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42 | 2018-04-20 02:31:19 | Bariatric Surgery Types | By Dr Ananya Mandal, MD The type of bariatric surgery that is used to help extremely or morbidly obese individuals lose weight depends on a number of factors, with each type of surgery associated with advantages and disadvantages. Patients and healthcare providers need to discuss the risks and benefits of procedures before deciding on the most suitable type of surgery. Open and laparoscopic surgery An open surgery involves cutting open the abdomen and making modifications to the digestive tract. This involves making a single, large incision across the abdomen that may later take time to heal and may also lead to complications such as hernias. A laparoscopic surgery involves distending the abdomen with an inert gas and making several small half-inch incisions across it to enable insertion of surgical instruments and a small camera that can be used to aid the operating surgeon. Today, most bariatric surgery is laparoscopic because compared to open surgery, it requires smaller incisions that heal faster, are associated with fewer post-operative complications (especially hernias) and allow for early hospital discharge. However, not all patients are suitable for laparoscopy. Extremely obese individuals, those with complex medical problems such as severe heart and lung disease or those who have previously had abdominal surgery may require the open surgery approach. Types of bariatric surgery There are four types of operations that are commonly offered to patients: Adjustable gastric banding Roux-en-Y gastric bypass Biliopancreatic diversion with a duodenal switch Vertical sleeve gastrectomy Factors that are considered when choosing the surgery include: Benefits and risks associated with surgery type Patient preference and willingness to adhere to the post-surgery dietary recommendations Body mass index Eating habits Health conditions related to obesity Previous stomach surgeries Diagram of Surgical Options. Image credit: Walter Pories, M.D. FACS. Related StoriesNeurocognitive deficits worsen outcomes for joint replacement surgery, finds studyThe Human Microbiome – A New Potential Fingerprint in Forensic Evidence?Breast cancers more likely to spread after surgery finds study Adjustable Gastric Banding (AGB) The basic principle of this type of surgery is to decrease food intake with the use of a small bracelet-like band placed around the top of the stomach. The band restricts the size of the opening from the throat to the stomach, limiting the amount of food a patient can ingest. The size of the opening can be modified using a balloon inside the band that can be inflated or deflated with saline solution according to the needs of the patient. Roux-en-Y Gastric Bypass (RYGB) This method is also used to decrease food intake and involves creating a small pouch that is similar in size to the pouch created with AGB. The food bypasses the rest of the stomach and reaches the small intestine, where it is absorbed to a much lesser degree than if it had passed through the stomach, duodenum, and upper intestine. Vertical Sleeve Gastrectomy (VSG) This procedure involves removal of most of the stomach, which not only restricts food intake and absorption, but lowers levels of the hormone ghrelin that is responsible for appetite. Biliopancreatic Diversion with a Duodenal Switch (BPD-DS) Also called the duodenal switch, this three-stage procedure involves the removal of a large part of the stomach which makes the patient feel full after eating only a small meal, followed by re-routing of the small intestines to prevent food absorption. The third step involves changing how bile and other digestive juices affect the process of digesting and absorbing calories. Reviewed by Sally Robertson, BSc Sources www.nhs.uk/conditions/weight-loss-surgery/Pages/Introduction.aspx http://win.niddk.nih.gov/publications/PDFs/Bariatric_Surgery_508.pdf www.medicine.virginia.edu/.../BARIATRIC-SURGERY.pdf www.siumed.edu/.../Gastric%20bypass%20surgery%20guide.pdf http://www.lapsf.com/bariatricsurgery.pdf louisville.edu/.../bariatric%20surgery.pdf Further ReadingBariatric Surgery - What is Bariatric Surgery?Bariatric Surgery Side EffectsDiet After Bariatric SurgeryWeight Loss After Bariatric SurgeryTaste Changes Following Bariatric SurgeryMore... Last Updated: Aug 27, 2013 |
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43 | 2018-04-20 02:31:21 | Diet After Bariatric Surgery | By Dr Ananya Mandal, MD Weight loss surgery involves reducing the capacity of the stomach to hold food, and therefore the amount of calories and nutrients that can be absorbed in the intestines. A patient’s diet needs to be modified accordingly after surgery to ensure maximum nutrition while reducing calorie intake. A typical diet plan for a patient who has undergone bariatric surgery involves: The stage 1 diet that is provided at hospital immediately after surgery. This initial diet comprises mainly liquids that the patient can slowly sip until the new stomach or stomach pouch is full. The stage 2 diet is made up of low-sugar, liquid or semi-liquid foods such as warmed cereal with milk. The stage 3 diet is designed for when a patient is discharged from hospital and includes semi-solid, pureed, and finally soft foods. The progress to soft food is slow to allow time for post-operative wounds in the stomach and intestines to heal. Diet progression Initial requirements include enough liquid to prevent dehydration and sufficient protein. Later, the diet needs to be adjusted to accommodate nutritional needs. The size of the stomach pouch is about one ounce and initially, as little as two to three teaspoons of food may make the patient feel full. Over time, the pouch stretches bit-by-bit to allow more food intake. The diet’s composition Related StoriesObesity surgery reduces the risk of death by half finds new study About three quarters of the patient’s calorie intake should come from protein sources such as eggs, fish and meat, while carbohydrates such as potatoes, rice and wheat should provide 10 to 20 % of the calorie intake, and fats between 5 to 15 %. For the first six months, the diet should provide the patient with 800 to 1,000 calories and 75 grams of protein a day. Foods to avoid Foods containing sugars should be avoided, firstly because they may hamper weight loss and, secondly, because eating sugary food may lead to a condition called dumping syndrome, which describes when sugar moves directly from the stomach pouch into the small intestine where it can cause palpitations, nausea, abdominal pain and diarrhea. Liquids should be avoided for a period of 30 minutes before and after eating solid food. When taken together with solids, liquids may cause nausea, as well as pushing food through the stomach pouch at a faster rate, leading to more eating than advised to satisfy appetite. Overeating should be avoided at all costs. Overeating by even an ounce may induce nausea, vomiting or lead to stretching of the pouch. Hydration Patients must maintain good levels of hydration, with 1 ½ to 2 liters of water consumed every 24 hours. This amount is to be increased by 20% if the patient is sweating. Carbonated beverages, soft fizzy drinks, sweetened drinks, and caffeine-containing drinks need to be avoided. Maintaining nutrition Due to the decreased food intake post-surgery, patients are at risk of vitamin and mineral deficiency and diet must be supplemented with multivitamins and minerals for the rest of the patient’s life. Reviewed by Sally Robertson, BSc Sources www.nhs.uk/conditions/weight-loss-surgery/Pages/Introduction.aspx http://win.niddk.nih.gov/publications/PDFs/Bariatric_Surgery_508.pdf www.medicine.virginia.edu/.../BARIATRIC-SURGERY.pdf www.siumed.edu/.../Gastric%20bypass%20surgery%20guide.pdf http://www.lapsf.com/bariatricsurgery.pdf louisville.edu/.../bariatric%20surgery.pdf Further ReadingBariatric Surgery - What is Bariatric Surgery?Bariatric Surgery Side EffectsBariatric Surgery TypesWeight Loss After Bariatric SurgeryTaste Changes Following Bariatric SurgeryMore... Last Updated: Aug 27, 2013 |
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44 | 2018-04-20 02:31:25 | Weight Loss After Bariatric Surgery | By Sally Robertson, BSc Also called weight loss surgery, bariatric surgery is an operation performed to reduce the size of the stomach and help people to lose weight if they have become severely or morbidly obese. Bariatric surgery has proved an effective tool for helping such individuals to reduce their food intake, lose weight and improve or cure conditions they have as a result of obesity. The main bariatric surgeries are gastric bypass, a gastric band procedure and sleeve gastrectomy, all of which reduce the amount of food the stomach can hold and decrease the amount a person needs to eat in order to feel full. In order to successfully lose weight after one of these procedures, it is crucial that patients adhere to the dietary recommendations made by their healthcare provider. Diet Following Gastric Band Procedure Immediately after this operation and for the next four weeks, patients are only able to consume liquids and small amounts of pureed foods. Soft foods can usually be consumed between four to six weeks after the procedure. After six weeks, people can gradually start to follow a healthy, long-term diet that includes small, nutritious amounts of food. People should adhere to this diet plan for the rest of their lives. Although weight loss is the aim of this diet plan, nutritional content must not be overlooked. Gastric Band for Weight Loss. Image Credit: bearsky23 / Shutterstock According to the “British Obesity Surgery Patient Association” (BOSPA), there are six main rules people should follow in order to benefit the most from their surgery. These include the following: Not eating any more than three meals a day. Avoiding eating snacks in-between meal times. Consuming solid foods – These make a person feel full more easily than soft foods do. Soft foods also tend to contain more fat and carbohydrate than solid foods. Eating slowly and stopping eating once full – Food should be cut into chunks that are then chewed slowly for as long as possible before being swallowed. People should not continue to eat once they feel full because over-eating can result in pain and sickness. Avoiding drinking while eating – Drinking fluids can push food through the small stomach and leave a person feeling less full. Not consuming calorie-rich drinks – These increase the intake of calories. Water or diet drinks should be consumed instead. Diet Following Gastric Bypass and Other Types of Weight Loss Surgery A person’s progression towards a healthy diet after gastric bypass is similar to that after a gastric band procedure. Patients only consume liquids for the first week following their surgery, moving on to pureed foods between weeks two and four and soft foods between weeks four to six. After six weeks, patients can follow a healthy diet and apply the same six rules recommended by BOSPA. Gastric Bypass for Weight Loss - Image Credit: bearsky23 / Shutterstock Related StoriesObesity surgery reduces the risk of death by half finds new studyHowever, patients need to bear several additional points in mind. Sugar-rich foods should be avoided, since the bypass alters how sugar is digested and sugar consumption will trigger the production of high amounts of insulin. This can lead to what is termed “dumping syndrome,” in which nausea, diarrhea, and abdominal pain occur. The bypass also affects the body’s ability to absorb all the vitamins and nutrients it requires and patients will need to take daily vitamin and mineral supplements. The dietary recommendations following any other type of bariatric surgery are likely to be similar to those described so far, but patients can discuss any particulars with their healthcare specialist. Exercise Weight loss and maintenance of a healthy weight also involve burning calories by exercising. In addition to aiding weight loss, exercise reduces the risk of heart disease and certain cancers, as well as leading to an overall improved sense of well-being. Exercise plans patients are provided with usually recommend engaging in low-to-moderate levels of physical activity and then slowly increasing the amount of exercise over time. The exercise should be sufficient to increase the heart rate and leave the person feeling short of breath. Recommended exercises include brisk walking, cycling, swimming, stair climbing and supervised exercise programs. Of course, people are more likely to maintain their exercise plan if they choose activities they enjoy. Due to this, patients are encouraged to be creative with their plans if wished. Reviewed by Afsaneh Khetrapal BSc (Hons) Sources https://medlineplus.gov/ency/patientinstructions/000173.htm www.nhs.uk/Conditions/weight-loss-surgery/Pages/Recommendations.aspx http://www.chelwest.nhs.uk/services/surgery/weight-loss-surgery Further ReadingBariatric Surgery - What is Bariatric Surgery?Bariatric Surgery Side EffectsBariatric Surgery TypesDiet After Bariatric SurgeryTaste Changes Following Bariatric SurgeryMore... Last Updated: Mar 15, 2017 |
