**5. Conclusion**

72 Gastrointestinal Endoscopy

Efficiency Repeated sessions Perfora-

dilation

1 required repeated

Mean 3.4 dilations per patient, range 1-

Repeated in 6 patients at least twice over the following year

Not specified Not specified Yes 2–3 day

Four patients with recurrent dysphagia (mean number of procedures, 2.5; range, 2–4) over an average period of 4.5 years (range 1– 10 years).

13)

tion

No Yes Pneumomediastinum

Yes (4 of them) No 2 extensive

Yes (in 4 patients) No Severe mucosal

No No Development of

Not specified No No.

Other complications

and early mediastinitis, requiring subtotal esophagectomy.

No Deep mucosal tears Increased post endoscopy analgesia. Difficulty in inserting the endoscope.

tearing.

No Tears were recorded in 13 (87%).

No Extensive esophageal trauma.

> hospitalization, severe chest pain and odynophagia.

Overnight hospitalization.

No No.

Moderate chest pain.

disquieting lesions in response to the procedure.

esophageal tearing, chest pain and overnight hospitalization.

Author and year

Riou PJ. et al.,

Morrow JB. et al., 2001

Vasilopoulos S. et al., 2002

Straumann A. et al., 2003

Croese J. et al., 2003

Straumann A. et al., 2003

Nurko S. et al., 2004

Potter JW. et al., 2004

Langdom DE.

Zimmerman SL. et al., 2005

2005

7 children

11 (not specified)

1996

Patients dilated

1 patient Stenotic esophagus despite dilation

improved

16 adults 16 clinically

5 adults 5/5 clinically improved

11 adults A single dilation of 7 patients 50% reduction in symptoms 1 patient did not show improvement of symptoms

17 adults 16/17 improved clinically

5 adults 5 asymptomatic for 3 to 24 months

relief

8 adults 8 temporary relief of dysphagia.

13 adults 7/13 showed transient (<3 months) improvement

5 total symptomatic

2 partial response

Eosinophilic esophagitis is a rapidly emerging disease which has become a common pathology in clinical practice. A wide range of endoscopic findings typical of EoE has been described in the literature, but none of them is pathognomonic for the disease. If a patient

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#### **6. References**


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**7** 

*Sweden* 

**Expression of Reactive** 

Emma Andreasson and Anna Casselbrant

*Sahlgrenska Academy, University of Gothenburg,* 

**Oxygen Species in Reflux Disease** 

*Department of Gastrosurgical Research and Education, Institute of Clinical Sciences,* 

Reflux of acidic gastric contents, or bile and pancreatic enzymes into the esophagus may cause mucosal inflammation (esophagitis or red streak). This disorder is commonly called gastroesohageal reflux disease (GERD), and in signs of esophageal mucosal injuries the disorder is called 'erosive reflux disease' (ERD). If the reflux is frequent and long standing such episodes can elicit severe inflammation or damage of the esophageal squamous

Oxygen is a requirement for life but oxygen metabolites can cause serious tissue injuries. It is normal for the immune system to respond to injury to the mucosa or pathogens by producing oxygen and nitrogen radicals. Reactive oxygen species (ROS) are an often-used term that includes true radicals that have unpaired electrons as well as chemicals that can gain or loose electrons. Oxidative stress is a general term used to describe the steady state of oxidative damage in a cell, tissue or organ, caused by ROS. If there is an unbalance between the production of ROS and the systems ability to detoxify the reactive species or easily repair the resulting damage, oxidative stress is caused and this is a reality in most living organisms. ROS are used in immune system to attack and eliminate pathogens but ROS are also involved in the development of many diseases such as atherosclerosis and

There are many different sources by which ROS are generated. Among a lot of enzymes and molecules that cause oxidative stress there are three major enzymes; myeloperoxidase (MPO), nicotinamide adenine dinucleotide phosphate oxidase (NADPH oxidase) and nitric oxide syntase (NOS) that produce the products superoxide (O2- ), hydrogen peroxide (H2O2),

We have previously shown that extremely high levels of NO are formed when nitrite in swallowed saliva meets acidic refluxates in the distal esophagus (6). NO has radicalcharacteristics and has been suggested to initiate esophageal carcinogenesis (7). This view may be questioned because luminally formed NO appears to be quite harmless and is rapidly eliminated during normal tissue conditions. However, in inflamed tissue with production of ROS it is reasonable to assume that luminal NO will react with particularly O2- and form the extremely labile oxidising compound peroxynitrite (ONOO-). Such oxidative species have potential roles in all steps of carcinogenesis including DNA

**1. Introduction** 

epithelium (1-2).

cancer (3-5).

nitric oxide (NO) and hypocloric acid (HOCl).

