). The first group used Binosto (adendronic acid) 70 mg as effervescent tablets once a week. The results were assessed before initiation of treatment and 6 months after treatment with bisphosphonates. Symptoms were evaluated using the GerdQ questionnaire. Esophageal mucosal injury and gastroduodenal ulceration were assessed by upper gastrointestinal endoscopy.Results and discussion. After 6-month treatment, comparison of the two groups showed that the percentage of patients with a total GerdQ score of ≥ 8 points was significantly higher in the group of patients taking alendronate in the form of non-dissolving tablets (p = 0.04). The endoscopic findings showed that the number of patients with grade A reflux esophagitis in group 1 increased by 3.3%. The number of grade A reflux esophagitis cases in group 2 increased by 2.2%, those of grade B, C and D cases by 2.4%. The number of gastroduodenal ulcer cases also increased by 2.2% and 4.7% in groups 1 and 2, respectively. The number of gastroduodenal erosions increased by 3.5% in group 1 and 7% in group 2.Сonclusion. Symptoms were less severe in patients receiving alendronate in the form of a solution, which points to the importance of choosing the optimal oral bisphosphonate for each patient.

Comparative analysis of laparoscopic proximal gastrectomy plus semi-embedded valve anastomosis with laparoscopic total gastrectomy for adenocarcinoma of the esophagogastric junction: a single-center retrospective cohort study

BackgroundWe invented a new antireflux anastomosis method for use in proximal gastrectomy for adenocarcinoma of the esophagogastric junction (AEG) and named it semi-embedded valve anastomosis (SEV). This study was conducted to compare and analyze the short-term efficacy and long-term prognosis of this anastomosis reconstruction method versus laparoscopic total gastrectomy (LTG).MethodsWe retrospectively analyzed the general data and surgical outcomes of patients with AEG who underwent three united laparoscopic proximal gastrectomy plus semi-embedded valve anastomosis (TULPG-SEV, N = 20) and LTG (N = 20) at our hospital from January 2015 to September 2017 and investigated the incidence of postoperative reflux esophagitis and postoperative nutritional status between the two groups. Survival analysis was also performed.ResultsThe operative time (178.25 ± 15.41 vs 196.5 ± 21.16 min) and the gastrointestinal reconstruction time (19.3 ± 2.53 vs 34.65 ± 4.88 min) of the TULPG-SEV group were significantly less than that of the LTG group. There was no difference in intraoperative blood loss, length of hospital stay, and postoperative complications. There was no difference in the scores on the postoperative reflux disease questionnaires (RDQs) conducted 1 month (P = 0.501), 3 months (P = 0.238), and 6 months (P = 0.655) after surgery between the TULPG-SEV group and LTG group. Gastroscopy revealed 2 cases of reflux esophagitis (grade B or higher) in each group. The postoperative hemoglobin level was better in the TULPG-SEV group than in the LTG group, and the difference was most noticeable at 1 month after surgery (P = 0.024) and 3 months after surgery (P = 0.029). The levels of albumin and total protein were not significantly different between the groups. There were more patients with weight loss over 5 kg after surgery in the LTG group than in the TULPG-SEV group (P = 0.043). There was no significant difference in the 3-year overall survival rate between the two groups (P = 0.356).ConclusionSEV has a certain antireflux effect and can reduce the anastomosis time. Proximal gastrectomy may be better than total gastrectomy for maintaining postoperative hemoglobin levels and reducing weight loss.

Sex differences in risk factors for future onset of reflux esophagitis.

Reflux esophagitis is known to be more prevalent in males, and previous studies have suggested sex differences in its risk factors. However, little is known about sex differences in the time-course of risk factors before reflux esophagitis onset. Thus, we conducted a retrospective longitudinal study using health checkup records. From the records of 230,056 individuals obtained from nine institutes in Japan, we selected 1,558 male reflux esophagitis cases, 3,116 male controls, 508 female reflux esophagitis cases, and 1,016 female controls were selected. We compared time-courses of risk factors between the case and control groups and identified abdominal circumference (AC), diastolic blood pressure, alanine transaminase (ALT), and current smoking in males and body mass index (BMI) in females as sex-specific risk factors. We also found that AC and ALT in males and BMI in females were significantly different between the reflux esophagitis case and control groups during the five years before reflux esophagitis onset. Our results suggest that visceral fat-type obesity and fatty liver in males and higher BMI in females are more frequently observed in reflux esophagitis cases several years before reflux esophagitis onset, and that proactive intervention to lifestyle can help prevent reflux esophagitis in both males and females.

