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Gastro-oesophageal Junction (gastro-oesophageal + junction)
Selected AbstractsA gastrointestinal role for the amphibian ,diaphragm' of Xenopus laevisJOURNAL OF ZOOLOGY, Issue 1 2004Mark Pickering Abstract The ,diaphragm' of Xenopus laevis has close anatomical relations to the lower end of the oesophagus. In mammals, the crural diaphragm acts as a pinch valve at the gastro-oesophageal junction and is an important component of the gastro-oesophageal reflux barrier. The present study analysed the effect of amphibian ,diaphragm' contraction on oesophageal pressure using a superfused in situ oesophago-diaphragmatic preparation of large female Xenopus. Three-dimensional reconstruction of the oesophageal pressure profile was performed using four-port oesophageal infusion manometry. Bilateral electrical stimulation of the nerves supplying the ,diaphragm' of Xenopus increased the pressure volume vector of 5 mm of oesophagus (centred around the insertions of the diaphragm) from 20.4 ± 16 to 553.6 ± 232 mm · mmHg2 (mean ± SD). This was a statistically significant increase and statistically significantly higher than that evoked by electrical stimulation of both vagi (28.1 ± 30.7 mm·mmHg2). The amphibian ,diaphragm' seems to be functionally similar to the mammalian crural diaphragm. By analogy, we suggest that the original role of the diaphragm was not respiratory but gastrointestinal. [source] Clinical and laboratory studies of the antacid and raft-forming properties of Rennie alginate suspensionALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2006G. N. TYTGAT Summary Background Acid pockets at the gastro-oesophageal junction escape buffering from meals in the stomach. Combining high-dose antacid with alginate may therefore be of benefit in gastro-oesophageal reflux disease. Aim To characterize the antacid and raft-forming properties of Rennie alginate suspension (containing high-dose antacid and alginate; Bayer Consumer Care, Bladel, the Netherlands). Methods The in vitro acid-neutralizing capacity of Rennie algniate was compared with Gaviscon (Reckitt Benckiser, Slough, UK) by pH-recorded HCl titration. Alginate raft weight formed in vitro at different pH was used to evaluate the pH dependency of raft formation with each product. A double-blind, placebo-controlled, randomized crossover study also compared the antacid activity of Rennie alginate vs. placebo in vivo using continuous intragastric pH monitoring in 12 healthy fasting volunteers. Results Compared with Gaviscon, Rennie alginate had a higher acid-neutralizing capacity, greater maximum pH and longer duration of antacid activity in vitro. However, the two products produced comparable alginate rafts at each pH evaluated. In vivo, Rennie alginate provided rapid, effective and long-lasting acid neutralization, with an onset of action of <5 min, and duration of action of almost 90 min. Conclusions The dual mode of action of Rennie alginate offers an effective treatment option for mild symptomatic gastro-oesophageal reflux disease particularly considering recent findings regarding ,acid pockets'. [source] Oesophagectomy for tumours and dysplasia of the oesophagus and gastro-oesophageal junctionANZ JOURNAL OF SURGERY, Issue 4 2009Krishna Epari Abstract Background:, Neoadjuvant therapy, radical lymphadenectomy and treatment in high-volume centres have been proposed to improve outcomes for resectable oesophageal tumours. The aim of the present study was to review the oesophagectomy experience of a single surgeon with a moderate caseload who uses neoadjuvant therapy selectively and performs a conservative lymphadenectomy. Methods:, A retrospective review of prospectively collected data was performed. The study included 125 consecutive attempted oesophageal resections performed by a single surgeon (RC) from 1993 to 2006. Results:, All patients were staged with computed tomography and also laparoscopy for lower third and junctional tumours. Endoscopic ultrasound was used in 69%. Seventy-seven per cent were adenocarcinomas. Neoadjuvant therapy was used selectively in 23%. One hundred and twenty-one resections were carried out, giving an overall resection rate of 97% with an R0 resection in 82%. In-hospital mortality was 0.8%, clinical anastomotic leak 1.7% and median length of stay 14 days. Overall median and 5-year survival were 46 months and 47%. Stage-specific 5-year survival was 100%, 71%, 41% and 21% for