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1. Introduction
Due to anatomical location and function, esophageal motility disorders, inflammatory diseases, gastroesophageal reflux (GER), esophageal rings and webs, tumors and other esophageal conditions and diseases can cause many extraesophageal symptoms, which are increasingly recognised and diagnosed by otolaryngologists, pulmonologists, cardiologists, and, of course, gastroenterologists. Certain pathophysiological conditions that are not localized in the esophagus may be the first symptoms of esophageal disease or signs associated with the onset of esophageal disease. One of the etiological factors is the pathophysiological mechanism of the increase in intra-abdominal pressure that occurs during weight gain and in pregnancy. Another etiological factor is the pathophysiological mechanism of relaxation of the lower esophageal sphincter that may occur due to coronary heart disease drug therapy rich in nitrates. A similar thing happens during antirheumatic therapy in rheumatoid arthritis and some degenerative diseases of the locomotor system. Other conditions that may be associated with gastroesophageal reflux and esophageal diseases include diabetes mellitus, which results in prolonged gastric stagnation and consequent prolonged gastric emptying, and duodenal ulcer, duodenal stenosis, or malignant gastric disease in which delayed gastric emptying is present. So far, it is a well-known fact that the appropriate speed of food passage through the gastrointestinal tract, which is conditioned by a series of autoregulatory processes, is important. An optimal rate of passage is required - small enough to complete food digestion and absorption of substances and large enough to supply the body with the necessary nutrients in a timely manner [1]. The most common atypical symptoms of esophageal disease, primarily esophagitis and gastroesophageal reflux disease (GERD), will be listed here. For better visibility and easier understanding, the classification of atypical extraesophageal symptoms was performed according to the criterion of anatomical localization (Figure 1):
otolaryngological manifestations
thoracic manifestations
cardiac manifestations
Figure 1.
Extraesophageal manifestation of esophageal diseases.
And last but not least, the biopsychosocial dimensions of esophageal diseases and extraesophageal symptoms are being recognized, too.
2. Otolaryngologic manifestations
2.1 Chronic laryngitis and laryngopharyngeal reflux (LPR)
Patients with reflux laryngitis often have characteristic anamnestic data and records in the history of the disease. Common symptoms of laryngitis include chronic or intermittent recurrent cough, chronic sore throat, hoarseness, clearing of the throat, dry mouth, feeling of a ‘lump’ and tickling in the throat, nocturnal dyspnea, laryngospasm and dyspepsia. Inspection of the laryngeal mucosa may reveal erythema and edema of the mucosa covering the arytenoid cartilage, the posterior part of the larynx, and often the posterior part of the true vocal cords.
Two theories explain the pathogenesis of reflux laryngitis:
theory of direct injury of the laryngeal mucosa and surrounding tissue by acid and pepsin;
Due to direct injury to the laryngeal and pharyngeal mucosa, mucociliary transport is damaged and secretions accumulate in the throat, which causes additional irritation of the mucosa and contributes to the symptoms of postnasal drip, throat clearing and foreign body sensation in the throat. As the larynx lacks the protective external cleansing and salivary mechanisms that neutralize acid, gastric reflux remains undiluted for a long time, resulting in tissue injury. The action of pepsin leads to the depletion of the carbonic anhydrase isoenzyme III, and it catalyzes the reversible hydration of carbon dioxide resulting in the production of bicarbonate ions. The formation of bicarbonate ions directly neutralizes the acidic stomach contents and inactivates pepsin, so the ions actually protect the tissue from acid refluxate [3, 4]. On the other hand, depletion of carbonic anhydrase isoenzyme III reduces the neutralization of acidic gastric contents and allows its prolonged activity. According to the reflex theory, laryngopharyngeal reflux occurs due to esophageal reflux that stimulates vagal-mediated reflexes, resulting in a subjective need to ‘clear’ the throat and a chronic cough that leads to injury to the laryngeal mucosa. Laryngopharyngeal reflux is a clinical entity that represents the return of gastric contents to the space of the larynx and hypopharynx, which causes the contact of acid with the tissues of the upper aerodigestive tract [5]. In the physiological state, the upper and lower esophageal sphincters act together and prevent reflux of gastric contents into the esophagus and upper aerodigestive tract. Howewer, the pathophysiology of LPR is typically attributed to a defect or dysfunction of the upper esophageal sphincter. The esophagus features a number of protective mechanisms which prevent injury of the mucosa, which the laryngopharyngeal mucosa do not possess, and are more susceptible to damage from acid reflux. Laryngeal epithelium is up to 100 times more susceptible to pepsin damage than esophageal tissue [6]. Regurgitation of the contents may cause primary burning and/or sore throat, cough, need for excessive throat cleansing, and secondarily may cause symptoms such as dysphonia, productive expectoration and globus hystericus (feeling of a ‘lump’ in the throat). Signs of laryngopharyngeal reflux are visible in the form of laryngeal irritations, hyperemic mucosa of the vocal cords and arytenoids, thinned vocal cords, posterior pharyngeal wall abnormalities, erythema, edema, and discontinuity of mucosal continuity. Of these symptoms, laryngeal irritations and abnormalities of the posterior pharyngeal wall have a statistically significant prevalence in patients with reflux. It should be noted that these symptoms, in addition to esophagitis and gastroesophageal reflux disease, are also present in persons exposed to allergens and irritants and in postnasal drip syndrome. Most authors interpret laryngopharyngeal reflux as atypical gastroesophageal reflux, although some authors disagree with this interpretation given the different pathophysiology and symptomatology of these refluxes [7]. It is important to emphasize that the etiology of reflux in laryngopharyngeal and gastroesophageal reflux is not the same, just as the form and circumstances of occurrence are not quite the same. For example, laryngopharyngeal reflux occurs more often during the day in an upright position, while gastroesophageal reflux occurs in a horizontal position and at night, or during sleep. Different body composition of patients with laryngopharyngeal and gastroesophageal reflux [8] was also observed, and published studies show an association between increased body mass index (identified as obesity) and gastroesophageal reflux disease [9] and a statistically significant higher incidence of gastroesophageal reflux disease in patients with registered obesity. In contrast, increased body mass index is not statistically significant in patients suffering from laryngopharyngeal reflux [10, 11]. Reflux associated with laryngeal symptoms is verified by laryngoscopy and 24-hour pH monitoring. Patients with laryngopharyngeal reflux without alarming symptoms are treated empirically with proton pump inhibitors for one to two months. If this type of therapy is effective, according to individual needs, the therapy is extended to six months with the aim of complete healing of the laryngeal and pharyngeal mucosa.
2.2 Dysphonia
Chronic gastroesophageal reflux is an etiological factor that contributes to the manifestation of laryngeal symptoms, primarily hoarseness. In addition to hoarseness, laryngopharyngeal reflux and laryngitis may occur. Koufman et al. found that 78% of dysphonic patients have gastroesophageal reflux disease [12]. According to Vashana, acid reflux is especially common in singers. The author explains this statement in several facts: muscle activity due to a vocal technique that works against the lower esophageal sphincter; inadequate feeding and sleep dynamics; emotional components and exposure to stressors typical of this profession [13].