Spade-Shaped Anastomosis Following a Proximal Gastrectomy Using a Double Suture to Fix the Posterior Esophageal Wall to the Anterior Gastric Wall (SPADE Operation): Case-Control Study of Early Outcomes.

PurposeProximal gastrectomy (PG) is a function-preserving surgery in cases of proximally located early-stage gastric cancer. Because gastroesophageal reflux is a major pitfall of this operation, we devised a modified esophagogastrostomy (EG) anastomosis to fix the distal part of the posterior esophageal wall to the proximal part of the anterior stomach wall to produce an anti-reflux mechanism; we named this the SPADE operation. This study aimed to show demonstrate the clinical outcomes of the SPADE operation and compare them to those of previous PG cases.Materials and MethodsCase details of 56 patients who underwent PG between January 2012 and March 2018 were retrospectively reviewed: 30 underwent conventional esophagogastrostomy (CEG) anastomosis using a circular stapler, while 26 underwent the SPADE operation. Early postoperative clinical outcome-related reflux symptoms, endoscopic findings, and postoperative complications were compared in this case–control study.ResultsFollow-up endoscopy showed more frequent reflux esophagitis cases in the CEG group than in the SPADE group (30% vs. 15.3%, P=0.19). Similarly, bile reflux (26.7% vs. 7.7%, P=0.08) and residual food (P=0.01) cases occurred more frequently in the CEG group than in the SPADE group. In the CEG group, 13 patients (43.3%) had mild reflux symptoms, while 3 patients (10%) had severe reflux symptoms. In the SPADE group, 3 patients (11.5%) had mild reflux symptoms, while 1 had severe reflux symptoms (absolute difference, 31.8%; 95% confidence interval, 1.11–29.64; P=0.01).ConclusionsA novel modified EG, the SPADE operation, has the potential to decrease gastroesophageal reflux following a PG.

3110 A Case of Reflux Esophagitis Mimicking Globus Sensation in a Patient With Cannabis Abuse

INTRODUCTION: Cannabis is a widely used drug of abuse in the United States (US). It is mostly commonly abused by young individuals and is known for it's psychedelic effects. Cannabis is also utilized by the medical field for a number of medicinal purposes. We present a case of a young male who presented with sudden onset dysphagia and had a significant history of marijuana abuse for several years. CASE DESCRIPTION/METHODS: 28 year old Caucasian male with a past medical history of ADHD presented with dysphagia. The symptoms started 2 days ago. He felt like the food was stuck in his throat. Every time he attempted to drink water or liquids it regurgitated. He also reported several episodes of nausea and vomiting since the onset of his symptoms. Review of systems was negative for odynophagia, fever, drooling, weight loss, chest pain, diarrhea, constipation or acid reflux. Denied any allergies, surgical history or family history. He denied alcohol or cigarette smoking. He agreed to smoking marijunana 2-3 times per day for over 4 years. Physical examination revealed a healthy non obese male with blood pressure and pulse of 120/80 mmhg and 86 per minute respectively. Rest of his examination was unremarkable. Upper endoscopy was performed on the day of admission which revealed LA Grade D esophagitis with multiple superficial ulcers extending 5 cm from GE junction. Patient was started on proton pump inhibitors twice daily. His symptoms improved and was eventually discharged. Biopsies were suggestive of changes consistent with chronic reflux esophagitis. DISCUSSION: Tetrahydrocannabinol (THC) is the active ingredient derived from Cannabis Sativum. THC works by stimulating the G protein-coupled cannabinoid receptors (CBR) receptors. The presence of CBRs in the esophagus, specifically those affecting transient lower esophageal sphincter relaxations (TLESRs), offers a potential therapeutic target for treating GERD. Using Delta (9)-THC, Beaumont et al. demonstrated decreased rate of TLESRs in healthy volunteers who received 10 and 20 mg of Δ9-THC on three occasions a week apart. However, in the high dose of ΔDelta (9)-THC (20 mg) group, central activity led to increased nausea, vomiting and reflux symptoms. With ongoing discussions for the legalization of recreational cannabis use in US, we may encounter an increase in the number of reflux esophagitis cases. With this in mind, additional studies would be beneficial to determine potential risk factors for developing severe reflux esophagitis with extensive marijuana use.

