AIM: To assess the relationship between severity of gastroesophageal reflux disease and apnea-hypopnea index (AHI) as an indicator of the severity of obstructive sleep apnea. METHODS: Data of 57 patients with proven o...AIM: To assess the relationship between severity of gastroesophageal reflux disease and apnea-hypopnea index (AHI) as an indicator of the severity of obstructive sleep apnea. METHODS: Data of 57 patients with proven obstructive sleep apnea and gastroesophageal reflux disease were analyzed. Patients were divided into two groups according to severity of the sleep apnea: 'mild-moderate' (A)-AHI 5≥5-30, n=27, 'severe' (B)-AHI >30, n=30. All patients underwent apnea monitoring during the night, upper panendoscopy and were asked about typical reflux symptoms. RESULTS: All examined patients in both groups showed a significant overweight and there was a positive correlation between body mass index and the degree of sleep apnea (P = 0.0002). The occurence of erosive reflux disease was significantly higher in 'severe' group (P = 0.0001). Using a logistic regression analysis a positive correlation was found between the endoscopic severity of reflux disease and the AHI (P = 0.016). Forty-nine point five percent of the patients experienced the typical symptoms of reflux disease at least three times a week and there was no significant difference between the two groups. CONCLUSION: A positive correlation can be found between the severity of gastroesophageal reflux disease and obstructive sleep apnea.展开更多
AIM： Itopride is a newly developed prokinetic agent, which enhances gastric motility through both antidopaminergic and anti-acetylcholinesterasic actions. The importance of esophageal motor dysfunction in the pathoge...AIM： Itopride is a newly developed prokinetic agent, which enhances gastric motility through both antidopaminergic and anti-acetylcholinesterasic actions. The importance of esophageal motor dysfunction in the pathogenesis of gastro-esophageal reflux disease （GERD） makes it interesting to examine the effect of itopride on esophageal acid exposure.METHODS： The effect of itopride on esophageal acid reflux variables for 24 h was studied in 26 patients with GERD symptoms, pre-entry total acid exposure time （pH〈4） of more than 5% and mild esophagitis （SavaryMiller grades I, II） proven by endoscopy. Ambulatory 24hpH-metry and symptom assessment were performed after treatments with 150 or 300 mg itopride thrice a day （t.i.d.） for 30 d in random order, using an open label method.For evaluating the safety of itopride, blood biochemical laboratory test was performed and the serum prolactin level was also examined before and after treatment.RESULTS： Total symptom score was significantly decreased after treatment in 150- or 300-mg group. Itopride 300 mg was significantly effective than 150 mg on decreasing the total per cent time with pH〈4, total time with pH〈4 and DeMeester score. No serious adverse effects were observed with administration of itopride in both groups.CONCLUSION： Itopride 100 mg t.i.d, is effective on decreasing pathologic reflux in patient with GERD and therefore it has the potential to be effective in the treatment of this disease.展开更多
AIM：Gastro-esophageal reflux disease (GERD) is becoming increasingly common in Asia. Data on the efficacy of proton pump inhibitors in patients with non-erosive GERD (NERD)in Asia is lacking. This double-blind study ...AIM：Gastro-esophageal reflux disease (GERD) is becoming increasingly common in Asia. Data on the efficacy of proton pump inhibitors in patients with non-erosive GERD (NERD)in Asia is lacking. This double-blind study compared the efficacy and safety of rabeprazole with esomeprazole in relief of symptoms in patients with NERD.METHODS: One hundred and thirty-four patients with reflux symptoms of NERD and normal endoscopy were randomized to receive rabeprazole 10 mg or esomeprazole 20 mg once daily for 4 wk. Symptoms were recorded in a diary and changes in severity of symptoms noted.RESULTS: At 4 wk of treatment, rabeprazole 10 mg and esomeprazole 20 mg were comparable with regards to the primary endpoint of time to achieve 24-h symptomfree interval for heartburn 8.5 d vs9 d and regurgitation 6 d vs 7.5 d. Rabeprazole and esomeprazole were also