Esophageal

A toxic component of braken fern, perhaps either quercetin (105) or ptaquiloside, a glucoside (106), has a mixed history of carcinogenicity. It is sometimes impHcated in an increased incidence of bladder cancer in animals and esophageal cancer in humans. Multiple other dietary components seem to either promote or interfere with its action, and the significance of braken fern in human carcinogenesis remains unproven. 

The sales of antagonists of receptors, eg, diphenhydramine, terfenadine, and astemizole, used in the treatment of allergic diseases, represent 1% of the overall pharmaceutical market, ie, 1.7 biUion (U.S.). antagonists, eg, cimetidine and ranitidine, are effective in peptic ulcer disease and esophageal reflux. Sales represent 3.5% of the world market, ie, 6 biUion (U.S.). agonists or antagonists have not yet found a clear indication. 

At the tested daily dose of 50 mg, fluconazole appears to be slightly less active against dermatophytes. The substance is used mainly to treat vaginal candidosis (a single capsule of 150 mg) and oral and esophageal candidosis (50 mg od for 14 d). In a number of countries, ie, England, the maximal period of treatment is 14 d. 

Cisapride (27) is effective in the treatment of re/Iux esophagitis and constipation, with a novel mechanism thought to involve acetylchohne release in the gut. It IS devoid of CNS and cardiac side effects [23]... 

MMI and PTU can lead to methimazole embryopathy with choanal or esophageal atresia. In pregnant women the antithyroid diug dose should be minimized to prevent fetal hypothyroidism by maintaining the maternal free thyroxine serum level slightly above the upper limit of normal. 

LRP1B Loss-of-function (sporadic) Esophageal squamous cell carcinoma, nonsmall-cell lung cancer... 

Peripheral Gl, vascular and bronchial smooth muscle, vascular endothelium, platelets Peripheral Smooth muscle of ileum, stomach fundus (rat), uterus, vasculature, endothelium Peripheral None identified Peripheral Post-ganglionic sympathetic neurons, sensory neurons Peripheral Cardiac muscle, post-ganglionic parasympathetic neurons (myenteric plexus), esophageal and vascular smooth muscle... 

Abdominal pain, esophagitis, nausea, vomiting, diarrhea, skin rash, and blood dyscrasias may be seen with the use of the lincosamides. These drag s also can cause pseudomembranous colitis, which may range from mild to very severe Discontinuing the drag may relieve mild symptoms of pseudomembranous colitis. 

Headache, abdominal pain, arthralgia, recurrent bone pain, nausea, diarrhea, esophageal ulceration, dysphagia... 

XANTHINE DERIVATIVES. The patient taking theophylline may report heartburn because the drug relaxes the lower esophageal sphincter, allowing gastroesophageal reflux. Heartburn is minimized if the patient remains in an upright position and sleeps with the head of die bed elevated. 

Pancreatitis, abdominal distention, ulcerative esophagitis, nausea, increased appetite and weight gain, possible peptic ulcer with perforation, hemorrhage... 

The concentration of the drug in the esophageal mucosa was over 30 times the systemic levels after intravenous administration. Here again, more carefully controlled studies using gelatin will be required. 

CHEN J (1992) The effects of Chinese tea on the occurrence of esophageal tumors induced by N-nitrosomethylbenzylamine in rats , Prev Med, 21 (3), 385-91. 

MORSE M A, KRESTY L A, STEELE V E, KELLOFF G J, BOONE C W, BALENTINE D A, HARBOWY M E and STONER G D (1997) Effects of theaflavins on N-nitrosomethybenzylamine-induced esophageal tumorigenesis , Nutr Cancer, 29 (1), 7-12. 

NNN is formally a derivative of NPYR, but the pyridine ring has a marked effect on its metabolism and carcinogenicity. NNN induces lung adenomas in mice, esophageal and nasal cavity tumors... 

NPIP induces esophageal and nasal cavity tumors in the rat, forestomach, liver and lung tumors in the mouse, and tracheal tumors in the Syrian golden hamster (43, 44, 45). Its potent carcinogenicity is indicated by the fact that a single dose of only 22 mg/kg was sufficient to induce tumors in 20% of Syrian golden hamsters (45). The environmental occurrence of NPIP appears to be less frequent than that of NPYR, but it has been detected in food (J, 44). 

The related unsaturated compounds, N-nitroso-1,2,3,6-tetra-hydropyridine and N-nitroso-1,2,3,4-tetrahydropyridine, have been tested for carcinogenicity and both were potent esophageal carcinogens, as is nitrosopiperidine. However, N-nitroso-1,2,3,6-tetrahydropyridine also produced liver tumors, whereas N-nitro-so-1,2,3,4-tetrahydropyridine also gave tumors of the forestomach and oropharynx. The difference in tumor spectrum between the two unsaturated isomers may be related to differences in metabolism. N-Nitroso-1,2,3,6-tetrahydropyridine isomerized to N-nitro-so-1,2,3,4-tetrahydropyridine in vivo, but the reverse reaction was not observed (49). 

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