Clinical analysis of 20 cases with Jakohanmer's esophagus / 中国基层医药

Objective@#To evaluate the prevalence and characteristics of Jackhammer esophagus (JE).@*Methods@#From December 2015 to December 2018, the clinical data of 20 patients with JE in the People's Hospital of Yuhuan were retrospectively analyzed.The clinical data of JE patients with typical symptoms of proton pump inhibitor reactive gastroesophageal reflux disease (GERD) were evaluated.The differences between JE patients with or without GERD or allergic esophagus were analyzed, which including esophagogastroscopy (EGD), dynamic pH impedance monitoring of proton pump inhibitors and proton pump inhibitor tests.@*Results@#Of 20 patients with JE, the average age was (55.86±3.23) years old, and BMI was (26.10±3.21)kg/m2.Among JE patients, 10 cases (50.0%) were GERD positive, 2 cases (10.0%) were acid sensitive esophagus, and 8 cases (40.0%) were GERD negative.There were no statistically significant differences in heartburn (P=0.167), nausea (P=0.250), dysphagia (P=0.714) or non-cardiac chest pain (P=0.906) and their duration (P=0.319) among the three types of patients.It also affected the intake of proton pump inhibitor (P=0.377) and heartburn (P=0.494). The total number of reflux in patients with positive GERD caused by JE proton pump inhibitor was significantly increased (P=0.027).@*Conclusion@#JE has a low prevalence rate in patients with typical symptoms of GERD and proton pump inhibitor treatment response.In this study, only nearly half of the people were diagnosed as GERD positive, which indicates that additional objective tests are needed to stratify JE phenotypes.

Eosinophilic oesophagitis in children: an uncommon occurrence in a predominantly Chinese population in Singapore

<p><b>INTRODUCTION</b>We aimed to determine the prevalence and clinical manifestations of eosinophilic oesophagitis (EoE) in children who presented to a tertiary care hospital in Singapore.</p><p><b>METHODS</b>We conducted a retrospective review of all oesophageal biopsies taken during oesophagogastroduodenoscopy (OGD) from March 2010 to December 2011. The patients' demographics and clinical characteristics were collected. Biopsies were reviewed by a single pathologist who was blinded to the original reports, using the current consensus criteria for the histological diagnosis of EoE.</p><p><b>RESULTS</b>Of the 88 children who had biopsies during OGD, 4 (4.5%) children (three boys, one girl; three Chinese, one Caucasian) were diagnosed with EoE. Their median age was 9.5 (range 4.0-12.0) years. The main clinical presentations were abdominal pain (in the three older children) and vomiting (in the youngest child). Three children had a history of atopy. Three children were diagnosed with EoE in the original histology reports, while one was diagnosed after the second review following histology demonstrating > 15 eosinophil granulocytes per high power field and microabscess formation. Endoscopy findings revealed oesophagitis in two children, one of whom was already on acid suppression therapy. Although three children were started on acid suppression therapy, they continued to be symptomatic. One child was also treated with swallowed fluticasone and two with food allergen avoidance, resulting in symptom improvement.</p><p><b>CONCLUSION</b>Although EoE is uncommon in Singapore, greater awareness is needed among family physicians and general paediatricians. Paediatric gastroenterologists should alert pathologists when sending biopsy specimens that are suspicious for EoE.</p>

Effectiveness of thymoquinone, zeolite, and platelet-rich plasma in model of corrosive oesophagitis induced in rats

PURPOSE: The effectiveness of platelet-rich plasma (PRP), thymoquinone, and zeolite in corrosive esophageal burns was investigated in a rat model. METHODS: Four groups were comprised as containing 10 rats in each group. For group I, oesophagitis was induced and no other procedure was performed (control group). For group II, oesophagitis was induced and thymoquinone was administered for 1 week via oral gavage once a day (thymoquinone group). For group III, oesophagitis was induced for 1 week via oral gavage once a day (PRP group). For group IV, oesophagitis was induced and zeolite was administered for 1 week via oral gavage once a day (zeolite group). On the 10th day, the rats were sacrificed under anaesthesia and venous blood sampling was performed from the vena portae. The oesophaguses were totally excised. Biochemically, interleukin (IL)-1B, IL-6, TNF-α, and MCP-1 were examined from venous blood. Inflammation score was evaluated histopathologically in oesophageal tissue that was collected. RESULTS: There was a statistically significant difference among groups in terms of IL-1, IL-6, MCP levels, compared to the control group; median IL-1, IL-6, MCP levels of thymoquinone, PRP, and zeolite groups were statistically significantly lower. There was a statistically significant difference among groups in terms of inflammation scores, compared to group I; median inflammation scores of groups II, III and IV were statistically significantly lower thymoquinone. CONCLUSION: PRP, and zeolite exhibited positive effect on recovery in oesophagitis by reducing inflammation in the involved segment.

Imaging in noncardiovascular thoracic emergencies: a pictorial review

Cardiovascular and noncardiovascular conditions are commonly encountered in the emergency department. While the majority of patients have underlying cardiovascular aetiologies, such as acute myocardial infarction, congestive heart failure, aortic dissection and pulmonary embolism, a small subset of patients have underlying noncardiovascular conditions, although they present with similar symptoms of chest pain, dyspnoea, cough, haemoptysis and haematemesis. This article aims to describe the imaging findings in common noncardiovascular conditions of the chest that are frequently encountered in the emergency department, with a review of the existing literature.

Neurogenous hyperplasia in the oesophagus

Leiomyoma and gastrointestinal stromal tumours take fi rst place among mesenchymal tumours of the oesophagus, where tumours of peripheral nerve origin are rarely seen. Schwann and enterochromaffi n cell proliferation occur in neurogenous hyperplasia, an entity observed in the appendix which has not been reported in the oesophagus in the medical literature. Oesophagogastroscopy of a 58-year-old woman showed linear erosions and nodularity at the gastroesophageal junction. The microscopic examination of biopsies taken from this area revealed proliferation of spindle cells with oval-round nuclei forming focal fascicular arrangement in the lamina propria. These cells stained positive for synaptophysin and S100-protein, while immunohistochemistry for smooth muscle actin and CD117 were negative. The case was diagnosed as neurogenous hyperplasia with these fi ndings. Control endoscopic biopsies showed no evidence of neurogenous hyperplasia. Neurogenous hyperplasia can be considered as a distinct entity which might also be observed in the oesophagus as in the appendix.

Ameliorative effects of Panax quinquefolium on experimentally induced reflux oesophagitis in rats.

Background & objectives: Reflux oesophagitis (RE), is one of the most prevalent chronic gastrointestinal disorders commonly referred to as gastroesophageal reflux disease (GERD) and requires long term therapy. The present study was designed to investigate the protective effects of Panax quinquefolium (PQ), administered with variable doses, on experimentally induced reflux oesophagitis (RE) in rats. Methods: Forty two female Sprague-Dawley (180-220 g) rats were randomly divided to receive standardized root powder of PQ (50-200mg/kg, po), standard anti-reflux (omeprazole, 5 mg/kg, ip) and anti-oxidant (α-tocopherol, 16 mg/kg, po). After 45 min drug pretreatment, RE was produced in rats by simultaneous ligation of the pyloric end and forestomach. Several parameters, including macroscopic lesion index, glutathione system, lipid peroxidation (LPO) and tissue myeloperoxidase (MPO) activity were measured. Alterations in ICAM-1, CINC-2 and MCP-1 gene expression were examined through reverse transcriptase polymerase chain reaction (RT-PCR). Results: PQ significantly attenuated the severity of the macroscopic signs of RE-induced tissue damage, replenished the depleted GSH level and reduced the RE-associated LPO levels dose dependently. In contrast, omeprazole though effectively improved the mucosal damage, it failed to bring significant attenuation of RE-associated changes in LPO, GSH level and MPO activity. α-Tocopherol significantly ameliorated RE-induced tissue injury and improved LPO level and GSH/GSSG ratio but failed to counteract RE-induced MPO activity. PQ at dose of 100 mg/kg significantly downregulated ICAM-1 and CINC-2 expression whereas it showed no effect over MCP-1 expression. Interpretation & conclusions: The present data indicate that PQ protects against RE-induced oesophageal damage via a mechanism that inhibits the influx of inflammatory cell to oesophagus and a consequence excessive oxidative load, opening the avenue to its promising protective role in patients with gastroesophageal reflux disease (GERD).

Relationship of body mass index with hiatal hernia and reflux esophagitis / 中华消化内镜杂志

Objective To investigate the relationship of body mass index with hiatal hernia (HH) and reflux esophagitis (RE).Methods Two hundreds and twenty seven gastroesophageal reflux disease (GERD) patients with typical acid regurgitation and heartburn were enrolled and categorized into three groups according to body mass index (BMI, kg/m2) as normal weight (18.5≤BMI ＜24), overweight (24≤BMI＜28), and obesity (BMI≥28).RE, non-erosive reflux disease (NERD) and HH were diagnosed by gastroscopy.All the patients underwent ambulatory 24-hour pH monitoring and the pathological acid reflux was considered when the DeMeester score≥15.Effects of BMI on RE and HH were estimated by using logistic regression analysis.Results The percentages of RE and HH were 30.0%(68/227) and 5.7%(13/227), respectively.76.9% (10/13) HH patients had RE. Proportions of RE and HH increased significantly with increasing BMI (P＜0.05), so was that of RE above grade B in three groups (6.4%, 16.9% and 31.6%,P=0.003).DeMeester scores of the three groups were 15.9, 19.8 and 36.9, respectively (P＜0.05).The average 24-hour intra-esophagus pH value of overweight group, was significantly lower than that of normal weight patients in the afternoon and midnight (P＜0.01).Multivariate analysis showed obesity was a risk factor for HH with OR 7.058 (95% CI: 1.294～38.488, P=0.024), male (OR: 2.537, 95% CI: 1.350～4.766, P=0.004), overweight (OR: 1.921, 95% CI: 1.005～3.670, P=0.048), obesity (OR: 3.305, 95% CI: 1.123～9.724, P=0.030) and HH (OR: 6.879, 95% CI: 1.695～27.913, P=0.007) were risk factors for RE.Conclusion BMI has a significant association with HH and RE, obesity is a common risk factor for both HH and RE, HH may induce the development of RE.

