Cases reported "Esophagitis, Peptic"

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1/59. An operation for the treatment of intractable peptic stricture of the esophagus.

    The current management of severe strictures of the esophagus resulting from reflux esophagitis is unsatisfactory. A new operation comprising esophagoplasty and intrathoracic fundoplication is described. This preliminary report records the results of this operation in 10 patients. There was one operative death. Of the nine survivors, followed for six months to three years, seven are completely free of symptoms. The remaining two have mild residual symptoms, but no dysphagia.
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2/59. Esophageal inflammatory pseudotumor mimicking malignancy.

    A 54-year-old man with a complaint of dysphagia was found to have a prominent stricture in the proximal esophagus. A biopsy of the stenotic area indicated sarcoma, leading to subtotal esophagectomy. The surgically removed esophagus demonstrated a well-defined intramural mass, consisting of a mixture of fibroblastic cells with bland cytological appearances and inflammatory cells. Reflux esophagitis which was present distal to the stricture seemed to play a role in the development of this inflammatory pseudotumor.
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3/59. esophageal perforation: a rare complication of zollinger-ellison syndrome.

    Spontaneous perforation of the esophagus is a rare manifestation of zollinger-ellison syndrome (ZES). Failure to recognize its existence can lead to an unsuccessful treatment of the esophageal perforation. We present a rare case of reflux esophagitis-induced esophageal perforation in a patient with ZES. Presence of a gastrinoma should be considered when recurrent or complicated reflux esophagitis is encountered.
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4/59. adenocarcinoma in a Barrett oesophagus.

    A case of adenocarcinoma developing at the squamocolumnar epithelial junction of a Barrett oesophagus is reported. This rare tumour was remarkable because of the youth of the patient and because of the signet-cell cytological pattern of the neoplasm. It is postulated that both the columnar epithelial lining of the lower part of the oesophagus and the malignant change are a consequence of long-standing oesophageal reflux.
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ranking = 1.2
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5/59. Columnar-lined lower esophagus: an acquired lesion with malignant predisposition. Report on 140 cases of Barrett's esophagus with 12 adenocarcinomas.

    The analysis of a series of 1,225 cases of reflux esophagitis shows the serious nature of this condition. A liberal use of antireflux operations therefore seems justified. Extensive columnar metaplasia of the distal esophagus, or columnar-lined lower esophagus (CLLE), represents a late irreversible stage of reflux esophagitis. Repeated esophagoscopies demonstrate the acquired nature of the lesion. It is caused by the progressive healing, from below upward, of peptic ulcerations on the squamous epithelium by metaplasia of columnar mucosa. Antireflux operations stop the progressive ascent of heterotopic epithelium and thus stabilize reflux esophagitis and cure complications such as ulcerations and strictures. The premalignant character of this condition is established by a 10 per cent incidence of adenocarcinomas in a series of 140 cases of extensive columnar metaplasia. The transition toward malignancy seems to be irreversible and cannot be arrested by an antireflux operation. Therefore, repeated esophagoscopic controls and biopsies are an absolute necessity in all cases of extensive columnar metaplasia, even after cure of active reflux esophagitis by Nissen fundoplication.
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6/59. Barrett's esophagus and reflux esophagitis: is there a missing link?

    OBJECTIVES: Barrett's esophagus (BE) is associated with esophageal reflux. The development stage of BE is not well described. Epidemiological evidence indicates that the columnar epithelium in BE is acquired and reaches its full length rapidly. We tested the hypothesis that BE might result from direct replacement of erosions in reflux esophagitis (RE). methods: At endoscopy, we compared the length and distribution of esophageal erosions in 50 patients with RE with the length and distribution of columnar epithelium in 50 patients with BE. RESULTS: The median length of erosions in RE was 2 cm, less than the median length of columnar epithelium in BE, 5 cm (p < 0.001). Erosions in RE were usually multiple and scattered, involving the entire circumference of the esophagus in only 10% of cases, but circumferential involvement by columnar epithelium was found in 68% of BE cases (p < 0.001). Circumferential involvement, 3 cm or longer, was found in 0% of cases of RE versus 56% of BE cases (p < 0.001). Two patients without RE or BE had large areas of epithelial loss of uncertain etiology. CONCLUSIONS: The length and distribution of erosions in RE differ greatly from the length and distribution of columnar epithelium in BE. It is unlikely that BE arises directly from areas of esophagitis. We suggest that BE may develop after loss of a long segment of squamous epithelium, with columnar replacement in the presence of continuing acid reflux.
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keywords = esophagus
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7/59. The "Barrett syndrome" (the columnar-lined lower oesophagus): an acquired condition secondary to reflux oesophagitis. A case report with discussion of pathogenesis.

    A case of the "Barrett syndrome" in a patient with severe ulcerating reflux oesophagitis is reported. Evidence indicating that it is an acquired condition caused by reflux of bile-contaminated gastric juice is presented. The "Barrett ulcer" and the oesophagitis healed following a partial gastrectomy with a Roux-en Y gastrojejunostomy. The substitution of the squamous epithelium of the lower 15 cm of the oesophagus by columnar epithelium of cardia type is apparently irreversible.
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8/59. Double lumen esophagus due to reflux esophagitis with fibrous septom formation.

    The unique endoscopic finding of a double lumen esophagus due to the development of a fibrous septum within an area of peptic reflux esophagitis is presented. The pathogenesis of this septum was felt to represent adherence to granulation tissue from opposing esophageal walls. This abnormality was easily managed by esophageal bouginage.
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9/59. adenocarcinoma in Barrett's esophagus following total resection of the gastric remnant: a case report.

    We report a case of adenocarcinoma in Barrett's esophagus following a total resection of the gastric remnant. A 52-year-old man had undergone a distal gastrectomy for gastric cancer at 33 years of age and a total resection of the gastric remnant for local recurrence of the gastric cancer at 35 years of age. Repeated endoscopic examinations revealed the sequence of reflux esophagitis and Barrett's esophagus. Furthermore, adenocarcinoma in Barrett's esophagus was detected in December, 1989. A subtotal esophagectomy was performed in January, 1990. The elevated lesion in the lower esophagus showed coarse lobulation and measured 7.4 x 3.2 cm. The histologic type was that of well-differentiated adenocarcinoma, with the invasion limited to the muscularis mucosae without lymph node involvement. Severe dysplasia was seen adjacent to the definite carcinoma. The case supports the acquired theory of pathogenesis for Barrett's esophagus and suggests that reflux esophagitis after total gastrectomy may result in a dysplasia-carcinoma sequence.
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ranking = 1.8
keywords = esophagus
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10/59. Intramural esophageal hamartoma. An unusual cause of progressive stricture in a child.

    The unusual occurrence of an intramural hamartoma mimicking a peptic esophageal stricture in a child is presented. Early operative intervention is indicated to diagnose the condition and to avoid certain morbidity or death. The remarkable embryologic feature of this report is the presence of annular cartilage at the site of the esophageal stricture. Conservative resection of the involved esophagus and primary anastomosis is the treatment of choice.
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ranking = 0.2
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