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Early esophageal neoplasia: etiology, pathophysiology, pathogenesis and treatment. Barrett's esophagus and early esophageal adenocarcinoma
Krajčíová, Jana ; Martínek, Jan (advisor) ; Dolina, Jiří (referee) ; Bureš, Jan (referee)
Background: Barrett's esophagus (BE) is a premalignant condition defined by replacement of normal esophageal squamous-cell epithelium by cylindrical epithelium with intestinal metaplasia (IM). Patients with BE associated neoplasia (BORN) are candidates for endoscopic treatment. The aims of our studies were: (1) analysis of long-term efficacy of radiofrequency ablation (RFA) and evaluation of risk factors for persistent/ recurrent neoplasia/ IM; (2) to assess the results and safety of confocal laser endomicroscopy (CLE) compared to standard biopsies in patients after successful endoscopic treatment of BORN; (3) to assess the sampling quality obtained by different types of forceps; and (4) to assess "de novo" reflux after peroral endoscopic myotomy (POEM) and its severity (the risk of development of further complications). Patients and methods: We performed a total of 4 studies. (1) In a retrospective RFA study we evaluated data of 136 patients treated endoscopically for BORN in 4 centers in the Czech Republic. (2) In a prospective, pathologist-blinded, CLE study, we evaluated concordance in the detection of IM or neoplasia with CLE compared to standard biopsies in 56 patients who underwent standard surveillance endoscopy. (3) In a prospective study comparing 4 types of forceps, we evaluated the...
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Respiration and posture influence on the activity of upper and lower esophageal sphincters
Bitnar, Petr ; Kobesová, Alena (advisor) ; Dolina, Jiří (referee) ; Malá, Jitka (referee)
Respiration and posture influence on the activity of upper and lower esophageal sphincters Abstract This work explores the effect of postural respiratory function on pressures in the upper esophageal sphincter (UES) and the lower esophageal sphincter (LES). UES and LES pressures were measured using a high-resolution manometry (HRM). Leg raise in a supine position results in significant pressure increase in the UES and LES. Traction of the cervical spine and chest stabilization maneuver significantly reduces pressure in the UES and significantly increases pressure in the LES. Abdominal wall activity, i.e. intra-abdominal pressure (IAP) affecting UES and LES function, was measured using Ohm Belt sensors. IAP is related to body position, i.e. posture. Using verbal and manual guides, the subject can be instructed to increase abdominal wall activity and thus regulate (increase) IAP. Of the five monitored positions (sitting, lying on the back with leg raise, "bear", squat and hang), the greatest increase in IAP occurred in the bear position, i.e. in the position on all fours with a support on both hands and feet. IAP activation, which is significantly dependent on diaphragm activation, can potentially affect LES pressure and UES pressures. Based on the systematic review, it can be concluded that breathing...
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