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Glover J, Nadig A, Vesely S, Neelakantan D, Williams KM, Holter-Chakrabarty J. Fluorothymidine PET/CT Identifies a Case of Herpes Simplex Virus Esophagitis. Radiol Imaging Cancer 2023; 5:e220141. [PMID: 36961315 PMCID: PMC10077096 DOI: 10.1148/rycan.220141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/18/2023] [Accepted: 02/01/2023] [Indexed: 03/25/2023]
Affiliation(s)
- Joshua Glover
- From the Stephenson Cancer Center, University of Oklahoma Health
Sciences Center, 800 NE 10th St, Oklahoma City, OK 73104 (J.G., A.N., S.V.,
D.N., J.H.C.); and Aflac Cancer and Blood Disorders Center, Children’s
Healthcare of Atlanta, Emory University, Atlanta, Ga (K.M.W.)
| | - Ajay Nadig
- From the Stephenson Cancer Center, University of Oklahoma Health
Sciences Center, 800 NE 10th St, Oklahoma City, OK 73104 (J.G., A.N., S.V.,
D.N., J.H.C.); and Aflac Cancer and Blood Disorders Center, Children’s
Healthcare of Atlanta, Emory University, Atlanta, Ga (K.M.W.)
| | - Sara Vesely
- From the Stephenson Cancer Center, University of Oklahoma Health
Sciences Center, 800 NE 10th St, Oklahoma City, OK 73104 (J.G., A.N., S.V.,
D.N., J.H.C.); and Aflac Cancer and Blood Disorders Center, Children’s
Healthcare of Atlanta, Emory University, Atlanta, Ga (K.M.W.)
| | - Deepika Neelakantan
- From the Stephenson Cancer Center, University of Oklahoma Health
Sciences Center, 800 NE 10th St, Oklahoma City, OK 73104 (J.G., A.N., S.V.,
D.N., J.H.C.); and Aflac Cancer and Blood Disorders Center, Children’s
Healthcare of Atlanta, Emory University, Atlanta, Ga (K.M.W.)
| | - Kirsten M. Williams
- From the Stephenson Cancer Center, University of Oklahoma Health
Sciences Center, 800 NE 10th St, Oklahoma City, OK 73104 (J.G., A.N., S.V.,
D.N., J.H.C.); and Aflac Cancer and Blood Disorders Center, Children’s
Healthcare of Atlanta, Emory University, Atlanta, Ga (K.M.W.)
| | - Jennifer Holter-Chakrabarty
- From the Stephenson Cancer Center, University of Oklahoma Health
Sciences Center, 800 NE 10th St, Oklahoma City, OK 73104 (J.G., A.N., S.V.,
D.N., J.H.C.); and Aflac Cancer and Blood Disorders Center, Children’s
Healthcare of Atlanta, Emory University, Atlanta, Ga (K.M.W.)
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2
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Affiliation(s)
- Kiyoshi Takemoto
- Division of Critical Care Medicine, Nara Prefecture General Medical Center, Japan
| | - Kazuaki Atagi
- Division of Critical Care Medicine, Nara Prefecture General Medical Center, Japan
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3
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Forrest A, Ali N, D'Agostino R. Esophageal cast (desquamative esophagitis). Abdom Radiol (NY) 2021; 46:5050-5052. [PMID: 34137931 DOI: 10.1007/s00261-021-03174-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 05/09/2021] [Accepted: 06/09/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Allison Forrest
- Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT, 05401, USA.
| | - Naiim Ali
- Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT, 05401, USA
| | - Robert D'Agostino
- Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT, 05401, USA
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Avila M, Ambelil M, Tong Y, Khurana S, Abraham F, Ertan A, Thosani NC, DuPont AW, Cash BD, Younes M. Lymphocytic Esophagitis Is Not Similar to Eosinophilic Esophagitis Except for Seasonal Variation. Ann Clin Lab Sci 2021; 51:347-351. [PMID: 34162564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Unlike eosinophilic esophagitis (EoE), there is no consensus on the minimum number of intraepithelial lymphocytes (IEL) that is diagnostic of lymphocytic esophagitis (LyE). The aim of this study was to determine whether significant correlations exist between the numbers of intraepithelial lymphocytes (IEL) in esophageal biopsies and clinical and endoscopic manifestations usually associated with EoE. METHODS H&E slides from esophageal biopsies from 330 patients were reviewed. The number of IEL and intraepithelial eosinophils (IEE) per mm2 was counted in the area with the highest concentration in each biopsy. The numbers were then correlated with clinical and endoscopic findings. RESULTS As expected, a higher number of IEE was significantly associated with food impaction (p=0.001), dysphagia (p=0.021), esophageal stricture (p=0.017), rings (P<0.0001), and furrows (p<0.0001). By contrast, there was no significant association between increased IEL and any of the aforementioned clinical and endoscopic features in the original 330 patients or in a subset of 233 patients with no IEE. Interestingly, the number of both IEE and IEL varied significantly by the season when the biopsy was obtained, being lowest in the fall and highest in the spring (p=0002 for IEE and p<0.0001 for IEL). CONCLUSION In esophageal biopsies, increased IEL has no significant correlation with food impaction or dysphagia or with esophageal stricture, rings, or furrows. There is significant variation in the number of IEL depending on the season when the biopsy is obtained, which has not been previously reported.
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Affiliation(s)
- Meera Avila
- Department of Medicine, Section of Gastroenterology, Hepatology and Nutrition, Houston, TX, USA
| | - Manju Ambelil
- Department of Pathology and Laboratory Medicine, UTHealth, McGovern Medical School and Memorial Hermann Hospital-TMC, Houston, TX, USA
| | - Yi Tong
- Department of Pathology and Laboratory Medicine, UTHealth, McGovern Medical School and Memorial Hermann Hospital-TMC, Houston, TX, USA
| | - Shruti Khurana
- Department of Medicine, Section of Gastroenterology, Hepatology and Nutrition, Houston, TX, USA
| | - Fiyinfoluwa Abraham
- Department of Medicine, Section of Gastroenterology, Hepatology and Nutrition, Houston, TX, USA
| | - Atilla Ertan
- Department of Medicine, Section of Gastroenterology, Hepatology and Nutrition, Houston, TX, USA
| | - Nirav C Thosani
- Department of Medicine, Section of Gastroenterology, Hepatology and Nutrition, Houston, TX, USA
| | - Andrew W DuPont
- Department of Medicine, Section of Gastroenterology, Hepatology and Nutrition, Houston, TX, USA
| | - Brooks D Cash
- Department of Medicine, Section of Gastroenterology, Hepatology and Nutrition, Houston, TX, USA
| | - Mamoun Younes
- Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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5
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Shimamura Y, Goda K, Hirooka S, Inoue H. Observation of bilobed nucleus sign by endocytoscopy in eosinophilic esophagitis. Gastrointest Endosc 2021; 93:259-260. [PMID: 32598961 DOI: 10.1016/j.gie.2020.06.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 06/23/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Yuto Shimamura
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Kenichi Goda
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Shinichi Hirooka
- Department of Pathology, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Haruhiro Inoue
- Digestive Diseases Center, Showa University, Koto Toyosu Hospital, Tokyo, Japan
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Eskander A, Ghobrial C, Mohsen NA, Mounir B, Abd EL-Kareem D, Tarek S, El-Shabrawi MHF. Histopathological changes in the oesophageal mucosa in Egyptian children with corrosive strictures: A single-centre vast experience. World J Gastroenterol 2019; 25:870-879. [PMID: 30809086 PMCID: PMC6385009 DOI: 10.3748/wjg.v25.i7.870] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/17/2019] [Accepted: 01/26/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The caustic ingestion continues to be a major problem worldwide especially in developing countries. The long-term complications include stricture and increased life time risk of oesophageal carcinoma. Patients suffered from corrosive induced oesophageal strictures have more than a 1000-fold risk of developing carcinoma of the oesophagus.
AIM To determine the possibility of oesophageal mucosal dysplasia after prolonged dilatation in post corrosive stricture.
METHODS This observational study was conducted at the Paediatric Endoscopy Unit in Cairo University Children’s Hospital. It included children of both sexes older than 2 years of age who had an established diagnosis of post-corrosive oesophageal stricture and repeated endoscopic dilatation sessions for more than 6 mo. All patients were biopsied at the stricture site after 6 mo of endoscopic dilatation. A histopathological examination of an oesophageal mucosal biopsy was performed for the detection of chronic oesophagitis, inflammatory cellular infiltration and dysplasia.
