RESUMEN

Já explicamos, aqui no Coisa de Homem, o que é o refluxo gastroesofágico. Nesta quarta-feira (29) você fica sabendo o que é a esofagite, uma possível consequência do refluxo.

Asunto(s)

Esofagitis

RESUMEN

Infectious esophagitis (IE) is the leading cause of esophagitis, second only to gastroesophageal reflux disease. Infectious esophagitis is typically observed in immunocompromised individuals due to neutropenia, HIV/AIDS, solid organ malignancies, cancer-directed therapy, or chronic steroid use. The most common causes of IE are herpes simplex virus (HSV), cytomegalovirus (CMV), and Candida albicans. Acute bacterial esophagitis is exceedingly rare, particularly in immunocompetent patients. Herein, we describe a unique case of acute streptococcal esophagitis in a male patient with no pertinent medical history. The patient's substernal chest pain and odynophagia resolved after antibiotic treatment.

Asunto(s)

Antibacterianos , Esofagitis , Infecciones Estreptocócicas , Humanos , Masculino , Esofagitis/microbiología , Esofagitis/tratamiento farmacológico , Esofagitis/diagnóstico , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/complicaciones , Antibacterianos/uso terapéutico , Inmunocompetencia , Dolor en el Pecho/etiología

RESUMEN

PRACTICAL RELEVANCE: Acid-related disorders including esophagitis and gastroduodenal ulceration are uncommon in the cat. However, when they occur, they can have devastating consequences and require targeted intervention, including the use of gastroprotectants. Careful consideration of the causes of esophagitis and gastroduodenal ulceration can help the clinician to determine which gastroprotectant to use, and when to begin and end gastroprotective therapy. CLINICAL CHALLENGES: Gastroprotectants remain one of the most misused classes of drugs in veterinary and human medicine. There are very few studies evaluating the efficacy of gastroprotective agents in cats. Furthermore, goals for the degree of gastric acid suppression are extrapolated from studies performed in dogs and humans. AIMS: This review provides a foundation for the logical approach to the choice of gastroprotectant as indicated by the disease process, and is aimed at all veterinarians who prescribe gastroprotectants for use in cats. EVIDENCE BASE: The guidance provided in this review is supported by current literature, including consensus opinion from the American College of Veterinary Internal Medicine. Gaps in evidence for use of gastroprotectants in cats are filled by extrapolations from studies performed in dogs and humans.

Asunto(s)

Enfermedades de los Gatos , Gatos , Animales , Enfermedades de los Gatos/tratamiento farmacológico , Medicina Basada en la Evidencia , Antiulcerosos/uso terapéutico , Úlcera Péptica/veterinaria , Úlcera Péptica/tratamiento farmacológico , Esofagitis/veterinaria , Esofagitis/tratamiento farmacológico

RESUMEN

Objective: To investigate the role of an inflammatory microenvironment induced by Porphyromonasgingivalis (P. gingivalis) in the occurrence of esophageal squamous cell carcinoma (ESCC) in mice. Methods: A total of 180 C57BL/6 mice were randomly divided into 6 groups, i.e. control group, P. gingivalis group, 4NQO group, 4NQO + P. gingivalis group, 4NQO + P. gingivalis + celecoxib group, and 4NQO + P. gingivalis + antibiotic cocktail (ABC, including metronidazole, neomycin, ampicillin, and vancomycin) group, with 30 mice in each group, using the random number table. All mice were normalized by treatment with ABC in drinking water for 2 weeks. In the following 2 weeks, the mice in the control group and the P. gingivalis group were given drinking water, while the other 4 groups were treated with 30 µg/ml 4NQO in the drinking water. In weeks 11-12, the mice in the P. gingivalis group, the 4NQO + P. gingivalis group, the 4NQO + P. gingivalis + celecoxib group, and the 4NQO + P. gingivalis + ABC group were subjected to ligation of the second molar in oral cavity followed by oral P. gingivalis infection thrice weekly for 24 weeks in weeks 11-34. In weeks 13-34, the mice in 4NQO + P. gingivalis+celecoxib group and 4NQO + P. gingivalis + ABC group were administered with celecoxib and ABC for 22 weeks, respectively. At the end of 34 weeks, gross and microscopic alterations were examined followed by RT-qPCR and immunohistochemistry to examine the expression profiles of inflammatory- and tumor-molecules in esophagi of mice. Results: At 34 weeks, 4NQO treatment alone did not affect the foci of papillary hyperproliferation, diseased area, and the thickness of the esophageal wall, but significantly enhanced the foci of hyperproliferation (median 1.00, P＜0.05) and mild/moderate dysplasia (median 2.00, P＜0.01). In addition, the expression levels of IL-6 [8.35(3.45,8.99)], IL-1ß [6.90(2.01,9.72)], TNF-α [12.04(3.31,14.08)], c-myc [2.21(1.80,3.04)], pSTAT3, Ki-67, and pH2AX were higher than those in the control group. The pathological changes of the esophageal mucosa were significantly more overt in the 4NQO + P. gingivalis group in terms of the foci of papillary hyperproliferation (median 2.00), diseased area (median 2.51 mm2), the thickness of the esophageal wall (median 172.52 µm), the foci of hyperproliferation (median 1.00, P＜0.05), and mild/moderate dysplasia (median 1.00, P＜0.01). In mice of the 4NQO + P. gingivalis group, the expression levels of IL-6 [12.27(5.35,22.08)], IL-1ß [13.89(10.04,15.96)], TNF-α [19.56(6.07,20.36)], IFN-γ [11.37(8.23,20.07)], c-myc [2.62(1.51,4.25)], cyclin D1 [4.52(2.68,7.83)], nuclear pSTAT3, COX-2, Ki-67, and pH2AX were significantly increased compared with the mice in the control group. In mice of the 4NQO + P. gingivalis group, the diseased area, invasive malignant foci as well as pSTAT3 and pH2AX expression were significantly blunted by celecoxib. Treatment with ABC markedly reduced the papillary hyperproliferative foci, invasive malignant foci, and pSTAT3 expression but not pH2AX. Conclusions: P. gingivalis promotes the occurrence of esophageal squamous cell carcinoma in mice by inducing an inflammatory microenvironment primed with 4NQO induced DNA damage. Clearance of P. gingivalis with ABC or anti-inflammatory intervention holds promise for prevention of esophageal squamous cell malignant pathogenesis via blockage of IL-6/STAT3 signaling and amelioration of inflammation.

