Risk factors analysis of the complications caused by button battery ingestions in 58 children / 中国小儿急救医学

Objective:To analyze the clinical characteristics, endoscopic manifestations, complications and related risk factors of button battery ingestion in 58 children, thus providing the basis for clinical diagnosis and treatment.Methods:The medical data of 58 children with button battery ingestion were collected and researched at Children′s Hospital Affiliated to Zhengzhou University from September 2015 to September 2020.The demographic information, battery impaction location, duration, symptoms, mucosal injury level, battery size, treatment, complications and follow-up results were analyzed.Results:The average age of the patients with button battery ingestion was (25.7±15.4)months, including 40 boys(68.9%). The average retention time of the battery in digestive tract was 13.8(2, 96) h. Vomiting, salivation, dysphagia, cough and fever were the common chief complaints.There were 29(50.0%) cases of grade I mucosal injury, as well as 14(24.1%) cases, 10(17.2%) cases and 10(17.2%) cases for grade Ⅱ, grade Ⅲ and grade Ⅳ, respectively.Additionally, common complications included esophageal stenosis, esophageal perforation and esophageal-tracheal fistula.Logistic regression analysis showed that location(esophagus) and diameter(≥15 mm) of battery incarceration were important predictors of complications.Conclusion:The degree of mucosal damage is associated with the diameter and impaction location of battery.The button battery embedded in the esophagus is prone to complications, while the ones retained in the stomach were not vulnerable to serious complications.Endoscopy and other related examinations should be performed again in 1 to 3 weeks after the button removal to determine the outcome of complications and to intervene in time.

Fatal asphyxia due to laryngeal displacement by large-sized prey in a Guiana dolphin (Sotalia guianensis), Brazil / Asfixia por deslocamento laríngeo associado a consumo de presa de grande tamanho em boto-cinza (Sotalia guianensis), Brasil

ABSTRACT: The Guiana dolphin (Sotalia guianensis) is a small odontocete distributed from Santa Catarina state, Brazil, to Honduras. Although it is currently considered "near threatened" by the International Union for Conservation of Nature, considerable knowledge on health and disease aspects of this species has been gained over the last decade. The main threats for the species are represented by multiple anthropic factors. Guiana dolphins feed on a variety of taxa, primarily teleosts, crustaceans, and cephalopods. Herein, we reported a case of severe laryngeal displacement and esophageal impaction with ulceration associated with a deglutted adult leatherjacket (Oligoplites sp.). This fish species is not a common prey item of Guiana dolphins' diet. Severe upper aerodigestive compromise likely led to death by mechanical asphyxia (choke) in this dolphin. This report attested the occurrence of upper aerodigestive dysfunction due to overzealous feeding in Guiana dolphin and contributed to general knowledge on pathology of the species.

RESUMO: O boto-cinza (Sotalia guianensis) é um pequeno odontoceto que ocorre desde o estado de Santa Catarina, Brasil, até Honduras. Embora esta espécie seja considerada "quase ameaçada" pela União Internacional para a Conservação da Natureza, um considerável conhecimento sobre diversos aspectos de saúde e doença nesta espécie foi adquirido na última década. As principais ameaças para a espécie são representadas por múltiplos fatores antrópicos. Os botos-cinza se alimentam de uma variedade de táxons, incluindo principalmente teleósteos, crustáceos e cefalópodes. No presente estudo relatamos um caso de deslocamento laríngeo grave e impactação esofágica com ulceração pela deglutição de um peixe adulto do gênero Oligoplites. Esta espécie de peixe não é um elemento comum da dieta dos botos-cinza. É possível que o comprometimento aerodigestivo grave tenha levado o animal à morte por asfixia mecânica. Este relato atesta a ocorrência de disfunção aerodigestiva superior devido à alimentação de tamanho excessivo por um boto-cinza, e contribui para o conhecimento geral de patologias na espécie.

A Case Report of Esophageal Ulceration after Taking Doxycycline

Doxycycline is frequently prescribed to treat urogenital infections or acne vulgaris. A 39-year-old man was prescribed doxycycline as a treatment for his skin infection. He took each tablet on an empty stomach in the morning, and just before going to bed with insufficient water. After taking the prescribed medication for approximately 3 weeks, he was diagnosed with esophageal ulcer. He had not experienced these symptoms before, and the drug label says that doxycycline rarely causes esophageal ulcer. After discontinuing the medication, the symptoms disappeared. Using the World Health Organization-Uppsala Monitoring Center criteria, the causality for doxycycline-induced esophageal ulcer was evaluated as “possible.” Additionally, using the Naranjo scale and Korean causality assessment algorithm (Ver. 2), the causality was evaluated as “probable.” Previous reports have stated that most patients who took doxycycline with insufficient water just before going to bed or in the supine position developed esophageal ulcer. Therefore, all patients taking doxycycline must be provided with detailed instructions about the appropriate administration methods.