2.3 Chronic rhinosinusitis (CRS)
More recent studies has reported significant association between gastroesophageal reflux and chronic rhinosinusitis, but the nature of the association is still unknown. Gastroesophageal reflux disease can cause several upper airway symptoms and change the physiology of nasopharyngeal mucosa, while upper airway diseases might also exacerbate GERD symptoms [14]. This associaton can be explained by three physiological mechanisms: the direct effect of acid or acidic vapor in the nasal mucosa, a dysfunction of the autonomous nervous system and the presence of Helicobacter pylori. It is known that the direct contact of the acid with the nasopharyngeal mucosa results in mucosal edema, with reduction of the mucociliary clearance and obstruction of the sinusal ostium. The acid reflux is an uncommon event in the nasopharynx and occurs in only 5% of GERD patients. Autonomic dysfunction, in this case the increase of the vagal tonus, may partly account the hyper-reactivity of the airways to acid. The Heliobacter pylori has been identified in the esophagus, palatine and tonsils, saliva and teeth, and is not known how its presence can result in some abnormalities of this tissues. Retrospective studies describe an improvement of 69 to 89% of the nasosinusal symptoms after GER treatment. Despite this knowlege, it is still not possible to state that the gastroesophageal reflux is one of the leading risk factors to chronic rhinosinuitis, but it must be researched as an unchaining factor when there is no other evident etiology. Howewer, GER symptoms are very prevalent in patients with chronic rhinosinusitis [15].
2.4 Chronic otitis media (COM)
Chronic otitis media may lead to tympanic membrane perforation as a consequence of unresolved and resistant middle ear infection, blockage of the Eustachian tube, insufficiency of ciliary clearance, or an injury to the ear persisting more than 3 months. Various microorganisms are considered as etiologic agents in COM. Other predisposing factors may also play role in persistence of the disease. Many recent studies have shown a potential association between gastroesophageal reflux and otitis media chronica [16]. Gastroesophageal reflux can be an inflammatory cofactor and can result in upper respiratory tract disorders, including COM in pediatric and adult age group. Otitis media with effusion is the most common cause of hearing loss in children. The pathogenesis is multifactorial: infections, impaired immunologic status, allergic history, anatomical problems, familial predisposition and enviromental factors have role in pathogenesis. The angle and length of the Eustachian tube are more horizontal and shorter in infants than in adults, and may allow reflux of gastric contens from the nasopharynx into the middle ear. It can cause to lay the groundwork for mucociliary clearance dysfunction and bacterial infections. Some studies found pepsin concentrations in samples from middle ear effusions of up to 1000-fold greater in children who undergone myringotomy. It was suggested that the GER may be related to glue ear in children. The therapy of COM is mainly surgical. Higher level of damage in the middle ear of patients having GERD requires appropriate treatment which may positively affect outcomes for COM surgery [17].
2.5 Oral mucosal changes
More recent studies have pointed out that extraesophageal symptoms of GERD are acidic lesions of the oral mucosa. These lesions are caused by direct acid and pepsin exposure, or acidic vapor contact in the oral cavity. GERD was reported to be associated with microscopic alterations in the palatal mucosa, such as epithelial atrophy, deepening of epithelial crests in connective tissue and a higher prevalence of fibroblasts [18]. Mucosal changes are quite common and not pathognomonic and specific of patients with gastroesophageal or esophagopharyngeal reflux, but erythema of the soft palate and uvula, epithelial atrophy, xerostomia and glositis are quite common in GERD patients. Some authors pointed out the presence of aphtoid lesions, hoarseness, chronic periodontitis, dry oral mucosa with a keratotic appearance of the gingival tissues and the presence of burning mouth. In addition, persons with GERD may complain of a sour or acidic taste, impaired taste (dysgeusia), an oral burning sensation and water brash (flooding of the mouth with saliva in response to an esophageal reflux stimulus) [19]. Adequate mucin-rich salivary secretions coat all of the internal anatomical surfaces and are essential for the protection of the oropharyngeal and esophageal mucosa and the teeth from chemical, thermal, mechanical and microbial damage. Saliva also facilitates efficient swallowing and speech. Some studies have found a significant association between gastroesophageal reflux and hyposalivation. On the other hand, proton pump inhibitors can cause hyposalivation. Hyposalivation may result in xerostomia, impaired mastication and swallowing, painful mouth, cracked lips and angular cheilitis [20].
2.6 Hypersalivation
The quantity of salivation and the quality of saliva can be an indicator of a certain disease of the oropharynx and esophagus or it can be an indicator of the complication of such conditions. Saliva is produced by the parotid, submandibular and sublingual glands and the small salivary glands. Sialoreia usually occurs in neurological diseases, such as Parkinson’s and Wilson’s disease, Angelman’s syndrome, infections, heavy metal poisoning, and can also occur in the secretory phase of the menstrual cycle or as idiopathic paroxysmal sialoreia. Increased salivation can be caused by systemic consumption of drugs with a cholinergic effect (clozapine, risperidone, nitrazepam, lithium and bethanekol), and it also occurs as a subtle manifestation of gastroesophageal reflux disease in the form of ‘water brash’. However, hypersalivation, although uncomfortable and disruptive, does not necessarily have to be negative since saliva plays an important role in protecting the esophageal mucosa. There are studies on the importance of ingested saliva that neutralizes the pH of gastric acid regurgitated into the esophagus [21] and on the buffering of gastric acid that enters the esophagus by reflux [22]. The acid that accumulates in the upper part of the esophagus reflexively initiates the formation of saliva [23], which is not the case when the acid accumulates in the lower part of the esophagus [24].
2.7 Dental erosion
Chronic regurgitation of gastric acids in patients with gastroesophageal reflux and related condition - laryngopharyngeal reflux may cause dental erosion which can, in combination with attrition or bruxism, lead to extensive loss of coronal tooth tissue. Dental erosion is typically a slowly-progressing and ireversibile phenomenon defined as the loss of tooth substance by chemical processes (acid exposure) not involving bacteria [25]. The literature shows a strong correlation between GERD and dental erosion, with a median prevalence of 24% in a large range of age groups. The degree of erosion due to GERD is related to the duration of the disease, frequency of reflux, the pH and type of acid, and the quality and quantity of saliva. Demineralisation and the loss of calcium and phosphate ions from the mineral surface of the teeth result in visible defects, and cause significant reduction in microhardness which makes the softened surface more prone to mechanical damage [26]. It is recognized that refluxed acid attacks the palatal surfaces of the upper incisor teeth first, later, if the condition continues, erosion of the occlusal surfaces of the posterior teeth in both arches and the labial or buccal surfaces [27].