Asunto(s)

4-Nitroquinolina-1-Óxido , Celecoxib , Neoplasias Esofágicas , Carcinoma de Células Escamosas de Esófago , Ratones Endogámicos C57BL , Porphyromonas gingivalis , Microambiente Tumoral , Animales , Ratones , Neoplasias Esofágicas/microbiología , Neoplasias Esofágicas/patología , Carcinoma de Células Escamosas de Esófago/microbiología , Carcinoma de Células Escamosas de Esófago/metabolismo , Carcinoma de Células Escamosas de Esófago/patología , Celecoxib/farmacología , Inflamación , Infecciones por Bacteroidaceae/microbiología , Interleucina-6/metabolismo , Antibacterianos/farmacología , Factor de Transcripción STAT3/metabolismo , Ciclooxigenasa 2/metabolismo , Ciclooxigenasa 2/genética , Esófago/microbiología , Esófago/patología , Esofagitis/microbiología , Esofagitis/patología , Proteínas Proto-Oncogénicas p21(ras)/genética , Proteínas Proto-Oncogénicas p21(ras)/metabolismo , Carcinoma de Células Escamosas/microbiología , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/metabolismo

RESUMEN

PURPOSE: To develop a combined radiomics and deep learning (DL) model in predicting radiation esophagitis (RE) of a grade ≥ 2 for patients with esophageal cancer (EC) underwent volumetric modulated arc therapy (VMAT) based on computed tomography (CT) and radiation dose (RD) distribution images. MATERIALS AND METHODS: A total of 273 EC patients underwent VMAT were retrospectively reviewed and enrolled from two centers and divided into training (n = 152), internal validation (n = 66), and external validation (n = 55) cohorts, respectively. Radiomic and dosiomic features along with DL features using convolutional neural networks were extracted and screened from CT and RD images to predict RE. The performance of these models was evaluated and compared using the area under curve (AUC) of the receiver operating characteristic curves (ROC). RESULTS: There were 5 and 10 radiomic and dosiomic features were screened, respectively. XGBoost achieved a best AUC of 0.703, 0.694 and 0.801, 0.729 with radiomic and dosiomic features in the internal and external validation cohorts, respectively. ResNet34 achieved a best prediction AUC of 0.642, 0.657 and 0.762, 0.737 for radiomics based DL model (DLR) and RD based DL model (DLD) in the internal and external validation cohorts, respectively. Combined model of DLD + Dosiomics + clinical factors achieved a best AUC of 0.913, 0.821 and 0.805 in the training, internal, and external validation cohorts, respectively. CONCLUSION: Although the dose was not responsible for the prediction accuracy, the combination of various feature extraction methods was a factor in improving the RE prediction accuracy. Combining DLD with dosiomic features was promising in the pretreatment prediction of RE for EC patients underwent VMAT.