Uso de Hemospray® en sangrado post-escleroterapia / Use of Hemospray® in post-sclerotherapy bleeding

Resumen: Introducción: Hemospray® es un nuevo dispositivo para hemostasia endoscópica utilizado para el sangrado gastrointestinal no variceal. Permite la hemostasia mediante la activación plaquetaria y el aumento de la concentración de factores de coagulación, así como la formación de una barrera mecánica sobre la pared de un vaso sangrante creando un tapón mecánico en el sitio de sangrado. Dentro de las principales indicaciones para su uso se encuentran lesiones de difícil acceso endoscópico, hemorragia gastrointestinal masiva, múltiples sitios de sangrado, modificación de la anatomía por terapia endoscópica previa, presencia de coagulopatía, dificultad para tener visualización directa o cuando es imposible tener contacto con la lesión sangrante. Sin embargo, su uso en niños aún no ha sido aprobado por la FDA. Existe un caso publicado de un paciente de 11 meses tratado exitosamente con Hemospray® por hemorragia gastrointestinal no variceal. Caso clínico: Se reporta el caso de una paciente de 2 años con falla hepática aguda y cirrosis biliar primaria con hipertensión portal y sangrado post-escleroterapia. Se analizó el caso para sustentar las nuevas terapias para el control del sangrado masivo en úlceras post-escleroterapia. Conclusiones: La aplicación demostró ser segura y sin efectos adversos. El uso de Hemospray® es una alternativa efectiva en el control del sangrado gastrointestinal.

Abstract: Background: Hemospray® is a new device for endoscopic hemostasis used for non-variceal gastrointestinal bleeding. It enables hemostasis and platelet activation by increasing the concentration of clotting factors and forming a mechanical barrier on the wall of a bleeding vessel creating a mechanical plug at the site of bleeding. Within the main indications for use are: injuries with difficult endoscopic access, massive gastrointestinal bleeding, multiple bleeding sites, modification of the anatomy by previous endoscopic therapy, presence of coagulopathy, difficulty in having direct visualization or when it is impossible to have contact with the bleeding lesion. However, its use in children has not been approved yet by the FDA. There is a case report of an 11-month-old patient successfully treated with Hemospray® for non-variceal gastrointestinal bleeding. Clinical case: We report the case of a 2-year-old female with acute liver failure and primary biliary cirrhosis with portal hypertension and bleeding after sclerotherapy. We analyzed the case to support new therapies for massive bleeding control in post-sclerotherapy esophageal ulcers. Conclusions: The application showed to be safe without side effects. Using Hemospray® is an effective alternative in controlling gastrointestinal bleeding.

A Case of Behcet's Disease with Both Esophageal and Pharyngeal Ulcers Successfully treated with Steroid and Sulfasalazine

Behcet's disease is a heterogeneous disease that involves variable organ systems. Gastrointestinal Behcet's disease is rare and it generally affects the terminal ileum with propagation toward the cecum and ascending colon. Therefore, esophageal ulcer associated with Behcet's disease has not been reported frequently. We report an unusual case of Behcet's disease associated with both esophageal and pharyngeal ulcers. A 64-year-old man was admitted for an evaluation of pharyngeal and substernal discomfort sustained for 3 months. He had no underlying chronic disease; however, he suffered from recurrent oral and genital ulcers for 20 years and had folliculitis-like skin lesions on the face, scalp and trunk. He was diagnosed with Behcet's disease and gastroesophageal fiberscopy revealed deep ulcers on both the pharynx and upper esophagus. Esophagopharyngeal ulcers were successfully treated with prednisolone, colchicines, dapsone, and sulfasalazine.

Upper Gastrointestinal Hemorrhage from Esophageal Ulcer Caused by Coinfection of Herpes Simplex Virus and Cytomegalovirus in Immunocompromised Patient

Coinfection with herpes simplex virus and cytomegalovirus is a very rare cause of esophageal ulcer and upper gastrointestinal hemorrhage. A 26 year-old male kidney transplant recipient was referred with a complaint of melena. Upper gastrointestinal endoscopy showed a huge esophageal ulcer in the anastomosis site of the esophagogastrostomy. The ulcer occupied about two-thirds of the circumference of the esophageal lumen and an exposed vessel in the ulcer base was noted. Pathologic findings with immunohistochemical stain showed co-infection of herpes simplex virus and cytomegalovirus. He was treated successfully with endoscopic hemostasis and antiviral therapy. We report a case of upper gastrointestinal hemorrhage from esophageal ulcer caused by coinfection of herpes simplex virus and cytomegalovirus.

