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Digestive Diseases and Sciences Jun 2021Defining factors associated with severe reflux esophagitis allows for identification of subgroups most at risk for complications of strictures and esophageal malignancy....
BACKGROUND
Defining factors associated with severe reflux esophagitis allows for identification of subgroups most at risk for complications of strictures and esophageal malignancy. We hypothesized there might be unique clinical features in patients with reflux esophagitis in a predominantly Hispanic population of a large, safety-net hospital.
AIM
Define clinical and endoscopic features of reflux esophagitis in a predominantly Hispanic population of a large, safety-net hospital.
METHODS
This is retrospective comparative study of outpatients and hospitalized patients identified with mild (Los Angeles Grade A/B) and severe (Los Angeles Grade C/D) esophagitis through an endoscopy database review. The electronic medical record was reviewed for demographic and clinical data.
RESULTS
Reflux esophagitis was identified in 382/5925 individuals: 56.5% males and 79.8% Hispanic. Multivariable logistic regression model adjusted for age, gender, race, body mass index (BMI), tobacco and alcohol use, and hospitalization status with severity as the outcome showed an interaction between gender and BMI (p ≤ 0.01). Stratification by gender showed that obese females had decreased odds of severe esophagitis compared to normal BMI females (OR = 0.18, 95% CI = 0.07-0.47; p < 0.01). In males, the odds of esophagitis were higher in inpatient status (OR = 2.84, 95% CI = 1.52 - 5.28; p < 0.01) and as age increased (OR = 1.37, 95% CI = 1.03 - 1.83; p = 0.03).
CONCLUSIONS
We identify gender-specific associations with severe esophagitis in a predominantly Hispanic cohort. In females, obese BMI appears to be protective against severe esophagitis compared to normal BMI, while in men inpatient status and increasing age were associated with increased odds of severe esophagitis.
Topics: Adult; Aged; Esophagitis, Peptic; Female; Hispanic or Latino; Hospitals, County; Humans; Male; Middle Aged; Retrospective Studies; Risk Factors; Safety-net Providers; Sex Characteristics
PubMed: 32691385
DOI: 10.1007/s10620-020-06482-1 -
Archives of Pathology & Laboratory... Jul 2009Esophagitis is a common cause of symptoms for which patients seek the advice of a physician. Esophagitis of differing etiologies often demonstrate overlapping... (Review)
Review
CONTEXT
Esophagitis is a common cause of symptoms for which patients seek the advice of a physician. Esophagitis of differing etiologies often demonstrate overlapping histopathologic features, making their distinction difficult. This is especially true in esophageal disorders associated with increased numbers of intraepithelial eosinophils, some of which have just recently been recognized.
OBJECTIVE
This review discusses the important clinical and pathologic features of the 2 most common disorders associated with esophageal eosinophilic infiltrates--reflux esophagitis and eosinophilic esophagitis--with special emphasis on features that allow the surgical pathologist to distinguish between these disorders. The various forms of drug-induced esophagitis are also discussed because these are frequently underrecognized by pathologists.
DATA SOURCES
Data were extracted from articles identified through PubMed-based research. Histologic figures have been taken from the personal case collection of the author.
CONCLUSIONS
Reflux and eosinophilic esophagitis demonstrate overlapping histologic features, which may make their distinction difficult. Drug-induced esophagitis is probably a common phenomenon but is underrecognized by pathologists.
Topics: Adult; Diagnosis, Differential; Drug Hypersensitivity; Drug-Related Side Effects and Adverse Reactions; Eosinophils; Esophagitis; Esophagitis, Peptic; Humans
PubMed: 19642735
DOI: 10.5858/133.7.1087 -
Basic & Clinical Pharmacology &... Mar 2004Proton pump inhibitors are used at different dosages for the treatment of acid-related gastrointestinal disorders, such as gastro-oesophaeal reflux and peptic ulcer... (Review)
Review
Proton pump inhibitors are used at different dosages for the treatment of acid-related gastrointestinal disorders, such as gastro-oesophaeal reflux and peptic ulcer disease. Comparisons of four different proton pump inhibitors: lansoprazole, omeprazole, pantoprazole, and rabeprazole show that they all have similar potency and efficacy. Rabeprazole, however, displays a slightly more rapid onset of acid inhibition than the others; the clinical advantage of this seems limited. The S-isomer of omeprazole, esomeprazole, exhibits a somewhat higher potency than the other proton pump inhibitors. Reports supporting a clinical advantage of this property are not convincing. To conclude, all inhibitors seem comparable as regards inhibition of gastric acid secretion.