RESULTS The mean age of the enrolled children was 5.9 ± 2.6 years; 90% of the patients had ingested an alkaline corrosive substance (potash). The total number of endoscopic dilatation sessions were ranging from 16 to 100 with mean number of sessions was 37.2 ± 14.9. Histopathological examination of the specimens showed that 85% of patients had evidence of chronic oesophagitis (group A) in the form of basal cell hyperplasia, hyperkeratosis and subepithelial fibrosis. Thirteen percent of the patients had evidence of reactive atypia (group B) in the form of severe neutrophilic intraepithelial inflammatory cellular infiltration, and 2 patients (2%) had mild squamous dysplasia (group C); we rebiopsied these two patients 6 mo after the initial pathological assessment, guided by chromoendoscopy by Lugol's iodine.
CONCLUSION The histopathology of oesophageal mucosal biopsies in post-corrosive patients demonstrates evidence of chronic oesophagitis, intraepithelial inflammatory cellular infiltration and dysplasia. Dysplasia is one of the complications of post-corrosive oesophageal stricture.
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Affiliation(s)
- Ayman Eskander
- Department of Paediatrics, Kasr Alainy School of Medicine, Cairo University, Cairo 11562, Egypt
| | - Carolyne Ghobrial
- Department of Paediatrics, Kasr Alainy School of Medicine, Cairo University, Cairo 11562, Egypt
| | - Nabil A Mohsen
- Department of Paediatrics, Kasr Alainy School of Medicine, Cairo University, Cairo 11562, Egypt
| | - Bahaa Mounir
- Department of Pathology, Kasr Alainy School of Medicine, Cairo University, Cairo 11562, Egypt
| | - Dalia Abd EL-Kareem
- Department of Pathology, Kasr Alainy School of Medicine, Cairo University, Cairo 11562, Egypt
| | - Sara Tarek
- Department of Paediatrics, Kasr Alainy School of Medicine, Cairo University, Cairo 11562, Egypt
| | - Mortada HF El-Shabrawi
- Department of Paediatrics, Kasr Alainy School of Medicine, Cairo University, Cairo 11562, Egypt
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Coca DS, Santos CM, de Oliveira OSG, Pereira DA, Kiyoshi Furuya CJ, Artifon ELA. Upper gastrointestinal endoscopy applied in pediatrics: endoscopic and histological findings, including Helicobacter pylori. Rev Gastroenterol Peru 2018; 38:40-43. [PMID: 29791420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To present and discuss the endoscopic and histological results, as well as the incidence of Helicobacter pylori and other diseases, indications and characteristics of upper digestive endoscopies performed in children. MATERIAL AND METHODS Twenty-five endoscopies were performed in children aged six months to 11 years (mean 7.69 years), from February 2013 to January 2016. In 200 patients, endoscopies were diagnostic and serial biopsies were performed (esophagus, stomach and duodenum), in 120 of them. RESULTS The indication of endoscopy was diagnosed in 88.89% of the patients, and in 26 patients, a therapeutic procedure was performed. The most frequent endoscopic findings were esophagitis in 49 patients, gastritis in 84 and duodenitis in 16 patients. Four duodenal ulcers were diagnosed. In the therapeutic endoscopies, six gastrostomies were performed, 14 foreign body withdrawals, five nasoenteral tube passages and esophageal dilatation. The H. pylori survey was performed by anatomopathological method and was positive in 26 (13%) of the 200 patients in whom it was searched. CONCLUSION pediatric endoscopy is an important niche of the digestive endoscopy, where it is important to emphasize the relevance of the institutional structure that performs these procedures, in order to conduct them safely, being able to treat possible and feasible complications.
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Affiliation(s)
| | | | | | | | | | - Everson L A Artifon
- Endoscopy Service, Hospital Ana Costa. São Paulo, Brazil; Faculty of Medicine, University of São Paulo. São Paulo, Brazil
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Filiberti RA, Fontana V, De Ceglie A, Blanchi S, Grossi E, Della Casa D, Lacchin T, De Matthaeis M, Ignomirelli O, Cappiello R, Rosa A, Foti M, Laterza F, D'Onofrio V, Iaquinto G, Conio M. Association between coffee or tea drinking and Barrett's esophagus or esophagitis: an Italian study. Eur J Clin Nutr 2017; 71:980-986. [PMID: 28488688 DOI: 10.1038/ejcn.2017.64] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 02/01/2017] [Accepted: 04/07/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVES Only a few papers have treated of the relationship between Barrett's esophagus (BE) or erosive esophagitis (E) and coffee or tea intake. We evaluated the role of these beverages in BE and E occurrence. SUBJECTS/METHODS Patients with BE (339), E (462) and controls (619) were recruited. Data on coffee and tea and other individual characteristics were collected using a structured questionnaire. RESULTS BE risk was higher in former coffee drinkers, irrespective of levels of exposure (cup per day; ⩽1: OR=3.76, 95% CI 1.33-10.6; >1: OR=3.79, 95% CI 1.31-11.0; test for linear trend (TLT) P=0.006) and was higher with duration (>30 years: OR=4.18, 95% CI 1.43-12.3; TLT P=0.004) and for late quitters, respectively (⩽3 years from cessation: OR=5.95, 95% CI 2.19-16.2; TLT P<0.001). The risk of BE was also higher in subjects who started drinking coffee later (age >18 years: OR=6.10, 95% CI 2.15-17.3). No association was found in current drinkers, but for an increased risk of E in light drinkers (<1 cup per day OR =1.85, 95% CI 1.00-3.43).A discernible risk reduction of E (about 20%, not significant) and BE (about 30%, P<0.05) was observed in tea drinkers. CONCLUSIONS Our data were suggestive of a reduced risk of BE and E with tea intake. An adverse effect of coffee was found among BE patients who had stopped drinking coffee. Coffee or tea intakes could be indicative of other lifestyle habits with protective or adverse impact on esophageal mucosa.
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Affiliation(s)
- R A Filiberti
- Clinical Epidemiology, IRCCS AOU San Martino- IST-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - V Fontana
- Clinical Epidemiology, IRCCS AOU San Martino- IST-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - A De Ceglie
- Gastroenterology, General Hospital, Sanremo, Imperia, Italy
| | - S Blanchi
- Gastroenterology, General Hospital, Sanremo, Imperia, Italy
| | - E Grossi
- Medical Department, Bracco Spa, Milan, Italy
| | - D Della Casa
- Digestive Endoscopic Surgery, Spedali Civili di Brescia, Brescia, Italy
| | - T Lacchin
- Endoscopy, Policlinico San Giorgio, Pordenone, Italy
| | - M De Matthaeis
- Gastroenterology and Digestive Endoscopy, Ospedale di Lavagna, Lavagna, Italy
| | - O Ignomirelli
- Endoscopy, IRCCS, Rionero in Vulture, Potenza, Italy
| | - R Cappiello
- Gastroenterology, S. Maria degli Angeli Hospital, Pordenone, Italy
| | - A Rosa
- Clinical Epidemiology, IRCCS AOU San Martino- IST-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - M Foti
- Gastroenterology, LARC private Clinic, Torino, Italy
| | - F Laterza
- Internal Medicine and Gastroenterology, University &Foundation, Chieti, Italy
| | - V D'Onofrio
- Gastroenterology and Digestive Endoscopy, S. G. Moscati Hospital, Avellino, Italy
| | - G Iaquinto
- Gastroenterology and Digestive Endoscopy, S. G. Moscati Hospital, Avellino, Italy
| | - M Conio
- Gastroenterology, General Hospital, Sanremo, Imperia, Italy
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Grossi L, Ciccaglione AF, Marzio L. Esophagitis and its causes: Who is “guilty” when acid is found “not guilty”? World J Gastroenterol 2017; 23:3011-3016. [PMID: 28533657 PMCID: PMC5423037 DOI: 10.3748/wjg.v23.i17.3011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/14/2017] [Accepted: 04/12/2017] [Indexed: 02/06/2023] Open
Abstract
Esophagitis is mainly a consequence of gastroesophageal reflux disease, one of the most common diseases affecting the upper digestive tract. However the esophageal mucosa can also be targeted by some infectious, systemic or chemical conditions. Eosinophilic esophagitis (EoE) is an immune-mediated inflammatory disease, characterized by eosinophilic infiltration in the mucosa. Esophageal localization of Crohn’s disease is not very common, but it should always be considered in patients with inflammatory bowel disease complaining of upper digestive tract symptoms. There are also forms of infectious esophagitis (e.g., Herpes simplex virus or Candida albicans) occurring in patients with a compromised immune system, either because of specific diseases or immunosuppressive therapies. Another kind of damage to esophageal mucosa is due to drug use (including oncologic chemotherapeutic regimens and radiotherapy) or caustic ingestion, usually of alkaline liquids, with colliquative necrosis and destruction of mucosa within a few seconds. Dysphagia is a predominant symptom in EoE, while infectious, drug-induced and caustic damages usually cause chest pain and odynophagia. Endoscopy can be useful for diagnosing esophagitis, although no specific pattern can be identified. In conclusion when a patient refers upper gastrointestinal tract symptoms and the diagnosis of gastro-esophageal reflux disease is not convincing we should always carefully investigate the patient’s clinical history to consider possibilities other than the gastric refluxate.
