Clinical correlation and disease phenotype in patients with esophageal achalasia and comorbid autoimmune diseases

2020 ◽  
Author(s):  
Cassarano Sara ◽  
Pesce Marcella ◽  
Cargiolli Martina ◽  
Andreozzi Marta ◽  
Efficie Eleonora ◽  
...  
Keyword(s):  
Autoimmune Diseases ◽  
Disease Onset ◽  
Esophageal Achalasia ◽  
Epidemiologic Studies ◽  
Tertiary Referral Center ◽  
Idiopathic Achalasia ◽  
Gender And Age ◽  
Study Population ◽  
Barium Esophagogram ◽  
Manometric Pattern

Summary Background There is evidence that idiopathic achalasia has an autoimmune component and a significant association with several autoimmune comorbidities has been described. However, data regarding the prevalence of autoimmune diseases in achalasia are not well established, and few studies have explored this association. Objective Our primary aim was to prospectively investigate the type and frequency of autoimmune comorbidities in a large cohort of consecutive achalasia patients. Our secondary aim was to investigate the effects of autoimmune comorbidities on achalasia phenotype (clinical features and manometric pattern). Methods The study population consisted of 375 consecutive patients (215 females—median age 55 ± 17 years), referred at our tertiary referral center from January 2008 to January 2018, with clinical and instrumental (EGDS, barium esophagogram, and manometry) diagnosis of idiopathic achalasia. Gender- and age-matched subjects undergoing manometry and pH-impedance monitoring for typical gastroesophageal reflux (GERD) complaints served as controls. In all patients a detailed history taking was carried out, recording the presence and type of autoimmune comorbidities. Results The overall prevalence of autoimmune comorbidities was two times higher in achalasia than in control patients (12.3 vs. 5%, respectively). The presence of comorbidities did not significantly affect disease’s phenotype, as the age of disease onset was similar in achalasia patients with and without comorbidities (50.13 ± 14.47 and 48.3 ± 18.71, respectively, P = NS). Conclusions Although larger epidemiologic studies are needed to confirm our data, our findings likely suggest that achalasia has a complex multifactorial pathophysiology with an autoimmune component.

FA02.02: TWENTY-FIVE YEARS OF LAPAROSCOPIC TREATMENT FOR ESOPHAGEAL ACHALASIA: OUR EXPERIENCE ON 1000 LAPAROSCOPIC HELLER-DOR OPERATIONS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 3-3
Author(s):  
Mario Costantini ◽  
Renato Salvador ◽  
Giovanni Capovilla ◽  
Andrea Costantini ◽  
Anna Perazzolo ◽  
...  
Keyword(s):  
Chest Pain ◽  
Pain Score ◽  
Conflicts Of Interest ◽  
Ph Monitoring ◽  
Univariate Analysis ◽  
Esophageal Achalasia ◽  
Barium Swallow ◽  
Pneumatic Dilation ◽  
Tertiary Referral Center ◽  
Manometric Pattern