Topics: Anti-Ulcer Agents; Esophagitis, Peptic; Gastric Acid; Humans; Peptic Ulcer; Proton Pump Inhibitors
PubMed: 15049339
DOI: 10.1111/j.1742-7843.2004.pto940302.x -
Biochemical Society Transactions Apr 2010The precise mechanisms whereby gastro-oesophageal reflux disease causes reflux oesophagitis and Barrett's oesophagus are not clear, even though these diseases have been... (Review)
Review
The precise mechanisms whereby gastro-oesophageal reflux disease causes reflux oesophagitis and Barrett's oesophagus are not clear, even though these diseases have been known to be linked for many years. Recent studies indicate a role for the reflux-induced inflammatory response of oesophageal squamous epithelial cells and the immune cells in the pathogenesis of reflux oesophagitis. Although reflux oesophagitis commonly heals with oesophageal squamous cell regeneration, in some individuals the oesophagus heals through the process of metaplasia, a condition termed Barrett's oesophagus. Recent studies indicate that individual differences in the reflux-mediated response of oesophageal squamous epithelial cells in the type of immune response and/or in signalling pathways that regulate cell proliferation or cell phenotype may determine whether the oesophagus heals with the regeneration of squamous cells or through Barrett's metaplasia.
Topics: Barrett Esophagus; Bile Acids and Salts; Bile Reflux; Esophagitis, Peptic; Esophagus; Gastric Acid; Gastroesophageal Reflux; Humans; Immune System Diseases; Metaplasia
PubMed: 20298181
DOI: 10.1042/BST0380348 -
Cellular and Molecular Gastroenterology... 2018
Topics: Barrett Esophagus; Esophagitis, Peptic; Humans; Metaplasia; Models, Anatomic
PubMed: 30364646
DOI: 10.1016/j.jcmgh.2018.07.002 -
Gut Aug 2001
Topics: Anti-Ulcer Agents; Drug Design; Esophagitis, Peptic; Humans; Proton Pumps; Treatment Outcome
PubMed: 11454811
DOI: 10.1136/gut.49.2.309 -
Archives of Disease in Childhood Sep 1984Thirty three children aged 2 to 42 months (mean 9 months) with gastro-oesophageal reflux and peptic oesophagitis took part in a treatment trial comparing cimetidine (20... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
Thirty three children aged 2 to 42 months (mean 9 months) with gastro-oesophageal reflux and peptic oesophagitis took part in a treatment trial comparing cimetidine (20 mg/kg/day) with an intensive regimen of antacids (Maalox, 700 mmol (mEq)/1 X 73 m2/day). All children were evaluated clinically and by radiology, acid reflux test, and endoscopy. After 12 weeks of treatment all were again evaluated clinically, by pH measurement, and endoscopy. Twenty nine children, 15 on antacid and 14 on cimetidine, completed the trial. Eight patients on antacid and seven on cimetidine were cured; five on antacid and six on cimetidine improved; and two patients on antacid and one on cimetidine underwent surgery. Both groups of children showed a statistically significant reduction in the score of clinical, pH, and endoscopic variables after treatment. Lower oesophageal sphincter pressure before treatment did not correlate significantly with the final total score. Antacids in large quantities are as effective as cimetidine in medical treatment of gastro-oesophageal reflux and peptic oesophagitis.
Topics: Aluminum Hydroxide; Antacids; Child, Preschool; Cimetidine; Clinical Trials as Topic; Drug Combinations; Esophagitis, Peptic; Female; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Infant; Magnesium Hydroxide; Male; Random Allocation
PubMed: 6385868
DOI: 10.1136/adc.59.9.842 -
Medicine Aug 2020Gastroesophageal reflux disease is a common and troublesome condition. This paper reports a rare case of gastroesophageal reflux disease caused by ectopic biliary...
