Duodeno-Gastric-Esophageal Reflux—What is Pathologic? Comparison of Patients with Barrett’s Esophagus and Age-Matched Volunteers

Wolfgarten, E.; Pütz, Benito; Hölscher, Arnulf H.; Bollschweiler, Elfriede

doi:10.1007/s11605-006-0017-7

Cited by 14 publications

(7 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Despite the evidence that Barrett’s esophagus is associated with GERD and proposed to be an protective adaptation to such 42, 53 , typical GERD symptoms are the primary reason for endoscopy in only 33–44% of patients diagnosed with Barrett’s esophagus 48, 49 (Drs. Shyam Menon and Nigel Trudgill, unpublished data) and 20% do not have any detectable acid reflux when monitored by 24-hour pH-metry 54, 55 . Our findings suggest that a systemic inflammatory state, represented by metabolic syndrome, could increase risk for Barrett’s esophagus and thus represent an indirect causal pathway of obesity.…”

Section: Discussionmentioning

confidence: 90%

Metabolic Syndrome Increases Risk of Barrett Esophagus in the Absence of Gastroesophageal Reflux

Drahos

Ricker

Parsons

et al. 2015

Journal of Clinical Gastroenterology

View full text Add to dashboard Cite

GOALS: Evaluate the association between metabolic syndrome (MetS) and risk of Barrett’s esophagus (BE) using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database compared with two control groups—Medicare population controls and endoscopy controls. BACKGROUND: Barrett’s esophagus principally arises as an adaptation to the proinflammatory state induced by gastroesophageal reflux disease (GERD). The relationship between obesity and BE is presumed to be mediated by GERD. However, evidence suggests central adiposity also increases risk of BE independent of GERD. Central adiposity is one risk factor defining metabolic syndrome, which confers a systemic proinflammatory state—a potential GERD-independent mechanism by which obesity could increase risk of BE. STUDY: MetS was defined as diagnosis of at least three of the following conditions: obesity, elevated triglycerides, high blood pressure, and elevated fasting glucose. Multivariable logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs). RESULTS: In 2,198 incident BE cases, prior MetS was significantly associated with BE [OR 1.20; 95%CI 1.07, 1.36] compared with population controls. However, GERD status modified the association; among those without prior GERD, MetS increased risk of BE by 34%, however no association was observed among those with a prior GERD diagnosis (p-value for effect modification <0.001). MetS was not associated with risk of BE compared with endoscopy controls. CONCLUSIONS: MetS increased risk of BE compared with population controls, an association driven by and confined to the non-GERD stratum. MetS may mediate an association between central adiposity and BE for those without GERD.

show abstract

Section: Discussionmentioning

confidence: 90%

Metabolic Syndrome Increases Risk of Barrett Esophagus in the Absence of Gastroesophageal Reflux

Drahos

Ricker

Parsons

et al. 2015

Journal of Clinical Gastroenterology

View full text Add to dashboard Cite

show abstract

“…It has been generally accepted that RE and CLE are caused by duodenogastroesophageal reflux (DGER) 11–15 . Development of RE was one of the problems caused by DGER in patients who underwent esophagectomy followed by gastric tube reconstruction 16 .…”

Section: Discussionmentioning

confidence: 99%

Reflux esophagitis and columnar-lined esophagus after cervical esophagogastrostomy (following esophagectomy)