2.8 Halitosis
Halitosis is an unpleasant odor from the oral cavity and is a condition that affects a large number of people [28]. The prevalence of halitosis is 8–46% [29]. The pathophysiological mechanism of halitosis is still not completely clear and is mainly attributed to oral pathology due to microbial activity in the interdental space, between the teeth and periodontium, and on the dorsal side of the tongue. Published data suggest that halitosis may correlate with chronic sinusitis, upper and lower respiratory tract diseases, various systemic diseases, gastroenterological diseases, and consumption of certain drugs in patients without oral pathology. It has been stated that mouth breathing, too, can be the cause of halitosis [30]. Although halitosis has previously been considered a rare consequence of gastrointestinal disorders [31], recent literal data have shown that it is common in gastrointestinal pathology and is significantly more common in patients with gastroesophageal reflux disease than in healthy individuals [32]. Furthermore, the symptom is often present in patients with verified infection with Helicobacter pylori, a bacterium that is among the major pathogenic factors of inflammatory and ulcerative changes on the gastric mucosa [33, 34, 35, 36]. In addition, a high correlation has been demonstrated between halitosis and gastroesophageal reflux disease and peptic ulcer disease [37], and some authors have linked halitosis to volatile sulfur compounds [30, 38, 39] and to the chemical compounds cadaverine, some types of indoles [30]. Cadaverine (1,5-pentanediamine) is a toxic diamine formed by tissue putrefaction. Indole (benzopyrrole) is a heterocyclic compound formed by the breakdown of the amino acid tryptophan in the digestive tract, however, it is also used in the production of certain drugs, fragrances and essential oils [40]. An organic compound from the indole family associated with halitosis is skatol (3-methylindole), which occurs naturally in faeces, it is also present in flowers and essential oils (orange and jasmine) in low concentrations, and is used as a fixative in many perfumes [41]. A 2006 study by Lee et al. reported that Helicobacter pylori produces hydrogen sulfide and methyl mercaptan that contribute to halitosis [42], and the bacterium itself is one of the main factors in the manifestation of gastrointestinal diseases.
3. Thoracic manifestations
Thoracic manifestations can occur secondary to the wide range of esophageal disorders: inflammatory process, infections, trauma and perforation, congenital malformations, esophageal motility disorders and benign and malignant neoplasms. Complications associated with these diseases and disorders can involve the mediastinum, tracheobronchial tree, and lungs. Lower respiratory system and esophagus share a common embryological derivation and are anatomically related. Pulmonary complications can be associated with high morbidity and mortality. Such complications can be categorized as:
mediastinal complications (due to trauma, perforation, foreign bodies, caustic injury, or malignancy);
tracheobronchial complications (congenital or acquired tracheoesophageal fistulas);
pleural complications (esophagopleural fistulas);
lung complications (due to GERD, infectious and inflammatory process) [43].
Gastroesophageal reflux disease has been linked to a variety of respiratory diseases either as a direct cause, or as a risk factor to the inability to control or worsening of the disease. It can cause various pulmonary manifestations and nonspecific complaints: chronic cough and fewer, recurrent pneumonia, noncardiac chest pain, sputum production and dyspnoea, bronchospasm. Epidemiological studies in patients with reflux esophagitis have shown an increased risk for chronic bronchitis, chronic obstructive pulmonary disease, pneumonia, and idiopathic pulmonary fibrosis. Chronic cough and bronchial asthma are more common respiratory manifestations of GERD. Pathological GERD has been described in 30% to 80% of patients with asthma. Micro-aspiration of gastric contents and/or vagal irritation from gastro esophageal reflux may constitute airway irritants and thus represent a potential pathogenic mechanism for acute illness or acute exacerbations of chronic pulmonary diseases. Exacerbations of chronic obstructive pulmonary disease is twice as high in patients with GERD as in those without GERD symptoms. GERD can produce lung disease by two mechanisms: by reflex neural mechanisms occuring during reflux events limited to the lower part of esophagus, and direct from gastric contents refluxed into the pharynx producing upper airway damage and lung disease. While gastroesophageal reflux may increase airways resistance and cause inflammation by releasing pro-inflammatory mediators, esophagopharyngeal reflux creates the potential to aspiration and its consequences which varies depending of the duration, volume and nature of the aspirate [44]. Chronic cough is considered to be a cough that is continuously present for eight weeks and longer. Among the etiological factors, the three most common causes of chronic cough can be singled out: postnasal drip syndrome, asthma and gastroesophageal reflux. In 75% of cases, patients with chronic cough do not have the typical symptoms of esophagitis or gastroesophageal reflux disease, yet the result of 25% of patients with symptoms of both types speaks in favor of the association of chronic cough and esophageal disease [45]. Namely, the determination of correlation is primarily based on the strength and direction of the correlation, and not only on the frequency and percentage of results.
4. Cardiac manifestations
Coronary heart disease and gastroesophageal reflux disease can interact and produce chest pain. Some recent studies have shown that exposure of the esophageal mucosa to acid can compromise myocardial perfusion and cause chest pain by inducing coronary spasm or cardiac dysrythmia [46, 47, 48]. On the other hand, myocardial ischemia can cause esophageal dysmotility or relaxation of the lower esophageal sphincter and exacerbate GERD [49]. GERD can worsen sleep disturbances, and sleep apnea increases the risk of a cardiovascular diseases [50]. These two diseases have a number of common risk factors and comorbidities, such as diabetes, hypertension, hyperlipidemia, smoking and alcoholism, gender and age [51, 52]. Proton pump inhibitors, as a treatment option in GERD therapy can also affect cardiovascular physiology. One of the big population-based study shows that PPI usage can reduce the cardioprotective effects of certain therapies, and it can also reduce the contractility of myocardial tissue and raise the risk of atherosclerosis by increasing the serum levels of homocysteine by impairing the absorption of vitamin B12. This study indicates that GERD is associated with an increased risk of developing coronary heart disease, and PPI therapy that lasts longer than one year might increase the risk of CHD [53].
