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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
Endoscopy can provide important confirmation that symptoms of dysphagia and chest pain are related to esophageal mucosal disease. Endoscopic visualization allows determination of the extent of involvement and severity by standardized grading scores. Four grades of esophagitis are recognized at endoscopy: Grade I, erythema of mucosaGrade II, friability of mucosaGrade III, ulcerative esophagitisGrade IV, stricture
Hypofractionated vs. conventional radiation therapy for stage III non-small cell lung cancer treated without chemotherapy
Published in Acta Oncologica, 2020
Michelle Iocolano, Aaron T. Wild, Margaret Hannum, Zhigang Zhang, Charles B. Simone, Daphna Gelblum, Abraham J. Wu, Andreas Rimner, Annemarie F. Shepherd
The OS rates (2-year: HFRT 20.7% – CFRT 23.4%; 5 year: HFRT 5.1% – CFRT 6.5%) are consistent with the published literature on locally advanced NSCLC patients treated with RT alone [4,7]. To our knowledge, there are no randomized trials directly comparing CFRT vs. HFRT. Small, single-institution, single-arm studies have found RT alone with HFRT to be relatively well-tolerated with acceptable toxicity rates, disease control and OS [9,18,19]. The two systematic literature reviews examining HFRT in locally advanced NSCLC found that in patients treated with RT alone, the 2-year OS rates ranged from 18 to 68.7% and 5-year OS rates ranged from 0 to 7.4%. Acute grade ≥3 esophagitis occurred in 0–15%, while late esophageal toxicity was 0–16%. Acute pneumonitis (all grades) occurred in 0–44%, whereas late pneumonitis (all grades) occurred in 0–47%, most commonly grade ≤3 [23,24].
Treatment of newly-diagnosed gastroesophageal reflux disease: a nationwide register-based cohort study
Published in Scandinavian Journal of Gastroenterology, 2019
Jonas Sanberg Ljungdalh, Katrine Hass Rubin, Jesper Durup, Kim Christian Houlind
In the group receiving neither surgical nor pharmacological treatment, GERD without esophagitis was the dominating diagnosis whereas GERD with esophagitis was more predominant in patients receiving any type of treatment. This may be because esophagitis indicates more severe disease. However, it is worrying that 1861 patients were diagnosed with GERD with esophagitis without receiving any pharmacological or surgical treatment. The reason for this lack of treatment may be that these patients had a lower grade of esophagitis, but the Danish register does not allow for differentiating this as grading systems are not part of the ICD-10 coding practice. Patients with oesophagitis were more likely to receive any treatment compared to patients without oesophagitis (92.3% (n = 22,216) vs. 83.6% (n = 10,214). However, they were no more likely to receive surgical therapy (1.9% n = 449 vs. 1.8% n = 220). Patients with oesophagitis were also less likely to have received pharmacological treatment of GERD prior to endoscopy (20.0% n = 4826 vs. 15.5% n = 1891) and were more likely to receive PPIs in the first two years after diagnosis (91.3% n = 21,993 vs. 82.3% n = 10,047). As such, a diagnosis of oesophagitis in our study, does in general lead to a more intense course of treatment compared to other GERD-patients, but does not result in a higher rate of anti-reflux surgery.
Oral vinorelbine-based concomitant chemoradiotherapy in unresectable stage III non-small cell lung cancer: a systematic review
Published in Expert Review of Anticancer Therapy, 2018
Paul Lesueur, Isabelle Martel-Laffay, Alexandre Escande, Manon Kissel, Chrystel Locher, Radj Gervais, Roland Schott, Alain Vergnenegre, Christos Chouaid
The recent Phase II study of Isla et al. evaluated the efficacy and safety of chemoradiotherapy with metronomic oral vinorelbine in 57 patients with unresectable locally advanced NSCLC [34]. Patients received cisplatin 80 mg/m2 at day 1 every 3 weeks combined with oral vinorelbine 50 mg/day on days 1, 3, and 5 weekly for two cycles as induction. Patients without progression received two additional cycles of cisplatin at the same dose with oral vinorelbine 30 mg/day on days 1, 3, and 5 weekly concurrently with radiotherapy (66 Gy in 6.5 weeks). For a median follow-up of 11.2 months, PFS and OS for the first 57 included patients were 11.9 and 17 months. One (2.3%) patient achieved a complete response, 64.9% had a partial response and 12.3% had stable disease. Grade 3–4 adverse events were reported in 29.8% of patients (neutropenia, 22.8%; anemia, 3.5%; febrile neutropenia, 7%; esophagitis, 1.8%; pneumonitis 1.8%). Only one case of Grade 3–4 esophagitis was reported and only two patients stopped treatment due to toxicity.