similarly efficacious in term of patient's global evaluation with 96% of patients on rabeprazole and 87.9% of patients on esomeprazole, reporting that symptoms improved(P=NS). Satisfactory relief of day- and night-time symptoms was achieved in 98% of patients receiving rabeprazole and 81.4% of patients receiving esomeprazole. Adverse events were comparable in both groups (P = NS).CONCLUSION: Rabeprazole 10 mg has a similar efficacy and safety profile in Asians with NERD as esomeprazole 20 mg. Further study is necessary to investigate whether the small differences between the two drugs seen in this study are related to the improved pharmacodynamicpro perties of rabeprazole. Both drugs were well tolerated.展开更多
GastroEsophageal Reflux Disease (GERD) is mainly caused by prolonged exposure of the mucosa of the distal esophagus to acid and pepsin. Most patients have only reflux symptoms without esophagitis, but the symptoms hav...GastroEsophageal Reflux Disease (GERD) is mainly caused by prolonged exposure of the mucosa of the distal esophagus to acid and pepsin. Most patients have only reflux symptoms without esophagitis, but the symptoms have to be severe enough to impair quality of life in order to justify the diagnosis of GERD. Complications of GERD include esophagitis of varying severity (LA grade A-D), ulcer, stricture, Barrett's esophagus, and respiratory complications.展开更多
Barrett's oesophagus is a metaplastic condition in which the squamous epithelium of the oesophagus is replaced by specialised intestinal metaplasia. Barrett's oesophagus occurs in about 10% of patients with ga...Barrett's oesophagus is a metaplastic condition in which the squamous epithelium of the oesophagus is replaced by specialised intestinal metaplasia. Barrett's oesophagus occurs in about 10% of patients with gastrooesophageal reflux disease (GORD) and predisposes to dysplasia and adenocarcinoma. It has been estimated that the risk of developing an adenocarcinoma of the oesophagus and gastric cardia is increased 30-125 fold.展开更多
AIM:To examine the clinical spectrum of gastroesophageal reflux disease (GERD) and compare erosive (ERD) with non-erosive (NERD) in terms of clinical, demographic and psychiatric profiles. METHODS: Patients with reflu...AIM:To examine the clinical spectrum of gastroesophageal reflux disease (GERD) and compare erosive (ERD) with non-erosive (NERD) in terms of clinical, demographic and psychiatric profiles. METHODS: Patients with reflux symptoms were enrolled and stratified to NERD and ERD after endoscopy (LA classification). Patients with ERD presenting with dyspepsia were included. Patients on proton pump inhibitors (PPI) or H2 receptor antagonists before endoscopy were excluded. Demographic data, Helicobacter pylori(H pylori) status and presence of minor psychiatric morbidity (based on General Health Questionnaire-28) were analyzed. RESULTS: Among 690 patients screened, 533 were eligible for analysis (male to female ratio: 3:2; Chinese: 75.4%; Malay: 9.8%; Indian: 14.8%). Clinical spectrum of GERD: N: 40.5%; A: 46%; B: 9.2%; C: 2.1%; D: 0.6%; Barrett's esophagus: 1.7%. Compared to patients with NERD, patients with ERD were significantly older (45 vs 39.4 years), more likely to be male (64.4% vs 53.7%), tended to smoke (19.6% vs 9.7%), less likely to have minor psychiatric morbidity (26.4 vs 46.7%) and were more likely to respond to PPI (79.7 vs 66.8%). There was also a trend towards a higher BMI (24.5 vs 23.5). Race, alcohol consumption and H pylori status were not significant. On multivariate analysis, age and presence of minor psychiatric morbidity remained with significant differences. CONCLUSION: The majority of patients who have typical symptoms of GERD have NERD or mild erosive reflux disease. Compared to patients with erosive reflux disease, patients with NERD were younger and had a higher prevalence of minor psychiatric morbidity.展开更多