Nishimura

Tanaka

et al. 2010

Diseases of the Esophagus

View full text Add to dashboard Cite

Reflux esophagitis (RE) and columnar-lined esophagus (CLE) are frequently observed after esophagectomy. The incidence of these conditions according to time and to the route of esophageal reconstruction after esophagectomy remains unknown. The aim of this study was to clarify any changes and differences of the incidence of RE and CLE in patients who underwent gastric tube reconstruction after esophagectomy. A hundred patients who underwent cervical esophagogastrostomy after resection of the thoracic esophagus were included in this study. We reviewed their endoscopic findings at 1 month, at 1 year and at 2 years after surgery, and compared the incidence rates of RE and CLE with the passage of time and among the three reconstruction routes; a subcutaneous route, a retrosternal route, and a posterior mediastinal route. The incidence rate of RE was 42%, 37% and 38%, at 1 month, 1 year and at 2 years after surgery, respectively. There was no significant difference in the incidence of RE according to the time after surgery. The incidence rate of severe RE (Grade C and D in the Los Angeles Classification) was 9% percent at 1 month after surgery, 18% at 1 year after surgery and 22% at 2 years after surgery, significantly increasing with passage of time. The incidence rate of CLE was 0% at 1 month after surgery, 14% at 1 year after surgery and 40% at 2 years after surgery, significantly increasing with passage of time. No difference was observed in the incidence of RE and that of CLE among the three routes of esophageal reconstruction. Severe RE and CLE increase with passage of time after cervical esophagogastrostomy. Therefore, careful endoscopic follow-up is necessary for such patients irrespective of the route of esophageal reconstruction.

show abstract

“…A review paper summarized that the relationship is unclear [47]. Also, the relevance of alcohol consumption as a risk factor for EGD findings is considered controversial [40,42,44,48].…”

Section: Discussionmentioning

confidence: 99%

Frequency and Types of Pathological Upper Gastrointestinal Endoscopy Findings in Clinically Healthy Individuals

Scheidl

Benz²,

Loeff³

et al. 2020

Drugs R D

View full text Add to dashboard Cite

Background and objective Beyond its application for diagnostics in patients, esophagogastroduodenoscopy (EGD) is used to assess gastrointestinal drug effects in clinical trials, where the interpretation of any pathological findings depends on the respective background variability. The objective of this analysis was to characterize the occurrence of pathological findings in the upper gastrointestinal tract in symptom-free healthy individuals. Methods A baseline EGD was performed in clinically healthy individuals in three clinical trials aimed to assess gastrointestinal tolerability of drugs. Pathological findings were described by type (redness, erosion, ulcer or other), number, size and location, and by clinical relevance as assessed by the endoscopist. Characteristics of volunteers were tested as potential covariates. Results A total of 294 EGDs were assessed. Characteristics of individuals were as follows: 257 (87.4%) males, age (mean ± SD) 32.0 ± 8.1 years, body weight 76.0 ± 10.6 kg, body mass index (BMI) 24.0 ± 2.5 kg/m 2 , 200 consumed alcohol, 250 (of 290 where this information was available) consumed caffeine and 39 (of 152) were smokers, 30 (of 151) tested positive for H. pylori. Any pathological finding was present in 79.6%. Clinically relevant findings occurred in 44.2%, mainly erosions (39.1%). Nine stomach ulcers were observed. Only age and BMI had a statistically significant relationship to overall pathological findings [age 3.4 years higher (p = 0.027), and BMI 1.6 kg/m 2 higher (p < 0.001); for clinically relevant vs no findings]. Conclusion Upper gastrointestinal tract mucosal lesions, including those assessed as clinically relevant, are frequent in clinically healthy individuals, impeding the assessment of causality for both disease and drug effects on gastrointestinal health. Abbreviations BMI Body mass index CR Clinical relevant ECG Electrocardiogram EGD Esophagogastroduodenoscopy FIH First-inhuman GI Gastrointestinal NCR Not clinical relevant NSAID Nonsteroidal anti-inflammatory drug Key Point Pathological findings in esophagogastroduodenoscopy are frequent in healthy individuals without clinical symptoms and need to be considered to assess adverse drug effects in early clinical trials.

show abstract

Duodeno-Gastric-Esophageal Reflux—What is Pathologic? Comparison of Patients with Barrett’s Esophagus and Age-Matched Volunteers

Cited by 14 publications

References 28 publications

Metabolic Syndrome Increases Risk of Barrett Esophagus in the Absence of Gastroesophageal Reflux

Metabolic Syndrome Increases Risk of Barrett Esophagus in the Absence of Gastroesophageal Reflux

Reflux esophagitis and columnar-lined esophagus after cervical esophagogastrostomy (following esophagectomy)

Frequency and Types of Pathological Upper Gastrointestinal Endoscopy Findings in Clinically Healthy Individuals

Contact Info

Product

Resources

About