Upper Gastrointestinal Hemorrhage from Esophageal Ulcer Caused by Coinfection of Herpes Simplex Virus and Cytomegalovirus in Immunocompromised Patient

Coinfection with herpes simplex virus and cytomegalovirus is a very rare cause of esophageal ulcer and upper gastrointestinal hemorrhage. A 26 year-old male kidney transplant recipient was referred with a complaint of melena. Upper gastrointestinal endoscopy showed a huge esophageal ulcer in the anastomosis site of the esophagogastrostomy. The ulcer occupied about two-thirds of the circumference of the esophageal lumen and an exposed vessel in the ulcer base was noted. Pathologic findings with immunohistochemical stain showed co-infection of herpes simplex virus and cytomegalovirus. He was treated successfully with endoscopic hemostasis and antiviral therapy. We report a case of upper gastrointestinal hemorrhage from esophageal ulcer caused by coinfection of herpes simplex virus and cytomegalovirus.

Cytomegalovirus-associated esophageal ulcer in an immunocompetent infant: When should ganciclovir be administered? / 소아과

Cytomegalovirus (CMV)-associated esophageal ulcer is rare in immunocompetent infants. The presence of inclusion bodies and immunohistochemical staining for CMV in biopsy specimens obtained during esophagogastroduodenoscopy (EGD) indicate that such ulcers occur because of CMV infection. A 7-week-old female infant who experienced frequent vomiting and feeding intolerance was diagnosed with a massive CMV-associated ulcer in the distal esophagus. The ulcer improved after conservative treatment using proton-pump inhibitors; however, ganciclovir was not administered. In a follow-up EGD biopsy specimen, no CMV inclusion bodies were present, and immunohistochemical staining results for this virus were negative. The presence of CMV inclusion bodies indicates active viral replication. If persistent inclusion bodies or positive immunohistochemical staining for CMV is observed in follow-up biopsy specimens, ganciclovir may be used to treat CMV-associated esophageal ulcers.

Esófago de Barrett con ulceración recurrente y seguimiento a largo plazo / Barrett’s esophagus with recurrent ulceration and long-time follow-up

Seventy six year-old female with a history of at least 4 years of gastroesophageal reflux disease, consults in May 2004 due to increasing symptoms in the previous two months with chest pain and dysphagia. The endoscopy showed a large hiatal hernia and esophageal ulcer. Biopsies showed Barrett’s metaplasia with focal low grade glandular dysplasia. Her evolution has been good and has noted symptoms exacerbations related to dietary transgressions or suspension of medical treatment. In 2009 dysphagia reappeared, her lab work-up showed discrete anemia and positive immune occult hemorrhage test. Endoscopy demonstrated esophageal erosion near line “Z” with a self-limited bleeding. Colonoscopy revealed two small adenomas that were removed by biopsy and showed no bleeding lesion. In July 2010 a new control endoscopy is performed showing recurrence of the esophageal ulcer in the same location as observed in the first endoscopy. Her control biopsies showed persistence of Barrett’s disease and no dysplasia.

Paciente de 76 años de sexo femenino consulta en mayo del 2004 por ERGE desde hacía al menos 4 años, que se intensifica, incluso con presencia de dolor torácico y disfagia dos meses antes. La panendoscopia demostró hernia hiatal y una extensa úlcera esofágica. Las biopsias diagnosticaron una metaplasia de Barrett con displasia glandular focal. Su evolución ha sido buena y ha presentado molestias en relación a trasgresiones alimenticias o abandono del tratamiento médico. El 2009 reaparece la disfagia, y en sus exámenes de laboratorio se comprueba una anemia discreta y un Fecatest inmunológico positivo. La endoscopia demuestra una erosión esofágica cercana a línea “Z” que sangra en forma autolimitada. Una ileocolonoscopia demostró dos pequeños adenomas que fueron extirpados por biopsia y ninguna lesión sangrante. En julio de 2010 se practica nueva endoscopia y se observa que la úlcera esofágica ha recidivado en igual ubicación a lo observado en su primer examen. Las biopsias de control mostraron persistencia de Enfermedad de Barrett sin displasia.

