Asunto(s)
Azitromicina/administración & dosificación , Anomalías Cardiovasculares , Trastornos de Deglución , Infecciones por Mycoplasma , Prednisona/administración & dosificación , Arteria Subclavia/anomalías , Anillo Vascular , Antibacterianos/administración & dosificación , Anomalías Cardiovasculares/diagnóstico , Anomalías Cardiovasculares/fisiopatología , Niño , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/etiología , Trastornos de Deglución/fisiopatología , Trastornos de Deglución/terapia , Diagnóstico Diferencial , Ecocardiografía/métodos , Endoscopía del Sistema Digestivo/métodos , Esofagitis/diagnóstico , Esofagitis/etiología , Esofagitis/fisiopatología , Esofagitis/terapia , Hemorragia Gastrointestinal/diagnóstico por imagen , Hemorragia Gastrointestinal/etiología , Glucocorticoides/administración & dosificación , Humanos , Masculino , Infecciones por Mycoplasma/diagnóstico , Infecciones por Mycoplasma/tratamiento farmacológico , Infecciones por Mycoplasma/fisiopatología , Mycoplasma pneumoniae/aislamiento & purificación , Recurrencia , Arteria Subclavia/fisiopatología , Resultado del Tratamiento , Anillo Vascular/diagnóstico , Anillo Vascular/fisiopatologíaRESUMEN
BACKGROUND: The mechanisms associated with gastro-esophageal reflux (GER) episodes were studied using combined High-resolution Impedance Manometry (HRIM) and pH monitoring in ambulant subjects with different patterns of GERD. METHODS: Sixteen subjects with mild-moderate esophagitis (Los Angeles (LA) grade A&B) (group A) and 11 subjects with severe esophagitis (LA grade C&D) or Barrett's esophagus (BE) were studied before and after a meal, resting, while walking, and during standardized exercise, using a HRIM and a pH probe. KEY RESULTS: Post-prandial acid GER episodes were more common in group B (median 10 range (3-18) vs A (6.5 (0-18), p = 0.048). Postprandial acid clearance time was much longer in group B (median 0.71( 0.07-2.66 min) vs A (0.17 (0.04-2.44 min), p = 0.02). Transient lower esophageal sphincter relaxation (TLESR) was the most frequent mechanism associated with GER episodes in both groups. Post-prandial TLESRs with GER were more common in group B (median 17 (9-24) vs A 13.5 (7-34), p = 0.014), particularly during exercise (B 8 (6-9) vs A 6 (5-6.8), p = 0.007). Post-prandially TLESR with acid reflux increased during exercise in both groups (A rest median 2.4 (0-6.4) per hour vs exercise 4.7 (0-17.3), p = 0.005 and B 4 (0.8-9.6) vs 5.3 (2.7-13.3) per hour, p = 0.045). CONCLUSIONS AND INFERENCES: TLESR was the most common mechanism associated with reflux episodes in all subjects. Acid reflux episodes were more common in subjects with severe esophagitis or BE and esophageal acid clearance was much slower. Post-prandial exercise increased TLESR with acid reflux and GERD patients should be encouraged to avoid exercise immediately after a meal.
Asunto(s)
Esfínter Esofágico Inferior/fisiopatología , Monitorización del pH Esofágico/métodos , Reflujo Gastroesofágico/diagnóstico , Reflujo Gastroesofágico/fisiopatología , Manometría/métodos , Relajación Muscular/fisiología , Adulto , Anciano , Esofagitis/diagnóstico , Esofagitis/fisiopatología , Femenino , Humanos , Concentración de Iones de Hidrógeno , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
Currently, there are inconsistencies in the recommendations of when to obtain an esophagogastroduodenoscopy (EGD) in children with feeding difficulties. The aim of our study was to identify EGD findings in patients presenting to a large, outpatient feeding program. Additionally, we investigated the presence of any relationship between abnormal pathology seen on biopsies (inflammation) and symptoms of feeding intolerance such as vomiting, gagging, retching, or abdominal pain. Retrospective analysis of electronic medical records (EMRs) was conducted for all new patients aged 0-17 years presenting to the Multidisciplinary Feeding Clinic. Three hundred and thirty patients (50.2%) had an EGD with complete biopsies. Of these 330 patients, biopsies revealed esophagitis in 40%, gastritis in 33.6%, and duodenitis in 15.2%. Overall, 61.21% had an abnormal pathology in at least one site. We found that children with feeding disorders commonly have esophagitis, gastritis, and/or duodenitis and that symptoms are poor predictors of pathology. This study underscores the importance of gastrointestinal evaluation as part of a multidisciplinary evaluation in patients with feeding difficulties.