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45 | 2018-04-20 02:31:27 | Taste Changes Following Bariatric Surgery | By Sally Robertson, BSc Also known as weight loss surgery, bariatric surgery is a procedure carried out to help people who are severely or morbidly obese, to lose weight. Image Credit: Ursula Ferrara / Shutterstock Types of Bariatric Surgery There are four types of bariatric surgery that may be performed: Gastric band procedure – The size of the stomach is reduced using a band placed around the stomach. This reduces the amount of food a person needs to eating order to feel full. Gastric bypass – This involves dividing the stomach into a smaller upper section and larger lower section. The smaller section is then connected to part of the small intestine. Food only passes into the small stomach and this part of the small intestine, bypassing the remaining stomach and bowel. This reduces the amount of calories absorbed when food is passed through the digestive system, as well as decreasing the amount of food a person needs to eat in order to feel full. Sleeve gastrectomy – Here, a part of the stomach is removed to reduce its size and limit the amount of food intake required for a person to feel full. Sensory Changes Following Surgery Change in the taste, smell or tolerance of food following bariatric surgery is a common phenomenon. One study showed that as many as 97% of patients experience at least one such change following these surgeries. Related StoriesObesity surgery reduces the risk of death by half finds new studyFortunately, the changes often benefit patients, with research showing that they help people to lose more weight than people who do not experience any changes. According to a study conducted by researchers from the University Hospitals of Leicester, which included 103 patients who underwent gastric bypass, 73% reported changes in the taste of food and almost 50% reported changes in smell. The most commonly reported taste changes were heightened sensitivity to sweet food, sour food and fast food. Some patients also developed an oversensitivity to sweetness in protein shakes, which can be a problem should patients need to follow a liquid-only diet after their operation. If this happens, a patient should talk to their doctor to ensure their dietary requirements s are being met. Eating behaviors may also change following bariatric surgery. Patients may be less likely to find emotional eating is a problem and eating cues may have less impact. Evidence also suggests that the mood-altering effect of sweet foods may be reduced, with patients less likely to experience a “sugar high” after a bariatric procedure. The tendency to eat purely as a matter of habit may also fade. Cause The exact cause of these changes following bariatric surgery is not yet clear, but many researchers suspect that fluctuating gut hormones and the effect these have on the nervous system may play a role. The central nervous system relays hunger, craving and satiety messages between the brain and gastrointestinal tract. The nerves that carry these messages are affected when a part of the stomach removed, which impacts a person’s sense of taste, smell and satiety. Ghrelin is a hormone that plays an important role in hunger. A reduced calorie intake and weight loss leads to increased ghrelin production, which makes people feel hungry. In contrast, weight loss as a result of bariatric surgery leads to decreased ghrelin production, therefore reducing hunger and food intake following the procedure. Another important hormone, which is involved in satiety, is leptin. This relays messages between the gut and brain about how full a person is and determines whether calories are burned or stored as fat. Losing weight is thought to increase a person’s sensitivity to these messages, resulting in a person feeling full more easily after eating only small amounts of food. Reviewed by Afsaneh Khetrapal BSc (Hons) Sources bariatrictimes.com/.../ www.njbariatriccenter.com/.../ www.nhs.uk/Conditions/weight-loss-surgery/Pages/Introduction.aspx Further ReadingBariatric Surgery - What is Bariatric Surgery?Bariatric Surgery Side EffectsBariatric Surgery TypesDiet After Bariatric SurgeryWeight Loss After Bariatric SurgeryMore... // Last Updated: Mar 15, 2017 |
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46 | 2018-04-20 02:31:30 | Metabolic Syndrome and Bariatric Surgery | By Sally Robertson, BSc Also called weight loss surgery, bariatric surgery is a procedure used to treat people who have become dangerously obese. Life-threatening obesity is defined by the following: A body mass index (BMI) of 40 or more. A BMI of 35 or more and the presence of a serious metabolic risk factor that would benefit from weight loss such as type 2 diabetes or hypertension. Types of Bariatric Surgery The three main types of bariatric surgery include: Gastric band procedure – The size of the stomach is reduced by the use of a band placed around the stomach. By effectively reducing the storage capacity of the stomach, it follows that less ingested food is required to make a person feel full. Gastric bypass – The stomach is divided into a smaller upper portion and a larger lower portion. The smaller section is connected to a part of the small intestine. Food then only passes into the smaller part of the stomach and this section of the intestine, bypassing the remaining stomach and bowel. The new stomach absorbs less calories than before and this reduces the amount of food a person needs to eat to make them feel full. Sleeve gastrectomy – A part of the stomach is removed to reduce its size and make a person feel full after eating only small portions of food. People who are morbidly obese have a 50 - 100% increased risk of dying prematurely, compared with healthy individuals, and bariatric surgery reduces this risk by up to 40%. The procedure does this by quickly and effectively reducing body fat and can help to prevent, improve or even resolve over forty metabolic conditions related to obesity, including the following: Heart disease Type 2 diabetes Certain cancers Gastroesophageal reflux disease Hypertension Joint problems Sleep apnea Metabolic Syndrome “Metabolic syndrome” is the collective term for the health factors that increase the risk of metabolic conditions such as heart disease, stroke, diabetes, non-alcoholic fatty liver disease and coronary artery disease. Metabolic syndrome, signs and symptoms. Image Credit: Designua / Shutterstock Related StoriesRed and processed meat may increase the risk of liver diseaseExercise could extend the life expectancy of breast cancer survivors, study statesObesity surgery reduces the risk of death by half finds new studyIn general, compared to a person who does not have metabolic syndrome, a person who does have it is at twice the risk of developing heart disease and five times the risk of developing diabetes. The risk of developing metabolic syndrome is associated with excessive weight, obesity and inadequate levels of physical activity. Insulin resistance, which is associated with being overweight and obese, is another risk factor. Insulin resistance is a condition in which the body fails to use insulin effectively, and the blood sugar level rises as a direct result. The reasons why bariatric surgery can improve diabetes and other conditions are not yet clear, although the benefits are mainly assumed to result from the weight loss patients achieve, which is usually around a quarter of their overall weight. However, in the 1980s, clinicians observed fast metabolic changes in some patients after they had undergone surgery, which triggered curiosity over other potential factors involved. There has been much research interest in this area, with scientists performing a range of studies to try to identify the potential mechanisms underlying the ability of the digestive system to adapt to its rearrangement. Researchers hope to eventually be able to use such research to establish which patients will show the most positive effects in response to treatment. They also hope it will lead to the possibility of metabolism being altered in patients, without them having to undergo surgery. Reviewed by Afsaneh Khetrapal BSc (Hons) Sources www.nature.com/.../...ht-loss-surgery-a-gut-wrenching-question-1.15560 bariatric.surgery.ucsf.edu/.../metabolic-syndrome.aspx https://asmbs.org/resources/metabolic-and-bariatric-surgery www.nhs.uk/Conditions/weight-loss-surgery/Pages/Introduction.aspx Further ReadingBariatric Surgery - What is Bariatric Surgery?Bariatric Surgery Side EffectsBariatric Surgery TypesDiet After Bariatric SurgeryWeight Loss After Bariatric SurgeryMore... Last Updated: Mar 15, 2017 |
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47 | 2018-04-20 02:31:37 | Bariatric Surgery Research | By Sally Robertson, BSc Bariatric surgery is a procedure that makes changes to the digestive system in order to help people with severe or morbid obesity to lose weight. Research has shown that, depending on which form of surgery they have, many individuals who undergo bariatric or weight loss surgery manage to lose around 15% to 30% of the weight they were prior to surgery. However, none of the procedures can guarantee weight loss and some individuals are disappointed with the results. Factors that may influence how much weight is lost post-operatively include how obese the person was in the first place and the surgical method applied. The main procedures in bariatric surgery include Roux-en-Y gastric bypass, gastric band and sleeve gastrectomy. Currently, research is ongoing into the safety, effectiveness, and long-term outcomes of the different procedures, as well as the possibility of alternative, non-surgical treatment options. A study by K Ryan and R Seeley (University of Cincinnati, Ohio, US) investigated how vertical sleeve gastrectomy (VSG) leads to health benefits for obese individuals. VSG involves a reduction in stomach size of around 80% and the creation of a gastric “sleeve” to connect the small intestine to the esophagus. The procedure is known to increase the amount of circulating bile acids, which bind to a receptor that regulates the expression of a gene called farsenoid-X receptor (FXR). To investigate whether the influence VSG has on weight loss is associated with FXR, the team compared knock-out mice that did not have the FXR receptor to mice that did have the receptor. As reported in Nature in 2014, all of the mice were fed a high-fat diet until they became obese and then subjected to VSG. Following