Lactobacillus fermentum was enriched in oesophageal adenocarcinoma (p=0♰28), and lactic acid bacteria dominated the microenvironment in seven (47%) of 15 cases of oesophageal adenocarcinoma.
There was decreased microbial diversity in oesophageal adenocarcinoma tissue compared with tissue from healthy control patients as measured by the observed operational taxonomic unit (OTU) richness (p=0♰012), Chao estimated total richness (p=0♰004), and Shannon diversity index (p=0♰075). We compared fresh frozen tissue, fresh frozen endoscopic brushings, and the Cytosponge device for microbial DNA yield (qPCR), diversity, and community composition. Samples were taken from patients enrolled in the BEST2 study at five UK hospitals and the OCCAMS study at six UK hospitals. In this case-control study, 16S rRNA gene amplicon sequencing was done on 210 oesophageal samples from 86 patients representing the Barrett's oesophagus progression sequence (normal squamous controls, non-dysplastic and dysplastic Barrett's oesophagus, and oesophageal adenocarcinoma ), relevant negative controls, and replicates on the Illumina MiSeq platform. We aimed to profile the microbiota at different stages of Barrett's carcinogenesis and investigate the Cytosponge as a minimally invasive tool for sampling the oesophageal microbiota. The strongest risk factor for oesophageal adenocarcinoma is reflux disease, and the rising incidence of this coincides with the eradication of Helicobacter pylori, both of which might alter the oesophageal microbiota. The current paradigm of GERD management is shifting toward a personalized approach, utilizing physiologic testing to understand a particular patient mechanism of reflux and guide an evidence-based and patient-centered therapeutic plan. Expanding treatment options for PPI nonresponsive GERD include adjunctive pharmacologic therapy to further attempt to decrease the reflux burden, neuromodulation, psychologic interventions, and anti-reflux interventions, including surgical and endoluminal approaches. Up to 40% of patients with symptoms of GERD will not respond adequately to PPI therapy, and this group warrants further diagnostic evaluation with endoscopy and ambulatory reflux monitoring. GERD remains a known risk factor for development of Barrett’s esophagus which may further progress to esophageal adenocarcinoma, though women are less likely to develop Barrett’s esophagus. Proton pump inhibitor (PPI) therapy is most commonly trialed for gastric acid suppression, and with increasing utilization of PPI therapy, GERD less commonly manifests with erosive esophageal injury such as severe esophagitis and peptic strictures. First-line treatment options for GERD are lifestyle interventions and may include pharmacologic gastric acid suppression. Typical symptoms of GERD include heartburn and regurgitation, though atypical and extraesophageal symptom presentations of GERD also frequently need evaluation. Gastroesophageal reflux disease (GERD) affects up to three in ten adult women Americans and can present with symptoms and/or erosive complications.
0 kommentar(er)