Morphological state of the mucous membrane of the esophagus of patients with post-resection manifestations of reflux esophagitis depending on the method of the formation of mechanical esophagus-gastric anastomosis

The formation of mechanical gastrointestinal anastomosis after esophagectomy is often accompanied by the development in patients various degrees of reflux esophagitis. The aim of the study – to evaluate the pathogistological changes of the esophagus mucosa associated with gastro-esophageal reflux in patients with esophageal cancer and gastroesophageal, junction cancer after surgical treatment, depending on the technique of forming the esophagus-gastric anastomosis. The study included 30 patients who developed a mechanical invagination of the esophagus-gastric anastomosis developed by the Ukrainian patent (study group) and 30 patients who formed the end-to-end mechanical circulatory esophagus-gastric anastomosis (comparison group). At 12 months of observation all patients were given fibroesophagogastroduodenoscopy. Endoscopic diagnosis of esophagitis was performed according to a modified Los Angeles classification. To assess the morphological state of the esophageal mucosa, the esophageal mucosal biopsy was performed on the site of anastomosis and morphologically evaluated the severity of the reflux esophagitis. Reflux-associated changes in squamous epithelium of the esophagus were evaluated according to the consensus recommendations of the Esohisto Project. Statistical data analysis was performed using the EZR v statistical analysis package. 1.35 (Saitama Medical Center, Jichi Medical University, Saitama, Japan), a graphical interface to R (The R Foundation for Statistical Computing, Vienna, Austria). In a comparative analysis of frequency characteristics between different groups of patients, the c2 criterion was used; for tables 2´2 (in the case of a small number of patients (&lt;5 cases), in the study subgroups) Fisher’s exact test was used. The differences in the results obtained were considered statistically significant at p&lt;0.05, which ensures a 95% level of probability. It has been established that the frequency with which the microscopic signs of reflux esophagitis are fixed are almost 2 times lower in the group of patients who were formed mechanical invagination esophagus-gastric anastomosis in comparison with the mechanical circular (46.7% vs. 83.3%, p&lt;0.05), since invagination simulates the reproduction of antireflux properties of the lost gastrointestinal transition. Endoscopically diagnosed cases of reflux esophagitis are additionally supplemented by microscopically detected from 5.9% of subjects in the study group to 28.6% of subjects (p&lt;0.05) in the comparison group, which indicates a higher sensitivity histological diagnosis. The signs that are consistently associated with post-resection reflux esophagitis include hyperplasia of the basal layer at both the frequency (86.7% vs. 100%) and the severity of the severity (6.7% vs. 23.3%, p&lt;0.05), as well as moderate prolongation of papillae (30.0% vs. 66,6%, p&lt;0.01), according to which the best results were obtained in the group of patients that formed the invagination mechanical esophagus-gastric anastomosis. According to the Esohisto Project criteria, the frequency of both “mild” and “severe” esophagitis in the group of patients that formed the invagination mechanical esophagus-gastric anastomosis was lower compared to the group with mechanical circulatory esophagus-gastric anastomosis (36.7% and 10.0% vs. 63.3% and 20.0%, p&lt;0.01, respectively).

Mucosal inflammation in Candida esophagitis has distinctive features that may be helpful diagnostically

The diagnosis of Candida esophagitis can be challenging when the epithelium containing Candida filamentous forms is not readily seen or is entirely sloughed away. Mucosal inflammation could be helpful diagnostically, if distinctive. However it is thought to be nonspecific in Candida esophagitis. The goal of this retrospective study was to identify features of mucosal inflammation helpful in alerting a pathologist to the possibility of Candida esophagitis when Candida mycelia are not readily observed. The study group consisted of 99 consecutive cases of Candida esophagitis and a control group of 64 consecutive cases of reflux esophagitis diagnosed at our institution from 2008–2016. Band-like superficial intraepithelial neutrophils and increased intraepithelial lymphocytes were observed in 75 and 67% of Candida esophagitis cases, respectively and only in 14 and 19% of reflux esophagitis cases, respectively (p < .0001). Intraepithelial lymphocytes were peripapillary or CD4-predominant in 75% of Candida esophagitis cases with increased lymphocytes, in contrast to 17% of reflux esophagitis cases (p = .0011). Concurrent presence of intraepithelial neutrophils and increased lymphocytes showed increased specificity for Candida esophagitis and was observed in 61% of patients with Candida esophagitis and only in 2% of patients with reflux esophagitis (p < .0001). In addition, superficial band-like neutrophils were observed concurrently with increased peripapillary lymphocytes or CD4-predominant lymphocytes in 35 and 50% of Candida esophagitis cases, respectively, in contrast to no reflux esophagitis cases. Basal cell hyperplasia and elongation of stromal papillae were frequent in both groups. The data suggest that when Candida microorganisms are not readily observed, concurrent presence of superficial band-like neutrophils and increased lymphocytes may be indicative of Candida etiology of active esophagitis.