the procedure, all mice lost weight and their glucose tolerance improved. The composition of their gut microbes also changed. However, among the mice that did not have the FXR receptor, the improved glucose tolerance and weight loss were significantly less than that among the FXR mice. Related StoriesObesity surgery reduces the risk of death by half finds new studyauthors say the finding suggests that the health benefits resulting from VSG were not just down to the reduced stomach size, but to a higher level of circulating bile acids and altered gut microbes as a result of FXR signaling. Seeley says that manipulation of gut microbes may provide a way of imitating the effects of surgery, “without having to do the cutting and stapling.” In a study published in the International Journal of Obesity in 2016, A McCullough (Cleveland Clinic, Ohio, US) and colleagues investigated the efficacy and safety of bariatric surgery in patients with non-alcoholic fatty liver disease (NAFLD) and advanced fibrosis. Currently, the procedure is safely performed in people with NAFLD who only have minimal fibrosis (stage 1 to 2) and the benefits and safety of the procedure for patients with stage 3 to 4 fibrosis are not clear. The team compared patient outcomes between 99 patients with stage 3 to 4 fibrosis (group 1) and 198 patients with stage 1 to 2 fibrosis (group 2) over a one-year period, following bariatric surgery. Although group 1 patients did require a longer hospital stay than group 2 patients (4 versus 3 days), there was no significant difference in the proportion of people who experienced post-operative complications, at 36.4% versus 32.8%. Group 1 also had significantly higher transaminase levels than group 2, which improved over the one-year follow-up period. The authors say the findings suggest that post-operative complications are no more likely to occur among patients with advanced versus minimal fibrosis, following bariatric surgery. The improved transaminase level also implies that bariatric surgery results in reduced inflammation in the livers of those with advanced fibrosis. Other examples of research include a study by M Svane (Copenhagen University Hospital Hvidovre, Denmark), which concluded that increased postprandial secretion of glucagon-like peptide-1 and peptide YY among patients who have had a gastric bypass, may account for the reduced appetite and weight loss people experience as a result of the procedure. This research was published in Nature in 2016. Another study published in BMJ Open in 2016 looked at the effects that the experiences and expectations of individuals who undergo bariatric surgery may have on post-operative outcomes. C Homer (Sheffield Hallam University, Sheffield, UK) and colleagues found that patients unrealistically expected to see major physical and psychological improvement following the procedure. The expectations stemmed from feelings of stigma and shame and experiences of failed attempts at weight loss in the past. The authors concluded that the expectation could have negative effects on post-operative outcomes and that healthcare providers should address any feelings of shame or stigma, so as to modify expectations following surgery. Reviewed by Susha Cheriyedath, MSc Sources http://www.nature.com/ijo/journal/v41/n3/full/ijo2016212a.html www.nih.gov/.../new-insights-into-bariatric-surgery-obesity www.nhs.uk/conditions/weight-loss-surgery/Pages/Introduction.aspx www.niddk.nih.gov/.../definition-facts.aspx http://www.nature.com/ijo/journal/v40/n11/full/ijo2016121a.html http://bmjopen.bmj.com/content/6/2/e009389 Further ReadingBariatric Surgery - What is Bariatric Surgery?Bariatric Surgery Side EffectsBariatric Surgery TypesDiet After Bariatric SurgeryWeight Loss After Bariatric SurgeryMore... // Last Updated: Aug 3, 2017 |
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48 | 2018-04-20 02:31:40 | What is a Barium-Meal? | By Dr Ananya Mandal, MD Principles of Barium meal A barium meal is a diagnostic test used to detect abnormalities of the esophagus, stomach and small bowel using X-ray imaging. X-rays can only highlight bone and other radio-opaque tissues and would not usually enable visualization of soft tissue. However, infusion of the contrast medium barium sulfate, a radioopaque salt, coats the lining of the digestive tract, allowing accurate X-ray imaging of this part of the abdomen. The images produced are fluoroscopic and can be viewed in real-time as well as on plates. Who can perform a Barium meal test? A barium meal can be performed by a radiologist (or radiographer) who has specialist skills in imaging studies and works as a healthcare professional to diagnose and treat illness. Procedure Before a barium meal test is performed, the duodenum needs to be empty to allow clear visualization of structures. A patient may be given a laxative the night before the procedure to ensure the small bowel is empty at the time of the test, which is usually performed on an empty stomach. The patient is first asked to change into a hospital gown and remove all jewellery, dentures, glasses, metal objects and clothing as these items can interfere with imaging. First, some fizzy granules, called carbex granules are given to the patient to create gas and expand the stomach for clearer viewing. Next, the barium contrast liquid is given to the patient to drink. Some initial images are taken to check that the barium has passed through the esophagus, and into the stomach and small bowel. The radiographer then takes a series of X-ray images over time as the barium contrast moves through the digestive system. This may mean images are taken over anywhere between 1 and 4 hours. Once the barium contrast has passed through to the large bowel or the colon, more pictures are taken. The whole test may take around 5 hours. Why is this procedure performed? Barium meal examination is usually performed to help diagnose various diseases or disorders of the digestive system. These include constrictions, hernias, obstructions or masses in the esophagus or stomach, and inflammatory or other diseases of the intestines. Risks Exposure to X-rays carries a similar risk as exposure to ionizing radiation. However, the amount of radiation a person is exposed to during an X-ray is is very low and risks are minimal. There are no risks associated with the barium liquid because it is not absorbed by the body. Some patients, however, are at risk of breathing in or aspirating the barium. X-rays are also harmful to unborn babies and should be avoided by women who are or may be pregnant. Women are asked details of the dates of their last menstruation to ensure the test is performed while the risk of pregnancy is at its lowest. After the test Some patients may feel abdominal bloating after a barium meal test and the test may also lead to constipation. Patients are therefore advised to drink plenty of fluid and eat plenty of fruit and vegetables. Mild laxatives may also help. Stools may be pale or whitish for a few days after the test. Reviewed by Sally Robertson, BSc References http://www.nationalcapitaldiagnosticimaging.com.au/wp-content/uploads/2010/06/NCDI_018_BariumMeal_PIB-web.pdf http://www.ouh.nhs.uk/patient-guide/leaflets/files%5C100204bariummeal.pdf http://www.guysandstthomas.nhs.uk/resources/patient-information/radiology/Havingabariummealandfollowthrough.pdf http://www.scumj.eg.net/pdf/vol11-n1-2008/19.pdf http://prpimaging.com.au/Assets/Downloadablefile/PRP-Barium-Meal-15253.pdf http://www.liv.ac.uk/HumanAnatomy/phd/mbchb/travel/ba2.html Last Updated: Aug 27, 2013 |
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49 | 2018-04-20 02:31:46 | What is a Barium-Enema? | By Dr Ananya Mandal, MD A barium enema, in principle, is similar to a barium meal or barium follow-through but is used specifically to obtain X-ray images of the large intestine. Unlike the barium meal and follow through procedures where a patient swallows the barium solution, the barium enema involves insertion of a small tube via the anus into the colon where the liquid is then infused. When is this test performed? A barium enema is performed in cases of suspected bowel polyps or diverticulitis. Patients with abdominal pain or bleeding on defecation may be advised to have this test. Procedure The lower intestine needs to be completely empty before the barium enema is performed, so the patient is usually given a laxative the night before the procedure is due. A patient may also be advised to restrict their diet to soft or liquid food intake for two days prior to the test. The patient is instructed not to eat or drink anything after midnight before the enema, as residual food matter shows up on X-ray and interferes with image interpretation. At the hospital, a patient is asked to remove dentures, jewellery, clothes and all metallic objects from their person and to wear a hospital gown. Metals may compromise image accuracy. Once in the X-ray room, the patient is laid on a tilting table, over which an X-ray tube is suspended and connected to a monitor where images are displayed. The first image taken is checked to ensure the lower abdomen is clear. Next, the enema tube is inserted into the rectum via the anus. The tube is lubricated with a local anesthetic to numb any pain. Liquid barium flows through the enema tip a little at a time, coating the wall of the lower intestine and allowing radiographic visualization of the gastrointestinal tract. After the barium is infused, the patient is asked to turn over to one side as this helps the physician study the colon and obtain a series of X-rays. The patient may feel a pressure or fullness in the bowel and have an urge to defecate, but they are asked to try and hold in the enema until the procedure is complete. Afterwards, the toilet may be used to expel the enema and another image is then taken to check there is no residual barium in the large intestine. In some patients, air may be introduced along with the barium solution. This procedure is commonly called a double-contrast or air-contrast barium enema. The underlying principle is that air expands the walls of the colon, allowing the radiographer to view the barium-coated lining in more detail. Risks Exposure to X-rays carries a similar risk as exposure to ionizing radiation. However, the amount of radiation a person is exposed to during an X-ray is very low and risks are minimal. No risks are associated with the use of barium liquid because it is not absorbed by the body. X-rays are harmful to unborn babies and should be avoided by women who are or may be pregnant. The test is performed on females within ten days of the first day of their last menstruation, when the risk of pregnancy is low. After the test Some patients may feel abdominal bloating or cramping after a barium enema and the procedure may also lead to constipation. Patients are therefore advised to drink plenty of fluids and eat plenty of fruit and vegetables. Mild laxatives may also help. Stools may be pale or whitish for a few days after the test. Reviewed by Sally Robertson, BSc Sources www.ouh.nhs.uk/patient-guide/leaflets/files%5C100204bariumenema.pdf http://www.cw.bc.ca/library/PDF/pamphlets/BCCH1093BariumEnema.pdf http://www.iowaradiology.com/quickguide/Fluoro_Barium_Enema.pdf http://www.asrt.org/docs/PatientPages/BarEnema_PaPg.pdf // Last Updated: Aug 27, 2013 |
