The Natural History of Esophageal Cancer
Peter G. Shields in Cancer Risk Assessment, 2005
Squamous cell carcinoma develops from squamous epithelium according to a classical dysplasia–carcinoma sequence. Esophagitis, a benign, chronic inflammatory disease, seems to represent a risk factor for dysplasia. Esophagitis occurs frequently in response to various types of physical and chemical stress that may harm the esophagus. A hereditary basis of esophageal cancer has been described in the case of an extremely rare syndrome, tylosis, characterized by acute palmoplantar hypekeratosis. The gene responsible for this disease has been mapped to a locus (TOC, Tylosis and Esophageal Cancer) on 17q25, but has not been cloned so far (9,10). Apart for this very rare disease, there is no clear evidence for inherited susceptibility to SCCE, although some familial clustering has been reported in high-risk areas of China. In India, a recent study showed an association between a particular polymorphism in the CDKN1A gene and SCCE (11).
Endoscopy
Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson in Operative Thoracic Surgery, 2017
Esophagitis can be caused by a variety of factors. The most common is gastro-esophageal reflux, but it can be also caused by bile reflux, infection, medication, alcohol, stasis, and caustic ingestion. A number of autoimmune conditions can be complicated by esophagitis and chronic inflammation, such as Crohn’s disease, which, while rare, can affect the esophagus. For most of these disorders, a careful history may raise suspicion about the likely diagnosis, such as odynophagia and immunosuppression in patients with infective causes. Reflux esophagitis is usefully graded using the Los Angeles (LA) system, which describes the severity of inflammation from A to D (see Table 27.3). A carefully detailed description and photographs should be standard practice, as this classification is based on the worst grade seen at any point. Biopsy at the index endoscopy should be undertaken, and, in patients with ulcerative esophagitis, follow-up endoscopy after appropriate treatment is recommended to ensure an underlying malignancy is not missed. Signs of an incompetent antireflux mechanism are often also present with free esophagogastric reflux during the procedure. The presence of any associated hiatus hernia should be carefully sought.
Fundoplication
Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg in Operative Pediatric Surgery, 2020
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
Drug treatment strategies for eosinophilic esophagitis in adults
Published in Expert Opinion on Pharmacotherapy, 2022
Alfredo J Lucendo
Over the last 3 decades, the prevalence of EoE has increased exponentially, currently affecting at least 1 in every 1,000 inhabitants in North America and Europe [4–6]. Today it is the main cause of symptoms of chronic or intermittent esophageal dysfunction in children, adolescents, and young adults, and the second form of chronic esophagitis after GERD. Consequently, the health-care costs associated with EoE have become vast, due to quite common diagnostic delay, the dependence from endoscopy with biopsies to achieve a diagnosis of EoE and to monitor response to therapy, and the costs of new drugs. Recently, it has been estimated that the mean annual cost per adult EoE patient reach $ 2,300 in the United States (US) [7]. In children, this cost increases considerably up to $ 4,001 per year, far exceeding the cost of care for Crohn's disease ($ 985) and celiac disease ($ 856) [8]. Although rare, the average cost of each hospital admission associated with EoE in the US has been calculated to be $ 5,135 per patient, and the number of admissions increased by 70% over the period 2010–2016, to represent 13 for every 100,000 hospitalizations, at an annual cost of US $ 24 million [9].
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.
Analyses of the relationship between a ‘number of reflux episodes’ exceeding 70 and the pH index in neurologically impaired children by evaluating esophageal combined pH-multichannel intraluminal impedance measurements
Published in Scandinavian Journal of Gastroenterology, 2018
Suguru Fukahori, Minoru Yagi, Shinji Ishii, Kimio Asagiri, Nobuyuki Saikusa, Naoki Hashizume, Motomu Yoshida, Daisuke Masui, Naruki Higashidate, Saki Sakamoto, Hirotomo Nakahara, Yoshiaki Tanaka
A total of 61 NI children (male/female: 28/33, mean age 6.7 ± 5.1 years) were enrolled in this study. Regarding the causal disorder of NI, 14 patients had a genetic anomaly, 10 had a chromosomal anomaly, 8 had congenital parencephalia, 3 had congenital cytomegalovirus infection, 17 had cerebral damage in the neonatal period and 9 had cerebral damage in infancy or later. All of the patients required enteral nutrition via a nasogastric tube. A total of 35 patients underwent endoscopic examinations and 9 patients showed the findings of esophagitis according to the Los Angeles Classification [13]. The numbers of the children with NoRE >70 or ≤70 and pHI >4.0 or ≤4.0, >5.0 or ≤5.0, >7.0 or ≤7.0 were 11 vs. 50, 24 vs. 37, 23 vs. 38 and 19 vs. 42, respectively. Of the NI children with pHI >4.0, >5.0 and >7.0, those with NoRE >70 or ≤70 were 8 vs.16, 8 vs.15 and 8 vs.11, respectively. The clinical data of the each group are shown in Table 1. The percentages of patients with esophagitis at the time of the endoscopic examinations in the NoRE >70, pHI >4.0, >5.0 and >7.0 groups were significantly higher than those in the NoRE ≤70, pHI ≤4.0, 5.0 and ≤7.0 groups (55.6% vs. 7.7%, 50.0% vs. 0%, 53.8% vs. 0% and 54.5% vs. 4.2%, respectively). No significant differences were observed in any clinical parameters between each of the two groups.
Related Knowledge Centers
- Dysphagia
- Epigastrium
- Heartburn
- Mucous Membrane
- Pharynx
- Smooth Muscle
- Esophagus
- Stomach
- Asymptomatic
- Gastroesophageal Reflux Disease