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Blanco-Rodríguez G, Reyes-Retana R, Varela-Fascinetto G, Graham-Pontones S. Esophagitis caused by L-arginine capsule retention: Presentation of four cases. Rev Gastroenterol Mex (Engl Ed) 2017; 83:196-197. [PMID: 28318704 DOI: 10.1016/j.rgmx.2016.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/19/2016] [Accepted: 09/08/2016] [Indexed: 12/16/2022]
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Boschee ED, Yap JYK, Turner JM. Prediction of esophageal and gastric histology by macroscopic diagnosis during upper endoscopy in pediatric celiac disease. World J Gastroenterol 2017; 23:646-652. [PMID: 28216971 PMCID: PMC5292338 DOI: 10.3748/wjg.v23.i4.646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/10/2016] [Accepted: 12/19/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To determine the sensitivity of macroscopic appearance for predicting histological diagnosis at sites other than duodenum in pediatric celiac disease (CD).
METHODS Endoscopic and histologic findings in pediatric patients undergoing upper endoscopy for first-time diagnosis of CD at Stollery Children’s Hospital from 2010-2012 were retrospectively reviewed.
RESULTS Clinical charts from 140 patients were reviewed. Esophageal and gastric biopsies were taken in 54.3% and 77.9% of patients, respectively. Endoscopic appearance was normal in the esophagus and stomach in 75% and 86.2%. Endoscopic esophageal diagnoses were eosinophilic esophagitis (EE) (11.8%), esophagitis (7.9%), glycogenic acanthosis (1.3%) and non-specific abnormalities (3.9%). Endoscopic gastric diagnoses were gastritis (8.3%), pancreatic rest (0.9%), and non-specific abnormalities (4.6%). Histology was normal in 76.3% of esophageal and 87.2% of gastric specimens. Abnormal esophageal histology was EE (10.5%), esophagitis (10.5%), glycogenic acanthosis (1.3%) and non-specific (1.3%). Gastritis was reported in 12.8% of specimens. Sensitivity and specificity of normal endoscopy for predicting normal esophageal histology was 86.2% and 61.1%, and for normal gastric histology was 87.4% and 21.4%.
CONCLUSION In the absence of macroscopic abnormalities, routine esophageal and gastric biopsy during endoscopy for pediatric CD does not identify major pathologies. These findings have cost and time saving implications for clinical practice.
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de Magalhães Gomes R, Soletti RC, Soldan M, Madi K, Foster FS, Machado JC. In Vivo Endoluminal Ultrasound Biomicroscopy and Endoscopy of Inflamed Rat Esophagus. Ultrasound Med Biol 2016; 42:2687-2696. [PMID: 27530211 DOI: 10.1016/j.ultrasmedbio.2016.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 06/28/2016] [Accepted: 07/02/2016] [Indexed: 06/06/2023]
Abstract
The development of high-frequency endoscopic ultrasound for the investigation of models of esophageal disease may offer insights for future translation to human imaging. With respect to small animal models of esophageal diseases, ultrasound imaging instrumentation must employ frequencies scaled up to maintain the compromise between image resolution and inspected region. In this sense, a 40-MHz endoluminal ultrasound biomicroscopy (eUBM) system and an endoscope were tested as diagnostic methods of imaging rat esophageal lesions in the acute and chronic phases caused by sodium hydroxide. Although endoscopy allowed grading of the esophagus in accordance with a classification specific to the epithelial alterations and including hyperemia, edema, exudates, fibrin and superficial and deep ulcerations, the eUBM images yielded the detection of superficial and deep ulcerations, as well as wall alterations caused by edema and inflammatory infiltrate in the submucosa. Additionally, eUBM enabled wall thickness measurements, which were statistically significantly increased (p < 0.05) in the acute phase.
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Affiliation(s)
- Rodrigo de Magalhães Gomes
- Post-Graduation Program in Surgical Sciences, Department of Surgery, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rossana C Soletti
- Pharmacy Unit, Universidade Estadual da Zona Oeste, Rio de Janeiro, Brazil
| | - Mônica Soldan
- Division of Gastroenterology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Brazil
| | - Kalil Madi
- Division of Pathology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Brazil
| | - F Stuart Foster
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - João C Machado
- Post-Graduation Program in Surgical Sciences, Department of Surgery, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Biomedical Engineering Program, COPPE, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
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Majors J, Zhuge Y, Eubanks JW, Weksler B. Minimally invasive esophagectomy in a 6-year-old girl for the sequelae of corrosive esophagitis. J Thorac Cardiovasc Surg 2016; 152:e115-e116. [PMID: 27406439 DOI: 10.1016/j.jtcvs.2016.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/07/2016] [Accepted: 06/10/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Jacqueline Majors
- Division of Thoracic Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tenn
| | - Ying Zhuge
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tenn
| | - James W Eubanks
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tenn
| | - Benny Weksler
- Division of Thoracic Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tenn.
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Abstract
Immunoglobulin G4 (IgG4)-related disease is characterized by the typical histopathological features of a dense lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells, a high ratio of IgG4- to IgG-positive cells, storiform fibrosis (cellular fibrosis organized in an irregular whorled pattern), obliterative phlebitis, and variable presence of eosinophils. The disease exhibits systemic involvement but very rarely involves the esophagus. A 33-year-old man was admitted to our hospital for evaluation of a 1-year history of progressive dysphagia. Neck imaging revealed a 3.9-cm mass in the cervical esophagus and multifocal calcified lymph nodes in the lower neck and mediastinum. Two previous tertiary hospitals failed to diagnose the patient's condition despite the use of ultrasound-guided needle biopsy of the neck tumor. We performed neck imaging studies, a flexible endoscopic swallowing study, high-resolution manometry, upper endoscopy, and a review of the previous pathologic slides. The patient was finally diagnosed with IgG4-related esophagitis and showed a good response to corticosteroid therapy. We herein report a rare case of dysphagia associated with IgG4-related disease and present a review of the literature.
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Affiliation(s)
- Ji Hyun Oh
- From the Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul (JHO, THL, HSK, CSJ, CSJ, JSL), Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Bucheon (SJH), and Department of Pathology, College of Medicine, Soonchunhyang University, Seoul, Republic of Korea (SYJ)
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Abd Elrazek AE, Mahfouz H, Elazeem KA, Fakhry M, Elrazek EA, Foad M, Alboraie M, Ragab A, Baghdady S, Bilasy SE, Salama K, Masseih RA, Amer MO, Hassaneen S, Bhagavathula AS, Elnour AA, Al Nuaimi SK, Shehab A. The Value of U/S to Determine Priority for Upper Gastrointestinal Endoscopy in Emergency Room. Medicine (Baltimore) 2015; 94:e2241. [PMID: 26656368 PMCID: PMC5008513 DOI: 10.1097/md.0000000000002241] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
In countries endemic for liver and GIT diseases, frequent emergency department (ED) patients contribute to a disproportionate number of visits consuming substantial amount of medical resources. One of the most frequent ED visits is patients who present with hypovolemic shock, abdominal pain, or confusion with or without signs of upper gastrointestinal bleeding (UGIB). The use of conventional two-dimensional ultrasound (2D-U/S) may provide immediate and useful information on the presence of esophageal varices, gastrointestinal tumors, and other GIT abnormalities.The current study investigated the feasibility of using (2D-U/S) to predict the source of UGIB in ED and to determine patients' priority for UGE.Between February 2003 and March 2013, we retrospectively reviewed the profiles of 38,551 Egyptian patients, aged 2 to 75 years old, who presented with a history of GI/liver diseases and no alcohol consumption. We assessed the value of 2D-U/S technology in predicting the source of UGIB.Of 38,551 patients presenting to ED, 900 patients (2.3%), 534 male (59.3%) and 366 female (40.7%) developed UGIB. Analyzing results obtained from U/S examinations by data mining for emergent UGE were patients with liver cirrhosis (LC), splenomegaly, and ascites (42.6% incidence of UGIB), followed by LC and splenomegaly (14.6%), LC only (9.4%), and was only 0.5% who had no morbidity finding by 2D-U/S.Ultrasonographic instrumentation increases the feasibility of predictive emergency medicine. The area has recently not only gained a fresh impulse, but also a new set of complex problems that needs to be addressed in the emergency medicine setting according to each priority.