5. Conclusion
Esophageal symptoms are common and often overlap between different esophageal disorders, making a diagnosis based solely on patient history, symptoms, and physical presentation challenging. Esophageal motility disorders often manifest with chest pain and dysphagia. Other symptoms are heartburn, regurgitation, weight loss and malnutrition. Chest pain is localized behind the sternum, and does not spread to the shoulders and arms, which distinguishes it from cardiac pain. Gastroesophageal reflux (GER) symptoms have been reported in up to 20% of the adult population, which makes GER one of the common gastrointestinal disorders with a chronic or recurrent nature. Patients often complain of heartburn and acid regurgitation. The presence of this symptoms at least once a week for the last 3 months are considered essential in diagnosis of a clinical disorder called gastroesophageal reflux disease (GERD) [54]. Gastroesophageal reflux is often associated with symptoms of the respiratory tract. Chronic cough of unknown origin, laryngeal complaints, throat discomfort, breathing disorders, bronchitis, pneumonia and even non allergic asthma, resistant to steroid therapy, are suspicious of being reflux related. Other symptoms are haematemesis, eructation, dysphagia, odynophagia, hiccups, changes in the oral, nasal and pharyngeal mucosa, dental erosions and cardiac problems. Laryngopharyngeal reflux (LPR) is present in up to 60% of GERD patients. Symptoms of this multifactorial syndrome are mainly extraesophageal, and are found in the head and neck region. The most common symptoms are cough, hoarseness, dysphonia, sore throat, globus pharyngeus, chronic postnasal drip, and Eustachian tube dysfunction, Some studies have shown that LPR has been associated with vocal cord polyps, vocal cord granulomas, laryngospasm, subglottic stenosis and laryngeal carcinoma [55]. Esophagitis can be caused by reflux mechanism, infections, caustic agents, ionizing radiation, thermal injuries, eating disorders, medications, and as a part of some sistemic diseases. The most common symptoms are dysphagia and odynophagia, heartburn and acid regurgitation, haematemesis. Severe and prolonged vomiting and straining can results in tears in the mucous membrane of the esophagus. This condition is called Mallory-Weiss Syndrome. The main symptoms are hematemesis and melena, and in severe cases heavier bleeding may occur. Ribs and webs are the most common structural abnormalities of the esophagus. Most of them are asymptomatic, but can occasionally present with intermittent dysphagia to solids. They are associated with Zenker’s diverticulum and Plummer-Vinson Syndrome which is classically a triad of dysphagia, iron-deficiency anemia, and esophageal webs. Esophageal rings are almost always associated with a hiatal hernia [56]. The esophagus is the most common site of acute foreign body obstruction. The clinical presentation varies from mild to extremely severe, and the most common symptoms are hypersalivation and odynophagia [57]. Esophageal perforation is a rare and potentially life-threatening condition most commonly caused by manipulations with medical instruments, forced strining and foreign bodies. The most common symptoms are odynophagia, chest pain, vomiting and shortness of breath, and in 70% of patients with perforation of the intrathoracic esophagus there are pleuromediastinum and palpable crepitus in the soft tissue of the neck and thorax. Caustic injuries of the esophagus are potentially one of the most challenging clinical situations in gastroenterology. Caustics and corrosives cause tissue injury by a chemical reaction. The severity of injury and the clinical presentation depends on several aspects: Concentration of the substance, amount ingested, duration of tissue contact, location of damage, and pH of the agent: hoarseness, stridor, dysphagia, odynophagia, hematemesis, epigastric pain. Short-term complications include perforation and death [58, 59]. Esophageal cancer is the sixth most common cause of cancer deaths worldwide. In the initial stage it usually shows no symptoms. The most common symptoms are dysphagia, chest pain, pressure or burning, heartburn, coughing or hoarseness, weight loss, bleeding, and hiccups. As can be seen, almost all esophageal diseases shows atypical and extraesophageal symptomatology. Due to proper and accurate diagnosis and treatment, the cooperation of a multidisciplinary team is required.
Acknowledgments
We would like to thank Ms. Mirna Brunčić for translating this text.
Conflict of interest
The authors have no conflict of interest.
Notes
The figure is from the author’s own source.
\n',keywords:"chronic cough, chronic laryngitis, dysphonia, esophagitis, laryngopharyngeal reflux",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/75683.pdf",chapterXML:"https://mts.intechopen.com/source/xml/75683.xml",downloadPdfUrl:"/chapter/pdf-download/75683",previewPdfUrl:"/chapter/pdf-preview/75683",totalDownloads:228,totalViews:0,totalCrossrefCites:0,dateSubmitted:"February 14th 2021",dateReviewed:"February 19th 2021",datePrePublished:"April 30th 2021",datePublished:"December 22nd 2021",dateFinished:"March 12th 2021",readingETA:"0",abstract:"Esophageal diseases are diagnosed by gastroenterological processing indicated due to typical gastrointestinal symptoms, but typical gastrointestinal symptoms are not the only possible manifestation of esophageal disease. There are also external symptoms such as chronic cough, laryngitis, pharyngitis, oropharyngeal dysphagia, odynophagia, laryngopharyngeal reflux, dysphonia, sinusitis, ear pain, and changes in laryngopharyngeal mucosa (erythema, edema, ventricular obliteration, cricoid hyperplasia and pseudosulcus). Extraesophageal symptoms are common in esophagitis and GERD, and studies show increasing prevalence of LPR in patients with GERD, as well as an association of reflux disease with cough and dysphonia symptoms. The aim of the chapter is to describe these extraesophageal symptoms of esophageal disease and how to recognize and treat them, in order to facilitate gastroenterologists’ diagnostic processing of patients with these symptoms, improve their treatment and assessment of the therapy effectiveness, prevent the development of stronger symptoms, and encourage multidisciplinary cooperation and exchange of knowledge, scientific and clinical work.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/75683",risUrl:"/chapter/ris/75683",signatures:"Ljiljana Širić, Marinela Rosso and Aleksandar Včev",book:{id:"10314",type:"book",title:"Esophagitis and Gastritis",subtitle:"Recent Updates",fullTitle:"Esophagitis and Gastritis - Recent Updates",slug:"esophagitis-and-gastritis-recent-updates",publishedDate:"December 22nd 2021",bookSignature:"Vincenzo Neri and Monjur Ahmed",coverURL:"https://cdn.intechopen.com/books/images_new/10314.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-83969-060-0",printIsbn:"978-1-83969-059-4",pdfIsbn:"978-1-83969-061-7",isAvailableForWebshopOrdering:!0,editors:[{id:"170938",title:"Prof.",name:"Vincenzo",middleName:null,surname:"Neri",slug:"vincenzo-neri",fullName:"Vincenzo Neri"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"249257",title:"Dr.",name:"Ljiljana",middleName:null,surname:"Širić",fullName:"Ljiljana Širić",slug:"ljiljana-siric",email:"ljsiric@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"249659",title:"Dr.",name:"Marinela",middleName:null,surname:"Rosso",fullName:"Marinela Rosso",slug:"marinela-rosso",email:"rossom@net.hr",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"343628",title:"Prof.",name:"Aleksandar",middleName:null,surname:"Včev",fullName:"Aleksandar Včev",slug:"aleksandar-vcev",email:"aleksandar.vcev@fdmz.hr",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Otolaryngologic manifestations",level:"1"},{id:"sec_2_2",title:"2.1 Chronic laryngitis and laryngopharyngeal reflux (LPR)",level:"2"},{id:"sec_3_2",title:"2.2 Dysphonia",level:"2"},{id:"sec_4_2",title:"2.3 Chronic rhinosinusitis (CRS)",level:"2"},{id:"sec_5_2",title:"2.4 Chronic otitis media (COM)",level:"2"},{id:"sec_6_2",title:"2.5 Oral mucosal changes",level:"2"},{id:"sec_7_2",title:"2.6 Hypersalivation",level:"2"},{id:"sec_8_2",title:"2.7 Dental erosion",level:"2"},{id:"sec_9_2",title:"2.8 Halitosis",level:"2"},{id:"sec_11",title:"3. Thoracic manifestations",level:"1"},{id:"sec_12",title:"4. Cardiac manifestations",level:"1"},{id:"sec_13",title:"5. Conclusion",level:"1"},{id:"sec_14",title:"Acknowledgments",level:"1"},{id:"sec_17",title:"Conflict of interest",level:"1"},{id:"sec_14",title:"Notes",level:"1"}],chapterReferences:[{id:"B1",body:'Guyton AC. Kretanje hrane kroz alimentarni trakt. In: Guyton AC. Medicinska fiziologija. 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Published 2011 Oct 30. doi:10.1186/1757-7241-19-66.'},{id:"B58",body:'Katzka, D.A. Caustic injury to the esophagus. Curr Treat Options Gastro, 2001;4:59-66.'},{id:"B59",body:'De Lusong MAA, Timbol ABG, Tuazon DJS. Management of esophageal caustic injury. World J Gastrointest Pharmacol Ther. 2017;8(2):90-98.'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Ljiljana Širić",address:"ljsiric@gmail.com",affiliation:'