Abstract Background In the past decades, Laparoscopic Heller-Dor (LHD) progressively became the treatment of choice for esophageal achalasia. Aim of this study was to assess our 25-year experience with LHD at a single high-volume institution. Methods 1000 patients underwent LHD from 1992–2017 by 6 staff surgeons. Patients who had already been treated with surgical or endoscopic myotomy were ruled out. Symptoms were scored using a detailed questionnaire; barium swallow, endoscopy, manometry (conventional or High Resolution) were performed, before and after surgery, while 24-hour pH monitoring was performed 6 months after surgery. Treatment failure was defined as a postoperative symptom score >10th percentile of the preoperative score (i.e. >8). Results LHD was performed on 1000 patients (M: F = 536:464); the median age was 46 (IQR 36–54), 183 (18.3%) had a history of endoscopic treatments (pneumatic dilation or botox injections, or both). The surgical procedure was completed laparoscopically in all but 7 patients (0.7%) and there was one perioperative death for heart attack. There were 25 perforations (2.5%): 22 were recognized and repaired during the operation, 3 were detected by postoperative contrast swallow. In 674 patients the manometric pattern was classified as follows: 310 (46%) pattern I, 315 (46.7%) pattern II and 49 (7.3%) pattern III. The outcome was positive in 902 patients (90.2%). In patients who had a previous treatment the failures were 25/183 (13.7%) while in the primary treatment group the failures were 73/817 (8.9%) (P = 0.055). All the 98 patients whose LHD failed underwent one or more pneumatic dilations, which ameliorated their symptoms in all but 11 patients (10 required reoperation). The overall success rate of combined LHD and dilations was 98.4%. At univariate analysis, manometric pattern (P = 0.001), absent sigmoid megaesophagus (P = 0.003) and chest pain score (P = 0.002) were the only factors predictive of the result. At multivariate analysis, these three factors were independently associated with good outcome. Postoperative 24-hour pH was abnormal in 50/590 patients (8.5%). Two patients developed an esophageal cancer during follow-up. Conclusion In a university tertiary referral center, LHD relieves achalasia symptoms durably. The preoperative manometric pattern, the absence of a sigmoid esophagus and the chest pain score represent the strongest predictors of outcome. Disclosure All authors have declared no conflicts of interest.

scholarly journals Validation of the Japanese Version of the Center for Epidemiologic Studies Depression Scale—Revised: A Preliminary Analysis

2021 ◽  
Vol 11 (8) ◽  
pp. 107
Author(s):  
Hirohito Tsuboi ◽  
Yui Takakura ◽  
Hiromasa Tsujiguchi ◽  
Sakae Miyagi ◽  
Keita Suzuki ◽  
...  
Keyword(s):  
Factor Analysis ◽  
Depressive Symptoms ◽  
Native Speakers ◽  
Depression Scale ◽  
Japanese Version ◽  
Population Based ◽  
Epidemiologic Studies ◽  
Community Dwelling ◽  
Two Factors ◽  
Study Population

To make the Japanese version of the CESD-R—a revised version of the Center for Epidemiologic Studies depression scale (CES-D)—in the assessment of depressive symptoms in a general population. The English version of CESD-R was translated into Japanese, and back-translated into English by three native speakers of Japanese and English; then, we selected the version most completely consistent with the original items. The CESD-R was applied to 398 community-dwelling people (191 men: 48.0%, and 207 women: 52.0%) who were over 40 years old. The Japanese version of the CES-D was also carried out in the same population. Factor analysis was performed. Additionally, the correlations between the CESD-R and CES-D results were identified. The CESD-R scores showed a significantly positive correlation with CES-D scores (r = 0.74, p < 0.0005). Analysis of the CESD-R yielded a Cronbach’s alpha result of 0.90. Factor analysis revealed one principal factor in the CESD-R, whereas the original CES-D had two factors because of reversed items. The Japanese version of the CESD-R appears to have the reliability to be applicable for assessing depressive symptoms in population-based samples. However, because the Japanese expressions for some items might be unusual, our study population was also limited; further studies on other populations and on incorporating improved Japanese terminology will be needed.

Stria Vascularis Ultrastructural Pathology in the C3H/lpr Autoimmune Strain Mouse: A Potential Mechanism for Immune-Related Hearing Loss

1992 ◽  
Vol 106 (3) ◽  
pp. 288-295 ◽  
Author(s):  
Ilsa Schwartz ◽  
Sean O. McMenomey ◽  
Nancy J. Russell ◽  
Jane I. Morton ◽  
Dennis R. Trune
Keyword(s):  
Hearing Loss ◽  
Autoimmune Disease ◽  
Basement Membrane ◽  
Autoimmune Diseases ◽  
Stria Vascularis ◽  
Disease Onset ◽  
Systemic Autoimmune Disease ◽  
Potential Mechanism ◽  
Systemic Autoimmune Diseases ◽  
Strain Mouse