AIM： To assess the efficacy and safety of a compound containing alginic acid plus antacid （Topaal） compared to equal-strength antacid （Nacid） in patients with endoscopy-negative reflux disease （ENRD）. METHODS：...AIM： To assess the efficacy and safety of a compound containing alginic acid plus antacid （Topaal） compared to equal-strength antacid （Nacid） in patients with endoscopy-negative reflux disease （ENRD）. METHODS： A total of 121 patients with ENRD were randomized to receive Topaal （65 patients） or Nacid （56 patients） for 6 weeks, with a consultation every 3 weeks. The primary end-point assessment was the change in the severity of heartburn as evaluated using a visual analog scale （VAS） at 6 weeks. The secondary end-point assessments were the VAS at 3 weeks, the change of frequency of the reflux symptom, the change of quality of life and the adverse effects. RESULTS： Demographics of randomized subjects in each treatment group were comparable except that the Topaal group included more males. The baseline characteristics between the groups were similar. After 6 weeks of treatment, the reduction of VAS of heartburn was more prominent in the Topaal group （-6.29 cm vs -4.11 cm）. At the 3m week, Topaal group showed greater reduction of VAS for heartburn （P= 0.0016）, regurgitation （P=0.0006）, vomiting （P=0.0373）, and belching （P〈0.0001）. The patients of the Topaal group had lower frequency of heartburn （P=0.0015） and pain （P= 0.0163） at the end of the 6-week treatment period. From the doctor＇s point of view, the Topaal group also showed significant reduction in the severity of heartburn （P= 0.0020）, regurgitation （P=0.0081）, vomiting （P= 0.0182）, and belching （P= 0.0018） at the end of the treatment. The improvement of the quality of life was more remarkable in the Topaal group at the end of the 6-week treatment period （P〈 0.0001）. For the adverse effect, there was no difference in both the groups. CONCLUSION： Topaal is more effective than Nacid for the treatment of symptoms presented by patients with ENRD.展开更多
Uncomplicated reflux disease comprises the non-erosive reflux disease (NERD) and erosive reflux disease (ERD).The objectives of treatment are the adequate control of symptoms with restoration of quality of life, heali...Uncomplicated reflux disease comprises the non-erosive reflux disease (NERD) and erosive reflux disease (ERD).The objectives of treatment are the adequate control of symptoms with restoration of quality of life, healing of lesions and prevention of relapse. Treatment of NERD consists in the administration of proton pump inhibitors (PPI) for 2-4 wk, although patients with NERD show an overall poorer response to PPI treatment than patients with ERD owing to the fact that patients with NERD do not form a pathophysiologically homogenous group. For long-term management on-demand treatment with a PPI is probably the best option. In patients with ERD, therapy with a standard dose PPI for 4-8 wk is always recommended.Long-term treatment of ERD is applied either intermittently or as continuous maintenance treatment with an attempt to reduce the daily dosage of the PPI (step-down principle).In selected patients requiring long-term PPI treatment,antireflux surgery is an alternative option. In patients with troublesome reflux symptoms and without alarming features empirical PPI therapy is another option for initial management. Therapy should be withdrawn after initial success. In the case of relapse, the long-term care depends on a careful risk assessment and the response to PPI therapy.展开更多
AIM: To study the different gene expression profiles in rats with Barrett's esophagus (BE) and esophageal adenocarcinoma (EA) induced by gastro-duodenoesophageal reflux.METHODS: Esophagoduodenostomy was performed ...AIM: To study the different gene expression profiles in rats with Barrett's esophagus (BE) and esophageal adenocarcinoma (EA) induced by gastro-duodenoesophageal reflux.METHODS: Esophagoduodenostomy was performed in 8-wk old Sprague-Dawley rats to induce gastro-duodenoesophageal reflux, and a group of rats that received sham operation served as control. Esophageal epithelial pathological tissues were dissected and frozen in liquid nitrogen immediately. The expression profiles of 4 096genes in EA and BE tissues were compared to normal esophagus epithelium in normal control (NC) by cDNA microarray.RESULTS: Four hundred and forty-eight genes in BE were more than three times different from those in NC, including 312 upregulated and 136 downregulated genes. Three hundred and seventy-seven genes in EA were more than three times different from those in NC, including 