Mucosal impedance for esophageal disease: evaluating the evidence.

Impedance has traditionally been employed in esophageal disease as a means to assess bolus flow and reflux episodes. Recent and ongoing research has provided new and novel applications for this technology. Measurement of esophageal mucosal impedance, via either multichannel intraluminal impedance catheters or specially designed endoscopically deployed impedance catheters, provides a marker of mucosal integrity. Mucosal impedance has been shown to segregate gastroesophageal reflux disease (GERD) and eosinophilic esophagitis from non-GERD controls and may play a role in predicting response to reflux intervention. More data are needed with regard to other esophageal subgroups, outcome studies, and functional disease. Our paper reviews the history of impedance in esophageal disease, the means of assessing baseline and mucosal impedance, data with regard to the newly developed mucosal impedance probes, the clinical utility of mucosal impedance in specific clinical conditions, and limitations in our existing knowledge, along with suggestions for future studies.

The University of Chicago contribution to the treatment of gastroesophageal reflux disease and its complications: a tribute to David B. Skinner 1935-2003.

OBJECTIVE: To highlight the contributions from the University of Chicago under the leadership of Dr David B. Skinner to the understanding of gastroesophageal reflux disease (GERD) and its complications. BACKGROUND: The invention of the esophagoscope confirmed that GERD was a premorbid condition. The medical world was divided between those who believed in a morphological lower esophageal sphincter (LES) and those who did not. Those who did not believe attempted to rearrange the anatomy of the foregut organs to stop reflux with minimal success. The discovery of the LES focused attention on the sphincter as the main deterrent to reflux and the hope that measurement of a low LES pressure would mark the presence of GERD. This turned out not to be so. In July 1973, with this history of confusion, Dr Skinner at the age of 36 assumed the chair of surgery at the University of Chicago. METHODS: The publications of the University of Chicago's esophageal group were collected from private and public (PubMed) databases, reviewed, and seminal contributions selected. RESULTS: Twenty-four-hour esophageal pH monitoring led to the understanding of the LES, its contribution to GERD, and the complication of Barrett's esophagus. The relationship of Barrett's to adenocarcinoma was clarified. The rising incidence of esophageal adenocarcinoma led to contributions in the staging of esophageal cancer and its treatment with an en bloc resection. CONCLUSIONS: Ten years after the death of Dr Skinner, we can appreciate the monumental contributions to benign and malignant esophageal disease under his leadership.

[The road to modern esophageal surgery - from maximally invasive to minimally invasive]. / Der Weg zur modernen Speiseröhrenchirurgie - von maximal invasiv zu minimal invasiv.

520 new cases of esophageal carcinoma are diagnosed in Switzerland per year. 80% of these patients eventually die from their disease despite recent advances in surgical technique and systemic treatment. The first successful thoracic esophageal resection for carcinoma was performed in 1913, but only the introduction of modern anesthesia with oral intubation and positive pressure ventilation made thoracic operations routinely feasible. Esophageal resection can be performed open or minimally invasive. The minimally invasive esophageal resection has been proven to be safe with comparable mortality to open resection. Also, there is no difference in terms of radicality of the operation. Overall survival seems to be equal in published series, but results of prospective trials are still pending.

En Suisse chaque année sont diagnostiqués 520 nouveaux cas de cancer de l'oesophage. 80% des patients décèdent malgré les avancées notables des traitements chirurgicaux et médicaux dans ce domaine. La résection chirurgicale est le traitement de choix pour les cancers éligibles. En 1913 a eu lieu avec succès la première résection transthoracique d'un cancer de l'oesophage, mais ces interventions transthoraciques n'ont pu être réalisées dans la pratique courante qu'à compter du développement des techniques anesthésiologiques modernes incluant l'intubation orale et la ventilation par pression positive. L'intervention peut de nos jours être réalisée à ciel ouvert ou par technique mini-invasive. Cette dernière est une technique sûre, ayant un taux de mortalité comparable aux techniques à ciel ouvert dans les centres spécialisés. Aussi, il n'existe aucune différence quant à la radicalité de l'opération. Les résultats oncologiques sont comparables dans les séries publiées, toutefois les résultats d'études standardisées sont encore à venir.

Chevalier Jackson: pioneer and protector of children.

Chevalier Jackson was one of the greatest pioneers of otolaryngology. He was a pioneer of oesophagoscopy, bronchoscopy and the removal of foreign bodies. He changed the mortality rate for an airway foreign body from 98 per cent to a survival rate of 98 per cent. He became distressed by the number of preventable injuries in children from the ingestion of caustic substances, most commonly household lye. His experiences of children with oesophageal stricturing secondary to caustic ingestion moved him to start a campaign to force manufacturers to label all poisonous substances as such. This took him from the American Senate to the House of Representatives and back again; the Federal Caustic Poisons Act (1927) is still enforced today. In a career with over 400 publications, written during exacerbations of his pulmonary tuberculosis, his life story is a remarkable one, only part of which is widely known.