Asunto(s)

Aprendizaje Profundo , Neoplasias Esofágicas , Esofagitis , Radioterapia de Intensidad Modulada , Humanos , Neoplasias Esofágicas/radioterapia , Neoplasias Esofágicas/diagnóstico por imagen , Radioterapia de Intensidad Modulada/efectos adversos , Radioterapia de Intensidad Modulada/métodos , Esofagitis/etiología , Esofagitis/diagnóstico por imagen , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Traumatismos por Radiación/etiología , Tomografía Computarizada por Rayos X/métodos , Dosificación Radioterapéutica , Adulto , Anciano de 80 o más Años , Radiómica

RESUMEN

PURPOSE: Radiation esophagitis is frequent and annoying toxicity in high dose thoracic radiation therapy. Contalateral esophagus sparing intensity modulated radiation therapy (CES-IMRT) has been proposed to mitigate this problem, and this is to report the impact of CES-IMRT in definitive concurrent chemoradiotherapy (dCCRT) for lung cancer patients. MATERIALS AND METHODS: From January 2021 till May 2023, 183 stage III non-small cell lung cancer patients underwent dCCRT. Esophagus was located within 1 cm from internal target volume in 159 patients. We comparatively evaluated the frequency and severity of esophagitis by pain-killer usage, analgesic quantification algorithm (AQA) score, and failure patterns in 159 CES-necessary patients. RESULTS: All patients underwent dCCRT (66 Gy in 30 fractions with concurrent chemotherapy). Actual CES-IMRT application was determined based on the discretion of responsible radiation oncologists: CES-applied in 41 patients; and CES-unapplied in 118. CES-applied patients experienced pain events less frequently (pain-killer usage: 53.7 % vs. 77.1 %, p = 0.008) and less severely (AQA score of 2-3: 39.0 % vs. 68.6 %, p = 0.002). On multivariate analyses, overlapping volume of esophagus and planning target (HR = 1.32, 95 % CI 1.12-1.55, p = 0.001) and CES-IMRT application (HR = 0.31, 95 % CI 0.13-0.76, p = 0.010) were associated with AQA score of 2-3 less frequently. There were no differences in failure pattern, progression-free survival, and overall survival. CONCLUSIONS: CES-IMRT application resulted in less frequent and less severe pain events without compromising oncologic outcomes. Further studies, preferably in a randomized fashion, would be desired.

Asunto(s)

Carcinoma de Pulmón de Células no Pequeñas , Quimioradioterapia , Esofagitis , Neoplasias Pulmonares , Traumatismos por Radiación , Radioterapia de Intensidad Modulada , Humanos , Esofagitis/etiología , Masculino , Carcinoma de Pulmón de Células no Pequeñas/patología , Carcinoma de Pulmón de Células no Pequeñas/terapia , Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Quimioradioterapia/efectos adversos , Quimioradioterapia/métodos , Femenino , Radioterapia de Intensidad Modulada/efectos adversos , Radioterapia de Intensidad Modulada/métodos , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/terapia , Neoplasias Pulmonares/radioterapia , Persona de Mediana Edad , Anciano , Traumatismos por Radiación/etiología , Adulto , Estadificación de Neoplasias , Esófago/efectos de la radiación , Esófago/patología , Tratamientos Conservadores del Órgano/métodos , Anciano de 80 o más Años , Estudios Retrospectivos , Índice de Severidad de la Enfermedad

RESUMEN

INTRODUCTION: The role of routine preoperative esophagogastroduodenoscopy (EGD) in bariatric surgery candidates is controversial. This study compares preoperative EGD outcomes with patient-reported gastroesophageal reflux disease (GERD) symptoms to determine if a case-based EGD is appropriate. PATIENTS AND METHODS: A prospective cohort study was conducted from April 2022 through September 2023 in Mashhad, Iran. All patients underwent EGD. To assess GERD symptoms, we used the GERD-Health Related Quality of Life questionnaire. Patients were categorized into two groups: the asymptomatic group (GERD-HRQL = 0) and the symptomatic group (GERD-HRQL > 0). RESULTS: A total of 165 patients were included, out of which 133 (80.6%) were in the symptomatic group and 32 (19.4%) were in the asymptomatic group. Esophagitis was present in 41 (24.8%) patients. There was no significant difference in the frequency of esophagitis (18.8% vs. 26.3%, p-value = 0.37), hiatal hernia (18.8% vs. 18.8%, p-value = 1.00), gastritis (56.3% vs. 63.9%, p-value = 0.42), and H. pylori infection (9.4% vs. 12.0%, p-value = 1.00) between the asymptomatic and symptomatic groups, respectively. None of the demographic factors or comorbidities of asymptomatic patients were associated with esophagitis, except for hiatal hernia (OR = 7.67, 95% CI 3.01-19.53, p-value < 0.001). Receiver operating characteristic (ROC) analysis showed that the GERD-HRQL total scores, as well as the heartburn and regurgitation subscales, were poor predictors of esophagitis (AUC 0.57, 0.51, and 0.56, respectively). CONCLUSION: EGD findings were not associated with GERD symptoms in candidates for bariatric surgery.