The Prevalence and Clinical Characteristics of Esophageal Involvement in Patients with Behcet's Disease: A Single Center Experience in Korea

While a significant amount of clinical information has been reported concerning intestinal involvement in Behcet's disease (BD), esophageal involvement in BD has not yet been studied extensively. The aim of this study was to evaluate the prevalence of esophageal involvement in BD and its clinical characteristics. We retrospectively reviewed the medical records of 842 patients diagnosed with BD at a single tertiary institution in Korea between January 1990 and June 2006. Of the 842 patients with BD, 129 patients (15.3%) experienced upper gastrointestinal symptoms that required inspection through esophagogastroduodenoscopy. Esophageal involvement was found in 6 (4.7%) of the 129 patients. The activity index of Behcet's disease did not differ among patients with or without esophageal involvement. All patients with esophageal involvement responded well to medical treatment and no one experienced serious complications. The results of our study demonstrate that the prevalence of esophageal involvement in BD is very low and that most patients with such involvement face few complications and respond well to medical treatment.

Esophageal Ulcer by Thermal Injury from Steamed Egg / 대한소화기내시경학회지

The common causes of esophageal ulcers include severe reflux esophagitis, carcinomas, pill-induced esophagitis, viral diseases, caustic injury, foreign bodies and radiation injury. In rare cases, they can also be caused by Crohn's disease, Behcet's disease, syphilis and idiopathic causes. A thermal injury caused by the ingestion of hot food has not been reported to be a cause of esophageal ulcers. We report an alcoholic who developed an esophageal ulcer and odynophagia after ingesting part of an extremely hot steamed egg with a review of the few available reports regarding such injuries. We suggest that the ingestion of extremely hot food should also be considered a cause of esophageal ulcers.

Localized Esophageal Ulcerations after CyberKnife Treatment for Metastatic Hepatic Tumor of Colon Cancer / 대한소화기학회지

CyberKnife is an image-guided robotic system designed for stereotactic radiosurgery. It uses the combination of robotics and image guidance to deliver concentrated and accurate beams of radiation to intracranial and extracranial targets. Although the frameless nature of the CyberKnife allows tumors in the chest and abdomen to be treated as well, complications associated with CyberKnife treatment have not been established yet due to its short clinical experience. We describe a case of localized esophageal ulcerations after CyberKnife treatment for metastatic hepatic tumor of colon cancer.

Esophageal Ulcer Induced by Alendronate / 대한소화기내시경학회지

Alendronate sodium (Fosamax(R)) is an aminophosphonate used in treatment of postmenopausal osteoporosis by inhibition of osteoclastic activity. Esophageal ulcers related to alendronate use have been reported at the rate of 2~6%. However, there have been no reports of esophagitis or esophageal ulcer by alendronate in Korea. We present a case of esophageal ulcer caused by alendronate. The patient presented with retrosternal pain and severe odynophagia for a few days. Esophagogastroduodenoscopy revealed multiple deep ulcers at the esophagus. Her symptoms resolved completely after stopping alendronate. A follow-up esophagogastroduodenoscopy 6 weeks later revealed complete healing of the ulcers.

A Caes of Button-Type Lithium Battery Impaction at Esophagus Complicated Esophageal Ulcer and Pseudodiverticulum / 대한소아소화기영양학회지

A 16-month-old boy swallowed accidentally a button type lithium battery with diameter 23 mm. The battery impacted at the upper esophagus was removed by endoscpy in 9 hours. At the time of removal, dark-crust and erythematous mucosal lesion was noted where the battery impacted. At the first hospital day, fever over 38.5 degrees C developed, and NPO, antibiotics and H-2 blocker started. At the third hospital day, he had melena, and endoscopy revealed huge active esophageal ulceration ranging from upper esophagus and lower body of the esophagus. Steroid started. At the 10th hospital day, endoscopy revealed much smaller-sized ulceration, but mucosa where the battery impacted initially showed deep depression which might imply developing diverticulum. At the 17th hospital day, endoscopy revealed complete diverticulum. At the 27th hospital day, endoscopy revealed complete resolution of diverticulum.

A Case of CMV Infection Associated with Simultaneous Esophageal and Colonic Ulcers / 대한소화기내시경학회지

Gastrointestinal cytomegalovirus (CMV) disease causes substantial morbidity and mortality in immunocompromised patients, especially in transplant recipients and those who infected with HIV. Although acute infection is generally asymptomatic or produces only non-specific symptoms in the immunocompetent host, acute CMV infection accompanies gastrointestinal ulceration in a small number of patients. The colon is the most common site of the infection, although it may occur in other gastrointestinal tract. CMV infection associated with simultaneous esophageal and colonic ulcers has not been reported in Korea. We report a patient with subarchnoid hemorrhage who had suffered from simultaneous esophageal and colonic ulcers associated with CMV infection which showed characteristic histologic findings of CMV infection.