OPPORTUNITIES OF LAPAROSCOPY IN THE TREATMENT OF ESOPHAGEAL ACHALASIA

The article describes opportunities and results of laparoscopic oesophagocardiomiotomy and laparoscopic transhiatal oesophagus removal without hand assistance in esophageal achalasia (cardiospasm). In total, such operations were performed in 196 and 31 of cases (of 423 patients), respectively. There were minimal numbers of relapses (below 2.3%) after laparoscopic oesophagocardiomiotomy done by the proposed technique. All cases of reflux esophagitis were diagnosed after esophagocardiomiotomy with Dor fundoplication.After cardiodilatation, disease relapses were registered in 57% of patients. The advantages of a laparoscopic access for oesophagectomy are shown and technical particular of this intervention are analyzed based on a case history. The principles of Fast track surgery in this patient category are discussed that allow for reduction of the length of hospital stay by 40%.

Comparative study on clinical efficacy of different proton pump inhibitors combined with Mosapride in the treatment of reflux esophagitis

Objective To investigate the clinical efficacy and safety of different proton pump inhibitors combined with Mosapride in the treatment of reflux esophagitis.Methods 202 cases of reflux esophagitis in our hospital were randomly divided into Omeprazole group and Rabeprazole group.Omeprazole group received Omeprazole combined with Mosapride treatment,while Rabeprazole group received Rabeprazole combined with Mosapride treatment.The total effective rate and incidence of adverse reactions in two groups were compared.Results The total effective rate in Rabeprazole group was 97.0％,significantly higher than 86.1％ in Omeprazole group (P ＜ 0.05).No serious adverse reaction occurred in two groups.Conclusion Rabeprazole combined with Mosapride in the treatment of reflux esophagitis is effective,without serious adverse reactions,worthy of clinical wide application. Key words: Rabeprazole; Omeprazole; Mosapride; Reflux esophagitis

Clinical efficacy of esomeprazole auxiliary treatment of 16 cases of reflux esophagitis

Objective To evaluate the efficacy of esomeprazole combined with mosapride in the treatment of reflux esophagitis.Methods From February 2010 to March 2013,32 patients with reflux esophagitis were randomly divided into two groups,16 cases in each group.Observation group received esomeprazole and mosapride,while control group received omeprazole and mosapride.The efficacy of two groups was observed and compared.Results The total effective rate in observation group was 93.75％,that in control group was 81.25％,with statistical significant difference (P ＜ 0.05).There was no statistical significant difference in major symptom score between two groups before treatment; after treatment,symptom scores of acid reflux,heartburn,swallowing difficulty and retrostemal pain improved significantly (P ＜ 0.05).The incidence of adverse reactions in observation group was 6.25％,that in control group was 18.75％,with statistical significant difference (P ＜ 0.05).Conclusion Esomeprazole combined with mosapride in the treatment of reflux esophagitis is effective,worthy of clinical promotion. Key words: Esomeprazole; Mosapride; Omeprazole; Efficacy

Esophagogastric tube reconstruction with stapled pseudo-fornix in laparoscopic proximal gastrectomy: a novel technique proposed for Siewert type II tumors

