Esophageal Melanocytosis.

Esophageal melanocytosis is a rare entity defined by the proliferation of a melanocytic basal layer of the esophageal squamous lining and deposition of melanin in the esophageal mucosa. Esophageal melanocytosis is considered a benign entity of unknown etiology; however, it has been reported as a melanoma precursor. We report a case of esophageal melanocytosis in a diabetic and hypertensive 67-year-old male with recurrent dizziness and syncope for the past 6 months. Given his complaint of dyspepsia, he underwent an upper gastrointestinal endoscopy, in which an esophageal biopsy revealed the diagnosis of esophageal melanocytosis. The definitive diagnosis of esophageal melanocytosis can only be made by histological analysis. The histologic differential diagnoses include melanocytic nevi and malignant melanoma. Therefore, they need to be ruled out.

Esophagitis Dissecans Superficialis: Unveiling the Enigmatic Entity of Esophageal Mucosal Sloughing.

Esophagitis dissecans superficialis (EDS), formerly referred to as sloughing esophagitis, is a degenerative condition affecting the squamous epithelium. EDS is known to be a benign condition that resolves on its own. The exact etiology of EDS remains unclear, although associations with medications like bisphosphonates or nonsteroidal anti-inflammatory drugs, skin conditions, heavy smoking, and physical trauma have been reported. The clinical manifestations exhibit a wide range, encompassing both incidental findings and symptomatic presentations related to the esophagus. Here we present an interesting case of a middle-aged female patient with dysphagia who underwent early esophagogastroduodenoscopy (EGD) for timely identification and treatment of EDS, emphasizing the significance of early detection and management.

Viscoelastic Properties of Acellular Matrices of Porcine Esophageal Mucosa and Comparison with Acellular Matrices of Porcine Small Intestine Submucosa and Bovine Pericardium.

The aim of this study was to compare the viscoelastic properties of a decellularized mesh from the porcine esophagus, prepared by our group, with two commercial acellular tissues derived from porcine small intestine submucosa and bovine pericardium for use in medical devices. The tissues' viscoelastic properties were characterized by creep tests in tension, applying the load in the direction of the fibers or the transverse direction, and also by dynamic-shear mechanical tests between parallel plates or in tension at frequencies between 0.1 and 35 Hz. All the tests were performed in triplicate at a constant temperature of 37 °C immersed in distilled water. The tissues' surface and cross-sectional microstructure were observed by scanning electron microscopy (SEM) to characterize the orientation of the fibers. The matrices of the porcine esophagus present an elastic modulus in the order of 60 MPa when loaded in the longitudinal direction while those of the porcine intestine submucosa and bovine pericardium have an elastic modulus below 5 MPa. Nevertheless, the shear modulus of bovine pericardium nearly triplicates that of the esophageal matrix. The viscoelasticity of decellularized esophageal mucosa is characterized by a fast change in the creep compliance with time. The slope of the creep curve in the double logarithmic plot is twice that of the control samples. These results are consistent with the microstructure observed under electron microscopy regarding the orientation of the fibers that make up the matrices.

Decreased Expression of NRF2 Target Genes after Alcohol Exposure in the Background Esophageal Mucosa of Patients with Esophageal Squamous Cell Carcinoma.