Asunto(s)
Duodenitis/diagnóstico , Endoscopía del Sistema Digestivo/métodos , Esofagitis/diagnóstico , Gastritis/diagnóstico , Dolor Abdominal/etiología , Adolescente , Niño , Preescolar , Duodenitis/complicaciones , Duodenitis/fisiopatología , Esofagitis/complicaciones , Esofagitis/fisiopatología , Femenino , Gastritis/complicaciones , Gastritis/fisiopatología , Humanos , Lactante , Masculino , Estudios Retrospectivos , Vómitos/etiologíaRESUMEN
We herein report four patients with desquamative esophagitis that developed one to nine days after peripheral blood stem cell transplantation (PBSCT). Three patients underwent allogeneic PBSCT for leukemia, and the other underwent autologous PBSCT for pineoblastoma. Esophagogastroduodenoscopy revealed mucosal sloughing and fresh blood in the esophagus. Fasting and intravenous proton pump inhibitor therapy in addition to blood transfusion improved the esophageal lesions within five to seven days in three patients. These cases indicate that desquamative esophagitis can occur in patients who receive hematopoietic stem cell transplantation. Although blood transfusions may be required, it can be resolved within seven days.
Asunto(s)
Transfusión Sanguínea/métodos , Esofagitis/etiología , Esofagitis/fisiopatología , Esofagitis/terapia , Ayuno , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Inhibidores de la Bomba de Protones/uso terapéutico , Adolescente , Adulto , Femenino , Humanos , Japón , Masculino , Resultado del Tratamiento , Adulto JovenRESUMEN
Caustic ingestion represents a serious social-medical problem due to the devastating and irreversible consequences it can produce in the upper digestive tract. In Ibero-America, there are no published reliable data on the incidence or prevalence of caustic-induced injuries, and most of the available information on clinical presentation, diagnosis, treatment, and prognosis is based on retrospective clinical series and, indeed, its clinical management is often based primarily on expert opinion. Re cently as an initiative of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) and with the cooperation of the Spanish Society for Pediatric Gastroente rology, Hepatology and Nutrition (SEGHNP), we have designed a Clinical Practice Guideline that include a series of statements and recommendations aimed at optimizing patient medical care which is based on the systematic review of evidence. Two (2) successive papers focused on the evaluation of physiopathological and clinical-endoscopic diagnostic features of caustic esophagitis in children (1st. Paper) and, on the other hand, the most relevant therapeutic considerations (2nd. Paper). We expect this guideline to become a useful tool for the physician in the difficult decision-making process when assessing patients after caustic ingestion.
Asunto(s)
Quemaduras Químicas , Cáusticos/toxicidad , Esofagitis , Adolescente , Quemaduras Químicas/diagnóstico , Quemaduras Químicas/etiología , Quemaduras Químicas/fisiopatología , Quemaduras Químicas/terapia , Niño , Preescolar , Esofagitis/diagnóstico , Esofagitis/etiología , Esofagitis/fisiopatología , Esofagitis/terapia , Humanos , Lactante , PediatríaRESUMEN
Caustic ingestion represents a serious social-medical problem due to the devastating and irreversible consequences it can produce in the upper digestive tract. In Ibero-America, there are no published reliable data on the incidence or prevalence of caustic-induced injuries, and most of the available information on clinical presentation, diagnosis, treatment, and prognosis is based on retrospective clinical series and, indeed, its clinical management is often based primarily on expert opinion. Re cently as an initiative of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) and with the cooperation of the Spanish Society for Pediatric Gastroente rology, Hepatology and Nutrition (SEGHNP), we have designed a Clinical Practice Guideline that include a series of statements and recommendations aimed at optimizing patient medical care which is based on the systematic review of evidence. Two (2) separate papers focused on the evaluation of physiopathological and clinical-endoscopic diagnostic features of caustic esophagitis in children (1st. Paper) and, on the other hand, the most relevant therapeutic considerations (2nd. Paper). We expect this guideline to become a useful tool for the physician in the difficult decision-making process when assessing patients after caustic ingestion.