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Affiliation(s)
- Abd Elrazek Abd Elrazek
- From the Division of Liver Transplantation and Data Mining Research, Department of Hepatology and GIT; Senior Researcher (Al Azhar and Aswan University, Cairo, Asuit and Aswan, Egypt (AEAH); Department of Tropical, GI and Hepatology - Al Azhar School of Medicine-Asuit Branch-Al Azhar University-Asuit, Egypt (EMAE, HMM, MF, KAE); Department of Gynecology and Obstetrics, Al Azhar School of Medicine, Asuit Branch, Al Azhar University - Asuit, Egypt (MF); Department of Internal Medicine, Al Azhar School of Medicine, Al Azhar University, Cairo, Egypt (MA); Department of General and Laparoscopic Surgery, Al Azhar School of Medicine, Cairo (AR); Chest and Respiratory Intensive Care Unit, Aswan School of Medicine, Aswan University, Aswan, Egypt (SB); Department of Biochemistry, Faculty of Pharmacy, Suez canal University, Ismailia, Egypt (SEB); Graduate Medical Student, Egypt (KS); Department of Hepatology, UCLA, USA; Research Assistant (RAE); Department of Hepatology, National Liver Institute, Menofiya University-Menofiya, Egypt (MOA); Department of Radiology, Asuit faculty of Medicine, Asuit University, Asuit, Egypt (SH); Department of Clinical Pharmacy, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia (ASB); Departments of Clinical Pharmacology, Medicine and Cardiovascular Diseases, College of Medicine and Health Sciences (CMHS), University of Arab Emirates (AAE, SKA, AS); UAE-Emirates (AAE, SA, AS)
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16
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Gómez ÁA, Guerrero D, Hani AC, Cañadas R. [Acute necrotizing esophagitis (black esophagus) with secondary severe stenosis]. Rev Gastroenterol Peru 2015; 35:349-354. [PMID: 26802889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We report the case of a 67 years old patient with a history of diabetes mellitus, atrial fibrillation and chronic renal failure, who developed diabetic ketoacidosis and severe sepsis, later presenting an acute necrotizing esophagitis, and then a esophageal stenosis requiring treatment with self-expanding esophageal prosthesis with good clinical results.
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Affiliation(s)
| | | | - Albis C Hani
- Hospital Universitario San Ignacio. Bogotá, Colombia
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17
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Karmazanovsky GG, Buryakina SA, Kondratiev EV, Yang Q, Ruchkin DV, Kalinin DV. Value of two-phase dynamic multidetector computed tomography in differential diagnosis of post-inflammatory strictures from esophageal cancer. World J Gastroenterol 2015; 21:8878-8887. [PMID: 26269677 PMCID: PMC4528030 DOI: 10.3748/wjg.v21.i29.8878] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/25/2015] [Accepted: 05/07/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To characterize the computed tomography (CT) findings in patients with post-inflammatory esophageal strictures (corrosive and peptic) and reveal the optimal scanning phase protocols for distinguishing post-inflammatory esophageal stricture and esophageal cancer.
METHODS: Sixty-five patients with esophageal strictures of different etiology were included in this study: 24 patients with 27 histopathologically confirmed corrosive strictures, 10 patients with 12 peptic strictures and 31 patients with esophageal cancer were evaluated with a two-phase dynamic contrast-enhanced MDCT. Arterial and venous phases at 10 and 35 s after the attenuation of 200 HU were obtained at the descending aorta, with a delayed phase at 6-8 min after the start of injection of contrast media. For qualitative analysis, CT scans of benign strictures were reviewed for the presence/absence of the following features: “target sign”, luminal mass, homogeneity of contrast medium uptake, concentric wall thickening, conically shaped suprastenotic dilatation, smooth boundaries of stenosis and smooth mucous membrane at the transition to stenosis, which were compared with a control group of 31 patients who had esophageal cancer. The quantitative analysis included densitometric parameter acquisition using regions-of-interest measurement of the zone of stenosis and normal esophageal wall and the difference between those measurements (ΔCT) at all phases of bolus contrast enhancement. Esophageal wall thickening, length of esophageal wall thickening and size of the regional lymph nodes were also evaluated.
RESULTS: The presence of a concentric esophageal wall, conically shaped suprastenotic dilatation, smooth upper and lower boundaries, “target sign” and smooth mucous membrane at the transition to stenosis were suggestive of a benign cause, with sensitivities of 92.31%, 87.17%, 94.87%, 76.92% and 82.05%, respectively, and specificities of 70.96%, 89.66%, 80.65%, 96.77% and 93.55%, respectively. The features that were most suggestive of a malignant cause were eccentric esophageal wall thickening, tuberous upper and lower boundaries of stenosis, absence of mucous membrane visualization, rupture of the mucous membrane at the upper boundary of stenosis, cup-shaped suprastenotic dilatation, luminal mass and enlarged regional lymph nodes with specificities of 92.31% 94.87%, 67.86%, 100%, 97.44%, 94.87% and 82.86%, respectively and sensitivities of 70.97%, 80.65%, 96.77%, 80.65%, 54.84%, 87.10% and 60%, respectively. The highest tumor attenuation occurred in the arterial phase (mean attenuation 74.13 ± 17.42 HU), and the mean attenuation difference between the tumor and the normal esophageal wall (mean ΔCT) in the arterial phase was 23.86 ± 19.31 HU. Here, 11.5 HU of ΔCT in the arterial phase was the cut-off value used to differentiate esophageal cancer from post-inflammatory stricture (P = 0.000). The highest attenuation of post-inflammatory strictures occurred in the delayed phase (mean attenuation 71.66 ± 14.28 HU), and the mean ΔCT in delayed phase was 34.03 ± 15.94 HU. Here, 18.5 HU of ΔCT in delayed phase was the cut-off value used to differentiate post-inflammatory stricture from esophageal cancer (P < 0.0001).
CONCLUSION: The described imaging findings reveal high diagnostic significance in the differentiation of benign strictures from esophageal cancer.
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DiSantis DJ, Dyer RB. "Feline" esophagus. Abdom Imaging 2015; 40:2046. [PMID: 25431157 DOI: 10.1007/s00261-014-0298-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- David J DiSantis
- Department of Radiology, Chandler/UK Medical Center, College of Medicine, University of Kentucky, Room HX-315A, 800 Rose Street, Lexington, KY, 40536, USA,
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Stagg J, Farukhi I, Lazaga F, Thompson C, Bradshaw L, Kaif M, Gould-Simon A, Schmidt R. Significance of 18F-Fluorodeoxyglucose Uptake at the Gastroesophageal Junction: Comparison of PET to Esophagogastroduodenoscopy. Dig Dis Sci 2015; 60:1335-42. [PMID: 25502332 DOI: 10.1007/s10620-014-3456-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 11/18/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Positron emission tomography-computed tomography (PET/CT) occasionally reveals unexpected uptake of (18)F-fluorodeoxyglucose ((18)F-FDG) at the gastroesophageal junction (GEJ). The aim of this study was to determine the importance of unexpected (18)F-FDG uptake at the GEJ on PET/CT by correlating this finding with endoscopy results. METHODS We reviewed medical records from June 2009 to October 2012 to identify patients in our Veterans Affairs Medical Center who had an esophagogastroduodenoscopy (EGD) performed within 6 months of a PET/CT. Metabolic activity at the GEJ was quantified with standardized uptake values (SUV) and correlated with EGD and histopathology results. RESULTS A total of 219 patients were identified and assigned to one of five groups based upon EGD findings: esophageal malignancy (n = 34), esophagitis (n = 21), Barrett's esophagus (n = 8), other non-malignant disorders (n = 5), and normal (n = 151). The mean SUV Max for the groups was 6.72, 2.47, 2.40, 3.48, and 2.06, respectively. SUV Max and SUV Mean were significantly higher in the esophageal malignancy group than in all other groups (p < 0.001). SUV for patients with high-grade esophagitis was greater than in patients with low-grade esophagitis. A SUV Max ≥ 3.5 was found to predict necessity for EGD with a positive predictive value of 79 %. A SUV Max ≤ 2.2 yielded a negative predictive value of 86 %. CONCLUSION Differentiation between benign and potentially significant disease at the GEJ may be possible with quantification of incidental (18)F-FDG uptake at PET/CT. Our results suggest thresholds that may help determine need for further endoscopic evaluation in patients with abnormal metabolic activity at the GEJ.
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Affiliation(s)
- Joshua Stagg
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9030, USA,
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20
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Nakano H, Iseki K, Ozawa A, Tominaga A, Sadahiro R, Otani K. [Conservative treatment improved corrosive esophagitis and pneumomediastinum in a patient who ingested bleaching agent containing sodium hypochlorite and sodium hydroxide]. Chudoku Kenkyu 2014; 27:39-44. [PMID: 24724360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A 69-year-old man was admitted to the emergency department 3 hours after ingestion of a bleaching agent containing hypochlorous acid and sodium hydroxide in a suicide attempt. Enhanced chest computed tomography scans taken on admission indicated an edematous esophagus and air bubbles in the mediastinum. He underwent endotracheal intubation and mechanical ventilation until day 9 because of laryngeal edema. On day 10, his endoscopy indicated diffuse reddish mucosal hyperemia, erosions, and lacerated mucosal lesions in the esophagus that were indicative of grade 2b corrosive esophagitis. Treatment with a proton pump inhibitor was initiated, with which the condition of the esophagus improved, and on day 44, a slight stricture of the upper part of the esophagus was observed. He was discharged on day 64 without any complaints. The ingestion of sodium hypochlorite induces corrosive esophagitis and acute phase of gastritis. Ingestion of any corrosive agent is known as a risk factor for esophagus cancer in the long-term. In such cases with esophageal stricture, esophagectomy is recommended for preventing esophagus cancer. Considering the age of the patient, however, he did not undergo esophagectomy.
