Esophageal disease

If drug therapy is indicated, assess the patient for contraindications (e.g., esophageal disease or severe renal impairment for bisphosphonate therapy). 

Use caution when bisphosphonates are given to patients with active upper Gl problems (such as dysphagia, esophageal diseases, gastritis, duodenitis, or ulcers). Etidronate therapy has been withheld from patients with enterocolitis because diarrhea is seen in some patients, particularly at higher doses. 

In more advanced esophageal disease, oral azoles may be ineffective. Until recently, intravenous amphotericin B deoxycholate has been the alternative for patients with endoscopically proven disease who have failed fluconazole or itraconazole therapy.22 2" Moderate disease may be treated adequately with low- to moderate-dose amphotericin B for 10 days, although higher doses may be necessary for patients with AIDS or advanced disease. " Voriconzole, a new triazole antifungal available in both oral and intravenous preparations, produces comparable clinical response to fluconazole. Voriconazole has been associated with more side effects and multiple pharmacokinetic drug interactions. " ... 

More than 10000 Americans will develop esophageal cancer this year with an overall 5-year survival rate of 4-7% and a 1 year survival of 20% [6,7]. Surgical intervention is able to provide 40% of patients with palliation provided resection can be performed but mortality rates associated with surgery may be as high as 7-29% [8]. PDT has been used extensively in the management of esophageal diseases. 

On May 16, 1957, at the Broadmoor hotel. Dr. John Tilden Howard (right), the president of the American Gastrointestinal Endoscopy Society, eschewed his privilege to deliver the presidential address. He elected to yield the floor to Basil Hirschowitz, who presented the first studies of the fiberoptic endoscope (bottom). The subsequent evolution of fiberoptic endoscopy led to the elucidation of esophageal disease, which Tilden himself had previously declared terra incognita (no man s land). 

In the discussion of this pivotal presentation, the doyen of American esophageal disease, the venerable Chevalier Jackson of Philadelphia, rose to comment, stating ... 

The diagnosis of esophageal disease by spectral methods has a long history. In fact, very early studies by Puppels and coworkers [62] and later by Stone and coworkers [63-65] have demonstrated that in vivo and ex vivo Raman spectroscopy may present a valuable alternative to the presently available diagnostic methods, to be discussed later. 

Diagnosis of esophageal disease is of utmost importance, since adenocarcinoma of the esophagus is a nearly incurable disease. Early stages include... 

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. 

Hepatobiliary disease occurs due to bile duct obstruction from abnormal bile composition and flow. Hepatomegaly, splenomegaly, and cholecystitis may be present. Hepatic steatosis may also be present due to effects of malnutrition. The progression from cholestasis (impaired bile flow) to portal fibrosis and to focal and multilobar cirrhosis, esophageal varices, and portal hypertension takes several years. Many patients are compensated and asymptomatic but maybe susceptible to acute decompensation in the event of extrinsic hepatic insult from viruses, medications, or other factors.7... 

O GERD can be divided into three distinct categories erosive esophagitis, non-erosive reflux disease, and Barrett s esophagus. 

The PPIs are superior to H2RAs in patients with moderate to severe GERD. This includes not only patients with erosive esophagitis or complicated symptoms (Barrett s esophagus or strictures), but also those with non-erosive reflux disease who have moderate to severe symptoms. Symptomatic relief is seen in approximately 83% of patients and healing rates at 8 weeks as judged by endoscopy are 78%.1... 

GERD gastroesophageal reflux disease H2RA histamine2-receptor antagonist LES lower esophageal sphincter... 

Patients with the following conditions should use laxatives only under the supervision of a health care provider (1) colostomy (2) diabetes mellitus (some laxatives contain large amounts of sugars such as dextrose, galactose, and/or sucrose (3) heart disease (some products contain sodium (4) kidney disease and (5) swallowing difficulty (bulk-formers may produce esophageal obstruction). 

Chronic hepatitis (disease lasting longer than 6 months) is usually associated with hepatitis B, C, and D. Chronic viral hepatitis may lead to the development of cirrhosis, which may induce end-stage liver disease (ESLD). Complications of ESLD include ascites, edema, jaundice, hepatic encephalopathy, infections, and bleeding esophageal varices. Therefore, prevention and treatment of viral hepatitis may prevent ESLD. 

Oropharyngeal candidiasis (OPC) is a common fungal infection, usually associated with immune suppression. If left untreated, it will progress to more serious oral disease. Esophageal candidiasis, representing a serious progression of oropharyngeal candidiasis, is associated with increased morbidity. 

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