Asunto(s)
Quemaduras Químicas/etiología , Cáusticos/toxicidad , Esofagitis/inducido químicamente , Esófago/lesiones , Quemaduras Químicas/diagnóstico , Quemaduras Químicas/fisiopatología , Quemaduras Químicas/terapia , Toma de Decisiones Clínicas/métodos , Esofagitis/diagnóstico , Esofagitis/fisiopatología , Esofagitis/terapia , Esófago/fisiopatología , Humanos , América Latina , EspañaAsunto(s)
Infecciones por Citomegalovirus/fisiopatología , Citomegalovirus/patogenicidad , Esofagitis/fisiopatología , Reflujo Gastroesofágico/fisiopatología , Huésped Inmunocomprometido , Trasplante de Riñón , Antivirales/uso terapéutico , Convalecencia , Citomegalovirus/efectos de los fármacos , Citomegalovirus/crecimiento & desarrollo , Citomegalovirus/inmunología , Infecciones por Citomegalovirus/tratamiento farmacológico , Infecciones por Citomegalovirus/inmunología , Infecciones por Citomegalovirus/virología , Endoscopía del Sistema Digestivo , Esofagitis/tratamiento farmacológico , Esofagitis/inmunología , Esofagitis/virología , Femenino , Reflujo Gastroesofágico/tratamiento farmacológico , Reflujo Gastroesofágico/inmunología , Reflujo Gastroesofágico/virología , Humanos , Riñón/inmunología , Riñón/fisiopatología , Riñón/cirugía , Riñón/virología , Persona de Mediana Edad , Insuficiencia Renal Crónica/inmunología , Insuficiencia Renal Crónica/fisiopatología , Insuficiencia Renal Crónica/cirugía , Insuficiencia Renal Crónica/virología , Valganciclovir/uso terapéuticoRESUMEN
Although bariatric surgery is proven to sustain weight loss in morbidly obese patients, long-term adverse effects have yet to be fully characterized. This study compared the long-term consequences of two common forms of bariatric surgery: one-anastomosis gastric bypass (OAGB) and Roux-en-Y Gastric Bypass (RYGB) in a preclinical rat model. We evaluated the influence of biliopancreatic limb (BPL) length, malabsorption, and bile acid (BA) reflux on esogastric mucosa. After 30 weeks of follow-up, Wistar rats operated on RYGB, OAGB with a short BPL (15 cm, OAGB-15), or a long BPL (35 cm, OAGB-35), and unoperated rats exhibit no cases of esogastric cancer, metaplasia, dysplasia, or Barrett's esophagus. Compared to RYGB, OAGB-35 rats presented higher rate of esophagitis, fundic gastritis and perianastomotic foveolar hyperplasia. OAGB-35 rats also revealed the greatest weight loss and malabsorption. On the contrary, BA concentrations were the highest in the residual gastric pouch of OAGB-15 rats. Yet, no association could be established between the esogastric lesions and malabsorption, weight loss, or gastric bile acid concentrations. In conclusion, RYGB results in a better long-term outcome than OAGB, as chronic signs of biliary reflux or reactional gastritis were reported post-OAGB even after reducing the BPL length in a preclinical rat model.
