Cordycepin prevents the esophageal stricture formation in the alkali-burn rat model by exerting anti-inflammatory and antifibrotic effects

ABSTRACT Purpose To investigate the efficacy of cordycepin, an adenosine analogue, on prevention of esophageal damage and stricture formation due to esophageal caustic burns in rat model comparing with prednisolone. Methods Caustic esophageal burn was introduced by 37.5% of NaOH to distal esophagus. Thirty-two Wistar albino rats were divided in four groups: sham rats undergone laparotomy, treated with 0.9% NaCl; control rats injured with NaOH without cordycepin treatment; cordycepin group injured with NaOH, treated with 20 mg/kg cordycepin; prednisolone group injured with NaOH, treated with 1 mg/kg prednisolone for 28 days. Efficacy was assessed by histopathological and immunohistochemical analysis of esophageal tissues. Results Cordycepin treatment significantly decreased inflammation, granulation tissue and fibrous tissue formation and prevented formation of esophageal strictures shown by histopathological damage score and stenosis indexes compared to control group (p < 0.01). These effects are relatively more substantial than prednisolone, probably based on attenuation of elevation of proinflammatory cytokines hypoxia-inducible factor 1-alpha (HIF-1?), tumor necrosis factor alpha (TNF-?), proliferative and fibrotic factor fibroblast growth factor 2 (FGF2) and angiogenic factor vascular endothelial growth factor A (VEGFA) (p < 0.05). Conclusions The findings suggest that cordycepin has a complex multifactorial healing process in alkali-burned tissue, more successful than prednisolone in preventing the formation of esophageal strictures and may be used as a therapeutic agent in the acute phase of esophageal alkali-burn.

Esophageal stricture assessment by esophagogram: a pictorial review of differential diagnosis

The purpose of this article is to review the most frequent conditions associated with esophageal strictures on esophagogram. The most common causes include caustic ingestion, radiation therapy, malignancy, extrinsic compression, gastroesophageal reflux disease, infectious esophagitis, systemic diseases and membranes and rings. Adequate characterization of the stricture is necessary for formulation of the best diagnostic hypothesis and can be used to distinguish between malignant and non-malignant conditions. (AU)

End-to-end versus end-to-side anastomosis in the treatment of esophageal atresia or tracheo-esophageal fistula / Anastomose terminoterminal versus terminolateral no tratamento da atresia ou fístula traqueoesofágica

Background: Dehiscence of esophageal anastomosis is frequent and there are still controversies which type of anastomosis is preferred to diminish its incidence . Aim: To compare end-to-end anastomosis versus end-to-side anastomosis in terms of anastomotic leakage, esophageal stricture and gastroesophageal reflux symptom. Methods: This study was carried out for two year starting from 2012. End-to-side and end-to-side anastomosis were compared in terms of anastomotic leakage, esophageal stricture, gastroesophageal reflux symptom, length of surgery and pack cell infusion. Results: Respectively to end-to-end and end-to-side anastomosis, duration of surgery was 127.63±13.393 minutes and 130.29±10.727 minutes (p=0.353); esophageal stricture was noted in two (5.9%) and eight (21.1%) cases (p=0.09); gastroesophageal reflux disease was detected in six (15.8%) and three (8.8%) cases (p=0.485); anastomotic leakage was found in five (13.2%) and one (2.9%) cases (p=0.203); duration of neonatal intensive care unit admission was significantly shorter in end-to-end (11.05±2.438 day) compared to end-to-side anastomosis (13.88±2.306 day) (p<0.0001). Conclusion: There were no significant differences between end-to-end and end-to-side anastomosis except for length of neonatal intensive care unit admission which was significantly shorter in end-to-end anastomosis group.