History, molecular mechanisms, and endoscopic treatment of Barrett's esophagus.

This report is an adjunct to the American Gastroenterological Association Institute's medical position statement and technical review on the management of Barrett's esophagus, which will be published in the near future. Those documents will consider a number of broad questions on the diagnosis, clinical features, and management of patients with Barrett's esophagus, and the reader is referred to the technical review for an in-depth discussion of those topics. In this report, we review historical, molecular, and endoscopic therapeutic aspects of Barrett's esophagus that are of interest to clinicians and researchers.

When did the esophagus start shrinking? The history of the short esophagus.

Even though the history of this condition extends for almost 100 years, the short esophagus (SE) is still one of the most controversial topics in esophageal surgery with its existence still denied by some distinguished surgeons. We reviewed the evolution behind the diagnosis and treatment of the SE and the persons who wrote its history, from the first descriptions by radiologists, endoscopists, and surgeons to modern treatment.

[The role of Orvosi Hetilap in the development of Hungarian gastroenterology. Part 1: 1857-1904]. / Az Orvosi Hetilap szerepe a magyar gasztroenterológia kialakulásában. I. rész: 1857-1904.

UNLABELLED: The role of the Hungarian weekly medical journal Orvosi Hetilap - first published in 1857 - in the development of special medical fields has not been studied. AIM: Analysis of the papers dealing with diseases of the gastrointestinal tract published in Orvosi Hetilap. METHOD: The author manually reviewed the journal volumes between 1857 and 1904. The original articles, journal and book reviews were identified and classified according to their subject and origin. RESULTS: In the period studied, 455 original articles were published about gastrointestinal diseases, constituting 8.2% of the total publications. Diseases of the oesophagus were studied in 2.4% of the articles, gastric disturbances in 14.7%, intestinal diseases in 14.2%, and hepatobiliary diseases in 24.2%. 592 journal articles were reviewed from 113 different publications, 52.5% being German, 15.9% French and 10.0% English; 42.7% of the articles were published in 10 core journals (8 German and 2 British). Many of the 116 books presented became classics of the medical literature. Basic knowledge in endoscopy was mediated by French and German authors. After pioneering laryngoscopic and urologic examinations, the first oesophagoscopies with rigid instruments were performed in 1902. The most studied field was hepatology: the clinical and pathologic features of acute liver failure, chronic hepatitis and cirrhosis were then described. CONCLUSIONS: Most of the contemporary aspects of gastrointestinal diseases were covered by the original articles published in Orvosi Hetilap . German and French and, to a lesser extent, British sources of scientific information prevailed. Diseases of the liver and biliary tract were studied in most detail.

A century of progress in pediatric surgical airway management.

BACKGROUND: Tremendous technological advances have occurred in pediatric airway management within the past century. Pediatric surgeons have been involved in the technological progress and have also evolved as concerned care-givers. METHODS: A short history reveals a few outstanding physicians who not only contributed to the technological triumphs but also to promoting "high touch." CONCLUSION: Pediatric surgeons must be involved in the rapidly progressing technologies but must not allow high technology to outpace high touch.

Chevalier Jackson: the father of American bronchoesophagoscopy.

Chevalier Jackson was involved with bronchoesophagoscopy from the late 1800s until shortly before his death in 1958. A pioneer in the field, he developed numerous instruments used in peroral endoscopy and taught their safe and effective use. Most of the next generation of leaders in the field of bronchoesophagoscopy were trained in his clinics in Pittsburgh and in Philadelphia, where he held academic appointments at the six leading medical institutions of these cities. He was a keen observer, inventor, prolific writer, and humanitarian.

[History of esophagoscopy]. / Zur Geschichte der Oesophagoskopie.

Since the middle of the 19th century very many experts have endeavoured to develop the oesophagoscopy following two different principles of oesophagus examination. Some tried to transfer the technique of indirect laryngoscopy on the oesophagus by using a larynx speculum. In order to achieve an insight into the oesophagus they separated its closed upper end by means of special retracting instruments. Various instruments were developed for this purpose (by Voltolini, Semeleder, Stoerk, Bevan, Waldenburg, Mackenzie) which however not proved to be effective. Mostly angled or jointed tubes came into use which were stretched after insertion. More successful were those applying simple straight tubes. Except for Stoerk it was Kussmaul who had a sword-swallower swallow a tube instead of a sword. Today flexible fiberglass endoscopes are used as well as rigid tubes.