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Related Concept Videos

Gastroesophageal Reflux Disease II: Clinical Features and Management01:29

Gastroesophageal Reflux Disease II: Clinical Features and Management

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Gastroesophageal reflux disease, or GERD, is a persistent medical condition that affects many individuals worldwide. Its clinical manifestations can vary greatly, making diagnosis and management challenging for healthcare professionals. The following is a comprehensive overview of the clinical manifestations, assessment, and management strategies for GERD.
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Individuals with Barrett's esophagus are often asymptomatic, but they may experience symptoms commonly associated with GERD, such as heartburn and acid regurgitation. Additional symptoms can include difficulty swallowing, chest pain, unintentional weight loss, blood in the stool (which may appear black, tarry, or bloody), and episodes of vomiting.
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Medical treatment strategies for peptic ulcers encompass various methods. The primary goal of treatment is to diminish gastric acidity and strengthen mucosal defense mechanisms.
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Patients with esophageal strictures often experience a range of symptoms. Initially, they may have difficulty swallowing solid foods, which can progress to include liquids. Additional symptoms may involve chest pain or discomfort, regurgitating food and fluids, heartburn, unintentional weight loss, coughing or choking during meals, and hoarseness.
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Esophageal perforations manifest in various clinical forms, influenced by factors such as the perforation's cause and location (cervical, intrathoracic, or intra-abdominal), the extent of contamination, and potential injury to adjacent mediastinal structures. The timing between the perforation occurrence and treatment initiation also affects the clinical presentation.
Clinical Manifestations:
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Eosinophilic oesophagitis: recent advances and practical management.

Stephen Attwood1, Jenny Epstein2

  • 1Health Services Research, Durham University, Durham, UK.

Frontline Gastroenterology
|December 17, 2021
PubMed
Summary

Eosinophilic oesophagitis (EoE) is an inflammatory esophageal disease causing dysphagia. Diagnosis requires endoscopy and biopsies, as blood tests are not diagnostic, and treatment options are limited.

Keywords:
dysphagiaoesophageal diseaseoesophageal stricturesoesophagitispaediatric gastroenterology

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Area of Science:

  • Gastroenterology
  • Immunology
  • Pathology

Background:

  • Eosinophilic oesophagitis (EoE) is a chronic inflammatory esophageal disease characterized by dysphagia.
  • It progresses from an inflammatory stage to fibrosis, with distinct clinical presentations in children and adults.
  • EoE is the leading cause of spontaneous esophageal perforation and stricture formation.

Purpose of the Study:

  • To summarize the current understanding of Eosinophilic oesophagitis (EoE).
  • To highlight diagnostic criteria and therapeutic challenges.
  • To emphasize the need for further research into optimal treatment strategies.

Main Methods:

  • Diagnosis relies on endoscopy with biopsies, revealing >15 eosinophils/high-power field in hyperplastic esophageal mucosa.
  • IgG4-mediated local mucosal pathology dictates the condition, rendering blood tests diagnostically insignificant.
  • Endoscopic findings are differentiated from gastro-oesophageal reflux disease.

Main Results:

  • EoE diagnosis requires specific esophageal biopsy findings, not blood tests.
  • Current therapeutic options include diet modification, proton pump inhibitors, and topical steroids, but optimal approaches lack robust evidence.
  • Budesonide orodispersible tablets are the only licensed therapy for EoE.

Conclusions:

  • EoE is a significant esophageal condition with diagnostic and therapeutic challenges.
  • Further randomized controlled trials are crucial to establish optimal management strategies.
  • Effective treatment is needed to prevent complications like perforation and strictures.