الملخص
La ulceración esofágica por ingestión de doxiciclina es una de las causas más frecuentes de lesión esofágica. Ha sido subdiagnosticada y escasamente reconocida en dermatología. El dolor retroesternal, la odinofagia de aparición brusca y el antecedente de ingesta de doxiciclina u otros fármacos son características que facilitan su diagnóstico. Puede presentar complicaciones serias, como hemorragias, estenosis y mediastinitis.
Esophageal ulceration due to ingestion of doxycycline is one of the most frequent causes of esophageal injury. It has been underdiagnosed and scarcely recognized in dermatology. Retrosternal pain, sudden odynophagia and a history of doxycycline or other drugs intake are some of the characteristics that lead to diagnosis. It may cause severe complications such as bleeding, stenosis and mediastinitis.
الموضوعات
Humans , Female , Adult , Young Adult , Ulcer/chemically induced , Doxycycline/adverse effects , Esophageal Diseases/chemically induced , Anti-Bacterial Agents/adverse effects , Ulcer/diagnosis , Ulcer/drug therapy , Omeprazole/administration & dosage , Esophageal Diseases/diagnosis , Esophageal Diseases/drug therapy , Capsule Endoscopy , Anti-Ulcer Agents/administration & dosageالملخص
CONTEXT: Esophageal candidiasis is often observed in patients with risk factors for its development and fluconazole is the therapeutic choice for the treatment of this disease. OBJECTIVES: To determine its frequency, by performing upper digestive endoscopy; to determine Candida species involved in its pathogenesis and verify their distribution according with the predisposing factors and to determine susceptibility to fluconazole in the samples. METHODS: From March 2006 to April 2007, all patients submitted to esophagogastroduodenoscopy at the Digestive Endoscopy Unit in the Oswaldo Cruz University Hospital, Recife, PE, Brazil, were eligible for the study. Samples were collected from patients who presented lesions consistent with esophageal candidiasis in order to identify Candida species and verify their susceptibility to fluconazole. The predisposing factors for the occurrence of esophageal candidiasis were described. RESULTS: Of 2,672 patients referred to upper endoscopy at the Digestive Endoscopy Unit, 40 (1.5 percent) had endoscopic findings compatible with esophageal candidiasis. The average age was 49.1 years. Twenty one patients (52.5 percent) were less than 50 years old, of which 82.6 percent were infected with HIV. Most of them (52.5 percent) were males and 65.0 percent were inpatients. Diseases were identified in 90 percent of the patients and 21 (52.5 percent) were HIV positive. Concerning endoscopic findings, severe forms of esophagitis were found in 50 percent of the patients with CD4 count <200. Non-albicans Candida species were isolated in 22.7 percent of HIV positive and in 45 percent HIV negative patients. A total of 6 (14.28 percent) samples were resistant to fluconazole, while 2 (4.76 percent) samples had dose depending susceptibility to this drug. CONCLUSIONS: Esophageal candidiasis prevalence was low, although within the results described by other authors. Male and inpatients were the most affected. The species isolated...
CONTEXTO: A candidíase esofágica é comumente observada em pacientes com fatores de risco para seu desenvolvimento. OBJETIVOS:Determinar a freqüência da candidíase esofágica, por meio da endoscopia digestiva alta; identificar as espécies de Candida envolvidas na patogênese da candidíase esofágica e sua distribuição de acordo com o fator predisponente; determinar a susceptibilidade ao fluconazol nas amostras coletadas. MÉTODOS: De março de 2006 a abril de 2007, os pacientes submetidos a esofagogastroduodenoscopia no Hospital Universitário Oswaldo Cruz, Recife, PE, foram considerados elegíveis para o estudo. Aqueles que apresentaram lesões compatíveis com candidíase esofágica tiveram amostras coletadas para a identificação das espécies de Candida, de sua sensibilidade ao fluconazol e descritos os fatores de risco para a doença. RESULTADOS: Dos 2.672 pacientes encaminhados para endoscopia, 40 (1,5 por cento) apresentaram achados compatíveis com candidíase esofágica. A média de idade foi de 49,1 anos. Vinte e um pacientes (52,5 por cento) tinham menos que 50 anos, dos quais 82,6 por cento eram infectados pelo HIV. A maioria (52,5 por cento) era homens e 65,0 por cento encontravam-se internados. Fatores predisponentes foram identificados em 90 por cento da amostra, sendo que 21 (52,5 por cento) eram HIV positivos. As formas mais graves de esofagite foram encontradas em 50 por cento dos pacientes com CD4 <200. Espécies de Candida não-albicans foram detectadas em 22,7 por cento dos pacientes HIV positivos e em 45 por cento dos pacientes não infectados. A resistência ao fluconazol foi observada em seis amostras (14,28 por cento) e a sensibilidade dose-dependente em duas (4,76 por cento). CONCLUSÃO:A prevalência de candidíase esofágica foi baixa, embora dentro de variação esperada. Pacientes homens e que estavam internados foram os mais acometidos. Houve variação nas espécies encontradas, de acordo com as características dos grupos estudados. Tanto...
