Stuart Spechler

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Eosinophilic esophagitis (EoE) is a clinicopathologic condition of increasing recognition and prevalence. In 2007, a consensus recommendation provided clinical and histopathologic guidance for the diagnosis and treatment of EoE; however, only a minority of physicians use the 2007 guidelines, which require fulfillment of both histologic and clinical(More)
BACKGROUND Barrett's esophagus, a condition of intestinal metaplasia of the esophagus, is associated with an increased risk of esophageal adenocarcinoma. We assessed whether endoscopic radiofrequency ablation could eradicate dysplastic Barrett's esophagus and decrease the rate of neoplastic progression. METHODS In a multicenter, sham-controlled trial, we(More)
When the distal esophagus is lined by a segment of columnar epithelium that is abnormal either because it is extensive or because it has intestinal features, the condition is called Barrett's esophagus. Traditionally, Barrett's esophagus has been associated with severe gastroesophageal reflux disease (GERD) and with a high risk for adenocarcinoma. Recently,(More)
The AGA Institute Medical Position Panel consisted of the authors of the technical review (Stuart J. Spechler, MD, AGAF, Prateek Sharma, MD, Rhonda F. Souza, MD, AGAF, John M. Inadomi, MD, AGAF, Nicholas J. Shaheen, MD, MPH, AGAF), the chair of the Medical Position Panel (John I. Allen, MD, MBA, AGAF), the chair of the AGA Institute Practice Management and(More)
BACKGROUND Endoscopic oesophageal changes are diagnostically helpful and identify patients exposed to the risk of disease chronicity. However, there is a serious lack of agreement about how to describe and classify the appearance of reflux oesophagitis AIMS To examine the reliability of criteria that describe the circumferential extent of mucosal breaks(More)
BACKGROUND & AIMS The study and management of reflux esophagitis require an endoscopic classification system founded on esophageal lesions that can be reproducibly identified. The aim of this study was to investigate interobserver agreement for the identification of endoscopic lesions typical of reflux esophagitis. METHODS Paired comparisons of observers'(More)
CONTEXT Severe gastroesophageal reflux disease (GERD) is a lifelong problem that can be complicated by peptic esophageal stricture and adenocarcinoma of the esophagus. OBJECTIVE To determine the long-term outcome of medical and surgical therapies for GERD. DESIGN AND SETTING Follow-up study conducted from October 1997 through October 1999 of a(More)
Specialised columnar epithelium (SCE), a form of intestinal metaplasia usually found in Barrett's oesophagus, cannot be distinguished endoscopically from normal gastric epithelium. Endoscopists seldom obtain biopsy specimens from a normal-appearing gastro-oesophageal junction, and therefore short segments of SCE in this region may go unrecognised. We(More)
BACKGROUND Conventional medical treatment for gastroesophageal reflux disease involves life-style modifications and combination drug therapy, but few studies have included these features in their protocols. Antireflux surgery has seldom been studied prospectively, and there have been no trials comparing modern medical and surgical treatments for reflux(More)
Gastroesophageal reflux is associated with adenocarcinoma in Barrett's esophagus, but the incidence of this tumor is rising, despite widespread use of acid-suppressing medications. This suggests that refluxed material other than acid might contribute to carcinogenesis. We looked for potentially carcinogenetic effects of two bile acids, deoxycholic acid(More)