Asunto(s)
Reflujo Biliar , Mucosa Esofágica , Esofagitis , Derivación Gástrica/efectos adversos , Mucosa Gástrica , Modelos Biológicos , Obesidad Mórbida , Complicaciones Posoperatorias , Animales , Reflujo Biliar/etiología , Reflujo Biliar/metabolismo , Reflujo Biliar/patología , Reflujo Biliar/fisiopatología , Enfermedad Crónica , Mucosa Esofágica/metabolismo , Mucosa Esofágica/patología , Mucosa Esofágica/fisiopatología , Esofagitis/etiología , Esofagitis/metabolismo , Esofagitis/patología , Esofagitis/fisiopatología , Mucosa Gástrica/metabolismo , Mucosa Gástrica/patología , Mucosa Gástrica/fisiopatología , Hiperplasia/etiología , Hiperplasia/metabolismo , Hiperplasia/patología , Hiperplasia/fisiopatología , Obesidad Mórbida/metabolismo , Obesidad Mórbida/patología , Obesidad Mórbida/fisiopatología , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias/metabolismo , Complicaciones Posoperatorias/patología , Complicaciones Posoperatorias/fisiopatología , Ratas , Ratas WistarRESUMEN
RATIONALE: Dabigatran is an anticoagulant medication that has been widely used to prevent strokes caused by atrial fibrillation, deep vein thrombosis, and pulmonary embolism. However, the potential adverse effect of dabigatran of gastrointestinal mucosal injury is often neglected, and even induces esophagitis. PATIENT CONCERNS: A 77-year-old woman was admitted to the hospital with symptoms of progressive retrosternal pain, upper abdominal discomfort, and dysphagia. DIAGNOSIS: Esophagogastroduodenoscopy showed longitudinal sloughing mucosal casts in the distal esophagus. Histological examination showed squamous epithelium with neutrophil infiltration, partial epithelial degeneration, and Helicobacter pylori. Based on a literature review, medical history, and imaging examination, the patient was diagnosed with dabigatran-induced esophagitis. INTERVENTIONS: The patient recovered with standard H. pylori eradication therapy and proton pump inhibitor without discontinuing dabigatran. OUTCOMES: After 2 weeks, the retrosternal pain and dysphagia were relieved and upper abdominal discomfort was attenuated. LESSONS: Our case highlights the importance of physicians' awareness of the clinical and endoscopic characteristics of dabigatran-induced esophagitis and the importance of H. pylori-associated tests and eradication if necessary for patients with long-term dabigatran treatment.
Asunto(s)
Dabigatrán/efectos adversos , Esofagitis/etiología , Dolor Abdominal/tratamiento farmacológico , Dolor Abdominal/fisiopatología , Anciano , Antitrombinas/efectos adversos , Antitrombinas/uso terapéutico , Dabigatrán/uso terapéutico , Trastornos de Deglución/tratamiento farmacológico , Trastornos de Deglución/fisiopatología , Endoscopía del Sistema Digestivo/métodos , Esofagitis/fisiopatología , Femenino , Helicobacter pylori/efectos de los fármacos , Helicobacter pylori/patogenicidad , HumanosRESUMEN
Resumen: La ingestión de cáusticos representa un grave problema médico-social por las consecuencias devastadoras e irreversibles que puede producir en el tracto digestivo superior. En Iberoamérica no se han publicado datos fidedignos sobre la incidencia o la prevalencia de lesiones inducidas por cáusticos. La información disponible sobre la presentación clínica, diagnóstico, tratamiento y pronóstico se basa en series retrospectivas de casos y, de hecho, su manejo clínico se sustenta en muchos casos fundamentalmente en la opinión de expertos. Recientemente como una iniciativa de la Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica (SLAGHNP) y con la co laboración de colegas de la Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediá trica (SEGHNP), hemos diseñado una Guía de Práctica Clínica (GPC) la cual incluye una serie de enunciados y recomendaciones dirigidos a optimizar la atención a los pacientes y que se basan en la revisión sistemática de la evidencia. En dos (2) manuscritos sucesivos nos hemos enfocado primero, en los aspectos fisiopatológicos y de diagnóstico clínico-endoscópico de la esofagitis cáustica en niños (1a. Parte) y en segundo lugar, en los aspectos más relevantes del tratamiento (2a. Parte). Esperamos esta guía se convierta en una herramienta útil para el clínico en el difícil proceso de toma de decisio nes a la hora de evaluar un paciente posterior a la ingesta de una sustancia cáustica.
Abstract: Caustic ingestion represents a serious social-medical problem due to the devastating and irreversible consequences it can produce in the upper digestive tract. In Ibero-America, there are no published reliable data on the incidence or prevalence of caustic-induced injuries, and most of the available information on clinical presentation, diagnosis, treatment, and prognosis is based on retrospective clinical series and, indeed, its clinical management is often based primarily on expert opinion. Re cently as an initiative of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) and with the cooperation of the Spanish Society for Pediatric Gastroente rology, Hepatology and Nutrition (SEGHNP), we have designed a Clinical Practice Guideline that include a series of statements and recommendations aimed at optimizing patient medical care which is based on the systematic review of evidence. Two (2) separate papers focused on the evaluation of physiopathological and clinical-endoscopic diagnostic features of caustic esophagitis in children (1st. Paper) and, on the other hand, the most relevant therapeutic considerations (2nd. Paper). We expect this guideline to become a useful tool for the physician in the difficult decision-making process when assessing patients after caustic ingestion.