Asunto(s)

Cirugía Bariátrica , Endoscopía del Sistema Digestivo , Reflujo Gastroesofágico , Obesidad Mórbida , Calidad de Vida , Humanos , Reflujo Gastroesofágico/complicaciones , Femenino , Masculino , Estudios Prospectivos , Adulto , Irán/epidemiología , Persona de Mediana Edad , Obesidad Mórbida/cirugía , Obesidad Mórbida/complicaciones , Hernia Hiatal/complicaciones , Hernia Hiatal/cirugía , Esofagitis/diagnóstico , Esofagitis/epidemiología , Cuidados Preoperatorios/métodos , Encuestas y Cuestionarios , Gastritis/epidemiología

RESUMEN

SOURCE CITATION: Zhuang Q, Chen S, Zhou X, et al. Comparative efficacy of P-CAB vs proton pump inhibitors for grade C/D esophagitis: a systematic review and network meta-analysis. Am J Gastroenterol. 2024;119:803-813. 38345252.

Asunto(s)

Inhibidores de la Bomba de Protones , Pirroles , Sulfonamidas , Humanos , Esofagitis/tratamiento farmacológico , Esofagitis Péptica/tratamiento farmacológico , Inhibidores de la Bomba de Protones/uso terapéutico , Pirroles/uso terapéutico , Sulfonamidas/uso terapéutico , Revisiones Sistemáticas como Asunto , Metaanálisis como Asunto

RESUMEN

La esofagitis disecante superficial (EDS) es una entidad infrecuente que se caracteriza endoscópicamente por el desprendimiento de las capas superficiales del epitelio esofágico e, histológicamente, por el aspecto bitonal del epitelio escamoso esofágico secundario a la necrosis de los estratos más superficiales. La etiología es desconocida, aunque se ha asociado con la ingesta de determinados fármacos, enfermedades autoinmunes, estasis esofágica y procedimientos endoscópicos. Presentamos dos casos: uno de ellos acontece en una mujer tras un episodio de disfagia abrupta y el segundo en un varón con comorbilidades y clínica de dolor epigástrico. La EDS es una patología que hay que considerar en su adecuado contexto clínico y endoscópico, ya que su curso es autolimitado en comparación con otras entidades de evolución tórpida o que precisan un tratamiento específico. (AU)

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Esophagitis dissecans superficialis (EDS) is a rare disease characterized by sloughing of the superficial esophageal mucosa and, histologically, by the bitonal appearance of the squamous epithelium secondary to necrosis of the most superficial layers. Etiology is uncertain, however, it has been associated with some medications, autoimmune diseases, esophageal stasis and endoscopic procedures. Here, two cases are presented, one of them which appeared in a woman after an episode of dysphagia and another one which occurred to a man with comorbidities and epigastric pain. This entity should be considered due to its self-limiting clinical course, compared to other entities with a more torpid evolution or that require more specific treatment. (AU)

Asunto(s)

Humanos , Esofagitis , Preparaciones Farmacéuticas , Enfermedades Autoinmunes , Endoscopía Gastrointestinal , Comorbilidad

RESUMEN

BACKGROUND: The lack of standardized objective assessment of esophageal physiology and anatomy contributes to controversies regarding the effects of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) on gastroesophageal reflux disease. This study aimed to investigate esophageal acid exposure, esophageal motility, and endoscopic findings before and after SG and RYGB. METHODS: This was a systematic review and meta-analysis of studies reporting at least 1 objective measure of esophageal physiology and/or esophagogastroduodenoscopy (EGD) at baseline and after SG or RYGB. The changes in pH test, manometry, and EGD parameters were summarized. RESULTS: Acid exposure time (AET) and DeMeester score (DMS) significantly increased after SG (mean difference [MD]: 2.1 [95% CI, 0.3-3.9] and 8.6 [95% CI, 2.0-15.2], respectively). After RYGB, both AET and DMS significantly decreased (MD: -4.2 [95% CI, -6.1 to -2.3] and -16.6 [95% CI, -25.4 to -7.8], respectively). Lower esophageal sphincter resting pressure and length significantly decreased after SG (MD: -2.8 [95% CI, -4.6 to -1.1] and -0.1 [95% CI, -0.2 to -0.02], respectively). There were no significant changes in esophageal manometry after RYGB. The relative risks of erosive esophagitis were 2.3 (95% CI, 1.5-3.5) after SG and 0.4 (95% CI, 0.2-0.8) after RYGB. The prevalence rates of Barrett esophagus changed from 0% to 3.6% after SG and from 2.7% to 1.4% after RYGB. CONCLUSION: SG resulted in the worsening of all objective parameters, whereas RYGB resulted in the improvement in AET, DMS, and EGD findings. Determining the risk factors associated with these outcomes can help in surgical choice.

