ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Research continues in the area of esophageal motility and our understanding of esophageal peristalsis in health and disease continues to increase. Advances in our understanding of neurologic aspects of peristalsis have been elucidated by a number of studies. Neuromuscular function and morphology have been demonstrated experimentally in the obstructed esophagus. Advances in technique have included attempts to further define the normal range of 24-hour recording. A reverse-perfused sleeve device described this year will enable us to understand the sphincteric function of the crural diaphragm in the future and a newly described sphincterometer may play a role in prolonged ambulatory lower esophageal sphincter monitoring. The usefulness of classifying achalasia into vigorous and classic types has been questioned by two studies in the past year. Studies of the treatment of achalasia within the past year will not have significant impact on currently favored pneumatic dilatation, but transcutaneous electrical nerve stimulation may, in the future, be an alternate modality to treat achalasia patients. Diffuse esophageal spasm is probably less common than previously thought. Noncardiac chest pain continues to be evaluated with the use of 24-hour esophageal motility, pH monitoring and intraesophageal balloon distention.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Gastroesophageal reflux disease is a chronic, relapsing condition. The mechanisms underlying the development of gastroesophageal reflux disease and reflux esophagitis remain obscure although work continues on the roles of transient relaxations of the lower esophageal sphincters, the crural diaphragm, hiatus hernia, esophageal clearance, and mucosal defense. Endoscopy is the primary diagnostic procedure for the detection of esophagitis. There have been no technical advances with respect to esophageal pH monitoring, but evaluation procedures are being refined to allow identification of adult patients whose symptoms are attributable to gastroesophageal reflux episodes or acidification. In children, pH monitoring continues to be used to identify infants at risk of sudden infant death who might benefit from antireflux surgery and to identify the cause of persistent respiratory problems. There is further evidence for an association between gastroesophageal reflux and respiratory disease in patients with cystic fibrosis, but more studies are required to define the extent to which gastroesophageal reflux provokes respiratory symptoms. Omeprazole is the most effective medical treatment for the treatment of reflux esophagitis, and recent studies have shown that maintenance therapy will prevent relapse in most patients with no evidence, to date, of any serious adverse effects. Further studies are required to define the place of conservative measures, antisecretory agents, and surgery in the treatment of gastroesophageal reflux disease and, in the current economic climate, such studies must be combined with some form of cost-benefit analysis.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Over the past decade, there has been an alarming increase in the frequency of adenocarcinoma in Barrett's esophagus. These cancers are thought to evolve through a series of genetic alterations in the cells that comprise the Barrett's epithelium. The genetic alterations appear to involve activation of protooncogenes and dysfunction of tumor suppressor genes (eg, thep53gene), and result in morphologic changes recognizable as dysplasia. Dysplasia is widely regarded as the precursor of invasive cancer, and high-grade dysplasia in Barrett's esophagus frequently is associated with adenocarcinoma. Endoscopic surveillance can detect dysplasia and early, curable malignancies in Barrett's epithelium. Esophageal brush cytology and biopsy of Barrett's esophagus and both cytology and biopsy specimens should be obtained during surveillance endoscopic examinations.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Esophageal lesions occurring in the human immunodeficiency virus-related complex remains an important problem in recent literature. The pathogenic role of new infectious agents was recognized. A trial clearly showed that foscarnet is very effective in acquired immunodeficiency syndrome patients with cytomegalovirus-related ulcers. Direct comparison with ganciclovir should be encouraged. Three studies showed that fluconazole is safe and effective in human immunodeficiency virus-related candidiasis. Because of its long half-life and good tolerance, fluconazole is probably a good candidate for prophylaxis of relapse but preliminary results should be confirmed on larger groups of acquired immunodeficiency syndrome patients. Primary esophageal tuberculosis is a rare disease, which may be the presenting manifestation of acquired immunodeficiency syndrome. In the postpolio syndrome a slow, progressive deterioration seems to affect the bulbar neurons and may be responsible for difficulties in swallowing that appear many years after acute poliomyelitis.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Esophageal varices are one of the most common and severe complications of chronic liver disease. New aspects in epidemiology, pathogenesis, and treatment of varices are reviewed. Sclerotherapy is the first-line treatment for acute hemorrhage. Prevention of first or recurrent bleeding is still unsatisfactory. β-Blockers are slightly superior to sclerotherapy with regard to prophylaxis of first bleeding. β-Blockers or sclerotherapy may be used for prophylaxis of recurrent bleeding. However, prophylactic treatment regimens do not have a major impact on survival. Combination treatment, new drugs, or new devices may help to improve the efficacy of prophylactic measures.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Progress in esophageal oncology during the past year has been limited. An overview is given of the most relevant contributions with respect to benign esophageal neoplasms, oncogenic factors involved in malignant tumorigenesis and new information concerning the precancerous conditions. Thereafter new aspects of diagnostics and staging are discussed together with in-depth analysis of prognostic factors. Recent data on the various modalities to palliate malignant dysphagia are compared. The article ends with an overview of special forms of malignancy.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

As more experience is gained in therapeutic endoscopy, there is an increased tendency to update not-so-new techniques. Thus, self-dilation using balloon catheters or mercury bougies are proposed to treat benign strictures of the esophagus, as well as local injections of corticosteroids. Injection of sclerosing agents is also advocated for the palliation of malignant dysphagia. Nonetheless, new procedures are still being developed. Self-expandable stents may be a major breakthrough and replace standard esophageal stents, once efficacy equals ease of insertion. Combining endoscopic procedures to regional (radiation therapy) and systemic (chemotherapy) treatment offers a good alternative to surgical palliation for most esophageal tumors. Echoendoscopy allows a more precise staging of esophageal tumors, thus permitting choice of the best-suited therapeutic option for each individual case.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Decreased lower esophageal sphincter resistance and contamination of the refluxate with duodenal contents predispose to the development of mucosal injury in patients with gastroesophageal reflux disease. These patients do not receive long-term benefit from medical management. Restoration of lower esophageal sphincter resistance by a surgical antireflux procedure is the best method for reflux control in this situation. A short 360° fundoplication around the lower esophageal sphincter constructed over a 60F bougie achieves this goal with minimal side effects and provides relief of reflux symptoms in over 90% of patients for at least 10 years. In experienced hands, the morbidity associated with the laparotomy can be further reduced by performing the procedure laparoscopically. Excellent long-term results can be achieved with myotomy as the primary form of treatment in patients with achalasia. Laparoscopic or thoracoscopic myotomy of the lower esophageal sphincter will further decrease the reluctance of gastroenterologists to refer patients with achalasia for a surgical myotomy. In many centers of the Western world, adenocarcinoma of the esophagus now equals or outnumbers squamous cell carcinoma. Endosonography markedly improves the preoperative staging and identification of patients in whom a curative resection can be performed. En-block resection in patients with early tumors of the distal esophagus appears to have the best potential for long-term survival. The value of cervical lymphadenectomy and multimodality treatment of esophageal cancer needs to be established in randomized prospective trials. A colon interposition provides better functional long-term results as an esophageal substitute than a gastric pull-up.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Congenital lesions such as H-type fistulas and congenital stenosis can be recognized in children and adults and treated surgically. Acquired tracheoesophageal fistulas from prolonged intubation can be repaired primarily after weaning from the respirator. Damage to the esophagus from corrosive substances can be graded and therapy guided by gross appearance. Damage from concentrated hydrochloric acid ingestion may require immediate surgery, even before endoscopic appraisal.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID