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//Grabs the Iframe . 3. var ifr = document.getElementById(" PDF ");. 4. . 5. // PDF is completely loaded. (. load () wasn't working properly with PDFs ). 6. reflux, it arises from chronic reflux-induced injury to the esophageal squamous epithelium Barrett s esophagus is suspected at endoscopy from the presence of orange, gastric type epithelium that extends upward from the stomach into the distal tubular esophagus in a tongue-like or circumferential fashion Biopsies obtained at endoscopy confirm the diagnosis Three types of columnar epithelium may be identified: gastric cardiac, gastric fundic, and specialized intestinal metaplasia Only the latter is believed to carry an increased risk of neoplasia Barrett s esophagus does not provoke specific symptoms but gastroesophageal reflux does Most patients have a long history of reflux symptoms, such as heartburn and regurgitation Paradoxically, one-third of patients report minimal or no symptoms of gastroesophageal reflux disease, suggesting decreased acid sensitivity of Barrett s epithelium Indeed, over 90% of individuals with Barrett s esophagus in the general population do not seek medical attention Barrett s esophagus should be treated with long-term proton pump inhibitors Medical therapy may prevent progression, but there is no convincing evidence that regression occurs in most patients The most serious complication of Barrett s esophagus is esophageal adenocarcinoma It is believed that most adenocarcinomas of the esophagus and many such tumors of the gastric cardia arise from dysplastic epithelium in Barrett s esophagus The incidence of adenocarcinoma in patients with Barrett s esophagus is 05%/year Although this is a 40-fold increased risk compared with patients without Barrett s esophagus, adenocarcinoma of the esophagus remains a relatively uncommon malignancy in the United States (7000 cases/year) Given the large number of adults with chronic gastroesophageal reflux disease relative to the small number in whom adenocarcinoma develops, it is unclear whether screening or surveillance for Barrett s esophagus is cost-effective A number of endoscopic therapies (multipolar electrocoagulation, argon plasma coagulation, and photodynamic therapy using photosensitizers and laser energy) have been used to ablate the Barrett s epithelium in order to reduce the risk of progression to neoplasia These techniques are often incompletely effective, have a significant risk of complications (bleeding, perforation, strictures), and may result in mucosal healing in which residual metaplastic tissue is buried beneath reconstituted squamous epithelium The FDA has recently approved a bipolar probe (HALO) that uses radiofrequency wave energy for thermal ablative therapy Preliminary studies with this probe demonstrate complete eradication of Barrett s epithelium in up to 70% of patients without significant complications Further long-term studies are needed to establish the role of ablative therapy in patients with Barrett s esophagus without dysplasia Current clinical guidelines recommend screening endoscopy in patients with long-standing reflux symptoms to look for Barrett s esophagus and surveillance endoscopy every 3 5 years in patients with Barrett s esophagus to look for dysplasia or adenocarcinoma Patients with low-grade dysplasia require repeat endoscopic surveillance in 3 6 months to screen for coexisting high-grade dysplasia or cancer If low-grade dysplasia persists (which occurs in < 25% of. javascript pdf viewer print: Print silently pdf file in web application | The ASP.NET Forums javascript print pdf file print multiple document( pdf ) but show only one print dialogue ...
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