Asunto(s)

Endoscopía del Sistema Digestivo , Monitorización del pH Esofágico , Gastrectomía , Derivación Gástrica , Reflujo Gastroesofágico , Manometría , Humanos , Derivación Gástrica/efectos adversos , Derivación Gástrica/métodos , Gastrectomía/efectos adversos , Gastrectomía/métodos , Reflujo Gastroesofágico/etiología , Reflujo Gastroesofágico/fisiopatología , Endoscopía del Sistema Digestivo/métodos , Esófago/cirugía , Esófago/fisiopatología , Obesidad Mórbida/cirugía , Obesidad Mórbida/fisiopatología , Esófago de Barrett/cirugía , Esófago de Barrett/patología , Esofagitis/etiología

RESUMEN

PURPOSE: Although several potential radioprotectants have been explored, radiation esophagitis is still difficult to control. Further development of supportive therapies is required. Our purpose was to investigate the efficacy and safety of cystine and theanine for esophagitis in non-small cell lung cancer (NSCLC) patients undergoing chemoradiotherapy (CRT). METHODS: This study is a prospective observational study. The participants were recruited from unresectable locally advanced NSCLC who had scheduled to receive weekly paclitaxel or nab-paclitaxel/carboplatin plus radiation therapy (60 Gy in 30 fractions) for 6 weeks. They took an oral amino acid supplement containing 700 mg cystine and 280 mg theanine once daily regardless of CRT timing from the start of CRT until completion. The primary endpoint was the incidence of any grade esophagitis. The secondary endpoints were quality of life (QoL) and adverse events (AEs). RESULTS: A total of 26 patients were evaluated. All participants completed 60 Gy of RT in 30 fractions. The overall incidence of esophagitis was 73%; however, no ≥ grade 3 was reported. There were no AEs likely to be related to cystine and theanine. The mean EuroQoL 5-Dimension 5-Level health index score before and after chemoradiotherapy was 0.952 ± 0.0591 and 0.952 ± 0.0515 (P = 0.89), and the mean Visual Analogue Scale scores before and after treatment were 67.9 ± 15.4 and 79.4 ± 13.2 (P = 0.0047), respectively. CONCLUSION: Our study showed no severe esophagitis, any AEs, nor QoL decrease in NSCLC patients receiving CRT. Cystine and theanine are potentially effective to reduce severe CRT-induced esophagitis. TRIAL REGISTRATION: UMIN000052622, 26 October 2023, retrospectively registered.

Asunto(s)

Carcinoma de Pulmón de Células no Pequeñas , Quimioradioterapia , Cistina , Esofagitis , Glutamatos , Neoplasias Pulmonares , Calidad de Vida , Humanos , Carcinoma de Pulmón de Células no Pequeñas/terapia , Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Estudios Prospectivos , Masculino , Femenino , Esofagitis/etiología , Quimioradioterapia/efectos adversos , Quimioradioterapia/métodos , Persona de Mediana Edad , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/terapia , Anciano , Cistina/administración & dosificación , Cistina/análogos & derivados , Glutamatos/administración & dosificación , Glutamatos/efectos adversos , Glutamatos/uso terapéutico

RESUMEN

Patients with Crohn's disease are at higher risk of opportunistic infection, especially if treated with immunosuppressive therapy. Cytomegalovirus has been reported to cause ulcerated lesions mainly in the lower gastrointestinal tract of inflammatory bowel disease patients. We herein report a rare case of Crohn's disease complicated with cytomegalovirus esophagitis, which was difficult to distinguish from exacerbation of Crohn's disease. Diagnostic values of clinical course, blood tests, endoscopic and histological examinations are limited but the present case was therapeutically diagnosed by antiviral therapy in combination with histological evidence of cytomegalovirus.

