Esophageal stricture natural history, complications and prognosis: Difference between revisions

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https://en.wikibooks.org/wiki/Radiation_Oncology/Toxicity/Esophagus
https://en.wikibooks.org/wiki/Radiation_Oncology/Toxicity/Esophagus
* The natural history of  benign esophageal strictures started with gradual dysphagia to solid food and heartburn. <ref name="pmid26828759">{{cite journal |vauthors=Repici A, Small AJ, Mendelson A, Jovani M, Correale L, Hassan C, Ridola L, Anderloni A, Ferrara EC, Kochman ML |title=Natural history and management of refractory benign esophageal strictures |journal=Gastrointest. Endosc. |volume=84 |issue=2 |pages=222–8 |year=2016 |pmid=26828759 |doi=10.1016/j.gie.2016.01.053 |url=}}</ref>  Sometimes there is no history of heartburn and reflux symtoms before diagnosis of esophageal stricture because of progression of fibrosis.
* The natural history of  benign esophageal strictures starts with gradual dysphagia to solid food and heartburn. <ref name="pmid26828759">{{cite journal |vauthors=Repici A, Small AJ, Mendelson A, Jovani M, Correale L, Hassan C, Ridola L, Anderloni A, Ferrara EC, Kochman ML |title=Natural history and management of refractory benign esophageal strictures |journal=Gastrointest. Endosc. |volume=84 |issue=2 |pages=222–8 |year=2016 |pmid=26828759 |doi=10.1016/j.gie.2016.01.053 |url=}}</ref>  Sometimes there is no history of heartburn and reflux symtoms before diagnosis of esophageal stricture because of progression of fibrosis.
* e typical presentation of esophageal stricture includes the insidious and sometimes sudden occurrence of dysphagia to solid food with antecedent pyrosis. However, in up to 25% of cases there is no prior history of heartburn and other acid-related symptoms. In fact, some patients present a history in which reflux-related symptoms might even resolve over time secondary to progression of fibrosis and esophageal narrowing, only to return after therapeutic dilation.
* e typical presentation of esophageal stricture includes the insidious and sometimes sudden occurrence of dysphagia to solid food with antecedent pyrosis. However, in up to 25% of cases there is no prior history of heartburn and other acid-related symptoms. In fact, some patients present a history in which reflux-related symptoms might even resolve over time secondary to progression of fibrosis and esophageal narrowing, only to return after therapeutic dilation.
*The symptoms of (disease name) usually develop in the first/ second/ third decade of life, and start with symptoms such as ___.<ref>{{Cite journal|last=Lundell, M.D., Ph.D.|first=Lars|date=|title=Reflux esophagitis and peptic strictures|url=http://www.nature.com/gimo/contents/pt1/full/gimo43.html|journal=GI Motility online|volume=|pages=|via=}}</ref>
*The symptoms of (disease name) typically develop ___ years after exposure to ___.
*If left untreated, patients with esophageal stricture  may progress to develop pulmonary  aspiration, weight loss, and dehydration.  
*If left untreated, patients with esophageal stricture  may progress to develop pulmonary  aspiration, weight loss, and dehydration.  
*RBES resolution was achieved in only 22 of 70 (31.4%) patients. Two deaths (3%) were related to RBES. The success rate was lower in those who also were treated with endoprosthetics (odds ratio [OR] 3.7; 95% confidence interval [CI], 1.01-18.0). The mean dysphagia-free period was 3.3 months (95% CI, 2.4-4.1) for patients treated with dilation and 2.4 months (95% CI, 1.2-3.6) for those treated with stents (P = .062). Over time, the total dysphagia-free period increased at a rate of 4.1 days (95% CI, 1.7-6.4) per dilation. There was no difference in the rate of change across groups defined by sex (P = .976), age (P = .633), or endoscopic treatment (P = .267).  
*RBES resolution was achieved in only 22 of 70 (31.4%) patients. Two deaths (3%) were related to RBES. The success rate was lower in those who also were treated with endoprosthetics (odds ratio [OR] 3.7; 95% confidence interval [CI], 1.01-18.0). The mean dysphagia-free period was 3.3 months (95% CI, 2.4-4.1) for patients treated with dilation and 2.4 months (95% CI, 1.2-3.6) for those treated with stents (P = .062). Over time, the total dysphagia-free period increased at a rate of 4.1 days (95% CI, 1.7-6.4) per dilation. There was no difference in the rate of change across groups defined by sex (P = .976), age (P = .633), or endoscopic treatment (P = .267).  