Patients with esophageal squamous cell carcinoma (ESCC) might have a specific mechanism for the carcinogenesis by alcohol consumption in the background esophageal mucosa, and nuclear factor erythroid 2-related factor 2 (NRF2), which plays a protective role against esophageal carcinogenesis, and barrier dysfunction might be associated with this phenomenon. This study aimed to confirm this hypothesis. Twenty patients with superficial ESCCs (ESCC patients) and 20 age- and sex-matched patients without ESCC (non-ESCC patients) were enrolled. Biopsy samples were obtained from non-neoplastic esophageal mucosa: one for histological evaluation, one for quantitative real-time polymerase chain reaction (PCR), and two for the mini-Ussing chamber system to measure transepithelial electrical resistance (TEER) and, thereafter, for PCR. The TEER after acetaldehyde or both acetaldehyde and ethanol exposure did not differ significantly between ESCC and non-ESCC patients. Unlike non-ESCC patients, mRNA levels of NRF2 target genes and claudin4 in ESCC patients tended to decrease after the exposure, with a significant difference between no exposure and both acetaldehyde and ethanol exposure in NRF2 target genes (p < 0.05). Furthermore, in ESCC patients, the decreased tendency of mRNA levels of NRF2 target genes after the exposure was more pronounced in high-risk states, such as aldehyde dehydrogenase 2 (ALDH2) Lys alleles (Glu/Lys + Lys/Lys), Lugol-voiding lesion grade C, and drinking history. In conclusion, the protective role of NRF2 against carcinogenesis from alcohol exposure might be disrupted in the background esophageal mucosa of ESCC patients, which might lead to a high incidence of metachronous ESCC.

Guide mapping for effective superficial photothermal coagulation of the esophagus using computer simulations with ex vivo sheep model validation study.

OBJECTIVES: The transfer and widespread acceptance of laser-induced thermal therapy into gastroenterology remain a topic of interest. However, a practical approach to the quantitative effect of photothermal injury in the esophagus needs further investigation. Here, we aim to perform computer simulations that simulate laser scanning and calculate the laser-induced thermal damage area. The simulation engine offers the results in a guide map for laser coagulation with a well-confined therapeutic area according to laser irradiance and surface scanning speed. The study also presents validation experiments that include histology analyses in an ex vivo sheep esophagus model. METHODS: The simulation engine was developed based on the Monte-Carlo method and the Arrhenius damage integral. The computational model mimicked laser scanning by shifting the position of the calculated heat source in the grating system along the axis to be scanned. The performance of the simulations was tested in an ex vivo sheep esophagus model at a laser wavelength of 1505 nm. Histological analysis, hematoxylin-eosin staining, light microscope imaging, and block-face scanning electron microscopy were used to assess thermal damage to the tissue model. RESULTS: The developed simulation engine estimated the photothermal coagulation area for a surface scanning speed range of 0.5-8 mm/second and laser power of up to 0.5 W at a 0.9-nm laser diameter in a tissue model with a volume of 4 × 4 × 4 mm3 . For example, the optimum laser irradiation for effective photothermal coagulation in the mucosa and superficial submucosa depths was estimated to be between 16.4 and 31.8 W/cm2 , 23.2 and 38.1 W/cm2 at 0.5 and 1 mm/second, respectively. The computational results, summarized as a guide map, were directly compared with the results of ex vivo tissue experiments. In addition, it was pointed out that the comparative theoretical and experimental data overlap significantly in terms of energy density. CONCLUSIONS: Our results suggest that the developed simulation approach could be a seed algorithm for further preclinical and clinical trials and a complementary tool to the laser-induced photothermal coagulation technique for superficial treatments in the gastrointestinal tract. In future preclinical studies, it is thought that the simulation engine can be enriched by combining it with an in vivo model for different laser wavelengths.

Esofagitis disecante superficial: entidad subdiagnosticada en pacientes pluripatológicos

Paciente de 76 años con múltiples comorbilidades presenta sintomatología gastrointestinal, donde la endoscopía digestiva alta revela mucosa esofágica "acartonada" en tercio distal, que a la toma de biopsia se produce esfacelación de 20 mm de largo por 6 mm de ancho, con sangrado que se autolimita. Muestra patológica es compatible con Esofagitis Disecante Superficial (EDS). Esta es una entidad poco frecuente descrita por primera vez en 1800, caracterizada endoscópicamente por desprendimiento de mucosa en tiras verticales como "cinta de papel de regalo", que se confirma mediante patología con una mucosa "bitonal", compuesta por una capa superficial eosinofílica y una zona basofílica de apariencia normal. Puede estar acompañada de inflamación mínima focal. La etiopatogenia no es clara; sin embargo, tiene buena respuesta a inhibidores de bomba de protones (IBPs). En nuestro caso la paciente presentaba todas las características de EDS, y ante su baja frecuencia reportada, se realizó revisión de literatura y discusión de esta rara entidad.

