- Laparoscopic sleeve gastrectomy and gastroesophageal reflux. [Journal Article]
- RJRom J Intern Med 2018 Dec 01; 56(4):227-232
- The prevalence of obesity is rising, becoming a medical problem worldwide. Also GERD incidence is higher in obese patients compared with normal weight, with an increased risk of 2.5 of developing sym...
The prevalence of obesity is rising, becoming a medical problem worldwide. Also GERD incidence is higher in obese patients compared with normal weight, with an increased risk of 2.5 of developing symptoms and erosive esophagitis. Different treatment modalities have been proposed to treat obese patients, but bariatric surgery due to its complex interactions via anatomic, physiologic and neurohormonal changes achieved the best long-term results, with sustained weight loss and decrease of complications and mortality caused by obesity. The bariatric surgical procedures can be restrictive: laparoscopic adjustable gastric band (LAGB) and laparoscopic sleeve gastrectomy (LSG), or malabsorptive-restrictive such as Roux-en-Y gastric bypass (RYGB). These surgical procedures may influence esophageal motility and lead to esophageal complications like gastroesophageal reflux disease (GERD) and erosive esophagitis. From the literature we know that the RYGB can ameliorate GERD symptoms, and some bariatric procedures were finally converted to RYGB because of refractory reflux symptoms. For LAGB the results are good at the beginning, but some patients experienced new reflux symptoms in the follow-up period. Recently LSG has become more popular than other complex bariatric procedures, but some follow-up studies report a high risk of GERD after it. This article reviews the results published after LSG regarding gastroesophageal reflux and the mechanisms responsible for GERD in morbidly obese subjects.
- Association of Chemoradiotherapy With Outcomes Among Patients With Stage I to II vs Stage III Small Cell Lung Cancer: Secondary Analysis of a Randomized Clinical Trial. [Journal Article]
- JOJAMA Oncol 2018 Dec 06; :e185335
- CONCLUSIONS: Patients with stage I to II SCLC in CONVERT achieved long-term survival with acceptable toxic effects after chemoradiotherapy and PCI. This study suggests that patients with stage I to II small cell lung cancer treated with modern chemoradiotherapy have better outcomes compared with patients with stage III disease, providing information that practitioners can potentially give their patients to aid clinical decisions.
- Changes in the Distal Esophageal Microbiota in Chinese Patients with Reflux Esophagitis. [Journal Article]
- JDJ Dig Dis 2018 Dec 05
- CONCLUSIONS: The structure of distal esophageal microbiota in Chinese RE patients showed moderate changes compared to healthy volunteers. To what extent these changes are associated with the pathogenesis of reflux esophagitis needs further investigation.
- Clinical features at baseline do not predict symptomatic placebo response in patients with eosinophilic esophagitis. [Journal Article]
- CGClin Gastroenterol Hepatol 2018 Nov 28
- The relationship of habitual diet with oesophageal inflammation and integrity in Eosinophilic Esophagitis. [Letter]
- AAllergy 2018 Dec 04
- Facteurs en cause et formes cliniques du reflux gastro-oesophagien chez l’adulte. Une prévalence élevée qui augmente avec l’âge. [Journal Article]
- RPRev Prat 2016; 66(10):1080-1083
- Factors and clinical forms of gastroesophageal reflux disease in adults. Gastro-oesophageal reflux (GERD) is a common complaint. Factors involved in GERD are the antireflux barrier dysfunction, the o...
Factors and clinical forms of gastroesophageal reflux disease in adults. Gastro-oesophageal reflux (GERD) is a common complaint. Factors involved in GERD are the antireflux barrier dysfunction, the oesophageal sensitivity disorders, impaired oesophageal clearance, the acid component of the refluxate, and impaired gastric emptying. Risk factors for GERD are hiatal hernia and obesity. Although heartburn or regurgitations are specific to characterize GERD, patients usually report a number of associated symptoms such as cough, eructation, globus, hiccups, chest pain, and sleep disturbances. Complications of GERD are oesophagitis, gastrointestinal haemorrhage, peptic stricture or Barrett's oesophagus.