255upregulated and 142 downregulated genes. Compared to BE, there were 122 upregulated and 156 downregulated genes in EA. In the present study, the interested genes were those involved in carcinogenesis. Among them, the upregulated genes included cathepsin C, aminopeptidase M, arachidonic acid epoxygenase, tryptophan-2,3-dioxygenase, ubiquitin-conjugating enzyme, cyclic GMP-stimulated phosphodiesterase, tissue inhibitor of metalloproteinase-1, betaine-homocysteine methyltransferase, lysozyme, complement 4b binding protein,complement 9 protein, insulin-like growth factor binding protein, UDP-glucuronosyltransferase, tissue inhibitor of metalloproteinase-3, aldolase B, retinoid X receptor gamma, carboxylesterase and testicular cell adhesion molecule 1. The downregulated genes included glutathione synthetase, lecithin-cholesterol acyltransferase, p55CDC,heart fatty acid binding protein, cell adhesion regulator and endothelial cell selectin ligand.CONCLUSION: Esophageal epithelium exposed excessively to harmful ingredients of duodenal and gastric reflux may develop into BE and even EA gradually. The gene expression level is different between EA and BE, and may b展开更多
Most vertebrates have spiral bacteria that have adapted to persist in the mucus layer of the gastric mucosa. Similarly, in underdeveloped societies, most humans acquire Helicobacter pylori in childhood, and this infec...Most vertebrates have spiral bacteria that have adapted to persist in the mucus layer of the gastric mucosa. Similarly, in underdeveloped societies, most humans acquire Helicobacter pylori in childhood, and this infection persists for the person's lifetime, unless the mucosa develops atrophic gastritis. In the developed world, major changes have occurred in the prevalence of H.pylori over the past 50-100 years: the elderly population mostly has the bacterium, but very few children or young adults are infected. These changes in prevalence of H. pylori mean that the developed world is moving from peptic ulcer disease towards reflux oesophagitis.展开更多
A substantial proportion of patients with gastroesophageal reflux disease (GERD) has a chronic disease with frequent and prolonged relapses. Antireflux surgery (ARS) has proven effective to control the disease both in...A substantial proportion of patients with gastroesophageal reflux disease (GERD) has a chronic disease with frequent and prolonged relapses. Antireflux surgery (ARS) has proven effective to control the disease both in the short and long-term perspective. The efficacy of ARS has been objectively evaluated by use of symptom assessment of GERD is entirely based on PPI (proton pump inhibition) therapy whereupon the majority of GERD patients can have their symptoms and esophagitis controlled even when studied over many years. The relevant clinical question today and for the years to come is how these two therapeutic strategies compare to each other when a comprehensive scientific approach is applied?展开更多
文摘AIM: To assess the relationship between severity of gastroesophageal reflux disease and apnea-hypopnea index (AHI) as an indicator of the severity of obstructive sleep apnea. METHODS: Data of 57 patients with proven obstructive sleep apnea and gastroesophageal reflux disease were analyzed. Patients were divided into two groups according to severity of the sleep apnea: 'mild-moderate' (A)-AHI 5≥5-30, n=27, 'severe' (B)-AHI >30, n=30. All patients underwent apnea monitoring during the night, upper panendoscopy and were asked about typical reflux symptoms. RESULTS: All examined patients in both groups showed a significant overweight and there was a positive correlation between body mass index and the degree of sleep apnea (P = 0.0002). The occurence of erosive reflux disease was significantly higher in 'severe' group (P = 0.0001). Using a logistic regression analysis a positive correlation was found between the endoscopic severity of reflux disease and the AHI (P = 0.016). Forty-nine point five percent of the patients experienced the typical symptoms of reflux disease at least three times a week and there was no significant difference between the two groups. CONCLUSION: A positive correlation can be found between the severity of gastroesophageal reflux disease and obstructive sleep apnea.
