The hepatotoxicity of non-steroidal anti-inflammatory drugs

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72868/1/j.1365-2036.2004.02092.x.pd

Epidemiology, Diagnosis, and Management of Esophageal Adenocarcinoma

Esophageal adenocarcinoma (EAC) is rapidly increasing in incidence in Western cultures. Barrett’s esophagus (BE) is the presumed precursor lesion for this cancer. Several other risk factors for this cancer have been described, including chronic heartburn, tobacco use, Caucasian race, and obesity. Despite these known associations, most patients with EAC present with symptoms of dysphagia from late-stage tumors—only a small minority of patients are identified in screening and surveillance programs. Diagnostic analysis of EAC usually commences with upper endoscopy, followed by cross-sectional imaging. Endoscopic ultrasound is useful to assess local extent of disease as well as the involvement regional lymph nodes. T1a EAC may be treated endoscopically; some patients with T1b disease might also benefit from endoscopic therapy. Locally advanced disease is generally managed with esophagectomy, often accompanied by neoadjuvant chemoradiotherapy or chemotherapy. The prognosis is based on tumor stage: patients with T1a tumors have an excellent prognoses, whereas few patients with advanced disease have longterm survival

Empiric Β-blockers for the prophylaxis of variceal hemorrhage: Cost effective or clinically applicable?

No Abstract.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/34792/1/510370205_ftp.pd

A Pilot Study of the Association of Low Plasma Adiponectin and Barrett's Esophagus

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72851/1/j.1572-0241.2008.01823.x.pd

Prebiotic proanthocyanidins inhibit bile reflux–induced esophageal adenocarcinoma through reshaping the gut microbiome and esophageal metabolome

The gut and local esophageal microbiome progressively shift from healthy commensal bacteria to inflammation-linked pathogenic bacteria in patients with gastroesophageal reflux disease, Barrett’s esophagus, and esophageal adenocarcinoma (EAC). However, mechanisms by which microbial communities and metabolites contribute to reflux-driven EAC remain incompletely understood and challenging to target. Herein, we utilized a rat reflux-induced EAC model to investigate targeting the gut microbiome–esophageal metabolome axis with cranberry proanthocyanidins (C-PAC) to inhibit EAC progression. Sprague-Dawley rats, with or without reflux induction, received water or C-PAC ad libitum (700 μg/rat/day) for 25 or 40 weeks. C-PAC exerted prebiotic activity abrogating reflux-induced dysbiosis and mitigating bile acid metabolism and transport, culminating in significant inhibition of EAC through TLR/NF-κB/TP53 signaling cascades. At the species level, C-PAC mitigated reflux-induced pathogenic bacteria (Streptococcus parasanguinis, Escherichia coli, and Proteus mirabilis). C-PAC specifically reversed reflux-induced bacterial, inflammatory, and immune-implicated proteins and genes, including Ccl4, Cd14, Crp, Cxcl1, Il6, Il1b, Lbp, Lcn2, Myd88, Nfkb1, Tlr2, and Tlr4, aligning with changes in human EAC progression, as confirmed through public databases. C-PAC is a safe, promising dietary constituent that may be utilized alone or potentially as an adjuvant to current therapies to prevent EAC progression through ameliorating reflux-induced dysbiosis, inflammation, and cellular damage

Barrett's esophagus: prevalence–incidence and etiology–origins

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/86957/1/j.1749-6632.2011.06042.x.pd

Regional and racial variations in the utilization of endoscopic retrograde cholangiopancreatography among pancreatic cancer patients in the United States

BackgroundPancreatic cancer is projected to become the second leading cause of cancerâ related deaths by 2030. Endoscopic retrograde cholangiopancreatography (ERCP) is recommended as firstâ line therapy for biliary decompression in pancreatic cancer. The aim of our study was to characterize geographic and racial/ethnic disparities in ERCP utilization among patients with pancreatic cancer.MethodsRetrospective cohort study using the US Surveillance, Epidemiology, and End Results (SEER)â Medicare database to identify patients diagnosed with pancreatic cancer from 2003â 2013. The primary outcome was receipt of ERCP, with or without stent placement, vs any nonâ ERCP biliary intervention.ResultsOf the 36 619 patients with pancreatic cancer, 37.5% (n = 13 719) underwent an ERCP, percutaneous drainage, or surgical biliary bypass. The most common biliary intervention (82.6%) was ERCP. After adjusting for tumor location and stage, Blacks were significantly less likely to receive ERCP than Whites (aOR 0.84, 95% CI 0.72, 0.97) and more likely to receive percutaneous transhepatic biliary drainage (PTBD) (aOR 1.38, 95% CI 1.14, 1.66). Patients in the Southeast and the West were more likely to receive ERCP than those in the Northeast (Southeast aOR 1.21, 95% CI 1.04, 1.40; West aOR 1.16, 95% CI 1.01, 1.32).ConclusionRacial/ethnic and geographic disparities in access to biliary interventions including ERCP exist for patients with pancreatic cancer in the United States. Our results highlight the need for further research and policies to improve access to appropriate biliary intervention for all patients.To date, disparities in the receipt of endoscopic therapies among patients with pancreatic cancer have not been reported. The results from our study suggest that blacks with pancreatic cancer and patients in the Northeast region of the US are less likely to receive the gold standard therapy for obstructive jaundice.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149758/1/cam42225_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149758/2/cam42225.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149758/3/cam42225-sup-0001-Supinfo.pd

Radiofrequency Ablation of Barrett's Esophagus Reduces Esophageal Adenocarcinoma Incidence and Mortality in a Comparative Modeling Analysis

No Abstract Availabl