A 76-year-old patient presents multiple comorbidities and gastrointestinal symptoms. The upper gastrointestinal endoscopy exam reveals distal stiffness esophageal mucosa. A biopsy was taking creating sloughing of 20 mm long by 6 mm wide with self-limited bleeding. Specimen is compatible with Esophagitis Dissecans Superficialis (EDS). This is a rare entity first described in 1800, characterized endoscopically by mucosal detachment in vertical strips like "gift paper tape", which is confirmed by pathology with a mucosa with "two tones", composed of a eosinophilic superficial layer and a normal-appearing basophilic area. It may be accompanied by minimal focal inflammation. The etiopathogenesis is not clear; however, it has a good response to proton pump inhibitors (PPIs). In our case, the patient presented all the characteristics of EDS, and given its low reported frequency, a review of the literature and discussion of this rare entity was performed.

"Jingle All the Way!": Sharp Foreign Bodies Embedded Within the Esophageal Mucosa During the Holiday Season.

Sharp pointed objects in the esophagus are extremely hazardous and can lead to complications such as mucosal ulcerations, perforations, obstruction, abscess, and fistula formation. Patients exhibit symptomatology based on the location within the proximal or distal esophagus. Ingestion of a sharp foreign object warrants emergent endoscopic removal, particularly when lodged in the esophagus. We present two young children, a 30-month-old male and a 10-month-old male, who underwent emergent endoscopic evaluation following the ingestion of a jingle bell and a Christmas ornament hanger, respectively. Types of ingested sharp foreign bodies may vary during the holiday season and present unique diagnostic and therapeutic challenges for pediatric physicians. Additionally, foreign body ingestions are not limited to children including teenagers and should also be considered in infants. Here, we report two young patients who ingested unique holiday ornaments and describe the management of these impacted esophageal foreign bodies.

Multiple esophageal hematomas with oozing observed and successfully treated after transcatheter mitral valve edge-to-edge repair procedure.

Although previously reported as relatively rare, esophageal hematoma can likely develop in patients on anticoagulants or those with underlying hemorrhagic disorders. From April 2018 to December 2018, among 36 patients who received transcatheter mitral valve edge-to-edge repair (TMVr) at our hospital, seven (19.4%), who were suspected of having digestive tract hemorrhage evidenced by blood stains on a probe extracted after transesophageal echocardiography, underwent esophagogastroduodenoscopy. Esophageal hematomas were noted in all patients, and endoscopic hemostasis was performed in two cases. Depending on their form, hematomas were noted on the submucosa and the epithelium of the shallow esophageal layer. Esophageal hematomas caused by transesophageal echocardiography for TMVr are not rare, and clinicians should be aware of it.

Avaliação da expressão da filagrina em biópsias esofágicas de pacientes com esofagite eosinofílica / Evaluation of philagrin expression in esophageal biopsies of patients with eosinophilic esophagitis

Introdução: Mutações do gene da filagrina vêm sendo associadas, classicamente, a alterações da barreira epitelial em doenças alérgicas com comprometimento da pele e das superfícies mucosas. Particularmente na dermatite atópica, a relação entre filagrina, mecanismo fisiopatológico e evolução clínica tem sido demonstrada. Recentemente, alterações da barreira epitelial com redução da expressão da filagrina, também têm sido associadas a mecanismos imunológicos envolvidos na patogênese da esofagite eosinofílica. Devido a disfunções na barreira epitelial, microrganismos e alérgenos são capazes de penetrarem no epitélio da mucosa esofágica, assim como na dermatite atópica. Objetivo: Avaliar a possível correlação da expressão da filagrina com os achados histopatológicos em biópsias esofágicas de pacientes com esofagite eosinofílica. Métodos: A expressão da filagrina foi investigada in situ, por imuno-histoquímica, em biópsias esofágicas nos seguintes grupos: Grupo I, controle (n=8), amostras provenientes de pacientes saudáveis; Grupo II (n=27), amostras provenientes de pacientes com esofagite eosinofílica. Resultados: Os resultados demonstraram uma diminuição da expressão da filagrina na mucosa do esôfago de portadores de esofagite eosinofílica. Adicionalmente, a intensidade da marcação imuno-histoquímica foi menor na mucosa esofágica com maior infiltração de eosinófilos. Conclusão: A diminuição da expressão de filagrina pode ser um fenomeno fisiopatológico associado ao aumento da quantidade de eosinófilos na mucosa esofágica, podendo impactar na evolução clínica da esofagite eosinofílica.

Introduction:Filaggrin gene mutations have been classically associated with changes in the epithelial barrier in allergic diseases involving the skin and mucosal surfaces. Particularly in atopic dermatitis, the relationship between filaggrin, pathophysiological mechanism and clinical evolution hás been demonstrated. Recently, changes in the epithelial barrier with reduced expression of filaggrin have also been associated with immunological mechanisms involved in the pathogenesis of eosinophilic esophagitis. Due to dysfunction in the epithelial barrier, microorganisms and allergens are able to penetrate the epithelium of the esophageal mucosa, as well as in atopic dermatitis. Objective: To evaluated the possible correlation of filaggrin expression with histopathological findings in esophageal biopsies of patients with eosinophilic esophagitis. Methods: Filaggrin expression was investigated in situ by immunohistochemistry in esophageal biopsies in the following groups: Group I, control (n = 8), samples from healthy patients; Group II (n = 27), samples from patients with eosinophilic esophagitis. Results: The results demonstrated a decrease in the expression of filaggrin in the esophageal mucosa of patients with eosinophilic esophagitis. Additionally, the intensity of the immunohistochemical labeling was lower in the esophageal mucosa with greater infiltration of eosinophils. Conclusion: The reduction of filaggrin expression may be a pathophysiological phenomenon associated with an increase in the quantity of eosinophils in the esophageal mucosa, which may impact on the clinical evolution of eosinophilic esophagitis.

Risk of preneoplastic lesions in mucosal projections of different sizes of the columnar epithelium in the lower esophagus / Risco de lesões pré-neoplásicas em projeções de mucosa de diferentes tamanhos do epitélio colunar no esôfago inferior

ABSTRACT BACKGROUND: Barrett's esophagus is an acquired condition that predisposes to the development of esophageal adenocarcinoma. AIMS: The aim of this study was to establish an association between the endoscopic and the histopathological findings regarding differently sized endoscopic columnar epithelial mucosa projections in the low esophagus, under 3.0 cm in the longitudinal extent. METHODS: This is a prospective study, including 1262 patients who were submitted to upper gastrointestinal endoscopy in the period from July 2015 to June 2017. The suspicious projections were measured and subdivided into three groups according to the sizes encountered (Group I: <0.99 cm; Group II: 1.0-1.99 cm; and Group III: 2.0-2.99 cm), and biopsies were then performed. RESULTS: There was a general prevalence of suspicious lesions of 6.42% and of confirmed Barrett's lesions of 1.17%, without a general significant statistical difference among groups. However, from Groups I and II to Group III, the differences were significant, showing that the greater the lesion, the higher the probability of Barrett's esophagus diagnosis. The absolute number of Barrett's lesions was 7, 9, and 6 for Groups I, II, and III, respectively. CONCLUSIONS: The findings led to the conclusion that even projections under 3.0 cm present a similar possibility of evolution to Barrett's esophagus. If, on the one hand, short segments are more prevalent, on the other hand, the long segments have the higher probability of Barrett's esophagus diagnosis, which is why biopsies are required in all suspicious segments.