A Case of Behcet's Disease with Esophageal and Ileocecal Valve Ulcers / 대한소화기내시경학회지

Behcet's disease is a multisystemic, chronic inflammatory disease with a triad of symptoms including oral ulcers, genital ulcers, and inflammatory ocular lesions. While intestinal Behcet's disease commonly affects the ileocecal region, esophageal ulceration with odynophagia is very uncommon. A 38-year-old male patient was admitted due to odynophagia, a postprandial epigastric burning sensation, and right lower quadrant abdominal pain. He had a history of recurrent oral and genital ulcerations. An esophagogastroduodenoscopy revealed relatively well demarcated ulcerative lesions with mucosal nodularities on the mid to distal esophagus which was suspected to be esophageal cancer. But repeated biopsies showed lymphocytic and plasma cell infiltrations on the lamina propria. A colonoscopy revealed a well demarcated, deep ulcerative lesion with stenotic narrowing in the ileocecal valve. The diagnosis of intestinal Behcet's disease with an esophageal ulcer was made on the basis of clinical and pathological findings. The patient was treated with steroids and sulfasalazine and the response was favorable.

Behcet's Disease with Multiple Ulcers in Esophagus and Terminal Ileum: Report of Two Cases / 대한류마티스학회지

Behcet's disease is a chronic polysymptomatic disease of recurrent systemic vasculitis. The etiology remains unclear. This disease affects several organs of the body concurrently or consecutively and sometimes has a serious outcome, depending upon the system involved. Though gastrointestinal symptoms are relatively common in Behcet's disease, ulcerative change of the intestine is infrequent. The most common sites for the intestinal Behcet's disease are terminal ileum and cecum. Only a few literatures report the esophageal ulcers in Behcet's disease. We describe 2 cases of Behcet's disease who have multiple ulcers in esophagus and terminal ileum. Esophageal ulcers have improved with low-dose prednisolone, colchicine and sulfasalazine in these patients.

A Case Report of Esophageal Involvement in Behcets Disease / 대한소화기내시경학회지

Behcet's disease is a recurrent and multisystemic disorder which usually persists over many years and is classified under vasculitic syndrome. A classic triad in this disorder is composed of a recurrent oral ulcer, genital ulceration and uveitis. While intestinal Behcet's disease most commonly affects the ileoecal region, dysphagia associated with esophageal ulceration is very uncommon. A 34-year-old-female patient visited our hospital because of dysphagia, epigastric pain and fever. The patient had ulcers on the oral mucosa, soft palate and extemal genitalia. Multiple irregularly marginated ulcers surrounded with hyperemic edematous mucosa were found on the middle and distal esophagus and lesser curvature of the stomach by an esophagogastroduodenoscopic examination. The pathologic findings were non-specific ulcers with necrotizing vasculitis in the vulva and with suspicious vasculitis in the esophagus. So she was diagnosed to have a Behcets disease and was treated with steroid and sulfasalazine. In this study we report a case of esophageal involvement of Behcet's disease with a review of the literature.

A Case of Esophageal Superficial Squamous Cell Papilloma Complicated by Esophageal Ulcer and Bleeding in a Child

Esophageal squamous cell papilloma(ESP) is a benign tumor, and known to be very rare. Its symptoms varies, so this disease is usually found incidentally during gastrointestinal endoscopic procedure. Few pediatric cases of ESP with ulcer and bleeding were reported worldwide. Authors experienced and treated a case of huge esophageal ulcer and bleeding complicating ESP in a 8-year-old girl who had history of frequent vomiting during infancy. The lesion of papilloma was superficial and located at distal third of esophagus, and the pathologic finding showed papillary growing of squamous epithelium. The immunohistochemical study for human papilloma virus was negative. The brief review of related literature was made also.

A case of Behcets Esophageal Ulcer / 대한소화기내시경학회지

A 38-year-old man, with recurrent oral ulcers for 10 years, was admitted because of recent aggravation of odynophagia and sore throat. About 4 years earlier, he had been performed abdominal surgery for intestinal perforation. Gastrofiberscopic examination showed small round ulcers at hypiopharynx and 6cm sized longitudinal linear ulcer at mid esophagus. Biopsy specimens at mid-esophagus showed chronic inflammation. Besides oral ulcer, he had perianal ulcers and skin rashes. He was managed with steroid, colchicine and sulfasalazine under the diagnosis of esophageal involvement in Behcet's disease. After 3 months from discharge, esophagogram and gastrofiberscopic examination showed some improved appearance, but symptoms recurred for steroid tapering. He has been followed in much improved status for 8 months after discharge.