An investigation of the progression from Barrett's esophagus to adenocarcinoma

Barrett's esophagus is a metaplasia of the epithelium of the lower esophagus from a normal squamous appearance to a columnar appearance more typically found in the stomach. It is normally caused by prolonged gastric reflux. While Barrett's esophagus is not usually the direct cause of adverse symptoms, it does put a person at greater risk for developing esophageal adenocarcinoma, one of the least treatable cancers currently known. While the progression from gastric reflux to Barrett's esophagus is fairly clear, the relationship between Barrett's esophagus and esophageal adenocarcinoma is not as well understood. Not all patients diagnosed with Barrett's esophagus will go on to develop esophageal adenocarcinoma. There are several factors that may have some impact on this progression, including obesity, lifestyle, and genetic predisposition. The purpose of this study was to evaluate the literature to determine the potential impacts of each of these factors on development of esophageal adenocarcinoma. While obesity and lifestyle clearly have some impact on development of esophageal adenocarcinoma, it was found that the exact nature of that impact is still unclear. Obesity leads to several consequences, including increased gastroesophageal reflux, hormonal changes, and reduction in the bacterium H. pylori, all of which have been shown to have some impact on metaplasia in the esophagus. Lifestyle choices, including alcohol or tobacco use, also have been shown to have at least some effect on development of esophageal adenocarcinoma. The literature also reveals that inherited risk factors, namely genetic predisposition, may play a role in development of esophageal adenocarcinoma. Genetic predisposition to obesity may have some impact, but other studies have identified genetic variations that seem to directly influence development of esophageal adenocarcinoma. While it is clear that there are several factors that influence development of esophageal adenocarcinoma, we do not yet understand the complete etiology. By continuing to study these risk factors, we will be able to develop new treatments to combat the rising incidence of Barrett's esophagus and esophageal adenocarcinoma

A fully resolved active musculo-mechanical model for esophageal transport

Esophageal transport is a physiological process that mechanically transports an ingested food bolus from the pharynx to the stomach via the esophagus, a multi-layered muscular tube. This process involves interactions between the bolus, the esophagus, and the neurally coordinated activation of the esophageal muscles. In this work, we use an immersed boundary (IB) approach to simulate peristaltic transport in the esophagus. The bolus is treated as a viscous fluid that is actively transported by the muscular esophagus, which is modeled as an actively contracting, fiber-reinforced tube. A simplified version of our model is verified by comparison to an analytic solution to the tube dilation problem. Three different complex models of the multi-layered esophagus, which differ in their activation patterns and the layouts of the mucosal layers, are then extensively tested. To our knowledge, these simulations are the first of their kind to incorporate the bolus, the multi-layered esophagus tube, and muscle activation into an integrated model. Consistent with experimental observations, our simulations capture the pressure peak generated by the muscle activation pulse that travels along the bolus tail. These fully resolved simulations provide new insights into roles of the mucosal layers during bolus transport. In addition, the information on pressure and the kinematics of the esophageal wall due to the coordination of muscle activation is provided, which may help relate clinical data from manometry and ultrasound images to the underlying esophageal motor function

Epidemiology of Esophagus cancer in Ardabil province, a report of population based cancer registry in northwest Iran

Introduction: Esophageal cancer is the 8th most common malignancy and 6th most common cause of cancer death worldwide. Previous studies have shown that Esophagus cancer is the second cancer in male and female in Ardabil province. We provide an update report of Ardabil population based cancer registry to obtain the geographic pattern of Esophagus cancer occurrence in Ardabil province. Aims & Methods: Data on all newly diagnosed Esophagus cancer cases between 2004 and 2006 were actively collected. Age standard incidence rate (ASR) was calculated for each 9 districts of Ardabil province and to provide a comparison between them standard rate ratio calculated for each district. Results:During the period of study 608 new cases of esophagus cancer were registered. the age standardized incidence rate (ASR) of esophagus cancer was 19.5 in men and 19.7 in women per 100,000 person-years. The most common morphology in our cases was squamous cell carcinoma (74.7%) and esophagus adenocarcinoma consisted of 16.1% of all cases. In 33.9% of cases the origin of tumor was in middle third of esophagus and the lower third was consisting of 32.6% of cases that was significantly more common in men whereas in middle third of esophagus the risk of women was higher than men. the incidence of esophagus cancer was significantly higher in northern parts of the province and the highest rate (26.7/100,000) was related to Meshkinshahr that is a district near to the silent volcano of Sabalan. Conclusion:Esophagus cancer is the second common cancer in Ardabil and its incidence has been slightly increased in women since first official report in 2003. High incidence of esophagus cancer in the northern parts of province mandates further investigations of specific environmental and host factors