الموضوعات
Female , Humans , Male , Middle Aged , Antifungal Agents/therapeutic use , Candidiasis/drug therapy , Esophageal Diseases/drug therapy , Fluconazole/therapeutic use , Brazil/epidemiology , Candida/drug effects , Candidiasis/epidemiology , Candidiasis/microbiology , Esophageal Diseases/epidemiology , Esophageal Diseases/microbiology , HIV Infections/complicationsالملخص
Tuberculosis rates in Chile are higher than expected during the last years. This is directly related to the increase of immunodeficiency associated to human immunodeficiency virus (HIV) infection. Gastrointestinal tuberculosis is the sixth in frequency of extra pulmonary localizations. We report an HIV(+) 55 year-old male, that presented with fever and epigastric pain. In an upper GI endoscopy small elevated lesions were described in the esophagus. Pathological study was suggestive of tuberculous infection. The definitive diagnosis of esophageal tuberculosis was obtained by a PCR test of the biopsy sample. Antituberculous therapy was started and one year later there was a regression but not disappearance of esophageal lesions and granulomas in the pathological study.
الموضوعات
Humans , Male , Middle Aged , AIDS-Related Opportunistic Infections/diagnosis , Esophageal Diseases/diagnosis , Tuberculosis, Gastrointestinal/diagnosis , AIDS-Related Opportunistic Infections/drug therapy , Antitubercular Agents/therapeutic use , Biopsy , Esophageal Diseases/drug therapy , Esophageal Diseases/microbiology , Esophagoscopy , Mycobacterium tuberculosis/genetics , Mycobacterium tuberculosis/isolation & purification , Polymerase Chain Reaction , Tuberculosis, Gastrointestinal/drug therapyالملخص
Introducción: El exceso de peso y la obesidad son considerados factores precipitantes en la aparición de síntomas de reflujo gastro-esofágico (RGE). Además, los antiácidos y ácido-supresores son altamente eficaces en la paliación de tales síntomas. Objetivo: conocer la prevalencia de pirosis y ardor epigástrico, sus factores precipitantes, consumo de antiácidos y de ácido-supresores, auto-medicación y su relación con la obesidad en adultos. Material y Método: encuesta personal y examen físico a 433 adultos sin RGE diagnosticado, historia de cirugía gastrointestinal y uso de estos medicamentos indicado por médicos. Resultados: los síntomas en estudio estaban presentes en el 60.1 por ciento del grupo (62,9 por ciento en mujeres y 57,3 por ciento en hombres) siendo más frecuente el ardor epigástrico (35,6 por ciento) que la pirosis (24,5 por ciento). Entre los sujetos sintomáticos el 95 por ciento utilizó medicación en forma regular. El 65 por ciento-83 por ciento de los sujetos con síntomas esporádicos recurrieron a antiácidos. Por el contrario, el 23,5 por ciento refirió síntomas diarios y entre ellos el 64 por ciento usaba ácido-supresores. La auto-medicación fue reconocida por el 78 por ciento-92 por ciento de personas con síntomas esporádicos y significativamente menos (48 por ciento) por sujetos con síntomas diarios. La tensión emocional (35,1 por ciento- 58,6 por ciento), ingesta de alcohol (9 por ciento) y alimentos muy condimentados (5 por ciento) fueron mencionados como factores precipitantes de los síntomas. Menos del 4 por ciento de los encuestados consideraron el aumento de peso corporal como factor precipitante. El índice de masa corporal en el grupo asintomático fue: mujeres 23,2 + - 3,4 kg/m2 y hombres 24,3 + - 3,3 kg/m2. Para el grupo sintomático las cifras fueron 22,5 + - 3,1 kg/m2 y 25 + - 3,5 kg/m2 respectivamente. En el grupo asintomático, el sobrepeso fue de 25,4 por ciento y la obesidad 5,7 por ciento no significativamente diferente del 28...
