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  • 1
    ISSN: 1573-2568
    Keywords: BARRETT'S ESOPHAGUS ; GASTROESOPHAGEAL REFLUX DISEASE ; SPECIALIZED INTESTINAL METAPLASIA
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Over the past two decades, the incidence ofadenocarcinoma of the esophagus and gastric cardia hasincreased at a rate exceeding that of any other cancer.Barrett's esophagus is the only known risk factor for these malignancies. Recently, emphasis hasbeen placed on the significance of specializedintestinal metaplasia (SIM) on esophageal biopsies. Ouraim was to compare the prevalence of SIM at different esophageal locations in patients who are athigher risk of developing esophageal adenocarcinoma(Caucasians) and patients with lower risk of developingesophageal adenocarcinoma (African-Americans).Eighty-seven unselected patients (42 Caucasians and 45African-Americans) underwent routine upper endoscopywith biopsies from the proximal margin of columnarmucosa. We classified patients into those with acolumnar-lined esophagus with SIM (CLE with SIM); CLE withoutSIM; or SIM with a normal-appearing gastroesophagealjunction (SIM-GEJ). The prevalence of CLE with SIM, CLEwithout SIM, and SIM-GEJ was 28%, 10%, and 10% in Caucasians compared to 0%, 18% and 11% inAfrican-Americans (P = 0.0001, 0.26, and 0.81,respectively). We found CLE with SIM only in patientswith reflux symptoms at least twice a week. It isconcluded that CLE with SIM is seen most commonly inpatients thought to be at risk for esophagealadenocarcinoma (Caucasians with reflux symptoms). It israrely seen in other groups with lower risk for thismalignancy (African-Americans, nonrefluxers). Conversely,SIM-GEJ and CLE without SIM are common in all groups andare of questionable significance.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Digestive diseases and sciences 39 (1994), S. 2695-2700 
    ISSN: 1573-2568
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Digestive diseases and sciences 42 (1997), S. 2222-2226 
    ISSN: 1573-2568
    Keywords: AMBULATORY pH MONITORING ; GASTROESOPHAGEAL REFLUX DISEASE ; PROXIMAL GASTROESOPHAGEAL REFLUX ; ATYPICAL GASTROESOPHAGEAL REFLUX DISEASE
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Ambulatory pH monitoring of the distal esophagusis the most accurate diagnostic study for patients withsuspected gastroesophageal reflux disease (GERD). Themeasurement of proximal esophageal acid exposure time may be useful in patients with atypicalreflux symptoms. The aim of this study is to evaluate ifproximal esophageal pH monitoring provides usefulinformation beyond that learned with distal esophageal pH monitoring. We routinely performeddual-channel pH monitoring with pH electrodes positionedat 20 and 5 cm above the manometric lower esophagealsphincter from January 1992 to August 1995. All patients scored their esophageal symptoms from zero(none) to four (severe). We compared proximal esophagealreflux (PR) in patients with typical symptoms (i.e.,heartburn, regurgitation) and in patients with atypical symptoms (i.e., chest pain, cough, hoarseness,and asthma). We compared symptom profiles betweenpatients with and without PR. We reviewed our experiencein patients with abnormal PR, but with a normal amount of distal esophageal reflux (DR). We studied441 consecutive patients. There were no significantdifferences in PR between patients with typical andatypical symptoms. There were no differences in symptom profiles between patients with normal andabnormal PR. There were no differences of PR between thedifferent atypical symptoms. PR did not correlate withthe severity of the patient's symptoms. PR correlated well only with DR. Twenty-four patients hadisolated abnormal PR, but only six patients improvedwith antireflux therapy. We conclude that routineambulatory esophageal pH monitoring of the proximalesophagus appears to be of little value. The decision tooffer patients an empiric trial of antireflux therapyfor suspected GERD should not be based on the presenceor absence of PR.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Digestive diseases and sciences 35 (1990), S. 759-762 
    ISSN: 1573-2568
    Keywords: duodenogastric reflux ; Barrett's esophagus ; gastroesophageal reflux
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The role of duodenogastric reflux in the pathogenesis of gastroesophageal reflux disease is not clear. Using hepatobiliary scanning techniques, we found evidence of duodenogastric reflux in six of 13 patients with Barrett's esophagus. This compares with only two positive studies in 19 control subjects. This difference is statistically significant P=0.038, two-tailed Fisher's exact test). Three of nine patients who had gastroesophageal reflux without Barrett's esophagus had evidence of duodenogastric reflux, a frequency not significantly different from either of the other groups. Gastroesophageal reflux of bile and pancreatic enzymes, in addition to gastric acid may contribute to the greater esophageal damage often seen in Barrett's esophagus. The presence of duodenogastric reflux in these patients may have important pathophysiologic and therapeutic implications.
    Type of Medium: Electronic Resource
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