The incidence of adenocarcinoma of the esophagogastric junction is increasing, but laparoscopic proximal gastrectomy is not widely accepted due to the absence of a standardized technique of reconstruction. This report describes a novel technique of esophagogastric tube reconstruction in laparoscopic proximal gastrectomy for Siewert type II tumors. Laparoscopic proximal gastrectomy, sometimes with transhiatal distal esophagectomy, was performed. After a perigastric, suprapancreatic, and lower thoracic paraesophageal lymphadenectomy, a gastric tube of 35-mm width was prepared. An esophagogastric tube anastomosis with pseudo-fornix was made with a no-knife linear stapler to prevent postoperative reflux esophagitis. Fifteen patients with Siewert type II tumors underwent this operation. They included six patients with early-stage cancer, six at high risk for transhiatal total gastrectomy due to several comorbidities, and three who needed palliative tumor resection. The mean operation time was 315 min. One postoperative anastomotic leak was treated conservatively, and three anastomotic stenoses were resolved with endoscopic balloon dilatation. Postoperative 1-year follow-up endoscopy revealed four cases of reflux esophagitis that were well controlled by medication. This new technique of reconstruction was feasible. With the advantage of a gastric tube, a tension-free anastomosis was possible even for bulky tumors that needed lower esophagectomy. Although long-term follow-up and a larger number of patients are required to evaluate long-term functional outcomes and oncological adequacy, our procedure has the potential of becoming a treatment of choice for early-stage Siewert type II tumors and/or for some selected high-risk patients who need tumor resection.

Evaluation of Jejunal Pouch Interposition after Proximal Gastrectomy for Early Gastric Cancer in the Upper Third of the Stomach

Proximal gastrectomy has two problems, reflux esophagitis and curability. This study evaluates postoperative outcomes focusing on reflux esophagitis and curability of proximal gastrectomy with jejunal pouch interposition for early gastric cancer in the upper third of the stomach. One hundred and thirty nine patients who underwent jejunal pouch interposition between 1996 and 2011, 10 esophago-gastrostomy and 20 jejunal interposition at our institution were compared retrospectively to examine heart burn and reflux esophagitis. Furthermore, we examined the remote outcomes of jejunal pouch interposition patients. There were significantly fewer cases of heart burn; the numbers of cases of reflux esophagitis based on endoscopic findings were significantly small in jejunal pouch interposition. Carcinoma of the remnant stomach after jejunal pouch interposition was observed in 9 patients, curative treatment was possible with endoscopic therapy in 6 patients and surgical treatment in 3 patients. There are 119 survivals and 20 deaths at present Death caused primary disease is only 2 patients. Both recurrent patterns were peritoneal metastasis and the histopathological diagnosis was not indicated for proximal gastrectomy. Jejunal pouch interposition after proximal gastrectomy for early upper third gastric cancer proves beneficial and favorable modality achieving prevention of reflux esophagitis and high curability.

Methylation of p16 and hMLH1 genes in esophageal squamous cell carcinoma and reflux esophagitis

To study the promoter methylation pattern of p16 and hMLH1 genes in esophageal squamous cell carcinoma and reflux esophagitis, and to correlate the results with clinical and pathologic findings. Twelve cases of normal esophagus, 13 cases of esophageal squamous cell carcinoma, 43 cases of reflux esophagitis with basal cell hyperplasia and 21 cases of reflux esophagitis with dysplasia, as confirmed by endoscopic and pathologic examination, were enrolled into the study. Genomic DNA was extracted. The promoter methylation status of p16 was measured by methylation-specific polymerase chain reaction. The promoter methylation status of hMLH1 was measured by sodium bisulfite-restriction enzyme digestion. Immunohistochemical study for p16 and hMLH1 proteins was also carried out. The rates of p16 methylation in normal esophageal epithelium, basal cell hyperplasia, dysplasia and esophageal squamous cell carcinoma were 0/12, 14.0% (6/43), 38.1% (8/21) and 6/13, respectively. The p16 methylation correlated with the progress of esophageal lesions. On the other hand, the hMLH1 methylation was not observed in the normal esophageal epithelium and reflux esophagitis. One case of esophageal squamous cell carcinoma showed the presence of hMLH1 methylation. The hMLH1 promoter hypermethylation did not correlate with the clinical and pathologic features. The p16 methylation may be one of the earliest events in the pathogenesis of esophageal squamous cell carcinoma and is also observed in reflux esophagitis. Reflux esophagitis may be related to the development of esophageal squamous cell carcinoma in Chinese population. In contrast, hMLH1 methylation may not be directly involved in the tumorigenesis of esophageal squamous cell carcinoma.