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Psychosocial factors and their association with reflux oesophagitis,Barrett's oesophagus and oesophageal adenocarcinoma

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World Journal of Gastroenterology 2013年第11期19卷 1770-1777页

作者： Paul Denver Michael Donnelly Liam J Murray Lesley A Anderson Centre for Public Health Queen's University BelfastBelfast BT12 6BJNorthern IrelandUnited Kingdom

AIM:To investigate the role of psychological characteristics as risk factors for oesophageal adenocarcinoma(OAC),as well as the reflux-mediated precursor pathway.METHODS:An all-Ireland population-based case-control study recruited 230 reflux oesophagitis(RO),224 Barrett's oesophagus(BO) and 227 OAC patients and 260 controls.Each case/control group completed measures of stress,depression,self-efficacy,self-esteem,repression and social support.A comparative analysis was undertaken using polytomous logistic regression adjusted for potential confounders.RESULTS:Compared to controls,OAC patients were almost half as likely to report high stress levels over their lifetime(P = 0.010,OR 0.51;95%CI:0.29-0.90)and 36% less likely to report having experienced depression(OR 0.64;95%CI:0.42-0.98).RO patients reported significantly higher stress than controls particularly during middle-and senior-years(P for trends < 0.001).RO patients were 37% less likely to report having been highly emotionally repressed(OR 0.63;95%CI:0.41-0.95).All case groups(OAC,RO and BO) were more likely than controls to report having had substantial amounts of social support(OR 2.84;95%CI:1.63-4.97;OR 1.97;95%CI:1.13-3.44 and OR 1.83;95%CI:1.03-3.24,respectively).CONCLUSION:The improved psychological profile of OAC patients may be explained by response shift.The role of psychological factors in the development of OAC requires further investigation.

关键词： Reflux oesophagitis Barrett’s oesophagus Oesophageal adenocarcinoma Adjustment Psychological Psychosocial factors

Current hurdles in the management of eosinophilic oesophagitis:The next steps

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World Journal of Gastroenterology 2013年第6期19卷 790-796页

作者： Stephen EA Attwood Michael SJ Wilson Department of General Surgery North Tyneside HospitalRake LaneNorth ShieldsTyne and Wear NE29 8NHUnited Kingdom

Eosinophilic oesophagitis (EoE) is a chronic,antigen mediated disease of the disease of the oesophagus that may present in both adults and children.It is characterised by intermittent dysphagia,food bolus obstruction and weight loss.The pathogenesis is incompletely understood but is thought to culminate in poor compliance,or reduced distensibility.The condition is being reported and studied in the literature with increasing incidence,although equally it is highly likely that the diagnosis is being missed altogether with alarming frequency.Diagnosis of the condition requires at least one oesophageal biopsy with an eosinophil count greater than 15 per high power field.Endoscopic features include trachealisation,furrows,white exudate,narrowing and in the most severe cases stricture formation although none are pathognomonic of the condition.Therapy is often not required,but in the acute setting may take the form of dietary therapy or topical steroids.Long term maintenance therapy is usually only required in the most severe cases and the most effective treatment is the subject of ongoing research.There are a number of hurdles to be overcome in the management of patients with EoE.These include;improving our understanding of the aetiologyof the condition,investigating the individual causes,assessing the true disease severity and planning the best long term maintenance therapy.Distinguishing EoE from EoE gastro-oesophageal reflux disease is also a hurdle because the two conditions,both being common,can co-exist.In order to overcome these hurdles,a multifaceted approach is required.The management of food bolus obstruction requires a management algorithm that is accepted and endorsed by a number of specialties.National and international disease registers should be established in order to facilitate future research but more importantly to address areas where further education or increased diagnostic capabilities may be required.Assessment of disease severity should become a key goal,and the development of specific biomarker

关键词： Eosinophil oesophagitis Dysphagia Food bolus obstruction Therapy Gastroscopy