RESUMO RACIONAL: O esôfago de Barrett é uma condição adquirida que predispõe ao desenvolvimento de adenocarcinoma de esôfago. OBJETIVOS: Estabelecer uma associação entre os achados endoscópicos e histopatológicos em relação às projeções endoscópicas da mucosa epitelial colunar de diferentes tamanhos no esôfago, abaixo de 3,0 centímetros de extensão longitudinal. MÉTODOS: Foi realizado um estudo prospective incluindo 1262 pacientes submetidos à endoscopia digestiva alta, no período de julho de 2015 a junho de 2017. As projeções suspeitas foram medidas, subdivididas em 3 grupos de acordo com os tamanhos encontrados (Grupo I: <0,99 cm; Grupo II: 1,0 cm-1,99 cm; Grupo III: 2,0 cm-2,99 cm) e biópsias foram então realizadas. RESULTADOS: Houve prevalência geral de lesões suspeitas de 6,42% e de lesões de Barrett confirmadas de 1,17%, sem diferença estatística geral significativa entre os grupos. Porém, dos Grupos I e II, para o Grupo III, as diferenças foram significativas, mostrando que quanto maior a lesão, maior a probabilidade de diagnóstico de esôfago de Barrett. O número absoluto de lesões de Barrett foi 7, 9 e 6 para os grupos I, II e III, respectivamente. CONCLUSÕES: Os achados permitiram concluir que mesmo projeções abaixo de 3,0 cm apresentam possibilidade semelhante de evolução para o esôfago de Barrett. Se, por um lado os segmentos curtos são mais prevalentes, por outro os segmentos longos têm maior probabilidade de diagnóstico de esôfago de Barrett, razão pela qual são necessárias biópsias em todos os segmentos suspeitos.

Combination of Endoscopic Resection and Radiofrequency Ablation for the Treatment of Esophageal Squamous Cell Neoplasia With Multiple Lugol-Voiding Lesions.

BACKGROUND: Local recurrence of esophageal squamous cell neoplasia (ESCN) and metachronous ESCN was associated with severe background esophageal multiple Lugol-voiding lesions (LVLs) even though the primary early ESCNs were treated with endoscopic resection (ER). The aim of this study is to explore the feasibility and effectiveness of combination treatments of ER and radiofrequency ablation (RFA) in patients with early ESCNs with synchronous multiple LVLs. METHODS: A total of 329 patients with early ESCNs and synchronous multiple LVLs received ER combined with RFA from September 2010 to September 2020. Clinical and pathological features and treatment outcomes were retrospectively reviewed using medical records. Factors associated with background esophageal multiple LVLs before combined treatment were analyzed. RESULTS: The proportion of complete response (CR) was 96.7% after primary RFA, while 90.3% patients achieved CR for the last endoscopic examinations regardless if inside or outside the treatment area (TA). Degeneration of background esophageal multiple LVLs occurred in 70.2% of patients. The grade of background esophageal multiple LVLs before combined treatment was closely related to gender, smoking, and drinking. The incidence of metachronous ESCNs outside the TA of ER and local recurrence in the TA of ER was 3.9% and 1.2%, respectively. CONCLUSIONS: Prophylactic RFA treatment of multiple LVLs together with ER treatment of the primary ESCNs may be effective in reducing the incidence of metachronous ESCNs and local recurrence through improving the background esophageal mucosa.

Conventional and simple methods of measuring esophageal nocturnal baseline impedance show excellent agreement.