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Center Osijek, Croatia
Department of General and Applied Kinesiology, Faculty of Kinesiology, University of Zagreb, Croatia
Faculty of Medicine, Faculty of Dental Medicine and Health, J.J. Strossmayer University of Osijek, Croatia
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In 2008 I completed my MBA in management from the University of Redlands.",institutionString:null,institution:{name:"Loma Linda University",institutionURL:null,country:{name:"United States of America"}}},{id:"52298",title:"Prof.",name:"Oner",surname:"Ozdemir",slug:"oner-ozdemir",fullName:"Oner Ozdemir",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/52298/images/system/52298.jpg",biography:"Assoc. Prof. Dr. Öner Özdemir was born in Alaplı, Zonguldak, Turkey on September 18, 1965. He graduated from İstanbul University İstanbul Medical School and become a medical doctor in 1989. His pediatric residency was completed at the Department of Pediatrics at the Children’s Hospital of İstanbul Medical School, Istanbul, Turkey. His clinical fellowship training was completed at the Pediatric Allergy/Immunology program at Louisiana State University Health Sciences Ctr., New Orleans, LA. 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Max Planck Institute
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Bacteria such as Streptococcus pneumonia, Staphylococcus aureus and Haemophilus influenzae are generally considered as the main pathogens in community-acquired pneumonia and Legionella species, Chlamydia pneumoniae and Mycoplasma pneumonia in atypical pneumonias. In contrast the proportion of pneumonias due to viruses has been both difficult to detect and quantify with any precision. However, with the advent of powerful molecular techniques and rapidly developing technologies a greater number of viruses are being implicated as pathogens and co-pathogens in pneumonia. In the case of adults, the most commonly detected viruses are influenza virus, RSV and parainfluenza. Other viruses that have recently received considerable attention, are H5N1 influenza virus and coronaviruses. Infectious causes of pneumonia in immunocompromised patients include measles, HSV, CMV, HHV-6 and Influenza viruses. 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Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. 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He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. 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Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. 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She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. 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He received his Ph.D. in Environmental Analytical Chemistry from Assiut University, Egypt, in 1989. His research interest is in analytical and environmental chemistry with special emphasis on: (1) monitoring and assessing biological trace elements and toxic metals in human blood, urine, water, crops, vegetables, and medicinal plants; (2) relationships between environmental heavy metals and human diseases; (3) uses of biological indicators for monitoring water pollution; (4) environmental chemistry of lakes, rivers, and well water; (5) water and wastewater treatment by adsorption and photocatalysis techniques; (6) soil and water pollution monitoring, control, and treatment; and (7) advanced oxidation treatment. Prof. Rashed has supervised several MSc and Ph.D. theses in the field of analytical and environmental chemistry. He served as an examiner for several Ph.D. theses in analytical chemistry in India, Kazakhstan, and Botswana. 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His research interests include physiology, endocrine system, cancer, diabetes, cardiovascular system diseases, and isolated organ bath system studies.",institutionString:"Kafkas University",institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"418963",title:"Dr.",name:"Augustine Ododo",middleName:"Augustine",surname:"Osagie",slug:"augustine-ododo-osagie",fullName:"Augustine Ododo Osagie",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/418963/images/16900_n.jpg",biography:"Born into the family of Osagie, a prince of the Benin Kingdom. I am currently an academic in the Department of Medical Biochemistry, University of Benin. 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She is a fellow member of the Royal Society of Chemistry UK and the American Chemical Society of the United States.",institutionString:"King Saud University",institution:{name:"King Saud University",country:{name:"Saudi Arabia"}}},{id:"49848",title:"Dr.",name:"Wen-Long",middleName:null,surname:"Hu",slug:"wen-long-hu",fullName:"Wen-Long Hu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49848/images/system/49848.jpg",biography:"Wen-Long Hu is Chief of the Division of Acupuncture, Department of Chinese Medicine at Kaohsiung Chang Gung Memorial Hospital, as well as an adjunct associate professor at Fooyin University and Kaohsiung Medical University. Wen-Long is President of Taiwan Traditional Chinese Medicine Medical Association. He has 28 years of experience in clinical practice in laser acupuncture therapy and 34 years in acupuncture. He is an invited speaker for lectures and workshops in laser acupuncture at many symposiums held by medical associations. He owns the patent for herbal preparation and producing, and for the supercritical fluid-treated needle. Dr. Hu has published three books, 12 book chapters, and more than 30 papers in reputed journals, besides serving as an editorial board member of repute.",institutionString:"Kaohsiung Chang Gung Memorial Hospital",institution:{name:"Kaohsiung Chang Gung Memorial Hospital",country:{name:"Taiwan"}}},{id:"298472",title:"Prof.",name:"Andrey V.",middleName:null,surname:"Grechko",slug:"andrey-v.-grechko",fullName:"Andrey V. Grechko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/298472/images/system/298472.png",biography:"Andrey Vyacheslavovich Grechko, Ph.D., Professor, is a Corresponding Member of the Russian Academy of Sciences. He graduated from the Semashko Moscow Medical Institute (Semashko National Research Institute of Public Health) with a degree in Medicine (1998), the Clinical Department of Dermatovenerology (2000), and received a second higher education in Psychology (2009). Professor A.V. Grechko held the position of Сhief Physician of the Central Clinical Hospital in Moscow. He worked as a professor at the faculty and was engaged in scientific research at the Medical University. Starting in 2013, he has been the initiator of the creation of the Federal Scientific and Clinical Center for Intensive Care and Rehabilitology, Moscow, Russian Federation, where he also serves as Director since 2015. He has many years of experience in research and teaching in various fields of medicine, is an author/co-author of more than 200 scientific publications, 13 patents, 15 medical books/chapters, including Chapter in Book «Metabolomics», IntechOpen, 2020 «Metabolomic Discovery of Microbiota Dysfunction as the Cause of Pathology».",institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"199461",title:"Prof.",name:"Natalia V.",middleName:null,surname:"Beloborodova",slug:"natalia-v.