Revision as of 15:36, 9 November 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

Natural History, Complications, and Prognosis

Natural History

Natural history and management of refractory benign esophageal strictures.

Natural history and management of refractory benign esophageal strictures

Peptic esophageal stricture: is surgery still necessary?

Predictor of massive bleeding following stent placement for malignant oesophageal stricture/fistulae: a multicentre study

Complications of esophageal stricture dilation

Over time, the damage caused by stomach acid can scar the lining of the esophagus.When this scar tissue builds up, it makes the esophagus narrow. Called strictures, these narrow spots make it hard to swallow food and drinks, which can lead to weight lossand dehydration. medscape

Refractory Esophageal Strictures: What To Do When Dilation Fails

Patterns of acid reflux in complicated oesophagitis.https://en.wikibooks.org/wiki/Radiation_Oncology/Toxicity/Esophagus

https://en.wikibooks.org/wiki/Radiation_Oncology/Toxicity/Esophagus

  • The natural history of benign esophageal strictures starts with gradual dysphagia to solid food and heartburn. [1] Sometimes there is no history of heartburn and reflux symtoms before diagnosis of esophageal stricture because of progression of fibrosis.
  • e typical presentation of esophageal stricture includes the insidious and sometimes sudden occurrence of dysphagia to solid food with antecedent pyrosis. However, in up to 25% of cases there is no prior history of heartburn and other acid-related symptoms. In fact, some patients present a history in which reflux-related symptoms might even resolve over time secondary to progression of fibrosis and esophageal narrowing, only to return after therapeutic dilation.
  • If left untreated, patients with esophageal stricture may progress to develop pulmonary aspiration, weight loss, and dehydration.
  • RBES resolution was achieved in only 22 of 70 (31.4%) patients. Two deaths (3%) were related to RBES. The success rate was lower in those who also were treated with endoprosthetics (odds ratio [OR] 3.7; 95% confidence interval [CI], 1.01-18.0). The mean dysphagia-free period was 3.3 months (95% CI, 2.4-4.1) for patients treated with dilation and 2.4 months (95% CI, 1.2-3.6) for those treated with stents (P = .062). Over time, the total dysphagia-free period increased at a rate of 4.1 days (95% CI, 1.7-6.4) per dilation. There was no difference in the rate of change across groups defined by sex (P = .976), age (P = .633), or endoscopic treatment (P = .267).

Complications

  • Common complications of esophageal stricture include:[2]
    • Perforation
    • Bleeding[3]
    • Bacteremia

Prognosis

  • Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
  • Depending on the extent of the [tumor/disease progression/etc.] at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor/good/excellent.
  • The presence of weight loss is associated with a particularly poor prognosis among patients with esophageal stricture.
  • Loss of previous heartburn is associated with more esophageal stricture
  • [Subtype of disease/malignancy] is associated with the most favorable prognosis.
  • The prognosis varies with the [characteristic] of tumor; [subtype of disease/malignancy] have the most favorable prognosis.

References

  1. Repici A, Small AJ, Mendelson A, Jovani M, Correale L, Hassan C, Ridola L, Anderloni A, Ferrara EC, Kochman ML (2016). "Natural history and management of refractory benign esophageal strictures". Gastrointest. Endosc. 84 (2): 222–8. doi:10.1016/j.gie.2016.01.053. PMID 26828759.
  2. van Boeckel PG, Siersema PD (2015). "Refractory esophageal strictures: what to do when dilation fails". Curr Treat Options Gastroenterol. 13 (1): 47–58. doi:10.1007/s11938-014-0043-6. PMC 4328110. PMID 25647687.
  3. Liu SY, Xiao P, Li TX, Cao HC, Mao AW, Jiang HS, Cao GS, Liu J, Wang YD, Zhang XS (2016). "Predictor of massive bleeding following stent placement for malignant oesophageal stricture/fistulae: a multicentre study". Clin Radiol. 71 (5): 471–5. doi:10.1016/j.crad.2016.02.001. PMID 26944699.

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