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Effects of treatment on the thorax
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Dhakshina Moorthy Ganeshan, Herman I Libshitz, Revathy B Iyer
Cross-sectional imaging may demonstrate thickening of the oesophagus and mucosal enhancement corresponding to the inflammatory changes (Figure 38.9). The differential diagnosis includes other causes of oesophagitis in the absence of an appropriate history (61).
The gastrointestinal system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Sharon J. White, Francis A. Carey
Inflammation of the oesophagus, manifested endoscopically by the cardinal signs of congestion and redness of the mucosa, is usually caused by chemical irritation by refluxed gastroduodenal contents (reflux oesophagitis). A limited number of infectious agents (Candida spp., herpes simplex virus) may be a direct cause of oesophagitis. The oesophagus may be involved in Crohn's disease and systemic sclerosis. Oesophageal obstruction (tumour, achalasia) leads to a secondary proximal oesophagitis.
Drug therapy of gastro-oesophageal reflux disease
Published in Michael JG Farthing, Anne B Ballinger, Drug Therapy for Gastrointestinal and Liver Diseases, 2019
Jean Paul Galmiche, Arnaud Bourreille, Carmelo Scarpignato
Finally, there is now a consensus that symptom relief and long-term control of the disease are the primary aims of therapy for most patients. The inclusion of quality-of-life assessments in therapeutic trials is recommended for both drug therapy and anti-reflux surgery. In patients with moderate to severe oesophagitis and/or complications, healing also remains an important therapeutic goal.12
Oesophageal motor disorders and oesophageal endoscopic involvement in patients with systemic sclerosis: a systematic association?
Published in Scandinavian Journal of Gastroenterology, 2021
Véronique Vitton, Camille Bazin, Laure Luciano, Brigitte Granel, Marine Alessandrini, Jean-Robert Harle
In the present study based on patients suffering from SSc and with a typical OMD, the frequency of observed endoscopic lesions reached 47.2%. To our knowledge, this is the first study which specifically investigated endoscopic lesions in patients examined by OHRM, which is currently the reference technique for the assessment of OMD. We voluntary focused only on patients with OMD to try to establish a link with endoscopic lesions. Our study showed that 34.6% of endoscopic lesions were oesophagitis (only Grades A and B) and 13.5% were BE. These results are concordant with previously published studies. Indeed, oesophagitis and BE prevalence have been shown to vary between 32.3 and 60% and between 6.8 and 37%, respectively [14,15,17,23,24]. Moreover, we did not observe any cases of adenocarcinoma in our study. The fact that patients suffering from SSc are at higher risk for adenocarcinoma remains debated in scientific literature [25–27]. A recent study published in 2011 showed an increased risk of oesophageal adenocarcinoma in patients with SSc, with an incidence of 3% per year, whereas the incidence of oesophageal adenocarcinoma in BE patients is estimated to be 0.45% per year [28].
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.
Gastroesophageal reflux disease (GERD) in children
Published in Paediatrics and International Child Health, 2019
In the absence of warning signs, a history and physical examination are sufficient in most paediatric patients to diagnose uncomplicated GER and initiate therapy. Nevertheless, distinguishing between physiological GER and pathological GERD often poses a serious challenge, especially in infants. Accurate distinction between GER and GERD is essential to guide further investigation and treatment. When the presentation is atypical, investigation is required to make the diagnosis and assess the severity, and outcome of GERD. There is no single gold-standard test to diagnose GERD. The choice of investigation depends on the clinical situation for which the investigation is requested. pH/MII (multichannel intraluminal impedance) is required to document reflux in patients with extra-oesophageal symptoms (e.g. bronchial asthma, aspiration pneumonia, etc.) without any symptoms of GER. When oesophagitis is suspected, upper gastro-intestinal endoscopy and biopsy is recommended. However, when there is a suggestion of an anatomical abnormality such as dysphagia, a barium series is indicated.