Asunto(s)
Humanos , Quemaduras Químicas/etiología , Cáusticos/toxicidad , Esofagitis/inducido químicamente , Esófago/lesiones , España , Quemaduras Químicas/diagnóstico , Quemaduras Químicas/fisiopatología , Quemaduras Químicas/terapia , Esofagitis/diagnóstico , Esofagitis/fisiopatología , Esofagitis/terapia , Esófago/fisiopatología , Toma de Decisiones Clínicas/métodos , América LatinaAsunto(s)
Esofagitis , Esofagoscopía/métodos , Esófago , Anciano de 80 o más Años , Estreñimiento/complicaciones , Estreñimiento/diagnóstico , Diagnóstico Diferencial , Esofagitis/diagnóstico por imagen , Esofagitis/patología , Esofagitis/fisiopatología , Esófago/diagnóstico por imagen , Esófago/patología , Femenino , Humanos , Laxativos/administración & dosificación , Paraqueratosis/patología , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Vómitos/diagnóstico , Vómitos/etiologíaRESUMEN
Resumen: La ingestión de cáusticos representa un grave problema médico-social por las consecuencias devastadoras e irreversibles que puede producir en el tracto digestivo superior. En Iberoamérica no se han publicado datos fidedignos sobre la incidencia o la prevalencia de lesiones inducidas por cáusticos. La información disponible sobre la presentación clínica, diagnóstico, tratamiento y pronóstico se basa en series retrospectivas de casos y, de hecho, su manejo clínico se sustenta en muchos casos fundamentalmente en la opinión de expertos. Recientemente como una iniciativa de la Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica (SLAGHNP) y con la co laboración de colegas de la Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediá trica (SEGHNP), hemos diseñado una Guía de Práctica Clínica (GPC) la cual incluye una serie de enunciados y recomendaciones dirigidos a optimizar la atención a los pacientes y que se basan en la revisión sistemática de la evidencia. En dos (2) manuscritos sucesivos nos hemos enfocado primero, en los aspectos fisiopatológicos y de diagnóstico clínico-endoscópico de la esofagitis cáustica en niños (1a. Parte) y en segundo lugar, en los aspectos más relevantes del tratamiento (2a. Parte). Esperamos esta guía se convierta en una herramienta útil para el clínico en el difícil proceso de toma de decisio nes a la hora de evaluar un paciente posterior a la ingesta de una sustancia cáustica.
Abstract: Caustic ingestion represents a serious social-medical problem due to the devastating and irreversible consequences it can produce in the upper digestive tract. In Ibero-America, there are no published reliable data on the incidence or prevalence of caustic-induced injuries, and most of the available information on clinical presentation, diagnosis, treatment, and prognosis is based on retrospective clinical series and, indeed, its clinical management is often based primarily on expert opinion. Re cently as an initiative of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) and with the cooperation of the Spanish Society for Pediatric Gastroente rology, Hepatology and Nutrition (SEGHNP), we have designed a Clinical Practice Guideline that include a series of statements and recommendations aimed at optimizing patient medical care which is based on the systematic review of evidence. Two (2) successive papers focused on the evaluation of physiopathological and clinical-endoscopic diagnostic features of caustic esophagitis in children (1st. Paper) and, on the other hand, the most relevant therapeutic considerations (2nd. Paper). We expect this guideline to become a useful tool for the physician in the difficult decision-making process when assessing patients after caustic ingestion.