-beloborodova",fullName:"Natalia V. Beloborodova",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/199461/images/system/199461.jpg",biography:'Natalia Vladimirovna Beloborodova was educated at the Pirogov Russian National Research Medical University, with a degree in pediatrics in 1980, a Ph.D. in 1987, and a specialization in Clinical Microbiology from First Moscow State Medical University in 2004. She has been a Professor since 1996. Currently, she is the Head of the Laboratory of Metabolism, a division of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russian Federation. N.V. Beloborodova has many years of clinical experience in the field of intensive care and surgery. She studies infectious complications and sepsis. She initiated a series of interdisciplinary clinical and experimental studies based on the concept of integrating human metabolism and its microbiota. Her scientific achievements are widely known: she is the recipient of the Marie E. Coates Award \\"Best lecturer-scientist\\" Gustafsson Fund, Karolinska Institutes, Stockholm, Sweden, and the International Sepsis Forum Award, Pasteur Institute, Paris, France (2014), etc. Professor N.V. Beloborodova wrote 210 papers, five books, 10 chapters and has edited four books.',institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"354260",title:"Ph.D.",name:"Tércio Elyan",middleName:"Azevedo",surname:"Azevedo Martins",slug:"tercio-elyan-azevedo-martins",fullName:"Tércio Elyan Azevedo Martins",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/354260/images/16241_n.jpg",biography:"Graduated in Pharmacy from the Federal University of Ceará with the modality in Industrial Pharmacy, Specialist in Production and Control of Medicines from the University of São Paulo (USP), Master in Pharmaceuticals and Medicines from the University of São Paulo (USP) and Doctor of Science in the program of Pharmaceuticals and Medicines by the University of São Paulo. Professor at Universidade Paulista (UNIP) in the areas of chemistry, cosmetology and trichology. Assistant Coordinator of the Higher Course in Aesthetic and Cosmetic Technology at Universidade Paulista Campus Chácara Santo Antônio. Experience in the Pharmacy area, with emphasis on Pharmacotechnics, Pharmaceutical Technology, Research and Development of Cosmetics, acting mainly on topics such as cosmetology, antioxidant activity, aesthetics, photoprotection, cyclodextrin and thermal analysis.",institutionString:null,institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"334285",title:"Ph.D. Student",name:"Sameer",middleName:"Kumar",surname:"Jagirdar",slug:"sameer-jagirdar",fullName:"Sameer Jagirdar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334285/images/14691_n.jpg",biography:"I\\'m a graduate student at the center for biosystems science and engineering at the Indian Institute of Science, Bangalore, India. I am interested in studying host-pathogen interactions at the biomaterial interface.",institutionString:null,institution:{name:"Indian Institute of Science Bangalore",country:{name:"India"}}},{id:"329795",title:"Dr.",name:"Mohd Aftab",middleName:"Aftab",surname:"Siddiqui",slug:"mohd-aftab-siddiqui",fullName:"Mohd Aftab Siddiqui",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329795/images/15648_n.jpg",biography:"Dr. Mohd Aftab Siddiqui is currently working as Assistant Professor in the Faculty of Pharmacy, Integral University, Lucknow for the last 6 years. He has completed his Doctor in Philosophy (Pharmacology) in 2020 from Integral University, Lucknow. He completed his Bachelor in Pharmacy in 2013 and Master in Pharmacy (Pharmacology) in 2015 from Integral University, Lucknow. He is the gold medalist in Bachelor and Master degree. He qualified GPAT -2013, GPAT -2014, and GPAT 2015. His area of research is Pharmacological screening of herbal drugs/ natural products in liver and cardiac diseases. He has guided many M. Pharm. research projects. He has many national and international publications.",institutionString:"Integral University",institution:null},{id:"255360",title:"Dr.",name:"Usama",middleName:null,surname:"Ahmad",slug:"usama-ahmad",fullName:"Usama Ahmad",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255360/images/system/255360.png",biography:"Dr. Usama Ahmad holds a specialization in Pharmaceutics from Amity University, Lucknow, India. He received his Ph.D. degree from Integral University. Currently, he’s working as an Assistant Professor of Pharmaceutics in the Faculty of Pharmacy, Integral University. From 2013 to 2014 he worked on a research project funded by SERB-DST, Government of India. He has a rich publication record with more than 32 original articles published in reputed journals, 3 edited books, 5 book chapters, and a number of scientific articles published in ‘Ingredients South Asia Magazine’ and ‘QualPharma Magazine’. He is a member of the American Association for Cancer Research, International Association for the Study of Lung Cancer, and the British Society for Nanomedicine. Dr. Ahmad’s research focus is on the development of nanoformulations to facilitate the delivery of drugs that aim to provide practical solutions to current healthcare problems.",institutionString:"Integral University",institution:{name:"Integral University",country:{name:"India"}}},{id:"30568",title:"Prof.",name:"Madhu",middleName:null,surname:"Khullar",slug:"madhu-khullar",fullName:"Madhu Khullar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/30568/images/system/30568.jpg",biography:"Dr. Madhu Khullar is a Professor of Experimental Medicine and Biotechnology at the Post Graduate Institute of Medical Education and Research, Chandigarh, India. She completed her Post Doctorate in hypertension research at the Henry Ford Hospital, Detroit, USA in 1985. She is an editor and reviewer of several international journals, and a fellow and member of several cardiovascular research societies. Dr. Khullar has a keen research interest in genetics of hypertension, and is currently studying pharmacogenetics of hypertension.",institutionString:"Post Graduate Institute of Medical Education and Research",institution:{name:"Post Graduate Institute of Medical Education and Research",country:{name:"India"}}},{id:"223233",title:"Prof.",name:"Xianquan",middleName:null,surname:"Zhan",slug:"xianquan-zhan",fullName:"Xianquan Zhan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/223233/images/system/223233.png",biography:"Xianquan Zhan received his MD and Ph.D. in Preventive Medicine at West China University of Medical Sciences. He received his post-doctoral training in oncology and cancer proteomics at the Central South University, China, and the University of Tennessee Health Science Center (UTHSC), USA. He worked at UTHSC and the Cleveland Clinic in 2001–2012 and achieved the rank of associate professor at UTHSC. Currently, he is a full professor at Central South University and Shandong First Medical University, and an advisor to MS/PhD students and postdoctoral fellows. He is also a fellow of the Royal Society of Medicine and European Association for Predictive Preventive Personalized Medicine (EPMA), a national representative of EPMA, and a member of the American Society of Clinical Oncology (ASCO) and the American Association for the Advancement of Sciences (AAAS). He is also the editor in chief of International Journal of Chronic Diseases & Therapy, an associate editor of EPMA Journal, Frontiers in Endocrinology, and BMC Medical Genomics, and a guest editor of Mass Spectrometry Reviews, Frontiers in Endocrinology, EPMA Journal, and Oxidative Medicine and Cellular Longevity. He has published more than 148 articles, 28 book chapters, 6 books, and 2 US patents in the field of clinical proteomics and biomarkers.",institutionString:"Shandong First Medical University",institution:{name:"Affiliated Hospital of Shandong Academy of Medical Sciences",country:{name:"China"}}},{id:"297507",title:"Dr.",name:"Charles",middleName:"Elias",surname:"Assmann",slug:"charles-assmann",fullName:"Charles