OBJECTIVES: Mean nocturnal baseline impedance (MNBI) shows promise in investigating reflux disease by reflecting esophageal mucosal integrity. This study aimed to measure MNBI by both conventional and simple methods in patients with laryngopharyngeal reflux (LPR) and gastroesophageal reflux disease (GERD) in order to evaluate the efficacy of the simple measurement method. METHODS: Altogether 187 patients were divided into LPR (n = 105) or GERD (n = 82) groups according to their predominant symptom profile, and underwent off-therapy impedance-pH monitoring. MNBI was measured by both the conventional and simple methods. The Bland-Altman plots were constructed to assess mean differences and to identify bias in the two measurement methods. RESULTS: For the two measurement methods, mean difference was (-89 ± 328) Ω in the distal esophagus, (-6 ± 653) Ω in the proximal esophagus, and (128 ± 577) Ω in the pharynx, respectively. There was a strong correlation between conventional and simple MNBI values, with  the coefficient of 0.940 in the distal esophagus, 0.463 in the proximal esophagus, and 0.712 in the pharynx (all P < 0.001). CONCLUSIONS: There was an excellent agreement between the conventional and simple methods of MNBI measurement, with no evidence of proportional bias. Conventional and simple MNBI values correlated excellently in the distal esophagus and moderately well in the proximal esophagus and pharynx. This study supports the use of the simple method of measuring MNBI to enhance diagnoses of reflux disease.

Autologous esophageal mucosa with polyglycolic acid transplantation and temporary stent implantation can prevent stenosis after circumferential endoscopic submucosal dissection.

BACKGROUND: This research aimed at investigating the safety and efficacy of autologous esophageal mucosa (AEM) with polyglycolic acid (PGA) transplantation and temporary stent implantation (TSI) in preventing esophageal stenosis (ES) after early esophageal cancer (EC) surgery. METHODS: Between April 2019 and October 2020, patients scheduled for circumferential endoscopic submucosal dissection (ESD) were prospectively recruited. After ESD, autologous esophageal mucosal patches (MPs) were constructed on the absorbable PGA felt. Then, the felt was structured onto a covered metal mesh stent (CMMS) and attached to the ulcer surface. The stents were removed 6-8 weeks after the operation. The occurrence of ES and adverse events was observed and analyzed. RESULTS: Data from 25 patients were analyzed. In total, 14 patients (56%) had no stenosis during an average follow-up of 10.2 months, and 11 patients (44%) suffered strictures at a mean interval of 63.73 days after the ESD procedure. Stent migration occurred in 2 patients. No other complications, including perforations, bleeding, or wound infections, occurred. The median of endoscopic balloon dilatation (EBD) sessions was 2.16 (range, 0-14). There showed a higher post-ESD stricture rate in patients with lesions located in the middle-lower esophagus (P<0.05). More transplanted MPs may reduce the occurrence of ES. CONCLUSIONS: AEM with PGA transplantation and TSI is a safe and effective approach of preventing ES and improving the life quality after circumferential ESD.

Dermatomyositis with exfoliation of esophageal mucosa: A case report. / 皮肌炎合并食管黏膜剥脱1例.

Dermatomyositis (DM) is a kind of idiopathic inflammatory myopathy characterized by chronic proximal skeletal muscle weakness and unique skin lesions. However, DM with exfoliation of esophageal mucosa is rare. A 36-year-old male patient complained of muscular soreness of extremities, dysphagia, and pharyngalgia was diagnosed with DM with exfoliation of esophageal mucosa. After treatment with glucocorticoid, immunosuppressant, acupuncture, and endoscopic submucosal dissection (ESD), the above symptoms were disappeared. During the 3-year follow-up period, the results of routine physical examination, laboratory examination, gastroscopy, and imaging examination were normal. High-dose of corticosteroid is needed in the initial treatment, but it must be reduced regularly to avoid adverse reactions. Acupuncture and ESD are also effective as adjuvant therapy.

Rare spontaneous extensive annular intramural esophageal dissection with endoscopic treatment: A case report.