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50 | 2018-04-20 02:31:49 | Barrett's Esophagus - What is Barrett's Esophagus? | By Dr Ananya Mandal, MD Barrett's esophagus is a condition in which the flat, squamous cells lining the esophagus (food pipe) are replaced by columnar shaped cells resembling those present in the lining of the intestines. This change in the cellular lining is called metaplasia and is not usually associated with any signs or symptoms. The Healthy Esophagus The esophagus contains two sphincters or muscular gates at either end. When a person swallows, the upper sphincter relaxes to allow food or drink to pass from the mouth into the esophagus and the lower sphincter opens to let food into the stomach. The lower esophageal sphincter then rapidly closes to prevent the food or drink from leaking out of the stomach and back into the esophagus and mouth. Risk Factors for Barrett's Esophagus Barrett's esophagus is most commonly found in people with gastroesophageal reflux disease (GERD). Also called acid reflux disease, GERD occurs when the lower esophageal sphincter opens at inappropriate times or does not close properly, allowing the contents of the stomach to seep back into the esophagus. If GERD is left untreated, it can eventually lead to complications such as ulcer, scarring, narrowing of the esophagus or Barrett's esophagus. Although people who do not have GERD can develop Barrett's esophagus, the condition is found about three to five times more often in people who have GERD. Other risk factors include: Age: Barret's esophagus is commonly diagnosed in middle-aged and older adults, with an average age-at-diagnosis of 50 to 55 years. Barrett's esophagus is uncommon in children. Male gender: Men are twice as likely as women to develop Barrett's esophagus. Lifestyle: Smokers are more frequently diagnosed with Barrett's esophagus than nonsmokers. Outcome Barrett's esophagus may occasionally give rise to esophageal cancer. Less than one percent of people with Barrett's esophagus develop cancer but of those who do, Barrett's esophagus may well have been present for several years. Barrett's esophagus affects about one percent of adults in the United States. Diagnosis Detection of the condition is difficult as there may be few or even no symptoms. Physicians recommend that adults older than 40 who have had GERD for a number of years undergo a screening procedure called upper gastrointestinal endoscopy to test for the disease. The procedure involves inserting a thin flexible tube with a light and camera into the esophagus to view the inner lining. Surgical instruments can be slid through the tube to remove a small piece of tissues if a site appears to be affected, a process called biopsy. The tissue is then sliced into thin, microscopic sections, fixed onto a glass slide and stained with appropriate dyes. The slide is then examined under the microscope and checked for any alteration in cellular pattern. Treatment Treatment of Barrett's esophagus may be endoscopic or surgical. The endoscopic therapies available include destroying the altered wall lining using ablation techniques such as laser beam therapy or cryotherapy. The goal of the treatment is to encourage normal esophageal tissue to replace the damaged and destroyed areas. Surgical therapy involves removal of the affected segments of the esophagus. Those with severe cellular changes may require complete removal of the esophagus. Reviewed by Sally Robertson, BSc Sources http://digestive.niddk.nih.gov/ddiseases/pubs/barretts/barretts.pdf http://www.bsg.org.uk/pdf_word_docs/Barretts_Oes.pdf http://gastro.ucsd.edu/fellowship/Documents/BarrettEsophagus.pdf gastroconsa.com/pdfs/patient_education/GCSA_Barretts-Esophagus.pdf http://s3.gi.org/patients/gihealth/pdf/barretts.pdf www.ldh.nhs.uk/.../Barretts_oesophagus_L&D_2011.pdf Last Updated: Oct 7, 2014 |
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51 | 2018-04-20 02:31:53 | What Causes Barrett's Esophagus? | Barrett’s esophagus (BE) is an abnormal metaplastic change in the esophageal epithelium (similar to intestinal tissue). BE may progress into esophageal adenocarcinoma, which is a rare cancer type. Even though the risk of converting BE to cancer is low, periodic checkups for precancerous cells or dysplasia must be performed. Usually, BE does not have any symptoms, but when associated with gastroesophageal reflux disease (GERD), it exhibits symptoms that include repeated heartburn, trouble swallowing, bloody vomit, and tarry stools. Causes The specific cause of BE is not exactly known, but one of the major risk factors is gastroesophageal reflux disease (GERD). People with long-term GERD are at higher risk of BE. In GERD, the sphincter valve at the lower end of the esophagus is damaged and allows the back flow of acids from the stomach into the esophagus. Patients with GERD are found to have metaplasia in the cells lining the wall of the esophagus because of the acid. This consequently leads to BE. Ten to twenty percent of patients with GERD present with BE. It is also possible for the people without GERD to develop BE. But the condition with GERD occurrs 3 to 5 times more often in people with GERD than people without GERD. The other risk factor for BE is hiatal hernia in which an acidic sack-like muscle from the stomach protrudes through diaphragm into the esophagus and thereby decreases the peristalsis. This in turn can cause BE. In studies, patients affected with GERD who progressed to BE were diagnosed with hiatal hernia. Other Risk Factors Age, Sex, and Race The risk factors for BE are dependent age, sex, and race, as well as few other factors like tobacco smoking, and heartburn symptoms that last longer than ten years. P eople aged 60 years and above are most often diagnosed with BE. There is often a delay of 10 to 20 years before BE is diagnosed. . When compared with women, men tend to have three to four times the chance of developing BE. In addition, BE is more prevalent among c aucasian people. Obesity A nother risk factor for BE is obesity. A case-control study was conducted by comparing patients affected with and without BE. That study demonstrated that there is a direct relationship between high body mass index (BMI) and BE. A meta-analysis also concluded that people with a BMI higher than 30 kg/m2 are at greater risk of BE than the people with a BMI lower than 30 kg/m2. In another case-control study by Edelstein and colleagues, it was reported that the total risk for BE was greater in people with higher waist and hip ratios. Alcohol Alcohol consumption has also been considered as a risk factor for BE. Studies have shown an association between alcohol consumption and BE. BE occurs more commonly in people consuming alcohol at the highest level than people at a lower level. Diabetes and Metabolic Syndrome Type 2 diabetes increases risk for BE by 49% , while metabolic syndrome carries a 2-fold increase in risk in people with or without the symptoms of acid reflux. S tudies indicate that the increased risk of BE from both of these factors (diabetes and metabolic syndrome) is independent of other risk factors such as BMI, alcohol consumption, and smoking. Absence of Heliobacter pylori Infection Infection by Heliobacter pylori (H. pylori) causes gastritis, stomach ulcers, and gastric cancers. However, it was found that BE and bacterial infection are inversely related when endoscopically comparing people with and without BE. The bacterium has a strong relationship with abnormal change in the cells of the intestine and the stomach. The bacterial infection prevents BE by reducing the secretion of gastric acid. A study on H. pylori found that infection with a cytotoxin-associated gene A (cagA+) strain shields against BE. Another study from Japan also indicates that people with BE have a lower prevalence of Helicobacter infection. Therefore, absence of H. pylori infection can increase the risk of BE. The other risk factors for BE are lower birth weight, obstructive sleep apnea (OSA), and increased adipokine and cytokine levels. People who were born less at than 32 weeks of gestation are more likely to develop BE. OSA associated with a proinflammatory condition may lead to BE. Furthermore, the levels of cytokines and adipokines produced by adipose tissue were high in patients affected with BE. Reviewed by Catherine Shaffer, M.Sc. Sources Mayo Clinic, Barrett’s esophagus, www.mayoclinic.org/.../dxc-20322961 NIH, Symptoms & Causes of Barrett's Esophagus, www.niddk.nih.gov/.../symptoms-causes Barrett’s oesophagus, www.macmillan.org.uk/.../barretts-oesophagus.html NIDDK, Barrett’s esophagus, http://www.ecnb.org/pdf/barretts.pdf Barrett’s esophagus: Incidence, etiology, pathophysiology, prevention and treatment, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2387291/ Pubmed Health, Barrett’s esophagus, https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0025308/ The prevalence of Helicobacter pylori infection and the status of gastric acid secretion in patients with gastroesophageal junction adenocarcinoma in Japan, https://link.springer.com/article/10.1007/s10787-006-1549-x Risk factors for Barrett’s esophagus, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5121541/ Further ReadingBarrett's Esophagus - What is Barrett's Esophagus?Barrett's Esophagus SymptomsBarrett's Esophagus PathologyBarrett's Esophagus TreatmentsBarrett's Esophagus GeneticsMore... // Last Updated: Oct 24, 2017 |
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52 | 2018-04-20 02:31:55 | Barrett's Esophagus Symptoms | By Dr Ananya Mandal, MD Barrett's esophagus may present with very few or even no symptoms. Some of the risk factors that are associated with Barrett's esophagus, however, may provide clues to the cause and symptoms of this condition. Risk factors and features associated with Barrett's esophagus Gastroesophageal reflux disease: Barrett's esophagus is most commonly found in people with gastroesophageal reflux disease (GERD), a condition that occurs when the lower esophageal sphincter opens at inappropriate times or does not close properly. Although people who do not have GERD can develop Barrett's esophagus, the condition is about three to five times more common in people who also have GERD. Among individuals with Barrett's esophagus, GERD may well have been present for a decade or more. Age: Barrett's esophagus is often diagnosed in middle-aged and older adults with an average age-at-diagnosis of 50 to 55 years. The condition is rarely found in children. Gender: Men are twice as likely as women to develop Barrett's esophagus. Lifestyle: Smokers are more frequently diagnosed with Barrett's esophagus than nonsmokers. Symptoms common to both Barrett's esophagus and GERD Symptoms that are associated with both Barrett's esophagus and GERD include: Heartburn: Heartburn is a feeling of discomfort or a burning sensation that occurs beneath the breast bone and is caused due to irritation of the inner lining of the esophagus by a backflow of acid from the stomach. The pain worsens after eating or when bending over or lying down. The pain may resemble the pain felt during a heart attack or as a result of angina. Regurgitation of reflux: Acid from the stomach may sometimes be regurgitated into the back of the mouth, causing a sour or bitter taste in the mouth or throat. Some patients may experience nausea or even vomit. Regurgitation of reflux may also lead to a persistent dry cough and if acid seeps into the airways, it may trigger asthma symptoms, pneumonia, lung abscesses, or pulmonary fibrosis. Regurgitation of reflux may manifest in the following ways: There may be repeated burping Some patients experience water brash or excessive salivation Seepage of the acid into the wind pipe may lead to inflammation of the larynx or voice box, leading to laryngitis and a hoarse and raspy voice Persistent acid in the mouth may lead to decaying and erosion of the teeth's enamel and therefore tooth decay There may be pain over the abdomen and bloating in some individuals Reviewed by Sally Robertson, BSc Sources http://digestive.niddk.nih.gov/ddiseases/pubs/barretts/barretts.pdf http://www.bsg.org.uk/pdf_word_docs/Barretts_Oes.pdf http://gastro.ucsd.edu/fellowship/Documents/BarrettEsophagus.pdf gastroconsa.com/pdfs/patient_education/GCSA_Barretts-Esophagus.pdf http://s3.gi.org/patients/gihealth/pdf/barretts.pdf www.ldh.nhs.uk/.../Barretts_oesophagus_L&D_2011.pdf Last Updated: Sep 23, 2013 |