Asunto(s)

Enfermedad de Crohn , Infecciones por Citomegalovirus , Esofagitis , Humanos , Enfermedad de Crohn/diagnóstico , Enfermedad de Crohn/tratamiento farmacológico , Enfermedad de Crohn/complicaciones , Infecciones por Citomegalovirus/diagnóstico , Infecciones por Citomegalovirus/complicaciones , Esofagitis/virología , Esofagitis/diagnóstico , Esofagitis/tratamiento farmacológico , Diagnóstico Diferencial , Antivirales/uso terapéutico , Masculino , Femenino , Adulto , Progresión de la Enfermedad

RESUMEN

INTRODUCTION: Limiting acute esophagitis remains a clinical challenge during the treatment of locally advanced non-small cell lung cancer (NSCLC). METHODS: Demographic, dosimetric, and acute toxicity data were prospectively collected for patients undergoing definitive radiation therapy +/- chemotherapy for stage II-III NSCLC from 2012 to 2022 across a statewide consortium. Logistic regression models were used to characterize the risk of grade 2 + and 3 + esophagitis as a function of dosimetric and clinical covariates. Multivariate regression models were fitted to predict the 50 % risk of grade 2 esophagitis and 3 % risk of grade 3 esophagitis. RESULTS: Of 1760 patients, 84.2 % had stage III disease and 85.3 % received concurrent chemotherapy. 79.2 % of patients had an ECOG performance status ≤ 1. Overall rates of acute grade 2 + and 3 + esophagitis were 48.4 % and 2.2 %, respectively. On multivariate analyses, performance status, mean esophageal dose (MED) and minimum dose to the 2 cc of esophagus receiving the highest dose (D2cc) were significantly associated with grade 2 + and 3 + esophagitis. Concurrent chemotherapy was associated with grade 2 + but not grade 3 + esophagitis. For all patients, MED of 29 Gy and D2cc of 61 Gy corresponded to a 3 % risk of acute grade 3 + esophagitis. For patients receiving chemotherapy, MED of 22 Gy and D2cc of 50 Gy corresponded to a 50 % risk of acute grade 2 + esophagitis. CONCLUSIONS: Performance status, concurrent chemotherapy, MED and D2cc are associated with acute esophagitis during definitive treatment of NSCLC. Models that quantitatively account for these factors can be useful in individualizing radiation plans.

Asunto(s)

Carcinoma de Pulmón de Células no Pequeñas , Esofagitis , Neoplasias Pulmonares , Humanos , Esofagitis/etiología , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/tratamiento farmacológico , Masculino , Femenino , Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Carcinoma de Pulmón de Células no Pequeñas/patología , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Anciano , Persona de Mediana Edad , Enfermedad Aguda , Dosificación Radioterapéutica , Traumatismos por Radiación/etiología , Estudios Prospectivos , Adulto , Anciano de 80 o más Años , Factores de Riesgo

RESUMEN

BACKGROUND: A recent phase I/II study determined the optimal dose of definitive carbon-ion radiotherapy (CIRT) for cT1bN0M0 esophageal cancer. This study aimed to further confirm the efficacy and feasibility of the recommended dose fractionation of CIRT with long-term follow-up results in a larger sample size. METHODS: This single center retrospective study evaluated patients with cT1bN0M0 esophageal squamous cell carcinoma treated with the recommended dose fractionation of 50.4 Gy relative biological effectiveness in 12 fractions, between 2012 and 2022. RESULTS: Thirty-eight patients underwent CIRT at our hospital. Although eight (21.1%) patients were older than 80 years, 15 (39.5%) had high surgical risk, and seven (18.4%) were at high risk for chemotherapy, all patients underwent CIRT as scheduled. Grade 3 esophagitis occurred in eight (21.1%) patients and grade 3 pneumonia in one (2.6%) patient in this study, but no grade 4 adverse events occurred. The only grade 3 late adverse event was pneumonia in one patient (2.6%). The 5-year overall survival rate, local control rate, and disease-free survival rates were 76.6% (95% CI, 90.9-62.4), 74.9% (95% CI, 90.7-59.0), and 66.4% (95% CI, 83.3-49.5), respectively. Additionally, post CIRT recurrence was as follows: seven (18.4%) patients had recurrence in another part of the esophagus, three (7.9%) in the primary site, three (7.9%) in lymph nodes outside the irradiated area, and one (2.6%) patient had liver metastasis. CONCLUSIONS: Our study demonstrates that CIRT using the recommended dose fractionation is feasible and effective for cT1bN0M0 esophageal squamous cell carcinoma.

Asunto(s)

Neoplasias Esofágicas , Carcinoma de Células Escamosas de Esófago , Radioterapia de Iones Pesados , Estadificación de Neoplasias , Humanos , Masculino , Femenino , Anciano , Radioterapia de Iones Pesados/métodos , Radioterapia de Iones Pesados/efectos adversos , Estudios Retrospectivos , Neoplasias Esofágicas/radioterapia , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/mortalidad , Persona de Mediana Edad , Carcinoma de Células Escamosas de Esófago/radioterapia , Carcinoma de Células Escamosas de Esófago/patología , Anciano de 80 o más Años , Resultado del Tratamiento , Tasa de Supervivencia , Estudios de Factibilidad , Fraccionamiento de la Dosis de Radiación , Recurrencia Local de Neoplasia/epidemiología , Recurrencia Local de Neoplasia/radioterapia , Esofagitis/etiología , Estudios de Seguimiento , Supervivencia sin Enfermedad , Metástasis Linfática