Assmann",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/297507/images/system/297507.jpg",biography:"Charles Elias Assmann is a biologist from Federal University of Santa Maria (UFSM, Brazil), who spent some time abroad at the Ludwig-Maximilians-Universität München (LMU, Germany). He has Masters Degree in Biochemistry (UFSM), and is currently a PhD student at Biochemistry at the Department of Biochemistry and Molecular Biology of the UFSM. His areas of expertise include: Biochemistry, Molecular Biology, Enzymology, Genetics and Toxicology. He is currently working on the following subjects: Aluminium toxicity, Neuroinflammation, Oxidative stress and Purinergic system. Since 2011 he has presented more than 80 abstracts in scientific proceedings of national and international meetings. Since 2014, he has published more than 20 peer reviewed papers (including 4 reviews, 3 in Portuguese) and 2 book chapters. He has also been a reviewer of international journals and ad hoc reviewer of scientific committees from Brazilian Universities.",institutionString:"Universidade Federal de Santa Maria",institution:{name:"Universidade Federal de Santa Maria",country:{name:"Brazil"}}},{id:"217850",title:"Dr.",name:"Margarete Dulce",middleName:null,surname:"Bagatini",slug:"margarete-dulce-bagatini",fullName:"Margarete Dulce Bagatini",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/217850/images/system/217850.jpeg",biography:"Dr. Margarete Dulce Bagatini is an associate professor at the Federal University of Fronteira Sul/Brazil. She has a degree in Pharmacy and a PhD in Biological Sciences: Toxicological Biochemistry. She is a member of the UFFS Research Advisory Committee\nand a member of the Biovitta Research Institute. She is currently:\nthe leader of the research group: Biological and Clinical Studies\nin Human Pathologies, professor of postgraduate program in\nBiochemistry at UFSC and postgraduate program in Science and Food Technology at\nUFFS. She has experience in the area of pharmacy and clinical analysis, acting mainly\non the following topics: oxidative stress, the purinergic system and human pathologies, being a reviewer of several international journals and books.",institutionString:"Universidade Federal da Fronteira Sul",institution:{name:"Universidade Federal da Fronteira Sul",country:{name:"Brazil"}}},{id:"226275",title:"Ph.D.",name:"Metin",middleName:null,surname:"Budak",slug:"metin-budak",fullName:"Metin Budak",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/226275/images/system/226275.jfif",biography:"Metin Budak, MSc, PhD is an Assistant Professor at Trakya University, Faculty of Medicine. He has been Head of the Molecular Research Lab at Prof. Mirko Tos Ear and Hearing Research Center since 2018. His specializations are biophysics, epigenetics, genetics, and methylation mechanisms. He has published around 25 peer-reviewed papers, 2 book chapters, and 28 abstracts. He is a member of the Clinical Research Ethics Committee and Quantification and Consideration Committee of Medicine Faculty. His research area is the role of methylation during gene transcription, chromatin packages DNA within the cell and DNA repair, replication, recombination, and gene transcription. His research focuses on how the cell overcomes chromatin structure and methylation to allow access to the underlying DNA and enable normal cellular function.",institutionString:"Trakya University",institution:{name:"Trakya University",country:{name:"Turkey"}}},{id:"243049",title:"Dr.",name:"Anca",middleName:null,surname:"Pantea Stoian",slug:"anca-pantea-stoian",fullName:"Anca Pantea Stoian",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243049/images/system/243049.jpg",biography:"Anca Pantea Stoian is a specialist in diabetes, nutrition, and metabolic diseases as well as health food hygiene. She also has competency in general ultrasonography.\n\nShe is an associate professor in the Diabetes, Nutrition and Metabolic Diseases Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. She has been chief of the Hygiene Department, Faculty of Dentistry, at the same university since 2019. Her interests include micro and macrovascular complications in diabetes and new therapies. Her research activities focus on nutritional intervention in chronic pathology, as well as cardio-renal-metabolic risk assessment, and diabetes in cancer. She is currently engaged in developing new therapies and technological tools for screening, prevention, and patient education in diabetes. \n\nShe is a member of the European Association for the Study of Diabetes, Cardiometabolic Academy, CEDA, Romanian Society of Diabetes, Nutrition and Metabolic Diseases, Romanian Diabetes Federation, and Association for Renal Metabolic and Nutrition studies. She has authored or co-authored 160 papers in national and international peer-reviewed journals.",institutionString:null,institution:{name:"Carol Davila University of Medicine and Pharmacy",country:{name:"Romania"}}},{id:"279792",title:"Dr.",name:"João",middleName:null,surname:"Cotas",slug:"joao-cotas",fullName:"João Cotas",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/279792/images/system/279792.jpg",biography:"Graduate and master in Biology from the University of Coimbra.\n\nI am a research fellow at the Macroalgae Laboratory Unit, in the MARE-UC – Marine and Environmental Sciences Centre of the University of Coimbra. My principal function is the collection, extraction and purification of macroalgae compounds, chemical and bioactive characterization of the compounds and algae extracts and development of new methodologies in marine biotechnology area. \nI am associated in two projects: one consists on discovery of natural compounds for oncobiology. The other project is the about the natural compounds/products for agricultural area.\n\nPublications:\nCotas, J.; Figueirinha, A.; Pereira, L.; Batista, T. 2018. An analysis of the effects of salinity on Fucus ceranoides (Ochrophyta, Phaeophyceae), in the Mondego River (Portugal). Journal of Oceanology and Limnology. in press. DOI: 10.1007/s00343-019-8111-3",institutionString:"Faculty of Sciences and Technology of University of Coimbra",institution:null},{id:"279788",title:"Dr.",name:"Leonel",middleName:null,surname:"Pereira",slug:"leonel-pereira",fullName:"Leonel Pereira",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/279788/images/system/279788.jpg",biography:"Leonel Pereira has an undergraduate degree in Biology, a Ph.D. in Biology (specialty in Cell Biology), and a Habilitation degree in Biosciences (specialization in Biotechnology) from the Faculty of Science and Technology, University of Coimbra, Portugal, where he is currently a professor. In addition to teaching at this university, he is an integrated researcher at the Marine and Environmental Sciences Center (MARE), Portugal. His interests include marine biodiversity (algae), marine biotechnology (algae bioactive compounds), and marine ecology (environmental assessment). Since 2008, he has been the author and editor of the electronic publication MACOI – Portuguese Seaweeds Website (www.seaweeds.uc.pt). He is also a member of the editorial boards of several scientific journals. Dr. Pereira has edited or authored more than 20 books, 100 journal articles, and 45 book chapters. He has given more than 100 lectures and oral communications at various national and international scientific events. He is the coordinator of several national and international research projects. In 1998, he received the Francisco de Holanda Award (Honorable Mention) and, more recently, the Mar Rei D. Carlos award (18th edition). He is also a winner of the 2016 CHOICE Award for an outstanding academic title for his book Edible Seaweeds of the World. In 2020, Dr. Pereira received an Honorable Mention for the Impact of International Publications from the Web of Science",institutionString:"University of Coimbra",institution:{name:"University of Coimbra",country:{name:"Portugal"}}},{id:"61946",title:"Dr.",name:"Carol",middleName:null,surname:"Bernstein",slug:"carol-bernstein",fullName:"Carol