الموضوعات
Male , Adolescent , Adult , Humans , Female , Middle Aged , Antacids/therapeutic use , Body Mass Index , Esophageal Diseases/drug therapy , Obesity/complications , Obesity/physiopathology , Heartburn/drug therapy , Esophagogastric Junction/physiopathology , Age Distribution , Anti-Ulcer Agents/therapeutic use , Cross-Sectional Studies , Data Collection , Hydrogen-Ion Concentration , Prevalence , Heartburn/epidemiology , Risk Factors , Gastroesophageal Reflux/diagnosis , Self Medication , Sex Distribution , Data Interpretation, Statistical , Signs and Symptomsالملخص
Esophageal tuberculosis is a rare clinical entity even in adults. Esophageal tuberculosis, can be either primary or secondary, the former is less common as compared to the latter. The authors present a 14-year-old boy, who presented with vomiting, cough, low-grade fever and anorexia for two months. He had a positive mantoux with history of contact to Tuberculosis. Upper GI scopy revealed an irregular ulcer in the mid esophagus and the biopsy was suggestive of tuberculosis. The CT scan of the chest showed consolidation left lower lobe with hilar and mediastinal adenopathy. He responded well to ATT.
الموضوعات
Adolescent , Antitubercular Agents/therapeutic use , Esophageal Diseases/drug therapy , Esophagoscopy , Follow-Up Studies , Humans , India , Male , Mycobacterium tuberculosis/isolation & purification , Rare Diseases , Risk Assessment , Tomography, X-Ray Computed , Treatment Outcome , Tuberculosis/diagnosisالملخص
BACKGROUND: Oropharyngeal candidiasis (OPC) and esophageal candidiasis (EPC) are frequent complications in AIDS patients. The use of Fluconazole, an effective and a low toxicity drug, has been associated to the emergency of secondary resistant strains. For this reason, in vitro antifungal susceptibility tests are necessary to predict a therapeutic failure. Etest is an easy to perform alternative test, that has showed a good agreement with the broth microdilution reference method (NCCLS, document M27-A). AIM: To measure the susceptibility of C. albicans isolates from AIDS patients complicated with OPC and EPC to Amphotericin B (AmB) and Fluconazole (Flu) using Etest. MATERIAL AND METHODS: Twenty strains from 20 AIDS patients were studied. AmB was tested in RPMI 1640 agar and Flu in Casitone agar. RESULTS: All studied strains showed minimal inhibitory concentrations (MICs) < 1 mg/mL for AmB. A highly resistant strain to Flu (> 256 mg/mL) was isolated from a patient previously treated with Flu. CONCLUSIONS: In AIDS patients with OPC and EPC, the susceptibility to Flu of the isolates should be screened, to detect resistant strains. Etest is a reliable alternative in these cases, for laboratories that cannot use the reference method.
الموضوعات
Humans , Male , Female , Antifungal Agents , Candida albicans/drug effects , Candidiasis/drug therapy , Esophageal Diseases/mortality , AIDS-Related Opportunistic Infections/drug therapy , Antifungal Agents , Amphotericin B/pharmacology , Amphotericin B/therapeutic use , Candida albicans/isolation & purification , Candidiasis, Oral/drug therapy , Pharyngeal Diseases/drug therapy , Esophageal Diseases/complications , Esophageal Diseases/drug therapy , Fluconazole/pharmacology , Fluconazole/therapeutic use , AIDS-Related Opportunistic Infections/microbiology , Drug Resistance, Fungal , Microbial Sensitivity Tests/methodsالملخص
Heterotopic gastric mucosa in the upper esophagus is frequently found during endoscopic examination. Although most patients with heterotopic gastric mucosa of the upper esophagus, referred as inlet patch, are asymptomatic, symptomatic patients with complications resulting from this ectopic mucosa have also been reported. Acid secretion by the inlet patch has been suggested in some reports. We report a case of heterotopic gastric mucosa in the upper esophagus, with secretion of acid, demonstrated by continuous ambulatory pH monitoring, and the improvement of pharyngeal symptoms after the use of a proton pump inhibitor.
