Biomedical subjects

John A Bonino

Publications and source records attributed to John A Bonino.

3 recordsLinked to original sources

PubMed2006

Barrett's esophagus.

PURPOSE OF REVIEW: Barrett's esophagus continues to be a popular topic among clinicians and researchers alike. Population based studies have finally been undertaken to better identify subset populations at high risk of developing Barrett's esophagus, and possible better tolerated alternatives to standard endoscopy for cost-effective screening. In addition, several studies over the past year have marked a transition from identifying those with Barrett's esophagus and in need of intensive surveillance, to an increasing number of novel treatment therapies that are now primed to move from experimental protocols to clinical practice. RECENT FINDINGS: Obesity's role as a risk factor for the development of Barrett's esophagus continues to be better defined. Various disorders affecting the motility of the gastrointestinal tract, such as celiac sprue and scleroderma, and their relationship with Barrett's esophagus development are becoming more widely recognized. The use of endoscopic mucosal resection and photodynamic therapy for treatment of dysplastic Barrett's esophagus continues to gain increased acceptance, with an additional wealth of supportive data for its effectiveness becoming available. SUMMARY: The past year has brought many advances in the epidemiology and endoscopic treatment of those with Barrett's esophagus. Clinicians will benefit from this review of these advances to ensure better patient outcomes.

Barrett Esophagus↗

PubMed2005

Barrett's esophagus.

PURPOSE OF REVIEW: Significant advances have been made over the past year to identify individuals with Barrett's esophagus, who are at increased risk of malignant transformation. We summarize some of the important advances in that regard including: improved understanding in areas of epidemiology of those with Barrett's esophagus, identification of the pathways responsible for dysplastic and metaplastic development, selection of patient populations who would most benefit from surveillance protocols, and identification of biomarkers signifying progression of metaplastic changes. RECENT FINDINGS: Barrett's esophagus is being better recognized in patients presenting with extra-esophageal symptoms of gastroesophageal reflux such as chronic cough and asthma. Recent reports from some surgical series further suggest the importance of gastric and even duodenal reflux in the etiology of esophageal metaplastic development. In vitro experiments using acidic environments, to stimulate MAPK pathways, suggest an etiology for increased COX-2 expression. There appears to be a select group of individuals with familial predilection for the development of Barrett's esophagus. Retrospective studies continue to show apparent survival benefit in individuals with Barrett's esophagus undergoing surveillance endoscopy. Endoscopic ablative therapy may provide clinicians an attractive alternative to surgical resection in individuals with high-grade esophageal dysplasia and early adenocarcinoma. SUMMARY: The past year has brought many advances in the epidemiology, pathogenesis, surveillance, and treatment of those with Barrett's esophagus. Clinicians will benefit from review of these advances, and use of the most up-to-date data to ensure better patient outcomes.

Adenocarcinoma↗

PubMed2004

Barrett esophagus.

PURPOSE OF REVIEW: Strides have been made in the past year to identify means of decreasing mortality from esophageal adenocarcinoma. This requires a thorough understanding of the risk factor for its development, Barrett esophagus. This article summarizes the most up-to-date and important advancements involving the epidemiology, screening, pathogenesis, surveillance, and treatment of Barrett esophagus over the past year. RECENT FINDINGS: Much of the literature over the past year involving Barrett esophagus centered on selecting subsets of patients who would benefit most from screening and surveillance protocols. Risk factors such as increasing age, heartburn symptoms, increasing length of Barrett's segment, and male sex are increasingly identified as increasing the risk for malignant esophageal transformation. New technologies, using smaller endoscopes, may allow more cost-effective screening in selected patient populations. Methylene blue continues to grow in acceptance for its utility in assisting identification of Barrett esophagus during endoscopy. Some concern has been raised recently about DNA damage secondary to the use of methylene blue, but the clinical significance of this is unknown. High-magnification endoscopy to identify certain mucosal patterns suggesting Barrett esophagus is also gaining acceptance, perhaps allowing more accurate surveillance in patients with this condition. Much controversy continues regarding the treatment of Barrett esophagus to prevent the development of esophageal adenocarcinoma. Data reports may show some advantage of surgical antireflux therapy in reducing the risk of adenocarcinoma, but a recent meta-analysis disputes this claim. Chromosomal abnormalities resulting in tumor suppressor dysfunction continue to be revealed. SUMMARY: The past year has brought many new advances involving the diagnosis, surveillance, and treatment of Barrett esophagus. It is important for physicians to be aware of these developments, to identify individuals in whom interventions may be undertaken to decrease the risk of the development of esophageal adenocarcinoma.

Journal Article↗