Bernstein",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/61946/images/system/61946.jpg",biography:"Carol Bernstein received her PhD in Genetics from the University of California (Davis). She was a faculty member at the University of Arizona College of Medicine for 43 years, retiring in 2011. Her research interests focus on DNA damage and its underlying role in sex, aging and in the early steps of initiation and progression to cancer. In her research, she had used organisms including bacteriophage T4, Neurospora crassa, Schizosaccharomyces pombe and mice, as well as human cells and tissues. She authored or co-authored more than 140 scientific publications, including articles in major peer reviewed journals, book chapters, invited reviews and one book.",institutionString:"University of Arizona",institution:{name:"University of Arizona",country:{name:"United States of America"}}},{id:"182258",title:"Dr.",name:"Ademar",middleName:"Pereira",surname:"Serra",slug:"ademar-serra",fullName:"Ademar Serra",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/182258/images/system/182258.jpeg",biography:"Dr. Serra studied Agronomy on Universidade Federal de Mato Grosso do Sul (UFMS) (2005). He received master degree in Agronomy, Crop Science (Soil fertility and plant nutrition) (2007) by Universidade Federal da Grande Dourados (UFGD), and PhD in agronomy (Soil fertility and plant nutrition) (2011) from Universidade Federal da Grande Dourados / Escola Superior de Agricultura Luiz de Queiroz (UFGD/ESALQ-USP). Dr. Serra is currently working at Brazilian Agricultural Research Corporation (EMBRAPA). His research focus is on mineral nutrition of plants, crop science and soil science. Dr. Serra\\'s current projects are soil organic matter, soil phosphorus fractions, compositional nutrient diagnosis (CND) and isometric log ratio (ilr) transformation in compositional data analysis.",institutionString:"Brazilian Agricultural Research Corporation",institution:{name:"Brazilian Agricultural Research Corporation",country:{name:"Brazil"}}}]}},subseries:{item:{id:"5",type:"subseries",title:"Parasitic Infectious Diseases",keywords:"Blood Borne Parasites, Intestinal Parasites, Protozoa, Helminths, Arthropods, Water Born Parasites, Epidemiology, Molecular Biology, Systematics, Genomics, Proteomics, Ecology",scope:"Parasitic diseases have evolved alongside their human hosts. In many cases, these diseases have adapted so well that they have developed efficient resilience methods in the human host and can live in the host for years. Others, particularly some blood parasites, can cause very acute diseases and are responsible for millions of deaths yearly. Many parasitic diseases are classified as neglected tropical diseases because they have received minimal funding over recent years and, in many cases, are under-reported despite the critical role they play in morbidity and mortality among human and animal hosts. The current topic, Parasitic Infectious Diseases, in the Infectious Diseases Series aims to publish studies on the systematics, epidemiology, molecular biology, genomics, pathogenesis, genetics, and clinical significance of parasitic diseases from blood borne to intestinal parasites as well as zoonotic parasites. We hope to cover all aspects of parasitic diseases to provide current and relevant research data on these very important diseases. In the current atmosphere of the Coronavirus pandemic, communities around the world, particularly those in different underdeveloped areas, are faced with the growing challenges of the high burden of parasitic diseases. At the same time, they are faced with the Covid-19 pandemic leading to what some authors have called potential syndemics that might worsen the outcome of such infections. Therefore, it is important to conduct studies that examine parasitic infections in the context of the coronavirus pandemic for the benefit of all communities to help foster more informed decisions for the betterment of human and animal health.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/5.jpg",hasOnlineFirst:!0,hasPublishedBooks:!0,annualVolume:11401,editor:{id:"67907",title:"Dr.",name:"Amidou",middleName:null,surname:"Samie",slug:"amidou-samie",fullName:"Amidou Samie",profilePictureURL:"https://mts.intechopen.com/storage/users/67907/images/system/67907.jpg",biography:"Dr. Amidou Samie is an Associate Professor of Microbiology at the University of Venda, in South Africa, where he graduated for his PhD in May 2008. He joined the Department of Microbiology the same year and has been giving lectures on topics covering parasitology, immunology, molecular biology and industrial microbiology. He is currently a rated researcher by the National Research Foundation of South Africa at category C2. He has published widely in the field of infectious diseases and has overseen several MSc’s and PhDs. His research activities mostly cover topics on infectious diseases from epidemiology to control. His particular interest lies in the study of intestinal protozoan parasites and opportunistic infections among HIV patients as well as the potential impact of childhood diarrhoea on growth and child development. He also conducts research on water-borne diseases and water quality and is involved in the evaluation of point-of-use water treatment technologies using silver and copper nanoparticles in collaboration with the University of Virginia, USA. He also studies the use of medicinal plants for the control of infectious diseases as well as antimicrobial drug resistance.",institutionString:null,institution:{name:"University of Venda",institutionURL:null,country:{name:"South Africa"}}},editorTwo:null,editorThree:null,series:{id:"6",title:"Infectious Diseases",doi:"10.5772/intechopen.71852",issn:"2631-6188"},editorialBoard:[{id:"188881",title:"Dr.",name:"Fernando José",middleName:null,surname:"Andrade-Narváez",slug:"fernando-jose-andrade-narvaez",fullName:"Fernando José Andrade-Narváez",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRIV7QAO/Profile_Picture_1628834308121",institutionString:null,institution:{name:"Autonomous University of Yucatán",institutionURL:null,country:{name:"Mexico"}}},{id:"269120",title:"Dr.",name:"Rajeev",middleName:"K.",surname:"Tyagi",slug:"rajeev-tyagi",fullName:"Rajeev Tyagi",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRaBqQAK/Profile_Picture_1644331884726",institutionString:"CSIR - Institute of Microbial Technology, India",institution:null},{id:"336849",title:"Prof.",name:"Ricardo",middleName:null,surname:"Izurieta",slug:"ricardo-izurieta",fullName:"Ricardo Izurieta",profilePictureURL:"https://mts.intechopen.com/storage/users/293169/images/system/293169.png",institutionString:null,institution:{name:"University of South Florida",institutionURL:null,country:{name:"United States of America"}}}]},onlineFirstChapters:{},publishedBooks:{paginationCount:3,paginationItems:[{type:"book",id:"8545",title:"Animal Reproduction in Veterinary Medicine",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/8545.jpg",slug:"animal-reproduction-in-veterinary-medicine",publishedDate:"January 20th 2021",editedByType:"Edited by",bookSignature:"Faruk Aral, Rita Payan-Carreira and Miguel 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Animals",editors:[{id:"251314",title:"Dr.",name:"Juan Carlos",middleName:null,surname:"Gardón",slug:"juan-carlos-gardon",fullName:"Juan Carlos Gardón",profilePictureURL:"https://mts.intechopen.com/storage/users/251314/images/system/251314.jpeg",institutionString:"Catholic University of Valencia San Vicente Mártir, Spain",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"7233",title:"New Insights into Theriogenology",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7233.jpg",slug:"new-insights-into-theriogenology",publishedDate:"December 5th 2018",editedByType:"Edited by",bookSignature:"Rita Payan-Carreira",hash:"74f4147e3fb214dd050e5edd3aaf53bc",volumeInSeries:1,fullTitle:"New Insights into Theriogenology",editors:[{id:"38652",title:"Prof.",name:"Rita",middleName:null,surname:"Payan-Carreira",slug:"rita-payan-carreira",fullName:"Rita 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