The stria vascularis in the C3H/ lpr autoimmune strain mouse was ultrastructurally examined in order to better understand the potential mechanisms by which systemic autoimmune disease affects the ear. The inner ears from C3H/ lpr mice before disease onset and C3H/HeJ controls showed no apparent pathology. However, the stria vascularis from older C3H/ lpr mice after systemic autoimmune disease onset showed considerable intercellular edema around the stria capillaries and thickening of the capillary basement membrane, compared to controls. These observations suggest that perivascular abnormalities, which are the hallmark of systemic autoimmune diseases, may underlie the stria dysfunction and hearing loss seen in autoimmune diseases in humans.

scholarly journals Assessment of vitamin D among Sudanese Patients with Hypothyroidism

2021 ◽  
Vol 1 (2) ◽  
pp. 057-061
Author(s):  
Hasna Osman Fadalla Mohamed ◽  
Omer Fadol Edris ◽  
Gad Allah Modawe ◽  
Suhair Abdelrahman Ahmed
Keyword(s):  
Vitamin D ◽  
Autoimmune Diseases ◽  
Vitamin D Deficiency ◽  
Vitamin D Supplementation ◽  
Control Hospital ◽  
Study Population ◽  
Thyroid Profile ◽  
Methods Analytical ◽  
The Relationship

Background: Vitamin D deficiency is a worldwide health issue and its role as an immune modulator has recently been emphasized. Evidence increasingly indicates the important role of vitamin D in reducing the incidence of autoimmune diseases. However, at this time the search for its role in autoimmune diseases and thyroid is not critical. Objectives: The study aimed to assess the relationship between vitamin D deficiency in Sudanese patients with hypothyroidism. Methods: Analytical case control hospital based study, conducted in Fadil Hospital and Police Hospital, Khartoum city, Khartoum state. The study carried out from March 2018 to September 2018. A total of 100 subjects were enrolled in the study. Vitamin D deficiency was set at levels below 20 ng / ml. Thyroid hormones (TSH, T3 and T4) were assessed in all participants using auto analyzer TOSOH AIA 313,while vitamin D was estimated using ELIZA. The data were analyzed using SPSS version (21). Results: The study included 76(76%) females and 24(24%) males, no significance differences between thyroid profile among study population.75 (75%) deficiency of vitamin D and 25(25%) normal vitamin D. vitamin D deficiency was significantly lower in female than male with( p =0.001). Conclusion: The results indicated that patients with hypothyroidism suffer from vitamin D deficiency significantly associated with the degree and severity of hypothyroidism. This encourages the desirability of vitamin D supplementation and recommends the detection of vitamin D deficiency for all hypothyroidism patients.

scholarly journals 2520

2017 ◽  
Vol 1 (S1) ◽  
pp. 82-82
Author(s):  
Meghan Spiroff ◽  
Lisa Connally ◽  
Anita Johnson ◽  
Aalap Doshi ◽  
Patricia Piechowski
Keyword(s):  
Clinical Trials ◽  
Best Practices ◽  
Health Research ◽  
Participant Recruitment ◽  
Gender And Age ◽  
Study Population ◽  
Gender And Age Differences ◽  
The University ◽  
Racial Ethnic ◽  
Research Studies

OBJECTIVES/SPECIFIC AIMS: Across the Clinical and Translational Science Award (CTSA) Consortium, participant recruitment into clinical trials is essential to advance science. Without proper participant recruitment, clinical trials do not result in gains in scientific knowledge, wastes time, funds, and other resources (Mahon et al., 2015). METHODS/STUDY POPULATION: Participant recruitment programs across the consortium are inconsistent in staffing, program services, and program goals. The participant recruitment program at the University of Michigan’s (U-M) Michigan Institute for Clinical & Health Research (MICHR) provides expertise, tools, and resources to facilitate participant recruitment in clinical and health research studies. RESULTS/ANTICIPATED RESULTS: We will explain our program infrastructure, staffing, services, and discuss how we maintain an engaged registry with over 27,000 participants interested in research studies at U-M. DISCUSSION/SIGNIFICANCE OF IMPACT: Proper recruitment into clinical trials results in findings that are relevant for genetic, cultural, linguistic, racial/ethnic, gender, and age differences (Cottler et al., 2013). We hope to share our best practices that aid in the development and success of participant recruitment across the CTSA Consortium.