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21
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Yang GD, Lu PX, Qin J, Liu ST, Zhan NY. Radiologic diagnosis for AIDS patients complicated with candidal esophagitis. Chin Med J (Engl) 2011; 124:965-967. [PMID: 21542950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Candidal esophagitis is the primary infection among all digestive tract opportunistic ones in acquired immunodeficiency syndrome (AIDS) cases. X-ray manifestation reports of it are still rare. This study aimed to conduct a retrospective analysis on the X-ray data of 6 AIDS cases complicated with candidal esophagitis, and to study the X-ray characteristics of it combined with the findings from gastroscopy. METHODS Among 6 cases in this series, all cases were confirmed by Shenzhen Center for Disease Control and Prevention (CDC) to be HIV positive and all of them had CD4 cell counts less than 150 × 10(6)/L. All cases underwent X-ray and gastroscopy, and mycelium were found in the mucous membrane of the esophagus. RESULTS In this series, the findings of the X-ray were as follows: (1) Affected areas: Four cases in the whole esophagus, 2 cases in the middle and lower part of esophagus; (2) Abnormal motivity: Six cases had decreased tension, loose walls, weakened peristalsis, decreased number of peristalsis waves and delayed emptying of barium; (3) Abnormal contour: Six cases had the sign of "decorative border" or "brush", two cases had narrowed canal; (4) Abnormal membrane and "cobblestone sign": Six cases had thickened membrane and "cobblestone sign" on the surface of the abnormal membrane. The hyperemia of mucosa was covered tightly with yellow-white pseudomembrane spots. This was in accordance with the small cobblestone-like filling defect found by X-ray. CONCLUSIONS If the AIDS cases have dysphagia, and X-ray shows that more than two sections of the esophagus are affected, with decreased motility, the walls in the sign of "brush" or "decorative edges", thickened membrane with "cobblestone sign", candidal esophagitis is highly possible.
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Affiliation(s)
- Gen-Dong Yang
- Department of Radiology, Shenzhen Third People's Hospital, Shenzhen, Guangdong 518020, China
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22
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Ciofetta G. Gastro-esophageal studies in relationship to respiratory problems. Q J Nucl Med Mol Imaging 2010; 54:372-378. [PMID: 20823805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Gastroesophageal reflux represents a physiological phenomenon in the first year of life. The reflux associated with clinical complications is defined as "gastroesophageal reflux disease" (GERD), that may be esophageal or extra-esophageal, as is for respiratory problems. Nuclear medicine investigations have given an important contribution to the diagnostic assessment and therapeutical management of GERD in children, by means of the following procedures: scintigraphy of the gastroduodenal transit and reflux detection, scintigraphic quantification of gastric emptying, scintigraphy of the esophageal transit, radioisotopic salivagram, scintigraphy of lung perfusion, ventilation and of mucociliary clearance. All of these investigations are among the less irradiating nuclear medicine procedures, therefore particularly adapted to paediatrics. The main clinical advantages of this body of information include: improvements in the management of many asthmatic children, surgical anti-reflux intervention success-rate increase, prompt regional lung alterations detection for preventing stable tissue damage, and many others.
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Affiliation(s)
- G Ciofetta
- Department of Diagnostic Imaging, Bambino Gesù Pediatric Hospital, Rome, Italy.
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Abstract
AIM To describe the findings of paediatric upper gastrointestinal endoscopy (UGE) and to reduce the rate of normal findings in children undergoing diagnostic UGE. METHODS Upper gastrointestinal endoscopy were performed at a single tertiary referral children's hospital over a 3-year period by four endoscopists. Patients were subgrouped into diagnostic categories (recurrent abdominal pain syndrome (RAP), oesophagitis, coeliac disease and enteropathy/inflammatory bowel disease) and endoscopists recorded their clinical diagnosis as above before each procedure. Endoscopic and biopsy findings were compared with clinical diagnosis. After the first year of audit each endoscopist was appraised of their practice and strategies implemented to reduce the normal UGE. In years 2 and 3 all endoscopists were audited by their peers on a monthly basis. RESULTS A total of 1172 UGE were performed over a 3-year period. Ninety per cent were diagnostic procedures, of which 48% were normal, 16% identified oesophagitis, 11% coeliac disease, 6% gastritis, 3%Helicobacter pylori and 1% peptic ulcer disease. Peer-review audit significantly reduced the number of normal findings in coeliac disease, RAP and overall (P < 0.01) but not in the groups with presumed oesophagitis or investigation of enteropathy/inflammatory bowel disease. CONCLUSIONS A high proportion of patients undergoing UGE have normal procedures. Peer-review audit can reduce the number of normal procedures particularly in RAP and in the diagnosis of coeliac disease.
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Affiliation(s)
- Edward V O'Loughlin
- Department of Gastroenterology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
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24
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Affiliation(s)
- P V Kaye
- Departments of Histopathology, Queen's Medical Centre, University Hospital NHS Trust, Nottingham, UK
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25
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Bhutani MS, Moparty B, Chaya CT, Schnadig V, Logrono R. Endoscopic ultrasound-guided fine-needle aspiration of enlarged mediastinal lymph nodes in eosinophilic esophagitis. Endoscopy 2007; 39 Suppl 1:E82-3. [PMID: 17440879 DOI: 10.1055/s-2006-945122] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- M S Bhutani
- Center for Endoscopic Ultrasound and CERTAIN (Center for Endoscopic Research, Training and Innovation),University of Texas Medical Branch, Galveston, Texas, USA.
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Henroteaux A, Hoyoux M, Ghaye B, Delvenne P, Canivet JL. [Image of the month. Significant infectious esophagitis demonstrated by thoracic x-ray computed tomography]. Rev Med Liege 2006; 61:793-4. [PMID: 17313112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Caleiro MTC, Lage LV, Navarro-Rodriguez T, Bresser A, da Costa PA, Yoshinari NH. Radionuclide imaging for the assessment of esophageal motility disorders in mixed connective tissue disease patients: relation to pulmonary impairment. Dis Esophagus 2006; 19:394-400. [PMID: 16984539 DOI: 10.1111/j.1442-2050.2006.00598.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Esophageal functional abnormalities may lead to regurgitation, chronic esophagitis and life-threatening conditions such as aspiration pneumonia. In mixed connective tissue disease patients, previous reports showed that esophageal dysfunction varies according to the method employed for investigation. Our study was conceived to: (i) assess esophageal motility and mucosal aspects in patients with mixed connective tissue disease by endoscopy, cine-esophogram and scintigraphy focusing on the prevalence of each exam; and (ii) verify the association between pulmonary and esophageal dysfunctions. Twenty-four mixed connective tissue disease patients were enrolled for this study. Cine-esophogram and upper digestive endoscopy with mucosal biopsy were performed according to previous standardization. Radionuclide esophageal scintigraphy was performed with a semisolid meal with (99m)Tc. Eleven healthy individuals voluntarily submitted to scintigraphy as controls. Cine-esophogram showed esophageal delayed emptying in 90% of patients. At scintigraphy there was a significant delay in total esophageal transit time in the group of patients when compared to healthy controls (35.3 +/- 8.2 s. vs. 13.6 +/- 9.5 s.; P < 0.0001). The whole esophageal body showed dysmotility in 96% of patients. The cine-esophogram detected functional esophageal impairment similar to scintigraphic findings. Histopathologic examination found esophagitis in 95% of studied patients. Reduced lung volumes were associated with esophagitis and delayed esophageal clearance at scintigraphy, observed at the distal portion of the esophagus. Esophageal scintigraphy is easy to perform, with good acceptance by patients with low radiation exposition. It is a useful non-invasive test for follow-up and interventional studies concerning esophagus dysfunction.
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Affiliation(s)
- M T C Caleiro
- Division of Rheumatology, Clinics Hospital, University of São Paulo, SP, Brazil.