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53 | 2018-04-20 02:31:59 | Barrett's Esophagus Pathology | By Dr Ananya Mandal, MD Barrett's esophagus is a condition characterized by abnormal alterations in the cells that line the esophagus. A normal esophagus is lined with flat squamous cells, while in the case of Barrett's esophagus, these cells adopt a tall columnar shape that closely resembles that of the cells found in the linings of the intestines. Sometimes called columnar-lined esophagus, the condition is diagnosed when these columnar cells are identified on endoscopy or microscopic analysis. The abnormal cells have an increased likelihood of becoming dysplasic over time and Barrett's esophagus is therefore considered a risk factor for esophageal cancer. Pathology Barrett's esophagus occurs as a result of long-standing and severe gastro-esophageal reflux disease (GERD). When acid regurgitation has occurred over a long-term period, the lower end of the esophagus and its mucosal lining can become inflamed and irritated on exposure to the gastric acids. In a small proportion of people with long term GERD, the cells of the esophageal lining adopt the columnar shape of the intestinal cells. In addition to GERD, a patient may also have had duodeno-gastro-esophageal reflux, which leads to reflux of the contents of the duodenum (first part of the small intestines) into the esophagus. In such cases, the lining of the esophagus is exposed to the corrosive and injurious effects of both the gastric acids and the bile present in the duodenum. With repeated exposure to acids, the lower end of the esophagus becomes inflamed which can eventually induce esophageal stem cells to produce new cells in an attempt to repair the tissue and, over time, the cells lining the esophagus may change into columnar cells. The extent of this cell metaplasia depends on the duration and severity of exposure to the acids as well as on the nature of the cytokine response or inflammatory response to injury. Risk factors Research suggests that there is an association between Barret's esophagus and smoking cigarettes, and alcohol consumption is also thought to be a risk factor. In addition, both smoking and alcohol consumption are in fact risk factors for GERD. By contrast, Helicobacter pylori infection has been shown to be protective against the development of Barret's esophagus, as the infection leads to reduced gastric acidity, thereby reducing the likelihood and extent of GERD. Reviewed by Sally Robertson, BSc Sources http://digestive.niddk.nih.gov/ddiseases/pubs/barretts/barretts.pdf http://www.bsg.org.uk/pdf_word_docs/Barretts_Oes.pdf http://gastro.ucsd.edu/fellowship/Documents/BarrettEsophagus.pdf gastroconsa.com/pdfs/patient_education/GCSA_Barretts-Esophagus.pdf http://s3.gi.org/patients/gihealth/pdf/barretts.pdf Further ReadingBarrett's Esophagus - What is Barrett's Esophagus?What Causes Barrett's Esophagus?Barrett's Esophagus SymptomsBarrett's Esophagus TreatmentsBarrett's Esophagus GeneticsMore... Last Updated: Sep 23, 2013 |
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54 | 2018-04-20 02:32:08 | Barrett's Esophagus Treatments | By Dr Ananya Mandal, MD The therapeutic approach to Barrett's esophagus involves treating a patient's symptoms as well as the disease itself. Symptoms of this condition primarily manifest as a result of gastro esophageal reflux disorder (GERD), the most common cause of Barrett's esophagus. Therefore, treatment of GERD is a central focus for relieving symptoms in patients with Barrett's esophagus. Treatment of GERD Treatment is based on lifestyle changes as well as medications. Medications include: Antacids: Available over the counter, these agents neutralize gastric acid and relieve the symptoms of heartburn and acid reflux. These drugs should not be taken along with other medications for GERD, due to the possibility of drug-to-drug interaction that may reduce their efficacy. Proton-pump inhibitors (PPIs): Patients who fail to respond to over-the-counter medications and lifestyle changes are prescribed PPIs such as omeprazole, pantoprazole, rabeprazole and lansoprazole, all of which reduce the acid produced by the stomach. H2-receptor antagonists: These are a variety of drug that may be taken along with or in place of PPIs. These agents include ranitidine, cimetidine and famotidine which all work by blocking the effects of histamine in helping to produce stomach acid. Lifestyle changes include: Weight reduction Cessation of smoking Eating smaller and more frequent meals Avoidance of alcohol, coffee, chocolate, and fatty or spicy foods. Eating a healthy, balanced diet and exercising regularly Sleeping with head propped up Avoidance of tight clothes, especially around the abdomen Treatment stages for Barrett's Esophagus During the early stages of the condition when a patient has low-grade dysplasia, acidsuppressing medication is either initiated or increased. Endoscopic examinations are performed every six months to monitor the esophageal tissue for growth or change in cancer status. During the later stages of dysplasia, treatment options are decided on after taking into consideration factors such as the patient's age, health status and the physician's preference. Surgical options include partial or entire removal of the esophagus (esophagectomy) and the removal of affected mucosa (endoscopic mucosal resection). Affected mucosa may also be destroyed using photodynamic or other ablation therapies. Surgery for Barrett's esophagus People with severe reflux may benefit from surgical procedures. Barrett's esophagus leads to precancerous changes in the lower part of the esophagus, which if left untreated, may progress to advanced changes and eventually cancer that may spread and affect surrounding tissues. There are several surgical options available to patients and these include: Esophagectomy: This is used only in cases of high-grade dysplasia or cancer and involves removing either the whole or part of the esophagus to prevent cancerous invasion of surrounding tissue. Endoscopic mucosal resection (EMR): During this procedure, a large but thin area of esophageal tissue is removed using an endoscope. Endoscopic tissue samples can then be sent for examination to aid treatment decisions. EMR is the preferred alternative to esophagectomy in patients with high-grade dysplasia or early stage esophageal cancer. Photodynamic therapy: This technique employs chemicals called photosensitizers which become toxic to diseased cells on exposure to light. Other ablation techniques: Affected tissue may also be ablated using laser beams, electro cauterization or cryotherapy. Reviewed by Sally Robertson, BSc Sources http://digestive.niddk.nih.gov/ddiseases/pubs/barretts/barretts.pdf http://www.bsg.org.uk/pdf_word_docs/Barretts_Oes.pdf http://gastro.ucsd.edu/fellowship/Documents/BarrettEsophagus.pdf gastroconsa.com/pdfs/patient_education/GCSA_Barretts-Esophagus.pdf http://s3.gi.org/patients/gihealth/pdf/barretts.pdf www.ldh.nhs.uk/.../Barretts_oesophagus_L&D_2011.pdf Further ReadingBarrett's Esophagus - What is Barrett's Esophagus?What Causes Barrett's Esophagus?Barrett's Esophagus SymptomsBarrett's Esophagus PathologyBarrett's Esophagus GeneticsMore... Last Updated: Sep 23, 2013 |
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55 | 2018-04-20 02:32:14 | Barrett's Esophagus Genetics | Although epidemiologic studies point to environmental factors, obesity, smoking, esophageal reflux, and diet as the main causes of Barrett’s esophagus (BE), there is growing evidence of a genetic predisposition as well. It is now fairly clear that the role of genetics is greatest in the initial stages of the disease. Intestinal (Barrett's) metaplasia of the esophagus is a response to injury from acid reflux (heartburn). It is associated with dysplasia and adenocarcinoma. Endoscopic biopsy photomicrograph. Image Credit: David Litman / Shutterstock A number of research studies on this subject have concluded that three genes are primarily responsible for this condition. These genes are thought to play a vital role in increasing the risk of Barrett’s esophagus following their transformation or mutation. These are CTHRC1, ASCC1, and MSR1, also called the predisposition genes, as they do not actually cause Barrett’s esophagus unless in mutated form. Genes Responsible for Barrett's Esophagus (BE) The germline mutations in the predisposition genes cause the progress of esophageal disorders. Also, the mutations in the MSR1, CTHRC1, and ASCC1 genes are associated with BE and esophageal adenocarcinoma (p<0.001). BE is typically identified only in the terminal phase, which endangers the patient severely. Esophageal carcinomas arise from the pre-existing condition of BE, which in turn develops as a result of chronic gastroesophageal reflux which produces chronic inflammation. MSR1 gene: The MSR1 gene encodes the A class scavenger macrophage receptors that include Type 1, Type 2, and Type 3. All the aforementioned types are due to random splicing of the MSR1 gene. These isoforms are macrophage-specific integral glycoproteins of the cell membrane and have been associated with several macrophage-associated pathological and physiological processes. These include atherosclerosis, host defenses, and Alzheimer’s disease. Type 1 and Type 2 genotypes are known as the operative receptors, which are capable of intermediating the modified low density lipoproteins (LDLs) in endocytosis. The position of the MSR1 gene is on the short arm (p) of chromosome 8 at position 22 (8p22). ASCC1 gene: The ASCC1 gene encodes a subunit that activates the signal co-integrator 1 (ASC-1). The ASC-1 complex is defined as the transcriptional co-activator that performs a vital role in transactivation of the gene through multiple transcription elements comprising protein 1 called AP-1, serum factor (SRF), and nuclear factor kappa-B. All these encoded proteins carry an N-terminal KH-type RNA-binding motif that is important for AP-1 transactivation through ASC-1 complex. Mutations in this gene are associated with both esophageal adenocarcinoma and Barrett’s esophagus. Spliced transcripts encode multiple isoforms. The ASCC1 gene is located on the long arm (q) of chromosome 10 at position 22.1 (10q22.1). CTHRC1 gene: The CTHRC1 gene is a locus that encodes the protein that plays a vital role in response to arterial cellular injury by vascular remodeling. Mutations of this gene locus are associated with Barrett’s esophagus and esophageal adenocarcinoma. They may act as negative regulators of the collagen matrix homeostasis. This gene is located on the long arm (q) of chromosome 8 at position 22.3 (8q22.3). Differential analytic techniques such as integrative genomic, single-SNP, and haplotype analysis generated 12 potential genes for future identification of gene mutations. The chromosome that contains the MSR1 gene encodes scavenger receptors which may be involved in pathologic inflammation and apoptosis. Apart from the truncating MSR1 c.877C>T mutation that has been identified in patients, another separate MSR1 germline mutation (c.760C>G, p.L254V) has been found in some patients. The ratio of occurrence of these gene mutations is estimated as 0.017 (95% 0.021 to 0.061, P=0.19). Furthermore, there were two other mutations identified, one of which is located on ASCC1 (c.869A>G, p.N290S) and the other on CTHRC1 (c.131A>C, p.Q44P). Genetic Code Involved in Barrett's Esophagus (BE) Inherited BE: First- or second-degree relatives of patients affected with BE, adenocarcinoma on the gastroesophageal junction, or esophageal adenocarcinoma (EAC) have increased risk of developing inherited BE. It has been identified from recent work that the risk of BE may be increased by a rare autosomal dominant susceptibility mutation in affected families. The exact