Prevalence of eosinophilic oesophagitis in adults presenting with oesophageal food bolus obstruction

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2015年第4期6卷 244-247页

作者： Neel Heerasing Shok Yin Lee Sina Alexander Damian Dowling Department of Gastroenterology Alfred Hospital Damian Dowling Department of Gastroenterology University Hospital Geelong

AIM: To look at the relationship between eosinophilic oesophagitis(EO) and food bolus impaction in adults. METHODS: We retrospectively analysed medical records of 100 consecutive patients who presented to our hospital with oesophageal food bolus obstruction(FBO) between 2012 and 2014. In this cohort, 96 were adults(64% male), and 4 paediatric patients were excluded from the analysis as our centre did not have paediatric gastroenterologists. Eighty-five adult patients underwent emergency gastroscopy. The food bolus was either advanced into the stomach using the push technique or retrieved using a standard retrieval net. Biopsies were obtained in 51 patients from the proximal and distal parts of the oesophagus at initial gastroscopy. All biopsy specimens were assessed and reviewed by dedicated gastrointestinal pathologists at the Department of Pathology, University Hospital Geelong. The diagnosis of EO was defined and established by the presence of the following histological features:(1) peak eosinophil counts > 20/hpf;(2) eosinophil microabscess;(3) superficial layering of eosinophils;(4) extracellular eosinophil granules;(5) basal cell hyperplasia;(6) dilated intercellular spaces; and(7) subepithelial or lamina propria fibrosis. The histology results of the biopsy specimens were accessed from the pathology database of the hospital and recorded for analysis. RESULTS: Our cohort had a median age of 60. Seventeen/51(33%) patients had evidence of EO on biopsy findings. The majority of patients with EO were male(71%). Classical endoscopic features of oesophageal rings, furrows or white plaques and exudates werefound in 59% of patients with EO. Previous episodes of FBO were present in 12/17 patients and 41% had a history of eczema, hay fever or asthma. Reflux oesophagitis and benign strictures were found in 20/34 patients who did not have biopsies. CONCLUSION: EO is present in approximately one third of patients who are admitted with FBO. Biopsies should be performed routinely at index endoscopy in order to pursue this

关键词： oesophagitis Eosinophilia Food bolus obstruction E

Rabeprazole is effective for bile reflux oesophagitis after total gastrectomy in a rat model

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World Journal of Gastrointestinal Pathophysiology 2015年第1期6卷 23-28页

作者： Naoki Hashimoto School of Medicine Kinki University

AIM:To elucidate the effect of a proton pump inhibitor(PPI,rabeparazole)on oesophageal bile reflux in oesophagitis after total gastrectomy.METHODS:Twenty-one 8-week-old male Wistar rats were studied.They were performed oesophagoduodenostomy of total gastrectomy to induce oesophageal reflux of biliary and pancreatic juice.Five rats were performed the sham operation(Sham).On post-operative day 7,they were treated with saline(Control)(n=8)or PPI(rabeprazole,30 mg/kg per day,ip)(n=8)for 2 wk.On post-operative 21,all rats were sacrificed and each oesophagus was evaluated histologically.Oesophageal injury was evaluated by macroscopic and microscopic findings as well as the expression of cyclooxygenase-2(COX2).We measured bile acid in the oesophageal lumen and the common bile duct.RESULTS:At 3 wk after surgery,a histological study analysis revealed an increase in the thickness of the epithelium,elongation of the lamina propria and basal cell hyperplasia in the oesophageal mucosa.The macroscopic ulcer score and microscopic ulcer length of the control group were significantly higher compared to those of the rabeprazole-treated group.The expression of COX2 was significantly increased according to the immunostaining in the control group compared to rabeprazole-treated group.Although there was no difference between the control and PPI groups in the total bile acid in the common bile duct,the bileacid activity in the oesophageal lumen was significantly decreased in the rabeprazole-treated group due to augmentation of the duodenal motor complex.CONCLUSION:With this model,rabeprazole is good effect for reflux esophagitis after total gastrectomy from bile reflux.Bile acid is an important factor in the mucosal lesion induced by duodenal reflux.

