A randomized blinded comparison of omeprazole and ranitidine in the treatment of chronic esophageal stricture secondary to acid peptic esophagitis

Silvis, Stephen E.; Farahmand, Mahnaz; Johnson, June A.; Ansel, Howard J.; Ho, Samuel B.

doi:10.1016/s0016-5107(96)70319-x

Cited by 44 publications

(9 citation statements)

References 14 publications

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“…It is well‐known that the interaction between bile and hydrochloric acid plays an important role in the development of severe forms or GERD such as Barrett epithelium and benign esophageal strictures 43 . It has also been demonstrated that the PES recurrence rate is lower among patients who receive PPIs than in those who were treated with H2‐receptor blockers 44–46 . In a study performed in the 1990s on six patients treated with PPIs, we found similar results 47 .…”

Section: Discussionsupporting

confidence: 79%

Peptic esophageal stricture: a report from Argentina

Mazzadi

García

Salis

et al. 2004

Diseases of the Esophagus

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Peptic esophageal stricture (PES) is a major complication of gastroesophageal reflux disease. The aims of this paper were to determine the characteristics of these patients with regard to demography, morphology, functional status and results of therapy. The charts of the patients treated at our service who underwent esophageal dilatation for PES between 1971 and 1998 were reviewed. Statistical analyses were performed by means of chi2, Mann-Whitney and Student's t-tests. One hundred and thirty-five patients with PES were dilated by various means. The mean age was 61.1 +/- 16.3 years, the ratio of men to women was 2.75/1 and mean duration of symptoms was 44.4 +/- 74.6 months. Their symptoms were dysphagia in 100%, pyrosis in 70%, and regurgitation in 40% of the cases. There was an average weight loss of 3.3 +/- 6 kg. The upper gastro-intestinal series showed pre- and post-dilatation diameters at the stricture of 8 +/- 2.5 mm and 15.9 +/- 1.2 mm, respectively. The stricture was located at the lower third of the esophagus in 97% and at the middle third in 3% of the cases. We found PES endoscopically in all instances, with different degrees of erosions in 64%, ulcers in 20% and Barrett's esophagus in 16% of the cases. The biopsy samples showed intestinal metaplasia in 16% and esophagitis in 75.5%, being normal in the remaining 8.5%. Brush cytology was negative for malignancy in 100% of the cases. Esophageal manometry showed peristaltic wave amplitude of 40 +/- 3 mmHg and presence of peristaltic waves of 62 +/- 38.6%. LES pressure was 8.6 +/- 6.3 mmHg (NV 24.2 +/- 6.3 mmHg). Measurement of pH showed 15% of patients had pH < 4. Patients needed a mean of 4.7 +/- 1.6 dilations per case, with successful results in 87.2% of cases. The perforation rate was 0.1% of the total number of procedures and 0.7%, of patients. The mortality rate was 0.7% (one case). We observed PES relapse in 32% of the cases. There was no correlation between relapse, age, duration of the stenosis or pharmacological treatment with H2 blockers or proton pump inhibitors. We conclude that in Argentina, demography, morphology, functional status and results of dilatation of PES patients are similar to those reported in the Western world, with the exception of the different behavior seen after treatment with H2 blockers or proton pump inhibitors.

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Section: Discussionsupporting

confidence: 79%

Peptic esophageal stricture: a report from Argentina

Mazzadi

García

Salis

et al. 2004

Diseases of the Esophagus

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“…PPIs promote esophagitis healing, and esophagitis healing, in turn, improves dysphagia and decreases dilation need in patients with peptic stricture [10]. Vigorously treating esophagitis with PPIs in patients with peptic strictures is a crucial part of the overall management [11]. Although the malignant transformation into adenocarcinoma in children is rare, proper surveillance of Barrett's epithelium is vital in management [12].…”

Section: Discussionmentioning

confidence: 99%

Persistent Vomiting and Weight Loss Leading to the Diagnosis of Barrett’s Esophagus in an Adolescent

