{"id":117467,"date":"2018-03-11T10:47:03","date_gmt":"2018-03-11T10:47:03","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/tratamiento-medico-versus-quirurgico-en-el-esofago-de-barret-resultados-cla%c2%adnicos-histologicos-y-moleculares-ki-67-p53-y-apoptosis-a-largo-plazo-de-un-estudio-prospectivo-y-randomizado\/"},"modified":"2018-03-11T10:47:03","modified_gmt":"2018-03-11T10:47:03","slug":"tratamiento-medico-versus-quirurgico-en-el-esofago-de-barret-resultados-cla%c2%adnicos-histologicos-y-moleculares-ki-67-p53-y-apoptosis-a-largo-plazo-de-un-estudio-prospectivo-y-randomizado","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/ciencias-medicas\/tratamiento-medico-versus-quirurgico-en-el-esofago-de-barret-resultados-cla%c2%adnicos-histologicos-y-moleculares-ki-67-p53-y-apoptosis-a-largo-plazo-de-un-estudio-prospectivo-y-randomizado\/","title":{"rendered":"Tratamiento m\u00e9dico versus quir\u00fargico en el es\u00f3fago de barret: resultados cl\u00ednicos, histol\u00f3gicos y moleculares (ki-67, p53 y apoptosis) a largo plazo, de un estudio prospectivo y randomizado."},"content":{"rendered":"

Tesis doctoral de David Ruiz De Angulo Martin <\/strong><\/h2>\n

Introducci\u00f3n \tel es\u00f3fago de barrett es la \u00fanica lesi\u00f3n conocida en la actualidad que predispone a padecer un adenocarcinoma de es\u00f3fago, enfermedad que asocia una baja supervivencia a los 5 a\u00f1os y cuya incidencia est\u00e1 aumentando en los pa\u00edses desarrollados. La metaplasia que representa el es\u00f3fago de barrett se produce como consecuencia de una exposici\u00f3n continuada de la mucosa esof\u00e1gica a un excesivo reflujo gastroesof\u00e1gico tanto \u00e1cido como biliar. \tlas dos principales opciones de tratamiento en el es\u00f3fago de barrett son el tratamiento m\u00e9dico de por vida, principalmente con inhibidores de la bomba de protones, y el tratamiento quir\u00fargico mediante la pr\u00e1ctica de t\u00e9cnicas antireflujo, siendo la m\u00e1s importante la fundoplicatura de nissen. Por otra parte, existen determinados biomarcadores moleculares, como ki-67, p53 y el \u00edndice de apoptosis, que intervienen en la tumorog\u00e9nesis y cuya cuantificaci\u00f3n indica el grado de inestabilidad de un epitelio. objetivos 1.\tDeterminar qu\u00e9 tipo de tratamiento, m\u00e9dico o quir\u00fargico, es m\u00e1s eficaz no solo en el control de los s\u00edntomas de reflujo en los pacientes con es\u00f3fago de barrett sino tambi\u00e9n en prevenir su progresi\u00f3n a displasia y adenocarcinoma. 2.\tEstudiar el grado de apoptosis, el \u00edndice de proliferaci\u00f3n celular (ki-67) y la expresi\u00f3n de proto-oncogenes (p53) en las biopsias de los pacientes con es\u00f3fago de barrett y observar su evoluci\u00f3n en el tiempo tras la aplicaci\u00f3n del tratamiento m\u00e9dico o quir\u00fargico, para determinar si alguno de los dos estabiliza el epitelio metapl\u00e1sico disminuyendo en mayor medida la probabilidad de sufrir transformaci\u00f3n maligna. pacientes y m\u00e9todo desde 1982 hasta 2012, 161 pacientes con es\u00f3fago de barrett fueron incluidos en el estudio asignando de manera aleatoria uno de los dos tratamientos (40 mg de omeprazol al d\u00eda o una fundoplicatura de nissen). La valoraci\u00f3n inicial de todos los sujetos (75 bajo tratamiento m\u00e9dico y 86 bajo tratamiento quir\u00fargico) as\u00ed como durante el seguimiento peri\u00f3dico incluye una entrevista cl\u00ednica, una endoscopia digestiva alta con toma m\u00faltiple de biopsias, un tr\u00e1nsito baritado y pruebas funcionales esof\u00e1gicas (manometr\u00eda intraluminal estacionaria, ph-metr\u00eda ambulatoria de 24 horas y bilitec). resultados \tambos tipos de tratamiento resultaron igualmente eficaces tanto en el control de s\u00edntomas como en su capacidad protectora respecto a la malignizaci\u00f3n. No obstante, cuando la fundoplicatura es competente (74 pacientes), protege en mayor medida de la progresi\u00f3n a displasia de bajo grado. La cirug\u00eda eficaz no elimin\u00f3 la posibilidad de malignizaci\u00f3n en todos los casos ya que 3 sujetos con una fundoplicatura competente sufrieron malignizaci\u00f3n. Dos de estos pacientes pertenecen a familias con alta preValencia de barrett y adenocarcinoma y el otro paciente padece esclerodermia, enfermedad reflux\u00f3gena. \tobservamos que los niveles de ki-67 y p53 se estabilizaron tras la fundoplicatura de nissen mientras que sufrieron un aumento progresivo en los sujetos sometidos a tratamiento m\u00e9dico. Al contrario sucedi\u00f3 con el \u00edndice apopt\u00f3tico que aument\u00f3 tras la cirug\u00eda y continu\u00f3 disminuyendo tras la aplicaci\u00f3n de los inhibidores de la bomba de protones. Estas diferencias se mantuvieron al comparar dos grupos de tratamiento quir\u00fargico y m\u00e9dico eficaces, es decir, con ph-metr\u00edas negativas. summary of the thesis introduction barrett's esophagus is the only currently known lesion that predisposes to suffer an adenocarcinoma of the esophagus, a condition associated with poor survival at 5 years and whose incidence is increasing in developed countries. The metaplasia representing barrett's esophagus occurs as a result of continued exposure of the esophageal mucosa to both excessive acid reflux biliary. the two main treatment options for barrett's esophagus include medical treatment for life, mainly inhibitors proton pump, and surgical treatment by practicing antireflux techniques, the most important is nissen fundoplication. Moreover, certain molecular biomarkers, such as ki-67, p53 and apoptosis index, involved in tumorigenesis which quantification and indicates the degree of instability of an epithelium. objectives 1. Determine what type of treatment, medical or surgical, is more effective not only in controlling reflux symptoms in patients with barrett's esophagus but also prevent progression to dysplasia and adenocarcinoma. 2. To study the degree of apoptosis, cell proliferation index (ki-67) and the expression of proto-oncogenes (p53) in biopsies of patients with barrett's esophagus and observe their evolution over time after application of medical treatment or surgical, to determine if any of the two stabilizes the metaplastic epithelium further decreasing the likelihood of malignant transformation. patients and methods from 1982-2012, 161 patients with barrett's esophagus were included in the study randomly assigned one of two treatments (40 mg omeprazole daily or nissen fundoplication). The initial assessment of all subjects (75 medical and 86 surgical) as well as during the periodic monitoring includes a clinical interview, an upper endoscopy with multiple biopsies a barium swallow and esophageal function tests (stationary intraluminal manometry , ambulatory ph monitoring 24 hours and bilitec). results both types of treatment both were equally effective in controlling symptoms such as in its protective capacity with respect to malignancy. However, when the fundoplication is competent (74 patients), protects more on the progression to low-grade dysplasia. Effective surgery did not eliminate the possibility of malignancy in all cases because 3 patients with malignant suffered a competent fundoplication. Two of these patients from families with high prevalence and barrett's adenocarcinoma and one patient suffering from scleroderma, pro-reflux disease. we observed that the levels of ki-67 and p53 stabilized after nissen fundoplication while suffered a progressive increase in subjects undergoing medical treatment. Unlike happened with the apoptotic index increased after surgery and continued to decline after application of inhibitors of proton pump. These differences remained when comparing two groups effective surgical and medical treatment, ie ph-negative asymmetries.<\/p>\n

