Items in AFP with MESH term: Disease Progression
Common Questions About Barrett Esophagus - Article
ABSTRACT: Barrett esophagus is a precancerous metaplasia of the esophagus that is more common in patients with chronic reflux symptoms, although it also occurs in patients without symptomatic reflux. Other risk factors include smoking, male sex, obesity, white race, hiatal hernia, and increasing age (particularly older than 50 years). Although Barrett esophagus is a risk factor for esophageal adenocarcinoma, its management and the need for screening or surveillance endoscopy are debatable. The annual incidence of progression to esophageal cancer is 0.12% to 0.33%; progression is more common in patients with high-grade dysplasia and long-segment Barrett esophagus. Screening endoscopy should be considered for patients with multiple risk factors, and those who have lesions with high-grade dysplasia should undergo endoscopic mucosal resection or other endoscopic procedures to remove the lesions. Although the cost-effectiveness is questionable, patients with nondysplastic Barrett esophagus can be followed with endoscopic surveillance. Lowgrade dysplasia should be monitored or eradicated via endoscopy. Although there is no evidence that medical or surgical therapies to reduce acid reflux prevent neoplastic progression, proton pump inhibitors can be used to help control reflux symptoms.
ABSTRACT: Adolescent idiopathic scoliosis is the most common form of scoliosis, affecting approximately 2% to 4% of adolescents. The incidence of scoliosis is about the same in males and females; however, females have up to a 10-fold greater risk of curve progression. Although most youths with scoliosis will not develop clinical symptoms, scoliosis can progress to rib deformity and respiratory compromise, and can cause significant cosmetic problems and emotional distress for some patients. For decades, scoliosis screenings were a routine part of school physical examinations in adolescents. The U.S. Preventive Services Task Force and American Academy of Family Physicians recommend against routine scoliosis screening in asymptomatic adolescents, concluding that harm from screening outweighs the benefit because screenings expose many low-risk adolescents to unnecessary radiographs and referrals. In contrast, the Scoliosis Research Society, American Academy of Orthopaedic Surgeons, American Academy of Pediatrics, and Pediatric Orthopaedic Society of North America suggest that the potential benefit of detecting scoliosis early justifies screening programs, but greater care should be used in deciding which patients with positive screening results need further evaluation. The goal for primary care physicians is to identify patients who are at risk of developing problems from scoliosis, without overtesting or overreferring patients who are unlikely to have further problems. Physical examination with the Adam’s forward bend test and a scoliometer measurement can guide judicious use of radiologic testing for Cobb angle measurement and orthopedic referrals. Treatment options include observation, braces, and surgery.