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Nutritional and Dietary Supplementation during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Reflux esophagitis results in heartburn or pyrosis and esophageal erosion is very common in pregnancy. It is thought to be secondary to decreased gastroesophageal sphincter tone, with resultant gastric acid reflux. Reflux therapy consists primarily of one of the antacid preparations discussed in the previous section. Frequent small feedings and elevation of the head at night may be beneficial. H2-receptor antagonists or PPI (omeprazole or esomeprazole) as well as metoclopramide may prove effective for severe forms of reflux. Esomeprazole and omeprazole are the most popular treatments for reflux esophagitis. Omeprazole and esomeprazole are sufficiently well studied during pregnancy to reasonably state they are safe.
Gastrointestinal diseases and pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Murtaza Arif, Anjana Sathyamurthy, Jessica Winn, Jamal A. Ibdah
A variety of complications can result from reflux esophagitis: Stricture formationBleedingPulmonary aspirationBarrett’s esophagus—Chronic esophageal inflammation is thought to lead to Barrett’s esophagus, in which the normal squamous esophageal epithelium is replaced by specialized columnar epithelium. This diagnosis is made by endoscopy with biopsy; routine surveillance with periodic endoscopic examination and biopsies is indicated because of an increased risk of esophageal cancer.
Fundoplication
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Douglas C. Barnhart, Robert A. Cina
Endoscopic biopsies should routinely be performed during endoscopy for foregut symptoms. Importantly, these biopsies will allow distinction between reflux esophagitis and eosinophilic esophagitis. Eosinophilic esophagitis should not be primarily treated with antireflux surgery. Histology of the biopsy will provide pathologic grading of reflux esophagitis.
Endoscopic treatment can be a viable therapeutic option for esophageal gastrointestinal stromal tumors
Published in Scandinavian Journal of Gastroenterology, 2022
Haojie Du, Longgui Ning, Hongtan Chen, Fengling Hu, Guodong Shan, Wenguo Chen, Guoqiang Xu
There were no significant differences in gender, age, symptoms, tumor location, tumor size, mitotic index, and adjuvant imatinib therapy between the surgery group and the endoscopic treatment group (all p > .05) (Table 2). The main clinical characteristics, therapeutic outcomes, and follow-up outcomes of these 20 patients were listed in Table 3. Five patients experienced temporary infection or fever after treatment. One patient with esophagectomy experienced reflux esophagitis. The mean follow-up period of the surgery group and the endoscopic treatment group was similar (70.8 ± 50.0 vs. 50.2 ± 27.9 months, p = .260). During the follow-up period, one patient in the surgery group exhibited disease recurrence and accepted adjuvant imatinib therapy, while no recurrence was observed in the endoscopic treatment group. The patient with local tumor recurrence underwent a tumor enucleation with a mitotic index of 5/50 HPF, which was slightly higher than that of other patients. The Kaplan-Meier curve suggested that there was no significant difference in disease-free survival between the surgery group and the endoscopic treatment group (p = .264) (Figure 3).
Effectiveness of esophagogastroduodenoscopy in changing treatment outcome in refractory gastro-esophageal reflux disease
Published in Scandinavian Journal of Gastroenterology, 2022
Ye Eun Kwak, Ahmed Saleh, Ahmed Abdelwahed, Mayra Sanchez, Amir Masoud
Patients with hiatal hernia were divided into small hiatal hernia groups with hernia less than 2 cm or ‘small’ hiatal hernia and large hiatal hernia with hernia more than 2 cm or ‘moderate’ to ‘large’ hiatal hernia [13]. Los Angeles (LA) classification of reflux esophagitis was used to identify the severity of reflux esophagitis [14]. Patients who had esophagitis without specific classification were included as grade unspecified. Ulcer, erosion, and erythema were recorded separately from esophagitis. Eosinophilic infiltrates with more than 15 per high-power field (HPF) in the proximal esophagus were defined as eosinophilic esophagitis [15]. Eosinophilic infiltrates in the distal esophagus or less than 15/HPF was included in the reactive changes in the pathologic findings. Other incidental esophageal findings unrelated to GERD were also recorded. Endoscopic intestinal metaplasia suspected lesions were defined as irregular z-line or salmon-colored mucosa. Although predictive value of irregular z-line for intestinal metaplasia is limited [16–19], irregular Z-line was included in the endoscopic intestinal metaplasia suspected lesions as many clinicians still use this description when they suspect intestinal metaplasia. There was no consistent documentation on the length or extent (isolate islands as opposed to the continuous lesion) of the columnar mucosa.
One year comprehensive prospective follow-up of achalasia patients after peroral endoscopic myotomy
Published in Annals of Medicine, 2021
Helge Evensen, Milada Cvancarova Småstuen, Anselm Schulz, Vendel Kristensen, Lene Larssen, Jorunn Skattum, Olav Sandstad, Truls Hauge, Asle W. Medhus
Similar to other studies, our data (Table 6) suggest that post-POEM reflux is prevalent [11] . Our cut-off for positive 24-h pH is in accordance with the recent and rather strict Lyon consensus [22], which might explain the higher endoscopic and symptomatic reflux rates recorded. There was no significant association between findings of 24-h pH and EGD, and of notice, there were several negative 24-h pH recordings in patients with reflux esophagitis. The presence of reflux esophagitis is, however, relevant for long-term complications such as peptic strictures and dysplasia, underlining the role of EGD in follow-up. The demonstrated frequency of post-POEM reflux esophagitis suggests that long-term, regular antiacid medication is indicated in many patients. Moreover, the high prevalence of supine reflux suggests that patients, in whom reflux is suspected, should be recommended to sleep with their torso elevated after POEM.