Esophageal Diseases

Current complementary and alternative therapy forgastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a widely prevalent gastrointestinal disorder, affecting ∼13.3% of the global population. There are shortages and limitations of current GERD treatment modalities, and complementary and alternative therapy (CAT) is a promising option to fill in the gap. Dietary and lifestyle modifications might play an important and complementary role in alleviating GERD symptoms. Traditional Chinese medicine and brain-gut behavior therapy, particularly transcutaneous electrical acustimulation and diaphragmatic breathing therapy were shown to be useful adjuncts or alternatives in treating GERD. CAT may help to relieve GERD symptoms, minimize medication dosage, and slow the demand for surgery. The aim of this review was to summarize the existing evidence of some common CATs in treating symptomatic GERD, including dietary modification, lifestyle change, traditional Chinese medicine, and brain-gut behavior therapy.

Associations of Changes in Intestinal Flora and Inflammatory Factors with Prognosis of Patients with Esophageal Cancer

This study aims to explore the associations of changes in intestinal flora and inflammatory factors with the prognosis of patients with esophageal cancer (EC). A total of 40 EC patients treated and 40 normal people who underwent gastroscopy and CT examination for gastrointestinal discomfort during the same period were selected as the participants of the study. The endotoxin level, colonization ability of intestinal flora, and distribution of intestinal flora (Bifidobacterium, Lactobacillus, Escherichia coli, and Enterococcus) were compared between the two groups. The levels of inflammatory factors interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), and tumor necrosis factor-α (TNF-α) were also compared between the two groups. All participants were followed up for 3 years, and the associations of survival time with colonization ability of intestinal flora and changes in hs-CRP were analyzed. Finally, the univariate and multivariate logistic regression analyses were performed for related factors affecting the survival time of EC patients. In the observation group, the endotoxin level was significantly higher (P < 0.05), the colonization ability of intestinal flora was significantly weaker (P < 0.05), the levels of Bifidobacterium and Lactobacillus were obviously lower (P < 0.05), and the levels of Escherichia coli and Enterococcus were obviously higher than those in the normal group (P < 0.05). Besides, the observation group had abnormal and evidently higher levels of IL-6, hs-CRP, and TNF-α than the normal group (P < 0.05). The survival time was positively correlated with the colonization ability of intestinal flora (P < 0.05), but negatively correlated with the changes in hs-CRP (P < 0.05). Moreover, the increased level of endotoxin, weakened colonization ability of intestinal flora, abnormal distribution of intestinal flora, and elevated levels of inflammatory factors were all related and independent risk factors affecting the survival time of EC patients. In EC patients, the endotoxin level markedly rises, the colonization ability of intestinal flora declines, and there are intestinal flora disorders and enhanced inflammatory response. With the decline in colonization ability of intestinal flora and the increase of inflammatory response, the survival time of EC patients will be shortened.

Antireflux surgery is required after endoscopic treatment for Barrett's esophagus

&lt;b&gt;Introduction:&lt;/b&gt; Barrett's esophagus is an acquired condition that develops as a result of transformation of normal stratified squamous epithelium in the lower part of the esophagus into columnar epithelium. Barrett's esophagus is considered to be a complication of gastroesophageal reflux disease (GERD). Various endoscopic techniques have been shown to be successful in the treatment of this condition. However, long-term success in preventing further esophageal dysplasia is not clear. Biological welding consists in the application of controlled high-frequency current on living tissues and has been used to stop gastrointestinal bleeding, similarly to the APC technique which involves ablation of small intestinal metaplasia of the esophageal mucosa.&lt;br/&gt; &lt;b&gt;Aim:&lt;/b&gt; The goal of this study was to evaluate the effectiveness of endoscopic techniques in the treatment of Barrett's esophagus and verify the need for a subsequent surgical intervention in patients with GERD complicated by Barrett's esophagus. &lt;br/&gt;&lt;b&gt; Material and methods: &lt;/b&gt; Patients with Barrett's esophagus C1-3M2-4 (Prague classification from 2004) and high dysplasia without nodules, as well as patients with confirmed GERD without hiatal hernia, were included in this study. Endoscopic treatment was performed with the use of argonoplasmic coagulation (APC) and high-frequency welding of living tissues (HFW). After the examination the patients were re-examined. Patients with recurrence of metaplasia and high DeMeester score (˃ 100) underwent antireflux surgery - crurography and Nissen fundoplication with creation of a soft and short cuff.&lt;br/&gt;&lt;b&gt;Results:&lt;/b&gt; A total of 89 patients were included in the study, 81 of whom were reexamined after ablation of Barrett's esophagus.In 12 patients, a recurrence of intestinal metaplasia resembling the small intestine was identified. Implementation of two-stage treatment was required for 9 patients - it involved a second procedure of ablation of the esophagus, followed by antireflux surgery. Surgical treatment was refused by 3 patients, who underwent only the second ablation procedure. All patients received drug therapy, consisting of prokinetics and proton pump inhibitors. Esophageal pH monitoring was repeated 3 months after surgery, showing normalization of the DeMeester score. As a result, the patients experienced no complaints such as heartburn, chest pain or dysphagia, which significantly improved their quality of life. Esophagogastroduodenoscopy and biopsy of the mucous membrane of the lower third of the esophagus were performed in accordance with the Seattle Protocol. After examining histological specimens, no regions of metaplasia were identified. &lt;br/&gt;&lt;b&gt;Conclusion:&lt;/b&gt; Antireflux surgery is required as a part of the treatment for Barrett's esophagus, which prevents further dysplasia and development of esophageal cancer.&lt;br/&gt.

MicroRNA-1275 induces radiosensitization in oesophageal cancer by regulating epithelial-to-mesenchymal transition via Wnt/β-catenin pathway

Acquired radioresistance is one of the main obstacles for the anti-tumour efficacy of radiotherapy in oesophageal cancer (EC). Recent studies have proposed microRNAs (miRNAs) as important participators in the development of radioresistance in various cancers. Here, we investigated the role of miR-1275 in acquired radioresistance and epithelial-mesenchymal transition (EMT) in EC. Firstly, a radioresistant cell line KYSE-150R was established, with an interesting discovery was observed that miR-1275 was down-regulated in KYSE-150R cells compared to the parental cells. Functionally, miR-1275 inhibition elevated radioresistance in KYSE-150 cells via promoting EMT, whereas enforced expression of miR-1275 increased radiosensitivity in KYSE-150R cells by inhibiting EMT. Mechanically, we demonstrated that miR-1275 directly targeted WNT1 and therefore inactivated Wnt/β-catenin signalling pathway in EC cells. Furthermore, WNT1 depletion countervailed the promoting effect of miR-1275 suppression on KYSE-150 cell radioresistance through hampering EMT, whereas WNT1 overexpression rescued miR-1275 up-regulation-impaired EMT to reduce the sensitivity of KYSE-150R cells to radiation. Collectively, our findings suggested that miR-1275 suppressed EMT to encourage radiosensitivity in EC cells via targeting WNT1-activated Wnt/β-catenin signalling, providing a new therapeutic outlet for overcoming radioresistance of patients with EC.