Lorenze

John

Riedel

et al. 2020

Cureus

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Barrett's esophagus in children with peptic strictures has not been well characterized, and its prevalence is unknown. We report a case of peptic esophageal stricture with Barrett's esophagus in an adolescent patient who presented with dysphagia with recurrent episodes of vomiting and limited medical history. A 13-year-old male with mild intellectual disability was transferred to our facility due to a twomonth history of dysphagia with recurrent episodes of vomiting and intolerance to both solids and liquids. Physical examination and laboratory values were within normal limits, including complete blood count and differential, serum electrolytes, glucose, amylase, lipase, liver and kidney function tests, and thyroid-stimulating hormone level. Barium esophagram revealed persistent focal narrowing of the proximal and midesophagus. An esophageal endoscopy revealed a snug circumferential stricture and biopsy consistent with erosive esophagitis. The patient was started on high dose pantoprazole and underwent serial endoscopic guided balloon dilations with marked improvement in symptoms. Peptic stricture with Barrett's esophagus is rare in children. It should be included in the differential diagnosis of a child with the common symptom of vomiting in the setting of developmental delay. Vigorous treatment with endoscopic balloon dilation and proton pump inhibitors is necessary to prevent the progression into adenocarcinoma.

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“…It is clear that dysphagia in patients with reflux oesophagitis may result from oesophagitis rather than stricture, and symptoms may improve with healing of oesophagitis using PPI therapy without the need for dilatation. 88 In addition, oesophagitis as well as stricture diameter contribute to the severity of dysphagia, 89–91 and healing of oesophagitis in patients with strictures is associated with a reduced need for redilatation. 92 Finally, PPI therapy, but not H2 receptor antagonist treatment, reduces the need for, and frequency of, dilatation of peptic strictures after the initial dilatation.…”

Section: Disease-specific Considerationsmentioning

confidence: 99%

“… 92–95 Offer PPI therapy to patients with GORD and dysphagia, as this treatment has been shown to reduce the need for oesophageal dilatation 83 84 89 92 (GRADE of evidence: high; strength of recommendation: strong). Offer PPI therapy after endoscopic dilatation for peptic strictures in order to reduce recurrence rate 89 92–94 (GRADE of evidence: high; strength of recommendation: strong). Offer PPI therapy rather than H2 receptor antagonists, which are ineffective in reducing the need for repeat dilatation (stricture recurrence), less effective in healing of oesophagitis and in providing symptom relief from GORD and dysphagia 89 92–95 (GRADE of evidence: high; strength of recommendation: strong).…”

Section: Disease-specific Considerationsmentioning

confidence: 99%

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UK guidelines on oesophageal dilatation in clinical practice

Sami

Haboubi

Ang

et al. 2018

Gut

106

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These are updated guidelines which supersede the original version published in 2004. This work has been endorsed by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG) under the auspices of the oesophageal section of the BSG. The original guidelines have undergone extensive revision by the 16 members of the Guideline Development Group with representation from individuals across all relevant disciplines, including the Heartburn Cancer UK charity, a nursing representative and a patient representative. The methodological rigour and transparency of the guideline development processes were appraised using the revised Appraisal of Guidelines for Research and Evaluation (AGREE II) tool.Dilatation of the oesophagus is a relatively high-risk intervention, and is required by an increasing range of disease states. Moreover, there is scarcity of evidence in the literature to guide clinicians on how to safely perform this procedure. These guidelines deal specifically with the dilatation procedure using balloon or bougie devices as a primary treatment strategy for non-malignant narrowing of the oesophagus. The use of stents is outside the remit of this paper; however, for cases of dilatation failure, alternative techniques—including stents—will be listed. The guideline is divided into the following subheadings: (1) patient preparation; (2) the dilatation procedure; (3) aftercare and (4) disease-specific considerations. A systematic literature search was performed. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool was used to evaluate the quality of evidence and decide on the strength of recommendations made.

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A randomized blinded comparison of omeprazole and ranitidine in the treatment of chronic esophageal stricture secondary to acid peptic esophagitis

Cited by 44 publications

References 14 publications

Peptic esophageal stricture: a report from Argentina

Peptic esophageal stricture: a report from Argentina

Persistent Vomiting and Weight Loss Leading to the Diagnosis of Barrett’s Esophagus in an Adolescent

UK guidelines on oesophageal dilatation in clinical practice

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