Asunto(s)
Humanos , Lactante , Preescolar , Niño , Adolescente , Quemaduras Químicas/diagnóstico , Quemaduras Químicas/etiología , Quemaduras Químicas/fisiopatología , Quemaduras Químicas/terapia , Cáusticos/toxicidad , Esofagitis/diagnóstico , Esofagitis/etiología , Esofagitis/fisiopatología , Esofagitis/terapia , PediatríaRESUMEN
Gastroesophageal reflux disease (GERD) is a common condition and impairs the quality of life for millions of patients, accounts for considerable health care spending, and is a primary risk factor for esophageal adenocarcinoma. There have been substantial advances in understanding the pathogenesis of GERD and its complications and much progress in diagnosis and management of GERD; however, these have not been comprehensively discussed in the recent radiology literature. Understanding the role of imaging in GERD and its complications is important to aid in multidisciplinary treatment of GERD. GERD results from prolonged or recurrent reflux of gastric contents into the esophagus. Common symptoms include heartburn or regurgitation. Prolonged reflux of gastric contents into the esophagus can cause erosive esophagitis. Over time, the inflammatory response related to esophagitis can lead to deposition of fibrous tissue and development of strictures. Alternatively, the esophageal mucosa can undergo metaplasia (Barrett esophagus), a precursor to dysplasia (which can lead to adenocarcinoma). Conventional barium esophagography has long been considered the primary imaging modality for the esophagus, and the fluoroscopic findings for diagnosis of GERD have been well established. Multimodality imaging has a clear role in detection and assessment of the complications of GERD, specifically reflux esophagitis and Barrett esophagus; differentiation of benign and malignant strictures; and detection, staging, and posttreatment surveillance of esophageal adenocarcinoma. Given the dramatic changes in utilization of abdominal imaging during the past 2 decades, with significantly declining volume of fluoroscopic procedures and concomitant increase in CT and MRI studies, it is crucial that modern radiologists appreciate the value of barium esophagography in the workup of GERD and recognize the key imaging features of GERD and its complications at CT and MRI.
Asunto(s)
Reflujo Gastroesofágico/complicaciones , Reflujo Gastroesofágico/diagnóstico por imagen , Reflujo Gastroesofágico/fisiopatología , Imagen Multimodal , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/etiología , Adenocarcinoma/fisiopatología , Esófago de Barrett/diagnóstico por imagen , Esófago de Barrett/etiología , Esófago de Barrett/fisiopatología , Neoplasias Esofágicas/diagnóstico por imagen , Neoplasias Esofágicas/etiología , Neoplasias Esofágicas/fisiopatología , Esofagitis/diagnóstico por imagen , Esofagitis/etiología , Esofagitis/fisiopatología , HumanosRESUMEN
BACKGROUND & AIMS: The Lyon Consensus defines LA grades C&D erosive esophagitis (EE) or acid exposure time (AET) >6% as the conclusive evidence for gastro-esophageal reflux disease (GERD). However, most of EE is LA grade A&B and the rate of AET exceeding 6% is low in China. We aimed to evaluate patients with EE in the Chinese population based on the Lyon Criteria. METHODS: A retrospective study was performed among patients with EE who had esophageal function tests performed in a tertiary hospital from 2013 to 2017. Erosive esophagitis was staged according to the Los Angeles classification. Their motor profiles from high-resolution manometry (HRM), reflux profiles from multichannel intraluminal impedance-pH (MII-pH) monitoring and proton pump inhibitor (PPI) efficacy were analyzed. Patients were categorized as conclusive or inconclusive GERD. RESULTS: Among 112 patients with EE who underwent esophageal function tests, EE of LA grade C&D was found in only 4.46% (N = 5). Almost 35% (N = 37) of patients with LA grade A&B EE had AET exceeded 6%, who had good PPI response similar to those with LA grade C&D EE (77.42% vs 100%, P = .559). The remaining 70 patients (62.50%) were inconclusive GERD, of whom 56.25% responded to PPI. Inconclusive GERD patients had a wide range (7.14%-97.14%) of positive adjunctive evidences from HRM and MII-pH monitoring without significant correlation to PPI response rate. CONCLUSIONS: The reflux burden within patients with EE is predominantly low in China, and adjunctive HRM and MII-pH profiles from Lyon criteria do not segregate PPI response.