基金Supported by the 2004 Research Fund of Wonkwang University
文摘AIM： Itopride is a newly developed prokinetic agent, which enhances gastric motility through both antidopaminergic and anti-acetylcholinesterasic actions. The importance of esophageal motor dysfunction in the pathogenesis of gastro-esophageal reflux disease （GERD） makes it interesting to examine the effect of itopride on esophageal acid exposure.METHODS： The effect of itopride on esophageal acid reflux variables for 24 h was studied in 26 patients with GERD symptoms, pre-entry total acid exposure time （pH〈4） of more than 5% and mild esophagitis （SavaryMiller grades I, II） proven by endoscopy. Ambulatory 24hpH-metry and symptom assessment were performed after treatments with 150 or 300 mg itopride thrice a day （t.i.d.） for 30 d in random order, using an open label method.For evaluating the safety of itopride, blood biochemical laboratory test was performed and the serum prolactin level was also examined before and after treatment.RESULTS： Total symptom score was significantly decreased after treatment in 150- or 300-mg group. Itopride 300 mg was significantly effective than 150 mg on decreasing the total per cent time with pH〈4, total time with pH〈4 and DeMeester score. No serious adverse effects were observed with administration of itopride in both groups.CONCLUSION： Itopride 100 mg t.i.d, is effective on decreasing pathologic reflux in patient with GERD and therefore it has the potential to be effective in the treatment of this disease.
文摘AIM：Gastro-esophageal reflux disease (GERD) is becoming increasingly common in Asia. Data on the efficacy of proton pump inhibitors in patients with non-erosive GERD (NERD)in Asia is lacking. This double-blind study compared the efficacy and safety of rabeprazole with esomeprazole in relief of symptoms in patients with NERD.METHODS: One hundred and thirty-four patients with reflux symptoms of NERD and normal endoscopy were randomized to receive rabeprazole 10 mg or esomeprazole 20 mg once daily for 4 wk. Symptoms were recorded in a diary and changes in severity of symptoms noted.RESULTS: At 4 wk of treatment, rabeprazole 10 mg and esomeprazole 20 mg were comparable with regards to the primary endpoint of time to achieve 24-h symptomfree interval for heartburn 8.5 d vs9 d and regurgitation 6 d vs 7.5 d. Rabeprazole and esomeprazole were also similarly efficacious in term of patient's global evaluation with 96% of patients on rabeprazole and 87.9% of patients on esomeprazole, reporting that symptoms improved(P=NS). Satisfactory relief of day- and night-time symptoms was achieved in 98% of patients receiving rabeprazole and 81.4% of patients receiving esomeprazole. Adverse events were comparable in both groups (P = NS).CONCLUSION: Rabeprazole 10 mg has a similar efficacy and safety profile in Asians with NERD as esomeprazole 20 mg. Further study is necessary to investigate whether the small differences between the two drugs seen in this study are related to the improved pharmacodynamicpro perties of rabeprazole. Both drugs were well tolerated.
文摘GastroEsophageal Reflux Disease (GERD) is mainly caused by prolonged exposure of the mucosa of the distal esophagus to acid and pepsin. Most patients have only reflux symptoms without esophagitis, but the symptoms have to be severe enough to impair quality of life in order to justify the diagnosis of GERD. Complications of GERD include esophagitis of varying severity (LA grade A-D), ulcer, stricture, Barrett's esophagus, and respiratory complications.
文摘Barrett's oesophagus is a metaplastic condition in which the squamous epithelium of the oesophagus is replaced by specialised intestinal metaplasia. Barrett's oesophagus occurs in about 10% of patients with gastrooesophageal reflux disease (GORD) and predisposes to dysplasia and adenocarcinoma. It has been estimated that the risk of developing an adenocarcinoma of the oesophagus and gastric cardia is increased 30-125 fold.