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Furuta K, Adachi K, Kowari K, Mishima Y, Imaoka H, Kadota C, Koshino K, Miyake T, Kadowaki Y, Furuta K, Kazumori H, Sato S, Ishihara S, Amano Y, Honda M, Kinoshita Y. A Japanese case of eosinophilic esophagitis. J Gastroenterol 2006; 41:706-10. [PMID: 16933010 DOI: 10.1007/s00535-006-1827-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2006] [Accepted: 03/26/2006] [Indexed: 02/04/2023]
Abstract
Eosinophilic esophagitis (EE) is a rarely diagnosed condition involving eosinophilic infiltration of the esophageal mucosa. Here we present a case of EE in a 69-year-old Japanese man, who presented with abdominal pain, appetite loss, and a history of bronchial asthma. Laboratory findings included peripheral eosinophilia and an increased serum immunoglobulin E level. Computed tomography showed diffuse severe thickening of the esophageal wall, and a barium esophagogram revealed a small caliber of the middle and lower portion of the esophagus, without normal peristaltic contractions. Endoscopy of the esophagus showed a pale mucosa, with adherent whitish exudates resembling fungal infection, and prominent ring-like contractions. Histologic examination of a biopsy specimen revealed marked eosinophil infiltration into the esophageal mucosa. Endoscopic ultrasonography (EUS) demonstrated marked circumferential thickening of the esophageal submucosal layer, and an esophageal manometry study showed a high percentage of ineffective esophageal peristalsis and high-amplitude esophageal body contractions. EUS findings showed no change even after oral corticosteroid therapy, although the histological findings were improved. This is thought to be the first documented Japanese case of EE. EE should be considered in the differential diagnosis in cases of esophageal motility disturbance, even if the patients do not complain of dysphagia.
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Affiliation(s)
- Koichiro Furuta
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, 693-8501, Japan
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Affiliation(s)
- Chun-Ho Yun
- Department of Radiology, Mackay Memorial Hospital, and Department of Radiology, Taipei Medical University, Taiwan.
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Shrikanthan S, Aydin A, Dhurairaj T, Alavi A, Zhuang H. Intense esophageal FDG activity caused by Candida infection obscured the concurrent primary esophageal cancer on PET imaging. Clin Nucl Med 2005; 30:695-7. [PMID: 16166848 DOI: 10.1097/01.rlu.0000178244.55482.2a] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Esophageal cancer frequently causes a focal intense FDG uptake on positron emission tomography (PET) imaging while esophagitis often results in a mild to moderate degree of FDG activity in a diffuse pattern. However, detection of an esophageal cancer can become difficult in the presence of a diffuse esophageal activity because of esophagitis. We present such case in which esophageal cancer superimposed by Candidal esophagitis is difficult to recognize on FDG PET images.
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Affiliation(s)
- Sankaran Shrikanthan
- Department of Radiology, Hospital of the University of Pennsylvania, PA 19104, USA
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Abstract
PURPOSE To retrospectively assess the findings of idiopathic eosinophilic esophagitis (IEE) at barium studies and determine the frequency of the ringed esophagus in patients with this condition. MATERIALS AND METHODS The institutional review board approved all aspects of this retrospective study and did not require informed consent from patients whose records were included in the study. The study was compliant with the Health Insurance Portability and Accountability Act. A review of the pathology and radiology databases at the authors' institution revealed 14 patients (11 men and three women; mean age, 41.3 years) with IEE (defined as more than 20 eosinophils per high-power field in biopsy specimens) who had undergone barium studies and endoscopy. The radiographs were reviewed for strictures, esophagitis, or other abnormalities. The endoscopic reports, clinical records, and laboratory data were also reviewed and compared with the radiographic findings. RESULTS Seven of the 14 patients (50%) had a history of allergies, and two of nine patients with complete blood cell counts (22%) had peripheral eosinophilia. Thirteen patients (93%) had dysphagia, six (43%) had food impactions, and six (43%) had reflux symptoms. Ten patients (71%) had a total of 11 strictures at barium studies (two in the upper part of the esophagus, two in the middle part, three in the distal part, one in the middle and distal parts, and three at the gastroesophageal junction). The strictures had a mean length of 5.1 cm. In seven patients (50%), the strictures contained multiple fixed ringlike indentations that produced a ringed esophagus. The ringlike indentations appeared as multiple, fixed, closely spaced, concentric rings traversing the stricture. Four patients (28%) had esophagitis. Of 13 patients who underwent recumbent imaging, 10 (77%) had hiatal hernias and nine (69%) had reflux. Eight of the 10 patients (80%) with strictures underwent endoscopic dilation procedures, which resulted in only temporary relief of dysphagia. CONCLUSION The findings suggest that most patients with IEE have esophageal strictures, often with distinctive ringlike indentations that produce a ringed esophagus.
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Affiliation(s)
- Stefan L Zimmerman
- Department of Radiology, Hospital of University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA
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Yoshikawa I. [Report from the 31st UOEH meeting of Gastrointestinal Image Diagnosis]. J UOEH 2005; 27:223-4. [PMID: 15986778 DOI: 10.7888/juoeh.27.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Fiorentino E, Cabibi D, Barbiera F, Pantuso G, Buscemi G, Latteri F, Mastrosimone A, Valenti A. [Hiatal hernia, gastro-oesophageal reflux and oesophagitis: videofluorographic, endoscopic and histopathological correlation]. Chir Ital 2004; 56:483-8. [PMID: 15452985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
The aim of the study was to evaluate the correlation between hiatal hernia and gastro-oesophageal reflux and related histological abnormalities in patients without endoscopic oesophagitis. A consecutive series of 78 patients with a history of gastro-oesophageal reflux symptoms and hiatal hernia, as defined by videofluorography combined with a water siphon test, underwent oesophagogastroduodenoscopy and multiple biopsies. Hiatal hernia was confirmed endoscopically in 99% of cases. The water siphon test was positive for reflux in 72% of cases. At endoscopy 42% of patients had oesophagitis and/or Barrett's oesophagus and 58% had no lesions. In the group without endoscopic lesions, at histology oesophagitis-related alterations were found in 98% and intestinal metaplasia in 27%. In conclusion, this study shows that symptomatic gastro-oesophageal reflux patients with radiologically defined hiatal hernia should undergo endoscopy with multiple biopsies above the squamocolumnar junction, even when endoscopy is normal. This is in order to detect histological gastro-oesophageal-reflux-related alterations, above all, when a positive water siphon test is also present, owing to its known correlation with intestinal metaplasia.
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Affiliation(s)
- Eugenio Fiorentino
- Dipartimento di Oncologia Sezione di Chirurgia Generale ad indirizzo oncologico, Università degli Studi di Palermo, Azienda Ospedaliera Universitaria Policlinico
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Abstract
OBJECTIVE We evaluated the ability of endoscopic ultrasonography to predict likelihood of stricture formation in patients with corrosive esophagitis. METHODS Consecutive patients with esophagitis resulting from alkaline or acid chemical ingestion (n = 11) were evaluated prospectively by endoscopic ultrasonography between hospital days 4 and 12. Findings for the most severe lesion were classified according to the appearance of the muscular layers: distinct muscular layers without thickening (grade 0); distinct muscular layers with thickening (grade I); obscured muscular layers with indistinct margins (grade II); and muscular layers that could not be differentiated (grade III). Findings were also classified according to whether apparent damage to muscular layers in the worst-appearing image involved part of the circumference (type a) or the whole circumference (type b). Implications of these findings for subsequent stricture formation were then evaluated. RESULTS Stricture formation did not occur in patients with grade 0 or grade I images; transient stricture formation occurred in a patient showing grade IIa. Stricture requiring repeated bougie dilation occurred in a patient showing grade IIIb. CONCLUSIONS Endoscopic ultrasonographic images presumed to reflect the destruction of muscular layers (grades II to III), as opposed to only edema (grade I), may be associated with stricture formation. This modality can accurately visualize deep lesions in corrosive esophagitis, making it prognostically useful.
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Affiliation(s)
- Yoshito Kamijo
- Department of Emergency and Critical Care Medicine, Kitasato University, School of Medicine, Kanagawa, Japan
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Nurko S, Teitelbaum JE, Husain K, Buonomo C, Fox VL, Antonioli D, Fortunato C, Badizadegan K, Furuta GT. Association of Schatzki ring with eosinophilic esophagitis in children. J Pediatr Gastroenterol Nutr 2004; 38:436-41. [PMID: 15085025 DOI: 10.1097/00005176-200404000-00014] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To describe the clinicopathologic characteristics of children with Schatzki ring and to determine if Schatzki ring is associated with eosinophilic esophagitis. METHODS The authors report 18 adolescents with radiographically diagnosed Schatzki ring (SR). Their clinical and histologic characteristics were reviewed in a blinded fashion. RESULTS The mean age of the patients was 15.8 +/- 0.8 years and mean duration of symptoms was 2.6 +/- 0.4 years. By histologic criteria, two groups of patients were defined. Eight had clinical and histologic criteria of eosinophilic esophagitis (EE) and 10 of peptic esophagitis. There were no differences in the symptoms or radiographic findings in the two groups. The SR was not identified by endoscopy in any EE patient and was identified in 70% of peptic esophagitis patients. Grossly apparent mucosal features associated with EE were significantly more common in those with EE. Those with peptic esophagitis had a significantly higher acid exposure than did those with EE (12.6 +/- 2.9 v 2.0 +/- 1.1%; P < 0.01) by esophageal pH probe. Patients with peptic esophagitis responded to proton pump inhibitors and/or dilatation, whereas those with EE did not have good response and required specific therapy for EE. CONCLUSIONS EE may play a role in the pathogenesis of some patients with SR.
