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Title: Studies in benign oesophageal diseases with special emphasis on symptomatic and economic impact
Author: Hewett, Rhys
ISNI:       0000 0004 6057 6693
Awarding Body: St George's, University of London
Current Institution: St George's, University of London
Date of Award: 2017
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Background: Barrett's oesophagus (BO) is a change in oesophageal cell type from chronic oesophageal acid exposure, achalasia is a primary oesophageal motility disorder thought to result from an aberrant immune response and eosinophilic oesophagitis (EoE) is an immune mediated condition. Although benign, Achalasia, BO and EoE may nonetheless have a considerable impact on the lives of those affected. Furthermore, whilst these three diseases may appear to be a heterogeneous, there is however considerable overlap between them; they are all chronic conditions, may need long-term or repeated courses of therapy and have a significant impact on the lives of those affected. Aims: 1 To assess the potential cost saving implications of UK hospital trusts adopting the latest BSG guidelines on BO surveillance. 2 To assess if there are any ethnic differences in histological findings in BO. 3 To investigate the quality of life (QoL) in EoE in the UK. 4 To investigate the potential physiological mechanisms underlying recurrent symptoms occurring after treatment in achalasia. Methods: 1 and 2 Retrospective endoscopy database analysis of St George's hospital BO patients. 2 Case-control study assessing QoL and dysphagia of EoE patients compared to healthy controls. 3 Symptomatic and physiological assessment of patients with achalasia with recurrent symptoms occurring after treatment. Results: 1 There may be considerable cost savings from UK hospital trusts adopting the latest BSG BO surveillance guidelines. 2 Indian sub-continent Asians (ISCAs) with BO have a lower risk of intestinal metaplasia than other ethnicities. 3 Physical QoL is unchanged in EoE, whereas mental QoL is marginally impaired. 4 No relationship was found between recurrent symptoms after treatment and oesophageal emptying, lower oesophageal sphincter (LOS) pressures and LOS distensibility; there was however significant correlation between these physiological variables. Conclusions: 1 UK hospital trusts would be advised to quickly adopt the latest BSG surveillance guidelines for BO. 2 Further study is warranted to investigate any reasons underlying lower rates of IM in ISCAs as this may be of therapeutic value. 3 Reassurance and education for newly diagnosed EoE patients would seem to be very important. 4 Mechanisms underlying symptom recurrence in achalasia may be complex and requires further study.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available