文摘AIM:To examine the clinical spectrum of gastroesophageal reflux disease (GERD) and compare erosive (ERD) with non-erosive (NERD) in terms of clinical, demographic and psychiatric profiles. METHODS: Patients with reflux symptoms were enrolled and stratified to NERD and ERD after endoscopy (LA classification). Patients with ERD presenting with dyspepsia were included. Patients on proton pump inhibitors (PPI) or H2 receptor antagonists before endoscopy were excluded. Demographic data, Helicobacter pylori(H pylori) status and presence of minor psychiatric morbidity (based on General Health Questionnaire-28) were analyzed. RESULTS: Among 690 patients screened, 533 were eligible for analysis (male to female ratio: 3:2; Chinese: 75.4%; Malay: 9.8%; Indian: 14.8%). Clinical spectrum of GERD: N: 40.5%; A: 46%; B: 9.2%; C: 2.1%; D: 0.6%; Barrett's esophagus: 1.7%. Compared to patients with NERD, patients with ERD were significantly older (45 vs 39.4 years), more likely to be male (64.4% vs 53.7%), tended to smoke (19.6% vs 9.7%), less likely to have minor psychiatric morbidity (26.4 vs 46.7%) and were more likely to respond to PPI (79.7 vs 66.8%). There was also a trend towards a higher BMI (24.5 vs 23.5). Race, alcohol consumption and H pylori status were not significant. On multivariate analysis, age and presence of minor psychiatric morbidity remained with significant differences. CONCLUSION: The majority of patients who have typical symptoms of GERD have NERD or mild erosive reflux disease. Compared to patients with erosive reflux disease, patients with NERD were younger and had a higher prevalence of minor psychiatric morbidity.
文摘AIM： To assess the efficacy and safety of a compound containing alginic acid plus antacid （Topaal） compared to equal-strength antacid （Nacid） in patients with endoscopy-negative reflux disease （ENRD）. METHODS： A total of 121 patients with ENRD were randomized to receive Topaal （65 patients） or Nacid （56 patients） for 6 weeks, with a consultation every 3 weeks. The primary end-point assessment was the change in the severity of heartburn as evaluated using a visual analog scale （VAS） at 6 weeks. The secondary end-point assessments were the VAS at 3 weeks, the change of frequency of the reflux symptom, the change of quality of life and the adverse effects. RESULTS： Demographics of randomized subjects in each treatment group were comparable except that the Topaal group included more males. The baseline characteristics between the groups were similar. After 6 weeks of treatment, the reduction of VAS of heartburn was more prominent in the Topaal group （-6.29 cm vs -4.11 cm）. At the 3m week, Topaal group showed greater reduction of VAS for heartburn （P= 0.0016）, regurgitation （P=0.0006）, vomiting （P=0.0373）, and belching （P〈0.0001）. The patients of the Topaal group had lower frequency of heartburn （P=0.0015） and pain （P= 0.0163） at the end of the 6-week treatment period. From the doctor＇s point of view, the Topaal group also showed significant reduction in the severity of heartburn （P= 0.0020）, regurgitation （P=0.0081）, vomiting （P= 0.0182）, and belching （P= 0.0018） at the end of the treatment. The improvement of the quality of life was more remarkable in the Topaal group at the end of the 6-week treatment period （P〈 0.0001）. For the adverse effect, there was no difference in both the groups. CONCLUSION： Topaal is more effective than Nacid for the treatment of symptoms presented by patients with ENRD.