Uncommon cases of foreign bodies in the esophagus--duplex coins

Two cases of multiple foreign bodies, i. e., duplex coins in the esophagus are reported. These foreign bodies were removed by peroral esophagoscopy successfully. Significance of roentgen-ray diagnosis is emphasized, and subtle and yet specific roentgenograms of duplex coins in the esophagus are illustrated.</p

Radiographic and ultrasonographic evaluation of the esophagus in the horse

The purpose of this study was to describe the radiographic and ultrasonographic appearance of the esophagus of ten healthy horses. Contrast radiography showed variations in the long-axis shape of the esophagus at the thoracic inlet. Administration of a large volume contrast medium by intubation showed stasis of contrast material for several minutes in two of the ten horses. The wall thickness of the non-distended esophagus on ultrasound was 2.6 +/- 0.3 mm with significant differences depending on the location. Distention of the esophagus by intubation or by a bolus of water or concentrate resulted in a decrease in wall thickness and it facilitated measuring with less variation. Stasis at the thoracic inlet was seen in five of the ten horses, when a water bolus was administered. Ultrasonographic evaluation of 100g spontaneously swallowed commercial concentrate was better than fluid (water bolus or 2.5mL/kg contrast medium) administration via intubation to assess esophageal motility at the thoracic inlet. Stasis seen at the thoracic inlet after bolus administration by intubation should not be regarded as an abnormal finding, and swallowing, with the subsequent peristaltic wave, has a positive influence on the bolus passage time

Three-Dimensional Myoarchitecture of the Lower Esophageal Sphincter and Esophageal Hiatus Using Optical Sectioning Microscopy.

Studies to date have failed to reveal the anatomical counterpart of the lower esophageal sphincter (LES). We assessed the LES and esophageal hiatus morphology using a block containing the human LES and crural diaphragm, serially sectioned at 50 μm intervals and imaged at 8.2 μm/pixel resolution. A 3D reconstruction of the tissue block was reconstructed in which each of the 652 cross sectional images were also segmented to identify the boundaries of longitudinal (LM) and circular muscle (CM) layers. The CM fascicles on the ventral surface of LES are arranged in a helical/spiral fashion. On the other hand, the CM fascicles from the two sides cross midline on dorsal surface and continue as sling/oblique muscle on the stomach. Some of the LM fascicles of the esophagus leave the esophagus to enter into the crural diaphragm and the remainder terminate into the sling fibers of the stomach. The muscle fascicles of the right crus of diaphragm which form the esophageal hiatus are arranged like a "noose" around the esophagus. We propose that circumferential squeeze of the LES and crural diaphragm is generated by a unique myo-architectural design, each of which forms a "noose" around the esophagus

Effects of ingestion of cold and hot water on the course of thermal changes in the stomach and intestine

With the use of a thermocouple and mirror galvanometer, calibrated before the experiment and after each test, it was found that the normal temperature in the esophagus is 0.1-0.4 C higher than in the oral cavity, the temperature in the duodenum is somewhat less than in the stomach, but higher with cholecystitis, duodenitis or gastritis, the temperature in the normal stomach equals or is somewhat higher than in the esophagus, and that the temperature of distended stomachs frequently is lower than in the esophagus. It was found that hot water is retained in the stomach longer than cold water, and that both hot and cold water are allowed to pass into the duodenum when the water temperature becomes approximately equal to that of the surrounding organs

Cooling or Warming the Esophagus to Reduce Esophageal Injury During Left Atrial Ablation in the Treatment of Atrial Fibrillation.

Ablation of the left atrium using either radiofrequency (RF) or cryothermal energy is an effective treatment for atrial fibrillation (AF) and is the most frequent type of cardiac ablation procedure performed. Although generally safe, collateral injury to surrounding structures, particularly the esophagus, remains a concern. Cooling or warming the esophagus to counteract the heat from RF ablation, or the cold from cryoablation, is a method that is used to reduce thermal esophageal injury, and there are increasing data to support this approach. This protocol describes the use of a commercially available esophageal temperature management device to cool or warm the esophagus to reduce esophageal injury during left atrial ablation. The temperature management device is powered by standard water-blanket heat exchangers, and is shaped like a standard orogastric tube placed for gastric suctioning and decompression. Water circulates through the device in a closed-loop circuit, transferring heat across the silicone walls of the device, through the esophageal wall. Placement of the device is analogous to the placement of a typical orogastric tube, and temperature is adjusted via the external heat-exchanger console