scholarly journals Increased Concentration of Soluble CD40 Ligand in Preeclampsia

2007 ◽  
Vol 13 (2) ◽  
pp. 201-205 ◽  
Author(s):  
Inci Alacacioglu ◽  
Mehmet Ali Ozcan ◽  
Ozden Piskin ◽  
Faize Yuksel ◽  
Ahmet Alacacioglu ◽  
...  
Keyword(s):  
Endothelial Cell ◽  
Inflammatory Response ◽  
Cell Activation ◽  
Disease Onset ◽  
Cd40 Ligand ◽  
Endothelial Cell Activation ◽  
Soluble Cd40 Ligand ◽  
Future Studies ◽  
Study Population ◽  
The Mean

Preeclampsia has been associated with increased platelet activation detected before disease onset. Platelets are involved in hemostasis and also directly initiate an inflammatory response of the vessel wall. Inappropriate activation of platelets may be involved in pathogenesis in preeclampsia by promoting coagulation and thrombosis, and also as a mediator of inflammation. Platelets may release inflammatory mediators such as soluble CD40 ligand. The plasma level of soluble CD40 ligand was investigated during preeclamptic (n =20) and normal pregnancies (n = 20) to emphasize inflammatory response in preeclampsia. The mean soluble CD40 ligand levels were 1.08 ± 0.43 ng/mL in patients with preeclampsia and 0.76 ± 0.24 ng/mL in healthy pregnant women, which was statistically significant ( P = .01). To clarify whether inflammation may cause inappropriate endothelial cell activation or inappropriate endothelial cell activation may start this inflammatory response, future studies are needed in a larger study population.

The Ratio of Treg/Th17 Cells Correlates with the Platelet Number in Different Disease State of Primary Immune Thrombocytopenia

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4649-4649
Author(s):  
Lili Ji ◽  
Feng Li ◽  
Yanxia Zhan ◽  
Fanli Hua ◽  
Shanhua Zou ◽  
...  
Keyword(s):  
Autoimmune Diseases ◽  
Th17 Cells ◽  
Immune Thrombocytopenia ◽  
Conflicts Of Interest ◽  
Disease Onset ◽  
Treg Cells ◽  
Healthy Controls ◽  
T Helper ◽  
Platelet Number ◽  
Primary Immune Thrombocytopenia

Abstract Abstract 4649 Background: Primary immune thrombocytopenia (ITP) is an autoimmune heterogeneous disorder that is characterized by decreased platelet count. Regulatory T (Treg) cells and T helper type 17 (Th17) cells are two subtypes of CD4+T helper (Th) cells. They play opposite roles in immune tolerance and autoimmune diseases, while they share a common differentiation pathway. The imbalance of Treg/Th17 has been demonstrated in several autoimmune diseases. In this study, we aimed to investigate the ratio of the number of Tregs to the number of Th17 cells in ITP patients and evaluate the clinical implications of the alterations in this ratio. Methods: Thirty adult patients with newly diagnosed ITP enrolled in this study. Patients who needed treatment had been clinically followed up for 12 months. The percentages of CD4+CD25hiFoxp3+ Treg cells and CD3+CD4+IL-17-producing Th17 cells in these patients and healthy controls (n=17) were longitudinally analyzed by flow cytometry. Results: The percentage of Treg cells in ITP patients was significantly lower than that of healthy controls and the percentage of Th17 cells increased significantly at disease onset. It is suggested that the ratio of Treg/Th17 correlated with the disease activity. Conclusion: The ratio of Treg/Th17 might be relevant to the clinical diversity of ITP patients, and this Treg/Th17 ratio might have prognostic role in ITP patients. Disclosures: No relevant conflicts of interest to declare.

