Research advances in esophageal diseases: bench to bedside.
Research advances in esophageal diseases: bench to bedside.
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DOI：
10.12703/p5-44
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发表时间：
2013-10-01
期刊：
影响因子：
--
通讯作者：
Fitzgerald RC
中科院分区：
文献类型：
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作者：
di Pietro M;Fitzgerald RC
在过去的一年里，在理解食道疾病的发病机制并将这些知识转化为临床实践方面已经取得了重要的进展。胃食道反流病(GERD)是胃肠病中最常见的门诊诊断，在普通人群中发病率较高。多达40%的GERD患者对药物治疗有不完全的反应，缺乏反应的病理生理机制现在得到了更好的理解。新的医疗和微创干预措施可用于优化GERD的管理。食道癌，不管是哪种组织亚型，都是所有恶性肿瘤中存活率最差的。利用基因组测序技术的进步，食道癌的突变谱现在正在出现，为靶向治疗提供了新的途径。早期诊断是提高存活率的另一条途径。虽然全基因组关联研究正在提供对遗传易感性的见解，但通过使用应用于食道样本的生物标记物并作为成像技术的一部分，正在设计出早期检测癌症的新方法。吞咽困难患者的鉴别诊断为运动障碍和嗜酸性食管炎。新的病理生理分类改进了运动障碍的管理。与此同时，在这些疾病的内窥镜治疗方面取得了令人振奋的进展。嗜酸性食管炎仍然是一种相对较新的疾病，其发病机制尚不清楚。然而，现在清楚的是，对食物的过敏反应起着重要的作用，饮食干预以及阻止炎症级联的生物制剂是临床研究的新领域，前景广阔。
Over the last year, significant steps have been made toward understanding the pathogenesis of esophageal diseases and translating this knowledge to clinical practice. Gastroesophageal reflux disease (GERD) is the most common outpatient diagnosis in gastroenterology and has a high prevalence in the general population. As many as 40% of patients with GERD have incomplete response to medical therapy, and the pathophysiological mechanisms underlying lack of response are now better understood. Novel medical and minimally invasive interventions are available to optimize management of GERD. Esophageal cancer, regardless of the histological subtype, has among the worst survival statistics among all malignancies. Taking advantage of technological advances in genome sequencing, the mutational spectra in esophageal cancer are now emerging, offering novel avenues for targeted therapies. Early diagnosis is another strand for improving survival. While genome-wide association studies are providing insights into genetic susceptibility, novel approaches to early detection of cancer are being devised through the use of biomarkers applied to esophageal samples and as part of imaging technologies. Dysmotility and eosinophilic esophagitis are the differential diagnoses in patients with dysphagia. New pathophysiological classifications have improved the management of motility disorders. Meanwhile, exciting progress has been made in the endoscopic management of these conditions. Eosinophilic esophagitis is still a relatively new entity, and the pathogenesis remains poorly understood. However, it is now clear that an allergic reaction to food plays an important role, and dietary interventions as well as biologic agents to block the inflammatory cascade are novel, promising fields of clinical research.