mutation is still unidentified. Sporadic Barrett’s esophagus: The primary risk factors of the Barrett’s esophagus include age, gender (male), the presence of gastroesophageal reflux disorder (GERD), and skin tone (white-skinned people). Obesity and GERD are known to be the most predictive factors for the development of genetic BE. GERD is a primary risk factor for BE. Sporadic cases have been found where patients are found to inherit GERD as well as BE. Many studies have confirmed that families affected by BE might actually have a GERD-related genetic component. The mechanism of obesity in the development of BE is not clearly defined, but it is found to increase the risk of GERD. Obesity-induced increases in signaling through certain insulin-like growth factor pathways which favor proliferation, and through insulin pathways, may be involved as well in the etiology of BE. Patients with obesity, either with or without BE, have been studied to determine the IGF-1R genotype. It was found that obese patients with BE had the pro-proliferative IGF-1R genotype more commonly than those without BE or GERD. Reviewed by Liji Thomas, MD. References https://deepblue.lib.umich.edu/bitstream/handle/2027.42/86844/j.1749-6632.2011.06043.x.pdf https://www.cancer.org/treatment/understanding-your-diagnosis/tests/understanding-your-pathology-report/esophagus-pathology/barrets-esophagus.html http://www.adasp.org/FAQs/02-esoph.html http://www.gastro.org/info_for_patients/barrett-s-esophagus-107-low-grade-dysplasia-in-barrett-s-esophagus http://surgpathcriteria.stanford.edu/gi/barrett-esophagus/dysplasia.html http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2011.02400.x/pdf https://rarediseases.info.nih.gov/diseases/20/barrett-esophagus https://ghr.nlm.nih.gov/gene/ASCC1#location Further ReadingBarrett's Esophagus - What is Barrett's Esophagus?What Causes Barrett's Esophagus?Barrett's Esophagus SymptomsBarrett's Esophagus PathologyBarrett's Esophagus TreatmentsMore... // Last Updated: Sep 13, 2017 |
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56 | 2018-04-20 02:32:17 | Barrett's Esophagus with Dysplasia | Barrett’s esophagus is a condition in which the tissue lining the esophagus – the tube that passes the food from the mouth to the stomach – is replaced by tissue similar to that of the intestinal lining. This occurs chiefly in the cells of the epithelial tissue which lines the lower end of the esophagus. About 10% of the patients with gastroesophageal reflux may be expected to develop Barrett’s esophagus, and in about 10% of the patients with Barrett’s esophagus, dysplasia occurs. Dysplasia is a pre-cancerous stage in Barrett’s esophagus, where the cell develops abnormal features. However, these abnormal cells do not have the capability to spread to other parts of the body. Depending upon the grades of dysplasia, treatment options are available. Characteristics of Dysplasia in Barrett’s Esophagus Dysplasia in Barrett’s esophagus is histologically classified into two types: “adenoma” and “non‐adenoma‐like” on the basis of the similarity or otherwise of the dysplastic cells to cells found in sporadic colonic adenomas. Other than these, uncommon and atypical forms of dysplasia are also known to occur in epithelium affected both by Barrett’s esophagus and by inflammatory bowel disease. There are two grades of dysplasia in Barrett’s esophagus: low-grade dysplasia and high-grade dysplasia. These are identified through either endoscopy or biopsy. Low Grade Dysplasia in Barrett’s Esophagus If microscopic examination reveals the presence of a few cells with mildly abnormal features, it is termed “low-grade dysplasia” (LGD). This condition is considered as the earliest precancerous stage of the esophageal epithelium. Cells with LGD have crowded nuclei which are elongated, irregular, and hyperchromatic, show prominent chromatin with or without numerous small nucleoli. Adenomatous LGD is the usual type of dysplasia in Barrett's esophagus. Here the crypts show comparatively preserved glandular architecture or only minimal distortion of nuclear architecture but a normal number of nuclei. Most often, dysplastic nuclei are observed aggregated at the base of the cells. The significance of LGD in Barrett’s esophagus is controversial, but in general, follow-up is recommended. Diagnosis and Treatment In low-grade dysplastic BE, the diagnosis might be difficult as there is little difference seen between “indefinite for dysplasia” and LGD in biopsies. However, there are substantial inter- and intra-observer differences in the diagnosis of both these conditions, which are thus combined into one as regards their clinical management. LGD requires effective treatment of the gastroesophageal reflux with proton pump inhibitors, or PPIs. Maintaining a healthy and balanced diet can also help in reducing the reflux. Regular biopsies are suggested to make sure that the dysplasia will not progress or develop into malignancy. When the dysplasia is no longer seen, endoscopic follow up may be discontinued, but it is wise to continue taking PPIs. In cases where the acid reflux drugs do not produce adequate response and fail to eliminate the dysplasia, endoscopic eradication therapy (EET) is suggested. Endoscopic Resection (ER) Endoscopic resection (ER) utilizes endoscopic techniques to remove dysplastic tissue. For proper dysplasia assessment, endoscopic resection should be performed only in patients with abnormalities that are visible on endoscopy. Generally, most of the suspicious areas of tissue are dissected during endoscopic resection for further analysis. Residual areas of dysplasia are removed through the radiofrequency ablation technique. Radiofrequency Ablation (RFA) In the RFA technique, radiofrequency waves are passed through a catheter to remove the diseased tissue in the esophagus without causing too much damage to the healthy neighboring tissues. Replacement of abnormal Barrett’s tissue by healthy tissue takes about four weeks with the RFA treatment. High Grade Dysplasia in Barrett’s Esophagus High-grade dysplasia (HGD) in Barrett’s esophagus (BE) is a further step on the precancerous continuum of tissue changes before the actual development of an esophageal adenocarcinoma. Barrett’s esophagus that occurs as a complication of gastroesophageal reflux disease (GERD) is an abnormal change that occurs in normal esophageal cells. HGD increases the risk of esophageal adenocarcinoma. Diagnosis and Treatment Esophagectomy: This procedure is the removal of the abnormal tissue of Barrett’s esophagus by surgery, and is also used to treat patients with HGD. in this procedure, the whole esophagus is removed and then an artificial organ reconstructed using parts of other organs (usually the stomach). Endoscopic Mucosal Resection (EMR): This procedure helps to remove abnormal tissue areas in the esophageal mucosa, including HGD. EMR is also frequently used to remove rough HGD areas. Radiofrequency ablation with Barx ablation: To treat HGD due to Barrett’s esophagus, heat energy is applied to the areas of intestinal metaplasia to ablate the abnormal cells in the esophagus. Photodynamic Therapy (PDT): It is a kind of treatment for HGD which uses light energy to remove the diseased cells in esophagus, following their pretreatment with a sensitizing chemical. Cryotherapy: This process involves spraying of liquid nitrogen or carbon dioxide onto the esophageal mucosa, which freezes the BE and HGD. Reviewed by Liji Thomas, MD. References http://www.pathology.washington.edu/about/education/barretts/page2.php https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0025308/ https://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=45675 https://www.cancer.org/treatment/understanding-your-diagnosis/tests/understanding-your-pathology-report/esophagus-pathology/barrets-esophagus.html http://www.gastro.org/info_for_patients/barrett-s-esophagus-107-low-grade-dysplasia-in-barrett-s-esophagus https://www.bmc.org/gastroenterology/high-grade-dysplasia https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1861756/ http://surgpathcriteria.stanford.edu/gi/barrett-esophagus/dysplasia.html http://www.albertahealthservices.ca/assets/info/hp/cancer/if-hp-cancer-guide-gi011-barretts-esophagus.pdf http://apps.pathology.jhu.edu/blogs/barretts/?tag=high-grade-dysplasia Further ReadingBarrett's Esophagus - What is Barrett's Esophagus?What Causes Barrett's Esophagus?Barrett's Esophagus SymptomsBarrett's Esophagus PathologyBarrett's Esophagus TreatmentsMore... // Last Updated: Sep 13, 2017 |
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57 | 2018-04-20 02:32:19 | Barrett's Esophagus Research | By Jeyashree Sundaram (MBA) Barrett’s esophagus (BE) which is a condition defined by the unusual growth of esophagus cells, in rare occasions, might grow into a cancer known as esophageal adenocarcinoma. The major cause of BE is GERD and acid reflux. Risk of arising adenocarcinoma is greater by 30-125 times in BE affected humans than in humans who doesn’t have BE. In case of BE, the diagnosis and treatment methods available are efficient enough; and the condition itself is not considered a harmful disease. But, if it converts into cancerous stage, it attains complexity. Therefore, researches in this field targets for preventing the progression of BE, for controlling the symptoms, and for providing better survival to the patient. Intestinal metaplasia of the esophagus, aka Barrett's, is a response to injury due to acid reflux. Image Credit: David Litman / Shutterstock Research on Genes In 2012, a study was conducted to examine the DNA methylation of vimentin gene in the neoplasm of the upper part of the gastrointestinal (GI) tract. Using a real-time quantitative methylation particular polymerase chain reaction (PCR) assay, researchers tested the archival samples of gastric neoplasia and esophagus for the methylation of vimentin. They found that the abnormal DNA methylation of vimentin gene is high in this type of neoplasm. Finally, they proved by cytology brushings test that vimentin DNA methylation noticeable in the case of BE is 100%, but it was beyond control. These results recommend that the biomarker of the upper part of GI tract is vimentin methylation. These findings are expected to be helpful in future studies of BE. Another study was carried out for finding the specific genes that methylate abnormally in BE. For this, a group of researchers conducted a genome-wide approach for DNA methylation during 2016. They analyzed the specimens of BE and stomach and then compared each specimen’s level of methylation at around 485,000CpG sites inside the DNA samples. Pyrosequencing assays are used for the approval of results and develop methylight assays for identifying the alleles of DNA methylated in endoscopic brushings. Thus, the result showed that the gene ZNF793 and B3GAT2 are unusually methylated highly in BE and these genes methylated grade were used to identify BE in sample tissues. Research on Cellular Process A study was carried out in 2015 for identifying the role of autophagy in a BE patient. At present, this research is poorly studied. In this, the level of autophagy in the cell lines of a BE patient, a transgenic BE mouse model, and biopsy of esophageal adenocarcinoma (EAC) are defined. The researchers found that the level of autophagic vesicles (AVs) is high in the non-dysplastic BE person, whereas it is decreased in the usual BE cells of dysplastic and squamous cells, and is not present in EAC. They also found that the level of AVs is highly increased in BE humans than EAC or usual squamous and recommended that functions of autophagy after damage by acid reflux improves the survival of cell. Thus, autophagy can play an important role in the progression and pathogenesis of BE. Research on Treatment Methods In May 2016, an article was published by ten authors on the development of