الموضوعات
Adult , Humans , Male , Ambulatory Care , Anti-Ulcer Agents/administration & dosage , Choristoma/diagnosis , Esophageal Diseases/drug therapy , Esophageal Diseases/diagnosis , Esophagoscopy , Gastric Acid/metabolism , Gastric Mucosa/metabolism , Hydrogen-Ion Concentration , Monitoring, Physiologic/methods , Prognosisالملخص
The infections esophagitis most frequently occur in patients with immunodefficiency, after chemotherapy, transplantation or Aids. The main etiology agents areCandida albicans, citomegalovirus and herpes simplex virus. For the treatment of candidiasis the most usedagents are the imidazolic derivates. In the present article the authors review important aspects of the disease, with emphasis on the diagnosis and treatment
الموضوعات
Humans , Candidiasis/diagnosis , Esophageal Diseases/microbiology , Candidiasis/drug therapy , Esophageal Diseases/drug therapy , Imidazoles/therapeutic useالملخص
Las tetraciclinas están descritas como antibióticos que suelen producir úlceras esofágicas. Objetivo. Ver el comportamiento de este tipo de úlceras, así como la respuesta al manejo con sucralfato. Método. Es un estudio retrospectivo de los últimos dos años donde se revisaron los casos de odinofagia y disfagia sometidos a endoscopia con antecedentes de ingesta reciente de doxiciclina. Todos fueron tratados suspendiendo la droga, mientras la gran mayoría recibieron tratamiento adicional con sucralfato 1 g cada ocho horas. Resultados. Once pacientes tuvieron como indicación: enfermedad pélvica inflamatoria, acné, infecciones urinarias y respiratorias. El síntoma más común fue odinofagia, presentándose aproximadamente 6 días después de iniciado el tratamiento con varios factores contribuyentes bien comprobados como ingesta antes de acostarse y con poco líquido. Las úlceras se caracterizaron por ser múltiples y localizadas principalmente en el tercio medio. La sintomatología en general cedió 3.7 días después de suspender los medicamentos, mientras aquellos con sucrafalto no mostraron menor duración de los síntomas. Conclusiones. Debemos ser conscientes de la inducción de úlceras por estos medicamentos, basando su tratamiento en la suspensión del antibiótico, recordando que el sucralfato puede ser parte del tratamiento ya que ha demostrado su adherencia a úlceras y lesiones esofágicas, aunque su uso no ha demostrado significancia clínica. Por ende debemos explicar las medidas prevención, como tomarlas con suficiente volumen de agua, en posición, como tomarlas con suficiente volumen de agua, en posición supina y tener precaución especial en ancianos y pacientes con patología anatómica y/o de motilidad esofágica
الموضوعات
Humans , Male , Female , Adolescent , Adult , Anti-Ulcer Agents/therapeutic use , Anti-Bacterial Agents/adverse effects , Doxycycline/adverse effects , Esophageal Diseases/chemically induced , Esophageal Diseases/diagnosis , Esophageal Diseases/drug therapy , Esophagoscopy , Risk Factors , Sucralfate/therapeutic use , Tetracycline/adverse effects , Ulcer/diagnosis , Ulcer/chemically induced , Ulcer/drug therapyالملخص
Relato do caso de um paciente com queixa de disfagia rapidamente progressiva, cujos exames radiológico e endoscópico demostraram a presença de lesao estenosante do terço distal do esôfago. A biopsia da mesma revelou a presença de fungos, cuja cultura mostrou tratar-se de Histoplasma capsulatum. A dilataçao endoscópica da lesao, indicada por falha do tratamento clínico específico, provocou ruptura esofágica. Foi realizada esofagectomia subtotal com remissao dos sintomas.