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Esofagitis/fisiopatología , Esófago/fisiopatología , Reflujo Gastroesofágico/complicaciones , Adulto , Anciano , China , Monitorización del pH Esofágico , Esofagitis/etiología , Femenino , Reflujo Gastroesofágico/tratamiento farmacológico , Motilidad Gastrointestinal , Humanos , Masculino , Manometría , Persona de Mediana Edad , Inhibidores de la Bomba de Protones/uso terapéutico , Estudios RetrospectivosAsunto(s)
Cirugía Bariátrica/métodos , Gastroscopía/métodos , Obesidad/cirugía , Pérdida de Peso , Adolescente , Adulto , Anciano , Cirugía Bariátrica/efectos adversos , Cirugía Bariátrica/instrumentación , Niño , Preescolar , Ensayos Clínicos como Asunto , Diabetes Mellitus Tipo 2/etiología , Diabetes Mellitus Tipo 2/patología , Diabetes Mellitus Tipo 2/prevención & control , Dislipidemias/etiología , Dislipidemias/patología , Dislipidemias/prevención & control , Esofagitis/diagnóstico , Esofagitis/etiología , Esofagitis/fisiopatología , Femenino , Gastroscopía/efectos adversos , Gastroscopía/instrumentación , Humanos , Hipertensión/etiología , Hipertensión/patología , Hipertensión/prevención & control , Masculino , Persona de Mediana Edad , Náusea/diagnóstico , Náusea/etiología , Náusea/fisiopatología , Obesidad/complicaciones , Obesidad/patología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/fisiopatología , Vómitos/diagnóstico , Vómitos/etiología , Vómitos/fisiopatologíaRESUMEN
BACKGROUND AND AIMS: Herpes simplex esophagitis (HSE) is the second most common cause of infectious esophagitis and occurs in both immunocompetent and immunocompromised patients. The aim of this study was to reappraise the clinical course of HSE in different patient populations based on degree of immunocompetence and the presence or absence of underlying esophageal disease. METHODS: Patients with histopathologically confirmed HSE identified from the Mayo Clinic pathology database from 2006 to 2016 were included in this study. Relevant demographic, clinical, and endoscopic data were retrospectively reviewed and compared between two cohorts: (a) immunocompromised and immunocompetent patients and (b) patients with and without underlying esophageal disorders. RESULTS: Forty-six patients were included in the study. The most common presenting symptoms were odynophagia (34.8%) and dysphagia (30.4%). Thirty-three (71.7%) patients were immunocompromised, and these patients who experienced longer duration of symptoms (25.5 ± 23.4 days vs. 7.0 ± 5.5 days, p = 0.04) were more likely to require an extension of treatment course (38.1% vs. 8.3%, p = 0.05) compared to their immunocompetent counterparts. Seventeen (37%) patients had underlying esophageal disease, and these patients were more likely to have concomitant esophageal candidiasis (41.2% vs. 10.3%, respectively; p = 0.01). CONCLUSION: Herpes simplex virus causes esophagitis in both immunocompetent and immunocompromised patients. While the disease course appears to be self-limited for all patient populations, clinical and endoscopic differences in the disease presentation and clinical course based on immune status and the presence or absence of underlying esophageal disease exist.
Asunto(s)
Trastornos de Deglución/inmunología , Esofagitis/inmunología , Esófago/inmunología , Herpes Simple/inmunología , Inmunocompetencia , Huésped Inmunocomprometido , Infecciones Oportunistas/inmunología , Adulto , Anciano , Antivirales/uso terapéutico , Biopsia , Candidiasis/inmunología , Bases de Datos Factuales , Deglución , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/fisiopatología , Trastornos de Deglución/virología , Esofagitis/diagnóstico , Esofagitis/fisiopatología , Esofagitis/virología , Esofagoscopía , Esófago/patología , Esófago/fisiopatología , Esófago/virología , Femenino , Herpes Simple/diagnóstico , Herpes Simple/fisiopatología , Herpes Simple/virología , Humanos , Masculino , Persona de Mediana Edad , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/fisiopatología , Infecciones Oportunistas/virología , Pronóstico , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Background: An association between obesity and gastroesophageal reflux disease has been reported. However, previous studies have focused on obesity or central obesity. Aims: To investigate the association of the anthropometric index and endoscopic erosive esophagitis in health checkups of Koreans. Study Design: Case-control study. Methods: A total of 1.207 consecutive subjects (aged 40-80 years) during health checkups underwent upper endoscopy and bioelectrical impedance analysis. We collected anthropometric data by bioelectrical impedance analysis, which consisted of body mass index, percent body fat, muscle mass, and fat mass. Results: Of 1.207 subjects who underwent upper gastrointestinal endoscopy (mean age, 50.55±9 years), 239 (19.8%) had endoscopic erosive esophagitis. In a univariate analysis, the endoscopic erosive esophagitis group was more likely to be a male and had a higher body mass index, muscle mass and fat mass. In logistic regression analysis, only muscle mass remained an independent risk factor for EE after adjustment for both age and gender. Higher muscle mass was associated with increased EE risk (rate ratio: 1.354, 95% confidence interval: 1.206-1.405, p= 0.027). Conclusion: High muscle mass, but body mass index, is an independent risk factor for erosive esophagitis in a population over 40 years of age.