treatment for BE. In this article, they state that BE can develop into cancer due to many reasons; this is identified by new testing methods (pH monitoring and specifically multichannel within lumen impedance) that aid to get better knowledge of the pathophysiology of GERD along with its complications. Such findings are more helpful in predicting the progression of BE neoplasm. Finally, they show a new treatment choice for BE and EAC termed endoscopic elimination, which is more effective for patients. This information gives more knowledge on the mechanical connection between GERD and BE. Research on Hereditary Factors In 2017, research is ongoing for predicting BE within the family; authors have come together to examine a clinical model from 92 multiplex pedigrees of BE and 787 individually ascertained pedigrees of BE, fitting a model to a multivariate logistics that includes medical risk factors and family history. The risk factors included in the model are education level, smoking, age, parental status, sex, regurgitation frequency, heartburn frequency, and using acid suppressant. Using the training dataset and separate validating dataset of the 643 multiplex pedigrees with BE, the exact prediction was determined. Eventually, the result showed that BE risk can be found with the help of family information; the possibility of predicting risk for individuals who are not a member of the family without the suggestion from any family relation was also identified. Research Related to Pathogenesis During 2007, a few authors combined to predict the risk of high-grade dysplasia and esophageal adenocarcinoma from BE. These were prospectively evaluated by the cases of nearly 325 BE patients; they were subjected to endoscopic biopsies. Among them, 269 patients were continuously followed up with one or many endoscopies by a strong platform for the analysis of heterozygosity loss (LOH) with baseline 17p (p53). Finally, it was found that LOH is the predictor of BE progression and the outcome is an increase in esophageal adenocarcinoma and high-grade dysplasia. Reviewed by Afsaneh Khetrapal Bsc (Hons) Sources: www.macmillan.org.uk/.../barretts-oesophagus.html https://www.ncbi.nlm.nih.gov/pubmed/22315367 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4670566/ https://www.ncbi.nlm.nih.gov/pubmed/26373456 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848241/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4873373/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1808263/ Further ReadingBarrett's Esophagus - What is Barrett's Esophagus?What Causes Barrett's Esophagus?Barrett's Esophagus SymptomsBarrett's Esophagus PathologyBarrett's Esophagus TreatmentsMore... // Last Updated: Sep 21, 2017 |
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58 | 2018-04-20 02:32:21 | Barrett’s Esophagus and Cancer Risk | By Jeyashree Sundaram, MBA Barrett’s esophagus (BE) is a condition where the tissues present in the esophagus undergo transformation and become similar to those found in the intestinal lining. It is present mostly in people who have gastroesophageal reflux disease (GERD), especially if it has been present for a very long period. This in turn is related to an increased risk for developing esophageal cancer. Endoscopic biopsy photomicrograph of intestinal (Barrett's) metaplasia of the esophagus. Credit: David Litman/Shutterstock.com Risk of transformation of cells Barrett’s esophagus does not proceed to cancer in all patients; however, it is estimated that around 10–15% of cases of BE may progress to esophageal cancer. There are two kinds of cell transformations that are associated with either squamous cell or adenocarcinoma of the esophagus. Squamous cell cancer of the esophagus is more common in people who drink excessively and/or smoke cigarettes. When there is a prolonged abnormal backward flow of stomach acid into the lower esophagus, it can affect the inner lining of the esophagus. Squamous cell metaplasia is caused by this process; here, the cells that line the esophagus are replaced by gland cells. These gland cells resemble the normal lining cells of the stomach and the small intestine. This, however, is not a frequently occurring cell transformation in Barrett’s esophagus. Adenocarcinoma of the esophagus occurs in people who have GERD. Patients who have a long history of acid reflux may develop Barrett’s esophagus. Most patients with this condition may have symptoms of heartburn, while a few do not exhibit any symptoms at all. The frequency of this type of cancer has rapidly increased over the years. Most adenocarcinomas of the esophagus start in Barrett’s tissue. Risk factors Dysplasia Dysplasia is a condition in which cells show precancerous changes, and it can occur within Barrett’s tissue. The development of dysplasia maybe the only risk factor for cancer in BE. Dysplasia is generally defined as the stage preceding the development of frank cancer. This condition can be diagnosed by endoscopic biopsy in Barrett’s esophagus. If dysplasia is identified by examining a biopsy under the microscope, healthcare providers often advise performing an endoscopy in order to destroy the whole of the metaplastic tissue. Though the risk of dysplasia is low, it is important to have regular checkups for dysplasia, so that it can be treated and prevented from developing into esophageal cancer. Depending upon the level of risk possessed by the dysplasia, it can be classified into different grades: negative to dysplasia, low grade dysplasia, and high grade dysplasia. Without Dysplasia/ negative to dysplasia: Barrett’s esophagus without dysplasia or negative to dysplasia means that no precancerous changes were identified in the cells visualized on microscopy of the biopsy tissue. If the area of dysplasia is very small or negligible, it may be missed when the biopsy is taken. Therefore, a higher number of biopsies may be taken, or more frequent endoscopies may be performed, every 3–5 years regularly. This may help to identify and destroy the abnormal changes in the Barrett’s tissue. The risk of cancer for non-dysplastic Barrett’s esophagus is very low. Low grade dysplasia (LGD): In this type, the cell changes are present but minimal. Out of 100 patients with BE and low-grade dysplasia, 20 are at risk of developing cancer of the esophagus within 5 years. High grade dysplasia (HGD): In this type, there are abnormal changes in the cells. This is mainly linked to a higher risk of esophageal carcinoma. In 30-60% of cases, it may progress to cancer if not treated properly. HGD is a more advanced pre-cancerous condition of the esophagus than low grade dysplasia. Both high as well as low grade dysplasia does not have the capability to spread to other parts of the body. Risk factors for HGD Some of the risk factors associated with the development of high grade dysplasia are: Segment: A recent study from Berlin has determined that segment length is associated with an increased risk of high grade dysplasia. That is, patients with long segment Barrett’s esophagus (LSBE) are at an increased risk of progression to high grade dysplasia than people with short segment Barrett’s esophagus (SSBE). Mucosal abnormalities: In Barrett’s esophagus, some types of mucosal changes are related to an increased risk of high grade dysplasia. Erosive and ulcerative esophagitis are associated with increased risk of progression to esophageal adenocarcinoma or high grade dysplasia. The greatest risk for patients with Barrett’s esophagus is the development of adenocarcinoma. However, only a few patients are at risk. According to epidemiological data, most patients with BE and adenocarcinoma are older white males. Patients who have specialized columnar epithelium cells are also at high risk for developing adenocarcinoma associated with BE. An additional risk factor for metachronous and synchronous adenocarcinoma is the presence of epithelial dysplasia, especially high grade. Many studies have also indicated that the frequency of the occurrence of dysplasia, either close to or distant from Barrett’s esophagus, is also connected with adenocarcinomas. Dysplasia is not only a sign of increased risk of adenocarcinoma but a pre-invasive lesion. Reviewed by Liji Thomas, MD. References https://www.cancer.org/cancer/esophagus-cancer/causes-risks-prevention/risk-factors.html https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1861756/ https://www.asge.org/home/for-patients/patient-information/understanding-gerd-barrett-39-s https://www.bmc.org/gastroenterology/high-grade-dysplasia https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113043/ http://pathology.uic.edu/understanding-your-report-esophagus-barretts/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4449455/ // Last Updated: Oct 12, 2017 |
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59 | 2018-04-20 02:32:27 | Barrett’s Esophagus and GERD | Gastro esophageal reflux disease (GERD) is considered the main cause of Barrett’s esophagus (BE). GERD results in BE, but the exact cause of GERD is still unknown, and the complications of BE and GERD are interrelated. Credit: CHAjAMP/Shutterstock.com Roughly 5%–13% of patients with GERD symptoms are susceptible to develop BE over their lifetime. Several other factors of GERD such asseverity, frequency, and duration of the symptoms have a huge impact on increasing the risk of BE. Gastro esophageal reflux disease The upward regurgitation of the stomach acid to the esophagus is referred to as GERD. GERD can cause specific symptoms of BE and may harm the esophagus. The primary and most common symptom of GERD is identified as heartburn. Heartburn is usually a burning sensation in the chest that frequently arises from the bottom of the breastbone leading towards the upper chest. These indications can be associated with excessive salivation in the mouth, dysphagia (discomfort in swallowing food), and burping. All the above symptoms can be positional and may become severe when lying down. Symptoms of GERD can worsen when consuming alcohol, fatty food, acidic food, peppermint, and juices with citric content. These symptoms have a prolonged association with acid reflux disorder. While these symptoms have a long-term association with reflux disease, there is now a growing concern about other symptoms that can be caused by reflux disease. These symptoms are known as the extra-esophageal symptoms of reflux disease such as sleep disorders, asthma, laryngitis, halitosis, and chronic cough. Complications of GERD and BE BE is a condition in which the tissue in the esophagus appears like the tissue that lines the intestine. It is known as the precancerous intestinal metaplasia (Dysplasia) of the lower esophagus mucosa, which develops in response to chronic exposure to the acidic contents of the stomach. The adenocarcinoma caused by BE is increasing by 30 to 40 times each year. BE is a complication of GERD. Patients affected by GERD symptoms at an early age are more prone to develop esophageal adenocarcinoma. It is uncertain that the risks for BE related with GERD indication depend only upon age. Furthermore, risks of esophageal adenocarcinoma linked with GERD symptoms are greater for people who are obese or a chain smoker. The potential modifiers of BE are still unclear; hence, there might be many other elements that might regulate the reaction of GERD with the risk of BE. Risk of BE in GERD GERD symptoms are more frequently observed in BE patients than in non-BE people. The risk of BE increases with prolonged increase in the frequency of GERD. Studies performed to analyze the association between symptoms related to age and risk of BE found that the huge risk of BE is observed in the people with long-term GERD symptoms at an early age of onset. By comparing patients of different age groups without GERD symptoms, it has been identified that the people aged 30 years or less with