stages 0, I, II and III, respectively. Isolated local recurrence occurred in 8%. Conclusions:, A moderate volume surgeon with specialist training in oesophageal resectional surgery can achieve a low mortality and anastomotic leak rate with good survival outcomes. The role for neoadjuvant therapy and radical lymphadenectomy is controversial and remains to be clearly defined. Accurate preoperative staging is essential for selection of patients for curative surgery with or without neoadjuvant therapy and for comparison of results. [source] Health-related quality of life among patients with adenocarcinoma of the gastro-oesophageal junction treated by gastrectomy or oesophagectomy,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2008A. P. Barbour Background: Tumours of the gastro-oesophageal junction may be resected by total gastrectomy (TG) or transthoracic oesophagectomy (TTO). This study compared health-related quality of life (HRQL) following these procedures. Methods: Prospective clinical and HRQL data (European Organization for Research and Treatment of Cancer QLQ-C30) were collected from 63 consecutive patients (20 TG and 43 TTO) before and 6 months after surgery for Siewert type I,III gastro-oesophageal tumours. Results: Questionnaire response rates exceeded 90 per cent. Patients were similar with respect to disease stage, treatment-related mortality and survival, but those selected for TTO were younger with less co-morbidity than those undergoing TG. These differences were reflected in baseline HRQL scores, which were better in patients selected for TTO. Six months after surgery, however, HRQL showed a greater deterioration after TTO than after TG in terms of role and social function, global quality of life and fatigue. Symptom scores for pain and diarrhoea increased in both groups. Conclusion: TTO had a greater negative impact on HRQL than TG for tumours of the gastro-oesophageal junction. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] New classification of oesophageal and gastric carcinomasBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2001K. Dolan Background: The current International Classification of Diseases (ICD)-O classification of carcinomas of the oesophagus and stomach causes epidemiological and clinical confusion, particularly the use of the term cardia and the overlapping subsites described in the stomach. This study compared the epidemiological and clinical features of each subtype and subsite of carcinoma of the oesophagus and stomach to assess requirements for a new classification of these carcinomas. Methods: Data were extracted with appropriate validity checks on all cases of oesophageal and gastric carcinoma identified throughout the period 1974,1993 by the Merseyside and Cheshire Cancer Registry, which covers a population of 2·5 million. Comparison of all identifiable epidemiological and clinical features of adenocarcinomas at four different subsites, namely the upper two-thirds of the oesophagus, the lower third of the oesophagus, cardia and subcardia of the stomach, was performed. Results: There were 5322 primary carcinomas of the oesophagus and 10 535 carcinomas of the stomach registered between 1974 and 1993. The incidence of adenocarcinoma of the lower oesophagus and cardia trebled in males and doubled in females, whereas adenocarcinoma of the subcardia region of the stomach declined in both sexes. The incidence of adenocarcinoma of the lower oesophagus and of the cardia was similar for median age at diagnosis, male: female ratio, percentage of patients who smoked, and survival; both were significantly different from values for carcinoma of the subcardia in these respects. Conclusion: These data suggest that there is considerable overlap between adenocarcinomas of the lower oesophagus and adenocarcinomas currently classified as of the cardia. The authors believe this is due to the group of carcinomas classified as cardia consisting mainly of carcinomas that traverse the gastro-oesophageal junction. These carcinomas were different in all studied parameters from carcinomas of the stomach and should be classified separately from gastric carcinomas. A new subsite classification of oesophageal and gastric carcinomas is proposed that includes the gastro-oesophageal junction as a subsite of the oesophagus and that simplifies the subsite classification of the stomach into proximal, distal and overlapping. © 2001 British Journal of Surgery Society Ltd [source] | ||||||||||