Minimally Invasive Thoracoscope-Assisted Heller Myotomy for Achalasia

2008 ◽  
Vol 16 (6) ◽  
pp. 459-462
Author(s):  
Nan Ma ◽  
Hong Zhong ◽  
Chuanzhong Ye ◽  
Genfa Shan ◽  
Fuxian Zhang ◽  
...  
Keyword(s):  
Heller Myotomy ◽  
Clinical Manifestations ◽  
Esophageal Achalasia ◽  
Clinical History ◽  
Esophageal Pressure ◽  
Normal Diet ◽  
Hospital Death ◽  
Minimal Incision ◽  
Mucosal Perforation ◽  
Barium Esophagogram

Forty-five patients (20 men and 25 women) with a median age of 46.5 years, who were diagnosed with esophageal achalasia by clinical history, esophagoscopy, and barium esophagogram, underwent thoracoscope-assisted Heller myotomy with a minimal incision. Esophageal pressure and pH were monitored. Two patients were excluded because of mucosal perforation during the operation, requiring conversion to an open procedure. There was no postoperative esophageal leakage or hospital death. All patients resumed a normal diet as soon as gastrointestinal function recovered, and their symptoms disappeared completely. The mean operative time was 1.2 hours (range, 0.5–3.8 hours). After 2.1 years of follow-up, the outcome was rated excellent in 33 (77%) patients, good in 7 (16%), and fair in 3 (7%). Esophageal dilation was required in 3 patients because of relapsing dysphagia within 3 months after the operation. Four (9%) patients had some regurgitation but no further surgical or medical treatment was needed. Esophageal pressure and pH correlated with the clinical manifestations. Our modified Heller myotomy with the assistance of thoracoscopy is effective for achalasia.

Early disease onset and increased risk of other autoimmune diseases in familial generalized vitiligo

2005 ◽  
Vol 18 (4) ◽  
pp. 300-305 ◽  
Author(s):  
Greggory Laberge ◽  
Christina M. Mailloux ◽  
Katherine Gowan ◽  
Paulene Holland ◽  
Dorothy C. Bennett ◽  
...  
Keyword(s):  
Autoimmune Diseases ◽  
Disease Onset ◽  
Early Disease ◽  
Increased Risk

scholarly journals High Prevalence of Antinuclear Antibodies in Children with Thyroid Autoimmunity

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Maria Segni ◽  
Ida Pucarelli ◽  
Simona Truglia ◽  
Ilaria Turriziani ◽  
Chiara Serafinelli ◽  
...  
Keyword(s):  
Autoimmune Diseases ◽  
Rheumatic Diseases ◽  
Antinuclear Antibodies ◽  
Pediatric Patients ◽  
Thyroid Autoimmunity ◽  
Disease Onset ◽  
Nuclear Antigen ◽  
Chronic Lymphocytic Thyroiditis ◽  
Autoimmune Thyroid Diseases ◽  
Autoimmune Thyroid

Background. Antinuclear antibodies (ANA) are a hallmark of many autoimmune diseases and can be detected many years before disease onset. Autoimmune thyroid diseases (AITD) are frequently associated with other organ- and non-organ-specific autoimmune disorders.Objectives. To assess the prevalence of ANA in pediatric patients with AITD and their clinical correlations.Methods. Ninety-three consecutive pediatric patients with AITD were enrolled (86 children with chronic lymphocytic thyroiditis and 7 with Graves’ disease). ANA, anti-double DNA (anti-dsDNA) antibodies, anti-extractable nuclear antigen (anti-ENA), anti-cyclic citrullinated peptide antibodies (anti-CCP), and rheumatoid factor (RF) was obtained. Signs and symptoms potentially related to rheumatic diseases in children were investigated by a questionnaire.Results. ANA positivity was found in 66/93 children (71%), anti-ENA in 4/93 (4.3%), anti-dsDNA in 1/93 (1.1%), RF in 3/93 (3.2%), and anti-CCP in none. No significant differences were found between the ANA-positive and ANA-negative groups with respect to age, sex, L-thyroxine treatment, or prevalence of other autoimmune diseases. Overall, parental autoimmunity was found in 23%.Conclusions. ANA positivity was demonstrated in 71% of children with AITD. ANA positivity was not related to overt immune-rheumatic diseases. However, because the positivity of ANA can occur even many years before the onset of systemic autoimmune diseases, prospective studies are warranted.

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