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Affiliation(s)
- Samuel Nurko
- Division of Gastroenterology, Children's Hospital Boston, and Department of Pediatrics, Harvard Medical School, Massachusetts, 02115, USA.
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Affiliation(s)
- Peeyush Bhargava
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
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Potter JW, Saeian K, Staff D, Massey BT, Komorowski RA, Shaker R, Hogan WJ. Eosinophilic esophagitis in adults: an emerging problem with unique esophageal features. Gastrointest Endosc 2004; 59:355-61. [PMID: 14997131 DOI: 10.1016/s0016-5107(03)02713-5] [Citation(s) in RCA: 228] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Eosinophilic esophagitis is an inflammatory condition in which there is dense eosinophilic infiltration of the surface lining of the esophagus. Reports of eosinophilic esophagitis pertain almost exclusively to pediatric populations. However, eosinophilic esophagitis is emerging as a clinical affliction of adults. This report describes the clinical and endoscopic findings of eosinophilic esophagitis in the largest cohort of adult patients reported to date. METHODS Twenty-nine patients (21 men, 8 women; mean age 35 years) with documented eosinophilic esophagitis (>/=15 eosinophils per high-power field in biopsy specimens) and a significant history of chronic dysphagia for solid food (24 patients) were evaluated clinically and endoscopically during a 3-year period (1999-2002). Fourteen patients (48%) had a history of asthma, environmental allergy, or atopy. In a subset of 15 patients, the diagnostic accuracy of endoscopy was compared with that of barium contrast esophagography. RESULTS Twenty-seven patients (93%) had abnormal endoscopic findings; 25 (86%) had unique esophageal structural changes, associated with a preserved mucosal surface, that were highly atypical for acid reflux injury. Structural alterations seen in adult patients with eosinophilic esophagitis may occur in combination or as a primary characteristic, e.g., uniform small-caliber esophagus, single or multiple corrugations (rings), proximal esophageal stenosis, or 1 to 2 mm whitish vesicles scattered over the mucosal surface. Barium contrast radiography combined with swallow of a barium-coated marshmallow identified 10 (67%) of the primary features observed endoscopically in 15 patients. However, radiography failed to detect other features noted at endoscopy (e.g., only 3/6 patients with proximal stenosis, 5/9 patients with concentric rings and none of 4 patients with small caliber esophagus). Eight of the 29 patients (20%) had a history of chronic heartburn. Twelve patients had been treated with a proton pump inhibitor and only 3 reported some improvement in the severity of dysphagia. CONCLUSIONS Relatively young age, a history of chronic dysphagia for solid food, and endoscopic detection of unique structural alterations atypical for GERD in an adult patient should prompt a suspicion of EE and subsequent biopsy confirmation. Acid reflux appears to have a secondary role in eosinophilic esophagitis. In an uncontrolled comparison, endoscopy was superior to barium contrast radiography for the diagnosis of eosinophilic esophagitis. The incidence of eosinophilic esophagitis in adults appears to be increasing.
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Affiliation(s)
- Jon W Potter
- Division of Gastroenterology and Hepatology, Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA
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Bradley J, Deasy JO, Bentzen S, El-Naqa I. Dosimetric correlates for acute esophagitis in patients treated with radiotherapy for lung carcinoma. Int J Radiat Oncol Biol Phys 2004; 58:1106-13. [PMID: 15001251 DOI: 10.1016/j.ijrobp.2003.09.080] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2003] [Revised: 09/18/2003] [Accepted: 09/22/2003] [Indexed: 10/26/2022]
Abstract
PURPOSE Acute esophagitis is a common complication of radiotherapy (RT) for non-small-cell carcinoma of the lung. Previous reports have related esophagitis to dosimetric parameters such as the length of the irradiated esophagus, maximal dose, or volume of the organ treated beyond a threshold dose. However, when using oblique beams, a portion of the esophageal circumference may be outside the treated field, resulting in partial esophageal irradiation. Therefore, our aim was to determine whether the irradiated esophageal surface area and/or esophageal volume are predictive of acute esophagitis in relation to other clinical and treatment-related factors. METHODS AND MATERIALS Complete dose-volume information was gathered for 166 patients receiving definitive RT for Stage I-IIIB non-small-cell carcinoma of the lung at our institution. Seventy-eight patients received chemotherapy (37 before RT and 41 concurrently). All patients were treated to doses of 60-74 Gy (median, 70 Gy) delivered in single daily fractions of 1.8-2.1 Gy. The doses were prescribed to the isocenter without using heterogeneity corrections; however, the doses were corrected to account for lung heterogeneity in this report. Esophageal contrast was used to contour the esophagus from the cricoid to the gastroesophageal junction in each case. Esophagitis was scored according to the Radiation Therapy Oncology Group criteria with Grade 2 or worse considered clinically significant. To determine the importance of the irradiated surface area, the volumetric treatment plan for each patient was prepared for analysis by relating a surface area to each point of the esophagus contour. Spearman's rank correlation was used to correlate the esophagitis score with A(d), where A represents the surface area (in centimeters squared) receiving the dose, d, or greater (in Gray), or V(d), where V represents the volume (in centimeters cubed) receiving d (in Gray). The surface areas studied were A(5)-A(80) or V(5)-V(80) in 5-Gy increments. The clinical parameters studied in univariate analysis included patient age, stage, performance status, use of pretreatment chemotherapy, and use of concurrent chemotherapy. Step-wise regression analysis was then used to determine the statistically significant factors predicting acute esophagitis. RESULTS Forty-five patients (27%) developed Grade 2 or worse esophagitis, 37 developed Grade 2, 7 Grade 3, and 1 Grade 4. No deaths resulted from this complication. The most statistically significant single parameters for predicting acute esophagitis were A(55), V(60), and the use of concurrent chemotherapy. Age, stage, performance status, and pre-RT chemotherapy had no statistically significant influence on the incidence of acute esophagitis. On logistic regression analysis, A(55) (p < or =0.0005), V(60) (p < or =0.001), and the use of concurrent chemotherapy (p = 0.001) emerged as statistically significant correlates of acute esophagitis. CONCLUSION The esophageal surface area receiving > or =55 Gy, the esophageal volume receiving > or =60 Gy, and the use of concurrent chemotherapy were the most statistically significant predictive factors for early esophagitis. Adequate dosimetric coverage of the planning target volume remains the goal of RT planning. High values of A(55) and/or V(60) are indicative of the development of acute esophagitis and may indicate a need to explore alternative RT planning options.
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Affiliation(s)
- Jeffrey Bradley
- Department of Radiation Oncology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63110, USA.
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Affiliation(s)
- Cheolkyu Jung
- Hanyang University Seoul Hospital, Seoul 133-792, South Korea
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Han E, Broussard J, Baer KE. Feline esophagitis secondary to gastroesophageal reflux disease: clinical signs and radiographic, endoscopic, and histopathological findings. J Am Anim Hosp Assoc 2003; 39:161-7. [PMID: 12617544 DOI: 10.5326/0390161] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Chronic esophagitis due to gastroesophageal reflux (GER) is rarely reported in the cat. This paper describes the clinical signs and diagnostic findings, including radiographic, endoscopic, and histopathological abnormalities, in three young, purebred, male cats with esophagitis presumed to be secondary to GER. Clinical signs included regurgitation, dysphagia, and weight loss. Contrast radiography revealed GER, esophageal dilatation, and decreased motility. Endoscopy showed hyperemia, increased vascularity, ulcers, erosion, and an abnormal lower esophageal sphincter. Histopathological lesions included squamous hyperplasia and dysplasia, erosions, ulcers, and an inflammatory infiltrate of lymphocytes, plasma cells, and neutrophils. Long-term follow-up demonstrated progression of the disease in two of the cats.