frequent symptoms of GERD are at greater risk of BE than those aged between 30 and 49 years and 50 to 79 years. Another analysis which was performed to study the relationship between age of onset of heartburn and risk of BE identified that both GERD and heartburn had a similar pattern of association with BE risk. GERD severity The risk of BE is mainly associated with the severity of the symptoms of the GERD. It has been identified that patients with GERD symptoms had 12-fold greater risk of developing BE when compared to those without GERD symptoms. Age of onset for higher risk of BE was found to be 30 years in patients with severe GERD symptoms, but these results were not statistically reliable as they overlapped with each other. GERD symptoms (cumulative) The powerful linear trend of increasing BE risk is linked with a rising cumulative GERD duration of the indications. In the case of patients with GERD symptoms, the risk of BE is increased to 30% with every ten additional years of the exposure. Patients of less than 20 years of age with prolonged cumulative GERD symptoms and patients of 30 years of age with recurring GERD symptoms had a similar risk of BE when compared with patients who developed later in their lifetime. As the age of onset varies continuously, it has been observed that an early age at onset of GERD symptoms are significantly related to the risk of BE. Esophagus adenocarcinoma is reported as the fatal condition that becomes common in several countries (United States, Industrialized nations, Australia, and Western Europe). Most of all cases of esophageal adenocarcinoma are reported to emerge with Barrett's Esophagus than GERD. The number of BE cases reported has risen drastically during the last few decades. Reviewed by Afsaneh Khetrapal Bsc (Hons) Sources https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3972036/ https://www.ncbi.nlm.nih.gov/pmc/articles/mid/NIHMS611949/ www.asge.org/.../understanding-gerd-barrett-39-s www.spg.pt/.../...sis-and-Management-of-Barrets-Esophagus-nov-2015.pdf www.valleyhealthcancercenter.com/.../barretts_first_brochure.pdf https://www.med.umich.edu/1info/FHP/practiceguides/gerd/gerd.12.pdf http://s3.gi.org/patients/gihealth/pdf/barretts.pdf Last Updated: Oct 12, 2017 |
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60 | 2018-04-20 02:32:30 | Non-Dysplastic Barrett's Esophagus | Barrett's esophagus (BE) is a condition in which tissue that is similar to the tissue lining in the intestines changes or replaces the lining of the esophagus (the tube that transports food from the mouth to the stomach). Even though BE has a chance of progressing into low- or high-grade dysplasia (a precancerous condition) and then transform into cancers of the esophagus, in most cases, the dysplasia may not be presented or cannot be identified by biopsy specimens. Such a condition is termed as non-dysplastic BE. All patients with non-dysplastic BE are subjected to endoscopic surveillance every two to three years in order to diagnose any prevalent signs for dysplasia. If discovered with such a risk of progression to dysplasia, patients are provided with rigorous treatment. Clinical Presentation and Risk Factors Non-dysplastic BE manifests as column-like cells including mucin-filled, blue-tinted goblets. The risk factors of progression from non-dysplastic BE to esophageal cancer may include length of the BE greater than or equal to 6 cm and hiatal hernia of length more than 3 cm. However, progression of non-dysplastic BE to esophageal adenocarcinoma and higher grade dysplasia is really uncommon with the risk accounting for less than 1%. This grade of non-dysplastic BE, where the tissue begins to change to resemble the red intestinal tissue linings is also referred as Intestinal Metaplasia (IM). Diagnosis BE (both with and without dysplasia) is diagnosed by a diagnostic endoscopy, which is performed using very high resolution and white light to view the internal lining of the esophagus. The management therapy and surveillance interval for patients with BE is determined by dysplasia grade. For non-dysplastic patients with BE, endoscopic surveillance is suggested every three years along with biopsies, as some patients with additional risk factors such as age less than 30 at the time of BE diagnosis and family history of esophageal cancer may promote non-dysplastic BE to cancer. The non-dysplastic BE suspected patient undergoes endoscopy for 6–12 months and biopsies are done each time to determine the cytological and structural changes to the epithelial cells. New advanced imaging techniques for detecting BE are improved and they include narrowband imaging, chemoendoscopy, optical coherence tomography, and laser confocal microscopy. Management of Non-Dysplastic BE For BE without the presence of dysplasia or cancer, the traditional management techniques are used as the common primary approach of treatment. This includes controlling the symptoms of BE and regular endoscopic surveillance to prevent progressive disease. Healthy changes in the lifestyle may help in clearing acid in the esophagus and lessening the prevalence of reflux events. Avoiding certain food such as citrus foods, beverages, spicy and fatty foods, and tomatoes will benefit in controlling the symptoms. Periodical endoscopies and biopsies must be done to estimate the affected area by Barrett’s disease. Some high-risk patients without dysplasia are recommended with treatment options such as endoscopic mucosal resection and radiofrequency ablation therapy. Endoscopic mucosal resection: Patients of BE without dysplasia may primarily undergo endoscopic mucosal resection as an initial diagnostic or treatment step. In this approach, the affected mucosal linings in the esophagus are therapeutically removed using endoscope. The damaged mucosa is resected and lifted using a saline solution and then eliminated by means of a cap or snare accessory. Adjacent and deep margins are examined by proper handling of the sample. In non-dysplastic BE cases, the patients are not subjected to routine endoscopic ablative therapy due to their lower risk of development of esophageal adenocarcinoma. Radiofrequency ablation: The non-dysplastic BE in patients is managed by radiofrequency ablation (RFA) therapy. The RFA process involves radiofrequency energy to ablate the damage tissue through endoscopy. Depending on cryotherapy, two methods are available. The first approach includes a liquid nitrogen spray that removes the tissue by freezing it, while the second approach involves a cryoballoon, i.e., a balloon filled with nitrous oxide is placed on the tissue to freeze them. The RFA therapy is repeated once or thrice to confirm the eradication of the whole affected tissue by BE. In this technique, the risk for bleeding after the procedure is very less and also does not involve any stricture formation. After RFA, initial surveillance is done to ensure complete elimination of BE and no recurrence. It is usually done every three to five years. The RFA for non-dysplastic BE is cost-effective and has an efficiency upto 90%; however, the periodic surveillance in non-dysplastic BE is quite expensive. Follow-up Patients with non-dysplastic BE after ablation therapy should involve follow-up of 4-quadrant biopsy for every 1 or 2 cm of complete area that was previously affected with BE. Endoscopic surveillance should be done on a routine basis initially once in six months in the first year post ablation therapy. Reviewed by Afsaneh Khetrapal Bsc (Hons) Sources www.albertahealthservices.ca/.../...guide-gi011-barretts-esophagus.pdf www.mja.com.au/system/files/issues/205_07/10.5694mja16.00796.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5114519/ gi.org/.../ACG-2015-Barretts-Esophagus-Guideline.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002583/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1357704/ [Further:Barrett's Esophagus] // Last Updated: Oct 30, 2017 |
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61 | 2018-04-20 02:32:33 | Barth Syndrome | By Dr Ananya Mandal, MD Barth syndrome is a rare, genetic disorder that affects males. The condition is caused by mutations in the tafazzin gene, which codes for an enzyme involved in the synthesis of cardiolipin, an important lipid component of the inner mitochondrial membrane. The condition affects energy production in the mitochondria and leads to complications such as cardiomyopathy, muscle weakness and neutropenia. Symptoms Symptoms are not always present but some typical features of Barth syndrome include: Cardiomyopathy - Cardiomyopathy describes a deterioration in the myocardium or heart muscle. The muscle is usually dilated or stretched with a varying degree of hypertrophy (increase in size). Neutropenia - This refers to an abnormally low number of neutrophils (a type of white blood cell) in the blood. Skeletal muscle development may be abnormal and muscle tone weak. Levels of organic acids in the blood and urine may be increased. Levels of 3-methylglutaconic acid, for example, are typically raised by 5 to 20-fold. Delayed growth during pre-teen years with growth often accelerated later on, in adolescence. Cardiolipin abnormality Complications of Barth's syndrome Barth's syndrome may cause a range of complications some of which are listed below: Cardiomyopathy increases the likelihood of a dangerous abnormal heart rhythm or arrhythmia which can be fatal. Neutropenia increases the likelihood of infection, particularly of the mucous membranes such as the skin or inside of the mouth. A fever may also be present. Diarrhea and/or constipation. Weak muscle tone may lead to fatigue and difficulty exercising. Affected individuals may have feeding problems such as difficulty in sucking, swallowing or chewing, an aversion to some foods and be selective or fussy eaters. The risk of thrombosis or blood clots is increased. There is a risk of hypoglycemia or low blood sugar, especially when a child is newborn. Chronic (long-term) headache, abdominal pain, and/or body aches, particularly, during puberty. Mild learning disabilities may develop. The risk for osteoporosis is increased. Phases of Barth syndrome General phases of the disease are often but not always seen in children with the syndrome and these include: Children often become seriously ill before the age of 5 Between ages 5 to 11, symptoms typically improve and patients tend to be free of symptoms Adolescence often marks the return of symptoms Treatment and management There is no cure for Barth's syndrome and treatment is focused on managing the condition. Usually, the treatment approach to Barth's syndrome involves a team of specialists including experts in biochemistry, genetics and neurology as well as nurses, social workers, nutritionists and physical and occupational therapists. Barth syndrome is suspected if a person presents with one of the main characteristics of the disease or if there is a family history of the condition. Diagnosis involves DNA sequencing to detect the tafazzin gene (TAZ, also called G4.5) mutation and analysis of cardiolipin in various cells and tissues. Genetics This is an X-linked inherited genetic disease, so a mother may be a carrier of the mutated gene despite not having any symptoms. There is a 50% chance that a boy born to a carrier mother will have the condition and a 50% chance that any daughters she has will be carriers themselves. All daughters of a male with the condition will be carriers but no sons will be affected. Reviewed by Sally Robertson, BSc Sources www.barthsyndrome.org/.../...re_BSF_June2011_web37PEL-6282011-6122.pdf https://www.orpha.net/data/patho/Pro/en/Barth-FRenPro1059.pdf http://www.childrenshospital.org/az/Site1404/mainpageS1404P1.html www.barthsyndrome.org/.../...eFAQs_FINAL_May200637WDF-5292006-9233.pdf Last Updated: Nov 18, 2013 |
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