Lesiones cáusticas por ingesta de pilas alcalinas: reporte de dos casos / Injuries caustic alkaline battery ingestion: report of two cases

Los niños pueden ingerir cualquier objeto, impulsados por su curiosidad y afán de reconocer objetos y de modo accidental en un 80% ocurren en la infancia. Por fortuna en la mayor parte de casos se expulsa sin problemas con la materia fecal, requiriendo extracción endoscópica solo en 10-20% de ellos y cirugía en < del 1%. En realidad es imposible mencionar todos los cuerpos extraños que pueden ingerir los niños. Se describe dos casos de ingesta de pilas de litio, en los que se realizó la extracción respectiva por vía endoscópica evidenciándose lesiones clínicas en hipofaringe y esófago. Realizamos una mención de la ingesta de cuerpos extraños ingeridos en general, con énfasis en una actualización sobre la ingesta de pilas alcalinas.

Children can ingest anything driven by curiosity and eagerness to identify objects; eighty percent of accidents occur during infancy. Fortunately, in most cases, objects are eliminated without problems with faeces, requiring endoscopic extraction only in 10-20% of the cases, and surgery in less than 1%. It is virtually impossible to mention all the objects that children can eat. We describe two cases of ingestion of lithium batteries, where the respective extraction was performed by endoscopy and clinical lesions were found in the hypopharinx and oesophagus. We mention the ingestion of objects in general with emphasis on the actualization of ingestion of alkaline batteries.

Study clinical signs, gastroscopic and oesophageal histopathologic features, pH monitoring 24h in the patients with gastroesophageal reflux disease

Background: pH monitoring 24h is used to diagnose atypical gastroesophageal reflux disease or can be applied to consider surgery for cases poorly respond with medical treatment. Objective: To study clinical signs, gastroscopic and oesophageal histopathologic features, pH monitoring 24h in the patients with gastroesophageal reflux disease (GERD). Subjects and method: The descriptive, cross-sectional study was conducted in patients with gastroesophageal reflux disease treated at Bach Mai Hospital from November 2005 to October 2006. 73 patients with GERD diagnosed according to Romell criteria were underwent gastroscopy and biopsy. 15 patients having extraesophageal manifestations of gastroesophageal reflux disease were underwent gastroesophageal reflux monitoring pH. Results: 31 (42.4%) patients had oesophagitis in which 67.7% grade A, 6.5% grade D and C, 2.7% Barret, and 53.4% having gastritis associated. 61 % oesophagitis and 13.9% Barret were seen on the biopsy. 40% (6/15) patients had abnormal pH monitoring but there was no statistically significant difference in pH monitoring between the group having oesophagitis from those without oesophagitis (p > 0.05). Conclusions: Among 15 patients underwent Ph monitoring, the rate of patients with abnormal pH monitoring was 40%. There was no statistically significant difference of pH monitoring result between patients with or without esophagus lesion.

Corrosive oesophagitis: Radiological study.

Thirty-six oesophagograms of 24 patients after ingestion of 75-90% formic acid in suicide attempts were reviewed. AII oesophagograms were obtained in the acute, subacute, and chronic phases. In the acute and suhacute phases, the radiographic findings consisted of mucosal oedema, submucosal oedema or haemorrhages, ulcerations, sloughing of the moucosa, atony and dilatiation. Stricture of the oesophsgus was present in the chronic phase. The severity of the corrosive oesophagitis was considerably related to the concentration, amount, and duration of contact between the caustic agent and the oesophageal mucosa.

Corrosive oesophagitis after formic acid ingestion.

The occurrence of corrosive oesophagitis following ingestion of formic acid has been studied. Twelve patients with this condition were seen by the authors in Songklanagarind Hospital during the three years period, January 1983 to December 1985. The sex ratio, male: female was 1 : 5. The ingestion of formic acid was due to attempted suicide in 83.3% of patients, and accidental in 16.7% of patients. Oesophagoscopy was done in all patients in every case. Pathological changes were seen in the oesophagus, in seven cases also in the stomach, and in one case even in the duodenum. The treatment varied from simple oesophageal dilatation in mild cases to surgical intervention in the more severe cases. The mean length of stay in hospital was 36.5 days (3-60 days). Postoperative complications occurred in 3 patients in 3 patients and 2 patients died.