INTRODUCTION
Gastroesophageal reflux disease is a common and troublesome condition. This paper reports a rare case of gastroesophageal reflux disease caused by ectopic biliary drainage accompanying the absence of a pyloric channel and duodenal bulb in a female patient with multiple underlying malformations.
PATIENT CONCERNS
A 24-year-old female presented with acid regurgitation and abdominal pain for one month. She was born two weeks premature and with blindness of the right eye. Cardiac murmur was detected in the physical examination.
DIAGNOSIS
Gastroendoscopy was performed, and a class D reflux esophagitis and ectopic papilla complicated with the absence of a pyloric channel and duodenal bulb were found. Doppler echocardiography further confirmed the defects of atrial and ventricular septa. Trio-based whole exome sequencing was performed on the proband and her family to find the potential association of multiple variations. However, no putative pathogenic mutations were found.
INTERVENTIONS
The patient received proton pump inhibitors and prokinetic treatment and underwent surgical repair of septal defects.
OUTCOMES
The symptoms were quickly relieved, and the patient was kept stable upon follow-up.
CONCLUSION
The combination of an absent pylorus and ectopic papilla is a rare cause of reflux esophagitis. Unusual gastrointestinal anatomical variations may be accompanied by other malformations. Though no remarkable mutation were detected in this case, sequencing is an efficient technique worth full consideration.
Topics: Abnormalities, Multiple; Ampulla of Vater; Blindness; Esophagitis, Peptic; Female; Gastroscopy; Heart Septal Defects, Atrial; Heart Septal Defects, Ventricular; Humans; Proton Pump Inhibitors; Exome Sequencing; Young Adult
PubMed: 32871896
DOI: 10.1097/MD.0000000000021758 -
Medicine Sep 2018Gastroesophageal reflux (GER) is the intermittent or permanent passage of stomach content into the esophagus and gastroesophageal reflux disease (GERD) is the reflux... (Observational Study)
Observational Study
Gastroesophageal reflux (GER) is the intermittent or permanent passage of stomach content into the esophagus and gastroesophageal reflux disease (GERD) is the reflux which triggers a whole set of symptoms or complications. The study compares the 24-hours esophageal pH-metry, used for diagnosis of the GERD, with the esophagitis degree observed at the upper digestive endoscopy.72 children were included, aged over 4 years old, admitted in a pediatric gastroenterology regional center in Northeast Romania, diagnosed with GERD by 24 hours pH-metry (with a positive Boix-Ochoa score), which also underwent the upper digestive endoscopy.Out of the 72 children diagnosed with GERD, 47 (65.28%) had grade A esophagitis and 25 (34.72%) grade B esophagitis. In GERD associated with grade B esophagitis the Boix-Ochoa score is statistically significant higher, compared with the GERD associated with grade A esophagitis (F = 9.76, P = .0036, 95% CI).Upper digestive endoscopy performed in patients with gastroesophageal reflux disease shows the constant presence of esophagitis at all patients. There were only grade A and B esophagitis due to the fact that they are young patients with a relative short history of the disease. The correlation tests show a perfect parallel between the pH-metry scores and the endoscopic lesion. The correlation is so accurate that the pH-metry scores can be sufficient to prove GERD and the grade of esophagitis, the upper digestive endoscopy being reserved only for the cases that does not respond to the medical treatment or have other complications.
Topics: Child; Child, Preschool; Esophagitis, Peptic; Esophagoscopy; Female; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Male; Romania
PubMed: 30212934
DOI: 10.1097/MD.0000000000012042 -
Mystery Solving: Acid Reflux and Cell Mobility in Barrett's Esophagus and Esophageal Adenocarcinoma.Cellular and Molecular Gastroenterology... 2020
Topics: Adenocarcinoma; Barrett Esophagus; Esophageal Neoplasms; Esophagitis, Peptic; Humans; RNA, Small Interfering
PubMed: 32598898
DOI: 10.1016/j.jcmgh.2020.06.002