RESUMEN

PURPOSE: We aimed to examine the effectiveness of mother milk exosomes in treating corrosive esophageal burns. MATERIALS AND METHODS: 32 rats were separated into four equal groups and weighed individually before the procedure. A corrosive esophageal burn model was created with 12.5% sodium hydroxide by a 3F Fogarty catheter. Group 1 did not apply any process or treatment, Group 2 was burned, and no treatment was performed. Group 3 was burned, and then 0.5 cc/day of mother milk exosome extract was given. Group 4 was not applied any process, and 0.5 cc/day mother milk exosome extract was given. All rats were weighed again and sacrificed. Biopsy samples were sent to the pathology laboratory for histopathological examination (in terms of inflammation, fibrosis, and necrosis).Kindly check and confrm all email ids.The e-mail addresses and affiliation of all authors were checked. Affiliation departments are as stated on the title page. There is no change. RESULTS: A significant difference was found in the results of inflammation and fibrosis. There was a meaningful difference in fibrosis between the 2nd and 3rd groups. There was weight gain in groups 1, 3 and 4. Statistical evaluations for each group were significant. CONCLUSION: It was observed that breast milk exosomes may be effective in inflammation and fibrosis formation in treating corrosive esophageal burns. This suggested that breast milk exosomes reduce stricture formation due to esophageal corrosion.Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 1 Given name: [specify authors given name] Last name [specify authors last name]. Also, kindly confirm the details in the metadata are correct.The names and affiliation of all authors were checked. Affiliation departments are as stated on the title page. There is no change. Also we confirm the details in the metadata.

Asunto(s)

Quemaduras Químicas , Modelos Animales de Enfermedad , Exosomas , Animales , Ratas , Quemaduras Químicas/terapia , Esofagitis/inducido químicamente , Esofagitis/patología , Cáusticos/toxicidad , Leche Humana , Femenino , Hidróxido de Sodio/toxicidad , Esófago/patología , Masculino

RESUMEN

There are various therapeutic options for achalasia. Nevertheless, peroral endoscopic myotomy (POEM) and laparoscopic Heller myotomy with fundoplication (LHM) are distinguished by their efficacy and low incidence of complications. Compare POEM and LHM regarding several outcomes in patients with achalasia. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An exhaustive literature search was performed using PubMed, Web of Science, and Cochrane Library databases. Studies comparing several outcomes between POEM and LHM in patients with achalasia were included. Data on clinical success, operative time, intraoperative complications, length of stay, reintervention rates, postoperative pain, overall complications, occurrence of GERD symptoms, use of proton bomb inhibitors and esophagitis were extracted. Quality assessment of the included studies was performed using the MINORS scale. We included 20 retrospective observational studies with a combined total of 5139 participants. The results demonstrated that there was no statistically significant difference in terms of intraoperative complications, postoperative complications, reintervention rate, occurrence of GERD symptoms, GERD HRQL, use of proton pump inhibitors, and esophagitis between POEM and LHM groups. Conversely, POEM was associated with higher clinical success and shorter operative time, length of stay, and postoperative pain. This meta-analysis concludes that both POEM and LHM, are effective and safe treatments for achalasia. However, POEM demonstrates better results regarding clinical success, operative time, length of stay, postoperative pain, and a tendency towards lower recurrence.

Asunto(s)

Acalasia del Esófago , Fundoplicación , Miotomía de Heller , Laparoscopía , Tiempo de Internación , Tempo Operativo , Complicaciones Posoperatorias , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Acalasia del Esófago/cirugía , Esofagitis/etiología , Fundoplicación/métodos , Fundoplicación/efectos adversos , Reflujo Gastroesofágico/cirugía , Miotomía de Heller/métodos , Miotomía de Heller/efectos adversos , Complicaciones Intraoperatorias/epidemiología , Complicaciones Intraoperatorias/etiología , Laparoscopía/métodos , Laparoscopía/efectos adversos , Tiempo de Internación/estadística & datos numéricos , Cirugía Endoscópica por Orificios Naturales/métodos , Cirugía Endoscópica por Orificios Naturales/efectos adversos , Dolor Postoperatorio/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Inhibidores de la Bomba de Protones/uso terapéutico , Estudios Retrospectivos , Resultado del Tratamiento

Asunto(s)

Esofagitis , Humanos , Esofagitis/diagnóstico , Esofagitis/patología , Masculino , Niño , Esófago/diagnóstico por imagen , Esófago/patología , Femenino

RESUMEN

Esophagitis dissecans superficialis (EDS) is a rare disease characterized by sloughing of the superficial esophageal mucosa and, histologically, by the bitonal appearance of the squamous epithelium secondary to necrosis of the most superficial layers. Etiology is uncertain, however, it has been associated with some medications, autoimmune diseases, esophageal stasis and endoscopic procedures. Here, two cases are presented, one of them which appeared in a woman after an episode of dysphagia and another one which occurred to a man with comorbidities and epigastric pain. This entity should be considered due to its self-limiting clinical course, compared to other entities with a more torpid evolution or that require more specific treatment.