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Antropometría/métodos , Esofagitis/clasificación , Adulto , Anciano , Anciano de 80 o más Años , Antropometría/instrumentación , Índice de Masa Corporal , Estudios de Casos y Controles , Endoscopía/métodos , Esofagitis/diagnóstico , Esofagitis/fisiopatología , Femenino , Reflujo Gastroesofágico/complicaciones , Reflujo Gastroesofágico/fisiopatología , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , República de Corea , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Lymphocytic esophagitis is a histologic pattern of injury characterized by increased intraepithelial lymphocytes (>20/high-power field) with rare, or absent granulocytes. Lymphocytes tend to be more numerous in the peripapillary epithelium, and are often associated with evidence of mucosal injury, edema, and scattered dyskeratotic cells. More than a decade following its original description, lymphocytic esophagitis remains an enigmatic entity with variable clinical presentations, associated disorders, etiologies, treatment, and natural history. Most of the confusion regarding the clinical significance of this disorder stems from its diagnostic criteria: lymphocytic esophagitis is currently defined based entirely on histologic criteria, despite the common occurrence of lymphocytosis in a variety of unrelated inflammatory conditions of the esophagus. The goal of this review is to summarize the literature regarding lymphocytic esophagitis and focus on key clinicopathologic features that distinguish it from other esophageal disorders that can show increased numbers of intraepithelial lymphocytes.
Asunto(s)
Esofagitis , Esofagoscopía , Esófago , Linfocitos/inmunología , Linfocitosis , Esofagitis/diagnóstico , Esofagitis/inmunología , Esofagitis/fisiopatología , Esofagitis/terapia , Esófago/inmunología , Esófago/fisiopatología , Humanos , Linfocitosis/diagnóstico , Linfocitosis/inmunología , Linfocitosis/fisiopatología , Linfocitosis/terapiaAsunto(s)
Trastornos de Deglución , Estenosis Esofágica , Esofagitis , Esofagoscopía/métodos , Glucocorticoides/administración & dosificación , Linfocitos/patología , Biopsia/métodos , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/etiología , Trastornos de Deglución/terapia , Dilatación/métodos , Esofagitis Eosinofílica/diagnóstico , Estenosis Esofágica/diagnóstico , Estenosis Esofágica/etiología , Estenosis Esofágica/terapia , Esofagitis/diagnóstico , Esofagitis/tratamiento farmacológico , Esofagitis/patología , Esofagitis/fisiopatología , Femenino , Humanos , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
BACKGROUND AND AIM: It has been speculated that impaired salivary flow contributes to abnormal acid clearance in patients with erosive esophagitis (EE). For easy and objective assessment of salivary function, we developed a salivary gland blood flow measurement technique using continuous-wave Doppler sonography. In the present study, we evaluated the salivary secretory function in patients with EE and those with nonerosive reflux disease (NERD) using this method. METHODS: Doppler waveform analysis was performed on the facial artery to assess blood inflow to the submandibular gland of 30 healthy subjects (HS). Blood flow was compared before and after secretory stimulation with 1 mL of lemon juice. Saliva was simultaneously collected and weighed before and after stimulation. Continuous-wave Doppler sonography was also performed in patients with EE and NERD. The size of the submandibular gland was compared in 26 patients with EE, 41 patients with NERD, and 86 HS. RESULTS: The submandibular gland blood flow increased after stimulation in all HS. Both within-day and day-to-day reproducibility were good. There was a significant correlation between the percent increase in the maximum velocity and the percent increase in salivary secretion. Although the size of the submandibular gland was not significantly different among the three groups, the percent increase in the maximum velocity in patients with EE was significantly smaller than that in HS. CONCLUSIONS: We have established an easy method of assessing salivary function in daily practice. This study revealed that a decrease in salivary secretory function is involved in the pathology of EE.