- A Quantitative Clinical Decision-support Strategy Identifying Which Oropharyngeal Head and Neck Cancer Patients may Benefit the Most from Proton Radiation Therapy. [Journal Article]
- IJInt J Radiat Oncol Biol Phys 2018 Nov 26
- CONCLUSIONS: This quantitative decision-support strategy allowed us to identify oropharyngeal cancer patients that might have the greatest benefit from proton RT, although the estimated benefit of proton therapy ultimately depends on the organ-at-risk doses achievable with modern photon IMRT solutions. These results can help radiation oncologists and proton therapy centers optimize resource allocation and improve HNC patients' quality of life.
- An update on the latest chemical therapies for reflux esophagitis in children. [Journal Article]
- EOExpert Opin Pharmacother 2018 Nov 29; :1-9
- Gastroesophageal reflux (GER), and its complicated form gastroesophageal reflux disease (GERD) is a common condition in infants and children. As GERD is often considered to cause extra-oesophageal sy...
Gastroesophageal reflux (GER), and its complicated form gastroesophageal reflux disease (GERD) is a common condition in infants and children. As GERD is often considered to cause extra-oesophageal symptoms in children and in the absence of standardized diagnostic and treatment algorithm, many children are inappropriately exposed to empirical anti-reflux treatments, with Acid-Suppressive Medications (ASM); mostly proton pump inhibitors (PPIs). Areas covered: The authors summarize the pharmacological management of pediatric GERD and discuss the efficacy of PPIs as randomized controlled trials have failed to demonstrate their clinical efficacy in the pediatric population. They consider the controversies surrounding the use of PPIs in the pediatric population as increasing evidence suggests of, although controversially, an increased risk of adverse events such as infection of the respiratory or gastrointestinal tract. Esophagitis is a complication that has a significant impact on weight gain and growth, as well as on the quality of life, and in such case, the benefit of treatment largely outweighs the risk. Expert opinion: Clinicians should reserve ASM use for infants and children with proven esophagitis and avoid their routine use in patients with merely symptoms of GER. Treatment need and options must be frequently re-evaluated to reduce the risks associated with ongoing therapy.
- Systematic review of histological remission criteria in eosinophilic esophagitis. [Review]
- JOJGH Open 2018; 2(4):158-165
- Elemental diets, dietary elimination, and steroid therapies are the most common therapies in the clinical trials for eosinophilic esophagitis (EoE). Histological findings (usually reported as eosinop...
Elemental diets, dietary elimination, and steroid therapies are the most common therapies in the clinical trials for eosinophilic esophagitis (EoE). Histological findings (usually reported as eosinophils per microscopic high-powered field [hpf]) remain the most common end-point used to define response. Yet, the threshold for defining "response" and "remission" are ill-defined among consensus guidelines and may vary from study to study. We conducted a systematic literature review of articles on eosinophilic esophagitis, published between January 2007 and November 2017, considering histological remission as the primary outcome. We abstracted treatment information and definitions of histological remission or response. A comparison of definitions of histological remission across and within institutions was performed. A total of 61 articles were included in this review, with approximately 60% of the studies published from centers in the United States. Histological definitions of remission of EoE ranged from 0 to ≤20 eosinophils/hpf. The most stringent criteria, ranging from 0 to ≤5 eosinophils/hpf, were commonly used in interventional trial studies that examined the effects of new treatments. We found remarkable variability in definitions between studies, treatment types, and regions. Age or epidemiological distribution of study subjects did not influence the criteria for histological remission. Clinical and histological improvements are important measures of the effects of treatment. Histological findings, the most objective measure of treatment, should provide an optimal method for comparing the effectiveness of various treatments. Yet, our findings suggest a lack of consistent remission criteria in published studies. Considering these inconsistencies, it is difficult to compare the effectiveness of various treatments.
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- Adiponectin level changes among Egyptians with gastroesophageal reflux disease. [Journal Article]
- JOJGH Open 2018; 2(1):21-27
- CONCLUSIONS: Low serum adiponectin level appears to be associated with an increased risk of erosive esophagitis, and visceral fat accumulation is related to the impaired secretion of adiponectin, which may have an influence on the pathogenesis of GERD.