关键词： Oesophagoduodenostomy Reflux oesophagitis Proton pump inhibitor Rabeprazole

Significance of feeding dysfunction in eosinophilic esophagitis

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World Journal of Gastroenterology 2014年第31期20卷 11019-11022页

作者： Calies Menard-Katcher Michelle Henry Glenn T Furuta Dan Atkins Nancy Creskoff Maune Angela M Haas Department of Pediatrics Digestive Health Institute Section of Pediatric Gastroenterology Hepatology and Nutrition Children’s Hospital Colorado Gastrointestinal Eosinophilic Diseases Program University of Colorado School of MedicineAurora CO 80045 United States Department of Clinical Nutrition Children’s Hospital Colorado Gastrointestinal Eosinophilic Diseases ProgramAurora CO 80045 United States Department of Pediatrics Digestive Health Institute Section of Pediatric Gastroenterology Hepatology and Nutrition Children’s Hospital Colorado Gastrointestinal Eosinophilic Diseases Program Mucosal Inflammation Program University of Colorado School of MedicineAurora CO 80045 United States Section of Pediatric Allergy Children’s Hospital Colorado Gastrointestinal Eosinophilic Diseases Program Department of Pediatrics University of Colorado School of MedicineAurora CO 80045 United States Department of Occupational Therapy Children’s Hospital ColoradoAurora CO80045 United States Department of Audiology Speech-Language Pathology Learning Services Children’s Hospital Colorado Aurora CO 80045 United States

Feeding dysfunction is a frequent presenting symptom of eosinophilic esophagitis(EoE). Here we present 3 children of various ages whose manifestations of EoE associated feeding dysfunction led to significant and life altering impact on their growth and development. Early identification of presenting symptoms of EoE will allow for prompt diagnosis and initiation of appropriate treatments. Recognition of salient features of dysfunction and treatment by feeding therapists and nutritionists led to symptom resolution and growth.

关键词： Eosinophilic esophagitis Eosinophilic oesophagitis

Helicobacter pylori eradication and reflux disease onset:Did gastric acid get "crazy"?

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World Journal of Gastroenterology 2013年第6期19卷 786-789页

作者： Angelo Zullo Cesare Hassan Alessandro Repici Vincenzo Bruzzese Gastroenterology and Digestive Endoscopy Unit Nuovo Regina Margherita Hospital Digestive Endoscopy Unit IRCCS Istituto Clinico Humanitas

Gastroesophageal reflux disease (GORD) is highly prevalent in the general population.In the last decade,a potential relationship between Helicobacter pylori (H.pylori) eradication and GORD onset has been claimed.The main putative mechanism is the gastric acid hypersecretion that develops after bacterial cure in those patients with corpus-predominant gastritis.We performed a critical reappraisal of the intricate pathogenesis and clinical data available in this field.oesophagitis onset after H.pylori eradication in duodenal ulcer patients has been ascribed to a gastric acid hypersecretion,which could develop following body gastritis healing.However,the absence of an acid hypersecretive status in these patients is documented by both pathophysiology and clinical studies.Indeed,duodenal ulcer recurrence is virtually abolished followingH.pylori eradication.In addition,intra-oesophageal pH recording studies failed to demonstrated increased acid reflux following bacterial eradication.Moreover,oesophageal manometric studies suggest that H.pylori eradication would reduce-rather than favor-acid reflux into the oesophagus.Finally,data of clinical studies would suggest that H.pylori eradication is not significantly associated with eitherreflux symptoms or erosive oesophagitis onset,some data suggesting also an advantage in curing the infection when oesophagitis is already present.Therefore,the legend of "crazy acid" remains-as all the others a fascinating,but imaginary tale.

关键词： Helicobacter pylori Oesophageal reflux oesophagitis Eradication Pathophysiology Clinical studies