 <\/p>\n

Datos acad\u00e9micos de la tesis doctoral \u00abTratamiento m\u00e9dico versus quir\u00fargico en el es\u00f3fago de barret: resultados cl\u00ednicos, histol\u00f3gicos y moleculares (ki-67, p53 y apoptosis) a largo plazo, de un estudio prospectivo y randomizado.<\/strong>\u00ab<\/h3>\n
    \n
  • T\u00edtulo de la tesis:<\/strong>\u00a0 Tratamiento m\u00e9dico versus quir\u00fargico en el es\u00f3fago de barret: resultados cl\u00ednicos, histol\u00f3gicos y moleculares (ki-67, p53 y apoptosis) a largo plazo, de un estudio prospectivo y randomizado. <\/li>\n
  • Autor:<\/strong>\u00a0 David Ruiz De Angulo Martin <\/li>\n
  • Universidad:<\/strong>\u00a0 Murcia<\/li>\n
  • Fecha de lectura de la tesis:<\/strong>\u00a0 13\/05\/2015<\/li>\n<\/ul>\n

     <\/p>\n

    Direcci\u00f3n y tribunal<\/h3>\n
      \n
    • Director de la tesis<\/strong>\n
        \n
      • Angeles Ortiz Escandell<\/li>\n<\/ul>\n<\/li>\n
      • Tribunal<\/strong>\n
          \n
        • Presidente del tribunal: vicente (secretario) Munitiz ruiz <\/li>\n
        • Manuel Pera rom\u00e1n (vocal)<\/li>\n
        • Miguel Minguez perez (vocal)<\/li>\n
        • (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

           <\/p>\n","protected":false},"excerpt":{"rendered":"

          Tesis doctoral de David Ruiz De Angulo Martin Introducci\u00f3n el es\u00f3fago de barrett es la \u00fanica lesi\u00f3n conocida en la […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"footnotes":""},"categories":[155,9,141,387,8235],"tags":[231444,231443,24960,85313,231445],"class_list":["post-117467","post","type-post","status-publish","format-standard","hentry","category-ciencias-clinicas","category-ciencias-medicas","category-cirugia","category-cirugia-abdominal","category-murcia","tag-angeles-ortiz-escandell","tag-david-ruiz-de-angulo-martin","tag-manuel-pera-roman","tag-miguel-minguez-perez","tag-vicente-secretario-munitiz-ruiz"],"_links":{"self":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/117467","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/comments?post=117467"}],"version-history":[{"count":0,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/117467\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/media?parent=117467"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/categories?post=117467"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/tags?post=117467"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}