Asunto(s)

Enfermedades Autoinmunes , Esofagitis , Masculino , Femenino , Humanos , Esofagitis/complicaciones , Esofagitis/patología , Epitelio/patología

RESUMEN

BACKGROUND: Erosive esophagitis (EE) is a gastroesophageal reflux disease characterized by mucosal breaks in the esophagus. Proton pump inhibitors are widely used as maintenance therapy for EE, but many patients still relapse. In this trial, we evaluated the noninferiority of vonoprazan vs. lansoprazole as maintenance therapy in patients with healed EE. METHODS: We performed a double-blind, double-dummy, multicenter, phase 3 clinical trial among non-Japanese Asian adults with endoscopically confirmed healed EE from April 2015 to February 2019. Patients from China, South Korea, and Malaysia were randomized to vonoprazan 10 mg or 20 mg once daily or lansoprazole 15 mg once daily for 24 weeks. The primary endpoint was endoscopically confirmed EE recurrence rate over 24 weeks with a noninferiority margin of 10% using a two-sided 95% confidence interval (CI). Treatment-emergent adverse events (TEAEs) were recorded. RESULTS: Among 703 patients, EE recurrence was observed in 24/181 (13.3%) and 21/171 (12.3%) patients receiving vonoprazan 10 mg or 20 mg, respectively, and 47/184 (25.5%) patients receiving lansoprazole (differences: -12.3% [95% CI, -20.3% to -4.3%] and -13.3% [95% CI, -21.3% to -5.3%], respectively), meeting the primary endpoint of noninferiority to lansoprazole in preventing EE recurrence at 24 weeks. Evidence of superiority (upper bound of 95% CI <0%) was also observed. At 12 weeks, endoscopically confirmed EE recurrence was observed in 5/18, 2/20, and 7/20 of patients receiving vonoprazan 10 mg, vonoprazan 20 mg, and lansoprazole, respectively. TEAEs were experienced by 66.8% (157/235), 69.0% (156/226), and 65.3% (158/242) of patients receiving vonoprazan 10 mg, vonoprazan 20 mg, and lansoprazole, respectively. The most common TEAE was upper respiratory tract infection in 12.8% (30/235) and 12.8% (29/226) patients in vonoprazan 10 mg and 20 mg groups, respectively and 8.7% (21/242) patients in lansoprazole group. CONCLUSION: Vonoprazan maintenance therapy was well-tolerated and noninferior to lansoprazole for preventing EE recurrence in Asian patients with healed EE. TRIAL REGISTRATION: https://clinicaltrials.gov; NCT02388737.

Asunto(s)

Lansoprazol , Inhibidores de la Bomba de Protones , Pirroles , Sulfonamidas , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pueblo Asiatico , Método Doble Ciego , Esofagitis/tratamiento farmacológico , Esofagitis Péptica/tratamiento farmacológico , Lansoprazol/uso terapéutico , Inhibidores de la Bomba de Protones/uso terapéutico , Pirroles/uso terapéutico , Sulfonamidas/uso terapéutico , Pueblos del Este de Asia , China , República de Corea , Malasia

RESUMEN

Data for pharmacologic treatments for non-eosinophilic esophagitis (EoE) eosinophilic gastrointestinal diseases (EGIDs) are limited. Nevertheless, because of the increasing understanding of EGID pathogenesis, a number of medications are used to treat EGIDs, though all are currently off-label. Initial therapy generally starts with corticosteroids, and "topical" delivery is preferred over systemic due to long-term side effects. A number of other small molecules could potentially be used, ranging from allergy medications to immunosuppressants. Biologics are also being used and investigated for EGIDs and represent promising targeted therapies. Multiple therapeutic targets have also been identified, many of which overlap with EoE targets.

Asunto(s)

Enteritis , Eosinofilia , Esofagitis , Humanos , Eosinofilia/diagnóstico , Eosinofilia/tratamiento farmacológico , Esofagitis/tratamiento farmacológico , Corticoesteroides/uso terapéutico , Inmunosupresores , Enteritis/diagnóstico , Enteritis/tratamiento farmacológico , Enteritis/etiología