Racional: Deiscência de anastomose esofágica é frequente e ainda existem controvérsias qual tipo de anastomose é preferível para diminuir sua incidência. Objetivo : Comparar a anastomose terminoterminal versus a lateroterminal em termos de deiscência de anastomose, estenose de esôfago, e sintoma de refluxo gastroesofágico. Métodos : Este estudo foi realizado por dois anos a partir de 2012. Anastomoses terminoterminal e terminolateral foram comparadas em termos de deiscência de anastomose, estenose de esôfago, sintoma do refluxo gastroesofágico, duração da operação e transfusão. Resultados : Na comparação das anastomoses terminoterminal e terminolateral, respectivamente, a duração em minutos das operações foi de 127.63±13.393 e 130.29±10.727 (p=0,353); estenose esofágica foi observada em dois (5,9%) e oito (21,1%) casos (p=0,09); doença do refluxo gastroesofágico foi detectada em seis (15,8%) e três (8,8%) casos (p=0,485); deiscência de anastomose foi encontrada em cinco (13,2%) e um (2,9%) caso (p=0,203); duração do internamento na UTI neonatal foi significativamente menor na terminoterminal (11,05±2,438 dias) em comparação com terminolateral (13,88±2,306 dias, p<0,0001). Conclusão : Não houve diferença significativa entre as anastomoses terminoterminal e terminolateral, exceto para UTI neonatal que foi significativamente menor no grupo de anastomose terminoterminal.

Severe corrosive oesophagitis: are high doses of methyl prednisolone efficient to prevent oesophageal caustic stricture in children?

Corrosive oesophagitis stricture is the long term complication of severe corrosive oesophagitis. The aim of our study was to evaluate the effect of a high doses of steroids on incidence and quality of oesophageal stricture. We reviewed the case histories of 28 children seen at children hospital from 31 December 1991 to 31 December 2001. These children has second and third degree oesophageal burns and they were treated by systemic Methylprednisolone [1000mg/l,73/m2 SC]. The frequency of stricture was 12/26 [46%]. Ten children required a mean of 6,7 [5,74] dilatation range [1 - 17].One patient required an oesocoloplasty. The frequency of stricture in the group treated early before the 24th hour and after the 24th hours was [9/21] [47,4%] versus [3/7] [42,9%]. This difference was not significant [P = 1]. The frequency of stricture in the group treated less than 21 days and more than 21 days was 6/17 [40%] versus 6/9 [66,7%]. This difference was not significant [P = 0,400]. High doses of methyl prednisolone seems to decrease the risk of oesophageal stricture. We found no difference between the children treated before the 24th hours and those treated after the 24 hours and those treated less than 21 days and those more than 21 days

Ingestión de cáusticos en niños

Estudio a 5 pacientes en edad de 1 a 4 años, que ingirieron sustancias álcalis en 4 casos y ácido en 1 caso, entre los álcalis, la que ocasionó lesiones másgraves fue la soda caústica, los signos y síntomas constatados, posterior a la ingestión del cáustico fueron: lesiones orofaringeas, con dolor y edema a ese nivel; sialorrea y vámitos. La endoscopía Digestiva Alta, realizada en las orimeras horas y días; fue el método auxiliar de diagnóstico más útil para valorar las lesiones esofágicas y el pronóstico de las mismas. Se constataron estenosis esofágicas en 3 casos de ingestión de álcalis fuerte (soda caústica) y en un caso con ácido (ácido muriático : H CL glacial), que requirieron dilataciones esofágicas por esopfagoscopía y se les sigue realizando en forma periódica, con evolución favorable, excepto 1 paciente con estenosis muy severa, con indicación de cirugía de reemplazo. A 3 de estos pacientes se le realizó gastrostomía quirúrgica para su alimentación. En 1 paciente que habia ingerido cáustico alcalino (limpiador de hornos que contiene hidróxido de sodio), se presentaron lesiones esofágicas leves con buena evolución

El empleo de una férula de silastic en la prevención de la estenosis del esófago secundaria a quemadura por ingestión de cáustico: informe preliminar / The use of a silastic tube in the prevention of esophageal stenosis following burn by caustic ingestion: preliminary report

Se informa el resultado obtenido en 53 pacientes que sufrieron esofagitis grado III por quemadura debida a ingestión de substancias caústicas y quienes fueron tratados mediante la aplicación de una férula esofágica de silastic por 4 semanas. En 47 de ellos, después de 6 meses de observación, no se encontró la estenosis y los estudios clínicos, radiológicos, endoscópicos y manométricos del esófago, fueron normales. De acuerdo a los resultados obtenidos, la aplicación de una férula en el esófago es un método efectivo para prevenir las estenosis esofágicas consecutivas a quemaduras por ingesta de sustancias caústicas