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John de Caestecker

Publications and source records attributed to John de Caestecker.

6 recordsLinked to original sources
PubMed2003

Pharmacotherapy for chronic gastro-oesophageal reflux disease and Barrett's oesophagus.

Over the last two decades there have been major advances in the medical treatment of gastro-oesophageal reflux disease (GORD) and Barrett's oesophagus. Motility agents, H(2)-receptor antagonists and proton-pump inhibitors (PPI) have all been evaluated in short- and long-term studies. Symptomatic response needs to be differentiated from healing of oesophagitis and maintenance of remission. Clinical trials have convincingly demonstrated the superiority of PPIs to motility agents and H(2)-receptor antagonists for all clinical aspects of GORD. Barrett's oesophagus requires lifelong acid suppression. Treatment with standard doses of PPIs is often insufficient and higher doses are frequently required. Medical treatment does not appear to result in clinically significant regression of Barrett's oesophagus.

Anti-Ulcer Agents↗
PubMed2002

Gastroenterology.

Explore the source record for details and available documents.

Attitude of Health Personnel↗
PubMed2002

Prokinetics and reflux: a promise unfulfilled.

Gastro-oesophageal reflux disease (GORD) has been described as a motility disorder of the upper gastrointestinal tract. Disturbances of lower oesophageal sphincter function, lower oesophageal body motility, oesophageal clearance and gastric emptying are well accepted. Cisapride improves most of these but its clinical benefits have been relatively modest. Some recent studies have indicated that the improvements achieved with cisapride may be less marked than originally thought. Furthermore, the agent has no effect on transient lower oesophageal sphincter relaxations, nor on other important factors influencing gastro-oesophageal junction competence, such as the external sphincter function of the diaphragmatic crus and mechanical influences such as lower oesophageal sphincter length exposed to intra-abdominal pressure changes. More potent, specific and predictable prokinetic agents would be welcome, but are unlikely to be effective as single agents across the range of GORD. There is certainly a need for such agents, including cisapride, as adjuncts to acid suppression in patients who fail to respond to the latter.

Cisapride↗
PubMed2002

Surgery or endotherapy for high-grade dysplasia/early adenocarcinoma in Barrett's oesophagus?

The incidence of oesophageal adenocarcinoma is increasing and Barrett's oesophagus (columnar-lined oesophagus) is the main risk factor. Currently, oesophagectomy for oesophageal adenocarcinoma is the only accepted effective therapy; however, it has significant associated morbidity and mortality. Recent developments in the staging of oesophageal adenocarcinoma have allowed early adenocarcinoma/high-grade dysplasia to be identified with confidence, allowing attempts at local endoscopic treatment without the need for oesophagectomy. Hitherto, there have been no reports of long-term follow-up. Follow-up of local endoscopic therapy in 115 patients with high-grade dysplasia/early adenocarcinoma has now been presented, suggesting that local endoscopic therapy appears to be an effective and safe option for the management of these conditions.

Adenocarcinoma↗