The Art of Endoscopic Dilation: Lessons Learned Over 4 Decades of Practice.

The author offers his approach to esophageal dilation based on 40 years of a practice specializing in swallowing disorders and esophageal disease. He discusses general concepts in the management of esophageal strictures and then provides an approach to dilation of different types of esophageal stenotic lesions.

Endoscopic Management of Benign Esophageal Strictures.

Purpose Of Review: This paper presents the author's approach to esophageal dilation. It offers a tailored approach to the application of dilation to specific types of esophageal stenotic lesions.

Recent Findings: In patients with inflammatory stricture, recent studies confirm the importance of treating the underlying inflammatory condition in order to decrease the rate of recurrence.

Gender is a determinative factor in the initial clinical presentation of eosinophilic esophagitis.

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease resulting in symptoms of esophageal dysmotility. Abnormalities include dysphagia, food impaction and reflux. Although men appear to comprise a majority of the EoE population, few studies have directly assessed gender-associated clinical differences.

Long non-coding RNA HNF1A-AS1 regulates proliferation and migration in oesophageal adenocarcinoma cells.

Objectives: Long non-coding RNAs (lncRNA) have been shown to play important roles in the development and progression of cancer. However, functional lncRNAs and their downstream mechanisms are largely unknown in the molecular pathogenesis of oesophageal adenocarcinoma (EAC) and its progression.

Design: lncRNAs that are abnormally upregulated in EACs were identified by RNA-sequencing analysis, followed by quantitative RT-PCR (qRTPCR) validation using tissues from 25 EAC patients.

Experience with a simplified, standardized 4-hour gastric-emptying protocol.

Unlabelled: Gastric-emptying studies have no accepted standard methodology or reference values. A simplified standardized protocol with a large reference database has been proposed, with imaging obtained at only 0, 1, 2, and 4 h. The rationale for its 4-h length is data suggesting that delayed emptying is detected with higher sensitivity at 4 h than at 2 h.

A case-control study of the pathology of oesophageal disease in systemic sclerosis (scleroderma).

Background: Atrophy of the smooth muscle layers of the muscularis propria characterises oesophageal involvement in systemic sclerosis (scleroderma). The aetiology of this atrophy and of the resultant oesophageal dysfunction is unknown.

Objectives: To examine oesophageal tissue for evidence of fibrosis, vascular disease, inflammatory reactions and neural abnormalities to determine the possible causes of this disease process.

Brainstorming about next-generation computer-based documentation: an AMIA clinical working group survey.

Unlabelled: Computer-based software to record histories, physical exams, and progress or procedure notes, known as computer-based documentation (CBD) software, has been touted as an important addition to the electronic health record. The functionality of CBD systems has remained static over the past 30 years, which may have contributed to the limited adoption of these tools. Early users of this technology, who have tried multiple products, may have insight into important features to be considered in next-generation CBD systems.

Accuracy and reliability of the endoscopic classification of portal hypertensive gastropathy.

Background: There is no consensus regarding the endoscopic classification of the severity of portal hypertensive gastropathy. This study compared the accuracy and reproducibility of the 2-category classification system (2-CCS) with the 3-category classification system (3-CCS).

Methods: Ninety-eight endoscopic pictures of portal hypertensive gastropathy and 22 of nonspecific gastritis were selected.

Sporadic fundic gland polyposis: a clinical, histological, and molecular analysis.

Sporadic fundic gland polyposis (SFGP) is defined as multiple fundic gland polyps in patients without familial adenomatous polyposis syndrome (FAP). Although little is known about the genetic changes in SFGP, mutations in the Wnt signaling pathway have been recently linked to fundic gland polyps in other settings: sporadic polyps are linked to activating beta-catenin mutations, whereas FAP-associated fundic gland polyps are caused by second somatic hits in the adenomatous polyposis coli gene. The relationship between SFGP, single sporadic fundic gland polyps, and FAP-associated polyps remains unclear, and SFGP remain poorly characterized at the clinical, histological, and molecular levels.

Neuromuscular diseases and disorders of the alimentary system.

This review outlines the relationship and interaction between neuromuscular diseases and disorders of the alimentary system. Neuromuscular manifestations of gastrointestinal and hepatobiliary diseases are first considered. Such diseases may cause neuromuscular disorders by leading to nutritional deficiency or by more direct mechanisms.

Control of alkaline reflux esophagitis after total gastrectomy by a percutaneous jejunostomy tube.

Postoperative alkaline reflux esophagitis is a potentially devastating complication after total gastrectomy. The advent of the Roux-en-Y reconstruction has significantly decreased the incidence of this complication. However, when reflux esophagitis occurs, it is often refractory to medical treatment.

Esophageal lichen planus: case report and review of the literature.

Involvement of the esophagus by lichen planus is a rarely reported condition. The histologic features of esophageal lichen planus, which may differ from those of cutaneous disease, have only rarely been illustrated. We describe a 58-year-old woman with skin and oral lichen planus who presented with dysphagia and an esophageal stricture that were ultimately diagnosed as esophageal lichen planus.

Computers in endoscopy.

Computers have taken over the endoscopy unit, as they have the rest of society. In 1980, most endoscopy units had no computers at all. Today, however, the average hospital endoscopy unit in the United States is equipped with many computers.

Can restrictions on reimbursement for anti-ulcer drugs decrease Medicaid pharmacy costs without increasing hospitalizations?

Objective: To examine the impact of a policy restricting reimbursement for Medicaid anti-ulcer drugs on anti-ulcer drug use and peptic-related hospitalizations.

Data Sources/study Setting: In addition to U.S.

Cyclic vomiting: association with multiple homeostatic abnormalities and response to ketorolac.

Cyclic vomiting is a rare syndrome that over the years has variously been ascribed to psychogenic causes, sensory seizures, abdominal migraine, and more recently, to mechanical or electrical disturbances in gastric physiology. We describe the case of a 65-year-old white diabetic female with a 10-yr history of recurrent episodes of nausea and vomiting, occurring every 10-12 days and lasting approximately 1-3 days at a time. These episodes were accompanied by edema, mild temperature elevations, and remarkable elevations in blood pressure.

Botulinum toxin for achalasia: long-term outcome and predictors of response.

Background & Aims: Botulinum toxin injection into the lower esophageal sphincter of patients with achalasia results in effective short-term relief of symptoms. The aims of this study were to examine the long-term outcome of these patients and to determine the predictors of response to this therapy.

Methods: Thirty-one patients with achalasia treated with botulinum toxin were followed up prospectively for a median duration of 890 days.

Intrasphincteric botulinum toxin for the treatment of achalasia.

Background: Achalasia is a disorder of swallowing in which the lower esophageal sphincter fails to relax. We report the use of botulinum toxin, a paralytic agent, for the treatment of this condition.

Methods: In a double-blind trial, 21 patients with achalasia received either 80 units of botulinum toxin or placebo, injected endoscopically into the lower esophageal sphincter.

Effects of intrasphincteric botulinum toxin on the lower esophageal sphincter in piglets.

Background: The toxin of Clostridium botulinum (BoTx) inhibits the release of acetylcholine from nerve terminals and causes paralysis of skeletal muscle. The present study examined the hypothesis that BoTx may have a similar effect on gastrointestinal smooth muscle.

Methods: Baseline lower esophageal sphincter (LES) pressures were obtained in five piglets, and normal saline was injected endoscopically into the LES.