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Affiliation(s)
- Eveline Han
- Department of Medicine, Bobst Hospital of The Animal Medical Center, 510 East 62nd Street, New York, New York 10021, USA
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Abstract
BACKGROUND The pathophysiology of dysphagia associated with eosinophilic esophagitis is unknown. This study investigated possible anatomic alterations in children with eosinophilic esophagitis in comparison with healthy children by using high-resolution EUS to precisely measure individual tissue layers of the esophagus. METHODS Children with eosinophilic esophagitis (n = 11) and control children (n = 8) without esophagitis were prospectively evaluated by high-resolution EUS with a 20-MHz catheter US probe during an endoscopic examination. Real-time measurements of the distal esophagus were obtained including the thickness of the total wall, combined mucosa and submucosa, muscularis propria, and circular muscle. RESULTS Statistically significant differences were found between patients with eosinophilic esophagitis and control patients for mean values for thickness of the total wall (respectively, 2.8 vs. 2.1 mm; p = 0.004), combined mucosa and submucosa (respectively, 1.6 vs. 1.1 mm; p = 0.001), and muscularis propria (respectively, 1.2 vs. 1.0 mm; p = 0.043). Mean values for circular muscle did not differ between patient groups. CONCLUSION High-resolution EUS reveals significant expansion of the esophageal wall and individual tissue layers including the combined mucosa and submucosa, and muscularis propria in children with eosinophilic esophagitis compared with healthy control patients.
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Affiliation(s)
- Victor L Fox
- Division of Gastroenterology and Nutrition, Department of Pediatrics, Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Hsu CH, Shiun SC, Hsu NY, Sun SS, Kao A, Lee CC, Lin CC. Using non-invasive radionuclide imaging to detect esophagitis in patients with gastroesophageal reflux disease. Hepatogastroenterology 2003; 50:107-9. [PMID: 12630003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND/AIMS The aim of our study was to evaluate technetium-99m tetrofosmin SPECT (single photon emission computed tomography) of the chest as a potential non-invasive method to evaluate esophagitis among gastroesophageal reflux disease patients. METHODOLOGY In this study, we used non-invasive radionuclide imaging technetium-99m tetrofosmin chest SPECT to detect and grade esophagitis in 60 patients with gastroesophageal reflux disease. RESULTS Based on the endoscopic findings according to the Savary-Miller system, the sensitivity, specificity, and accuracy rates of technetium-99m tetrofosmin chest SPECT in detecting esophagitis were 95.2%, 72.2%, and 88.3%, respectively. The agreement between the endoscopic and technetium-99m tetrofosmin chest SPECT findings was evaluated and found to be good (kappa: 0.633, p < 0.001). CONCLUSIONS Non-invasive technetium-99m tetrofosmin chest SPECT has excellent sensitivity and good accuracy as a screen for esophagitis among gastroesophageal reflux disease patients.
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Affiliation(s)
- Chang-Hu Hsu
- Division of Gastroenterology, China Medical College Hospital, No. 2, Yuh-Der Road, Taichung 404, Taiwan
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De Agustin JC, Sanz N, Canals MJ, Alvarez E, Morales JL, Soler J, Ollero JC, Vazquez J. Successful medical treatment of two patients with eosinophilic oesophagitis. J Pediatr Surg 2002; 37:207-13. [PMID: 11819200 DOI: 10.1053/jpsu.2002.30256] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND/PURPOSE Significant oesophageal eosinophilia is associated with oesophagitis and gastroesophageal reflux (GER). Eosinophilic oesophagitis is a rare disease that causes thickening of the oesophageal wall, narrowing of the oesophageal lumen, and severe motor disturbance. METHODS AND RESULTS Two 12 yr-old patients with eosinophilic oesophagitis were studied prospectively. Clinical and investigation details are presented. Elemental formula was administered until complete remission of disease. Final outcome was assessed after 3 months on regular diet with exclusion of specific allergic components. Both patients responded to the dietary manipulation. CONCLUSIONS Eosinophilic oesophagitis must be included in the differential diagnosis when dealing with oesophageal strictures of unknown or unclear aetiology. Elimination diet therapy plays a crucial role in ameliorating the course of the illness. Blood eosinophilia correlates with therapeutic response and with improvement of the disease.
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Abstract
CASE REPORT Two patients with corrosive esophagitis caused by alkaline household agents were examined with endoscopic ultrasound using a 20-MHz probe. In the first case, endoscopic ultrasound revealed circumferentially thickened mucosa and muscularis propria, and lack of differentiation between the mucosa and submucosa. However, esophageal stricture did not develop during 3 months of follow-up, suggesting that the deep lesion may have involved a narrow section of esophagus only. In the second case, a markedly thickened mucosa was seen, resulting in no sequelae. Endoscopic ultrasound offers a more accurate evaluation of the depth of the lesions in alkaline esophagitis compared to standard endoscopy or computed tomography. Longitudinal studies are needed to identify lesions at greatest risk for progression to stricture.
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Affiliation(s)
- Y Kamijo
- Department of Emergency and Critical Care Medicine, Kitasato University, School of Medicine, Sagamihara Kanagawa, Japan.
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Affiliation(s)
- C Stevoff
- Division of Gastroenterology and Hepatology, Northwestern University Medical School, Chicago, Illinois 60611, USA
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Kao CH, ChangLai SP, Lee JK. Detection of esophagitis by technetium 99m tetrofosmin chest SPECT. Am J Gastroenterol 2001; 96:1950-1. [PMID: 11419868 DOI: 10.1111/j.1572-0241.2001.03914.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Affiliation(s)
- A Bestetti
- Department of Nuclear Medicine and Institute of Radiological Sciences, San Paolo Hospital, University of Milan, Italy.
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Abstract
OBJECTIVE The purpose of our study was to determine the CT findings in patients with esophagitis. MATERIALS AND METHODS A search of medical and radiology files revealed 29 patients with esophagitis in whom thoracic CT was performed within 1 month of the diagnosis. The CT scans were reviewed retrospectively for esophageal wall thickening, a target sign, or other abnormalities. The thickness of the esophageal wall was also measured on CT in these 29 patients and compared with a control group of 85 patients. RESULTS We found that 16 patients (55%) with esophagitis had abnormal findings on CT, including a thickened esophageal wall (using 5 mm as the threshold for wall thickening) in all 16 (55%) and a target sign in five (17%). The overall mean esophageal wall thickness was 4.7 mm (standard deviation [SD], 2 mm; 95% confidence interval [CI], 0.7-8.7 mm) in patients with esophagitis versus a mean wall thickness of 2.9 mm (SD, 0.8 mm; 95% CI, 1.3-4.5 mm) in controls (p <.001). Using the same 5-mm threshold for wall thickening, we found that only three (4%) of 85 controls had a thickened esophageal wall on CT. CONCLUSION The majority of patients with esophagitis had abnormalities on CT, including a thickened esophageal wall (> or =5 mm) in 55% and a target sign in 17%. Although barium studies and endoscopy are more sensitive modalities for detecting this condition, the CT finding of a relatively long segment of circumferential esophageal wall thickening, with or without a target sign, should suggest the diagnosis of esophagitis in the proper clinical setting.
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Affiliation(s)
- G Y Berkovich
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, USA
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Canon CL, Levine MS, Cherukuri R, Johnson LF, Smith JK, Koehler RE. Intramural tracking: a feature of esophageal intramural pseudodiverticulosis. AJR Am J Roentgenol 2000; 175:371-4. [PMID: 10915677 DOI: 10.2214/ajr.175.2.1750371] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Our purpose was to determine the frequency of intramural tracking in patients with esophageal intramural pseudodiverticulosis and to characterize the morphologic features of this finding on barium studies. MATERIALS AND METHODS A review of radiology files at two institutions revealed 30 cases of esophageal intramural pseudodiverticulosis diagnosed at esophagography. In all cases, the radiographs were reviewed retrospectively to determine the frequency and morphologic features of intramural tracking in these patients. The number and distribution of pseudodiverticula and the presence or absence of strictures or esophagitis were also noted. RESULTS Fifteen (50%) of 30 patients with esophageal intramural pseudodiverticulosis had intramural tracking on esophagography. The tracks had an average length of 1.2 cm (length range, 0.3-7 cm) and an average width of 1.6 mm (width range, 1-4 mm). The pseudodiverticula were more numerous and had a more diffuse distribution in patients with tracking than in patients without tracking. Although patients with and without tracking had a similar frequency of strictures and esophagitis, patients with tracking were more likely to have strictures involving the upper or mid esophagus, whereas patients without tracking were more likely to have strictures in the distal esophagus. These findings indicate that intramural tracking is more likely to occur in patients with the diffuse form of esophageal intramural pseudodiverticulosis. CONCLUSION Intramural tracking was detected on esophagography in 50% of patients with esophageal intramural pseudodiverticulosis, so this type of tracking is a more common radiographic finding than has previously been recognized. Although intramural tracking has little or no known clinical significance, it is important to be aware of this finding so that it is not mistaken for a large flat ulcer in the esophagus or for an extramural collection associated with esophageal peridiverticulitis.
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Affiliation(s)
- C L Canon
- Department of Radiology, University of Alabama at Birmingham, 35249-6830, USA
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