文摘Uncomplicated reflux disease comprises the non-erosive reflux disease (NERD) and erosive reflux disease (ERD).The objectives of treatment are the adequate control of symptoms with restoration of quality of life, healing of lesions and prevention of relapse. Treatment of NERD consists in the administration of proton pump inhibitors (PPI) for 2-4 wk, although patients with NERD show an overall poorer response to PPI treatment than patients with ERD owing to the fact that patients with NERD do not form a pathophysiologically homogenous group. For long-term management on-demand treatment with a PPI is probably the best option. In patients with ERD, therapy with a standard dose PPI for 4-8 wk is always recommended.Long-term treatment of ERD is applied either intermittently or as continuous maintenance treatment with an attempt to reduce the daily dosage of the PPI (step-down principle).In selected patients requiring long-term PPI treatment,antireflux surgery is an alternative option. In patients with troublesome reflux symptoms and without alarming features empirical PPI therapy is another option for initial management. Therapy should be withdrawn after initial success. In the case of relapse, the long-term care depends on a careful risk assessment and the response to PPI therapy.
基金Supported by the Major Program of Clinical Medicine of Ministry of Public Health, No. 20012130
文摘AIM: To study the different gene expression profiles in rats with Barrett's esophagus (BE) and esophageal adenocarcinoma (EA) induced by gastro-duodenoesophageal reflux.METHODS: Esophagoduodenostomy was performed in 8-wk old Sprague-Dawley rats to induce gastro-duodenoesophageal reflux, and a group of rats that received sham operation served as control. Esophageal epithelial pathological tissues were dissected and frozen in liquid nitrogen immediately. The expression profiles of 4 096genes in EA and BE tissues were compared to normal esophagus epithelium in normal control (NC) by cDNA microarray.RESULTS: Four hundred and forty-eight genes in BE were more than three times different from those in NC, including 312 upregulated and 136 downregulated genes. Three hundred and seventy-seven genes in EA were more than three times different from those in NC, including 255upregulated and 142 downregulated genes. Compared to BE, there were 122 upregulated and 156 downregulated genes in EA. In the present study, the interested genes were those involved in carcinogenesis. Among them, the upregulated genes included cathepsin C, aminopeptidase M, arachidonic acid epoxygenase, tryptophan-2,3-dioxygenase, ubiquitin-conjugating enzyme, cyclic GMP-stimulated phosphodiesterase, tissue inhibitor of metalloproteinase-1, betaine-homocysteine methyltransferase, lysozyme, complement 4b binding protein,complement 9 protein, insulin-like growth factor binding protein, UDP-glucuronosyltransferase, tissue inhibitor of metalloproteinase-3, aldolase B, retinoid X receptor gamma, carboxylesterase and testicular cell adhesion molecule 1. The downregulated genes included glutathione synthetase, lecithin-cholesterol acyltransferase, p55CDC,heart fatty acid binding protein, cell adhesion regulator and endothelial cell selectin ligand.CONCLUSION: Esophageal epithelium exposed excessively to harmful ingredients of duodenal and gastric reflux may develop into BE and even EA gradually. The gene expression level is different between EA and BE, and may b
文摘Most vertebrates have spiral bacteria that have adapted to persist in the mucus layer of the gastric mucosa. Similarly, in underdeveloped societies, most humans acquire Helicobacter pylori in childhood, and this infection persists for the person's lifetime, unless the mucosa develops atrophic gastritis. In the developed world, major changes have occurred in the prevalence of H.pylori over the past 50-100 years: the elderly population mostly has the bacterium, but very few children or young adults are infected. These changes in prevalence of H. pylori mean that the developed world is moving from peptic ulcer disease towards reflux oesophagitis.
文摘A substantial proportion of patients with gastroesophageal reflux disease (GERD) has a chronic disease with frequent and prolonged relapses. Antireflux surgery (ARS) has proven effective to control the disease both in the short and long-term perspective. The efficacy of ARS has been objectively evaluated by use of symptom assessment of GERD is entirely based on PPI (proton pump inhibition) therapy whereupon the majority of GERD patients can have their symptoms and esophagitis controlled even when studied over many years. The relevant clinical question today and for the years to come is how these two therapeutic strategies compare to each other when a comprehensive scientific approach is applied?