BACKGROUND: Intramural esophageal dissection (IED) is a rare disease that should be considered in patients with chest pain, dysphagia, and hematemesis. Although it occurs most frequently in older adult women with impaired coagulation or as a sequela of endoscopy, the incidence of spontaneous IED without an obvious causative agent has risen gradually. CASE SUMMARY: This report describes a case of extensive annular IED in a 75-year-old male patient who presented with dysphagia for the past month. Esophageal barium meal radiography revealed slow passage of diluted iohexol through the esophagus after swallowing, prominent luminal dilation, obstruction of the lower segment with only a small amount of contrast medium entering the gastric cavity, and no obvious extravasation. Gastroscopy revealed smooth esophageal mucosa; several esophageal mucosal bridges and webbed mucosa were observed approximately 22 cm from the incisor. The mucosal surface was occasionally rough and uneven, and the length of the esophageal mucosal defect exceeded 10 cm. The anatomy was considered to be annular because the mucosal bridge connecting the proximal and distal tube was not attached to the surrounding myotubes. The final diagnosis was spontaneous extensive annular IED. We treated the patient successfully using endoscopic esophagotomy, which completely relieved the symptoms without complications. CONCLUSION: Spontaneous annular IED can be treated successfully by endoscopic resection of the mucosal septum between the true and false lumen.

Dermatomyositis with exfoliation of esophageal mucosa: A case report / 中南大学学报(医学版)

Dermatomyositis (DM) is a kind of idiopathic inflammatory myopathy characterized by chronic proximal skeletal muscle weakness and unique skin lesions. However, DM with exfoliation of esophageal mucosa is rare. A 36-year-old male patient complained of muscular soreness of extremities, dysphagia, and pharyngalgia was diagnosed with DM with exfoliation of esophageal mucosa. After treatment with glucocorticoid, immunosuppressant, acupuncture, and endoscopic submucosal dissection (ESD), the above symptoms were disappeared. During the 3-year follow-up period, the results of routine physical examination, laboratory examination, gastroscopy, and imaging examination were normal. High-dose of corticosteroid is needed in the initial treatment, but it must be reduced regularly to avoid adverse reactions. Acupuncture and ESD are also effective as adjuvant therapy.

Assessing the Degree of Acute Esophageal Injury Secondary to Corrosive Intake: Insights From a Public Sector Hospitals of a Developing Country.

Background Caustic ingestion continues to be a significant problem worldwide especially in developing countries and particularly in the age group of under six years. Ingestion of caustic substances is a medical emergency in both the adult and pediatric population and is associated with high morbidity and mortality. The ingestion of caustic substances induces an extensive spectrum of injuries to the aerodigestive tract, which includes extensive necrosis and perforation of the esophagus and stomach. Objectives The main aims were to determine upper and lower esophageal injuries associated with corrosive intake and to compare esophageal injury with age and gender. Rationale Once we'll find the extent and severity of esophageal injury associated with corrosive intake within 24 hours, we'll be able to manage the case timely and to limit further complications and disabilities. Materials and Methods This descriptive cross-sectional study was conducted on 150 patients who presented with corrosive ingestion and underwent urgent endoscopic evaluation. Data were collected using self-designed pro forma. Endoscopic findings were classified according to the Zargar classification. A descriptive analysis of study variables was performed using SPSS v.21.0 (IBM Corp., Armonk, NY, USA). The chi-square test was used, and a p-value of less than 0.05 was considered statistically significant. Results Out of 150 patients under study, 103 (68.7%) were females and 47 (31.3%) were males. The most prevalent age group presenting with corrosive intake was found to be between 21 and 34 years of age (43.3%) in both genders. The most common part of the esophagus prone to corrosive insult is the upper esophagus (99.3%), whereas, regarding severity, the lower esophagus has more severe injuries (predominant being stage 2B, i.e., 32%). There are no statistically significant differences in esophageal injuries in different age groups (upper esophageal injury: 0.319; lower esophageal injury: 0.696) and genders (upper esophageal injury: 0.769; lower esophageal injury: 0.752).  Conclusions Most of the patients under study belong to the female gender and teen and younger age group. The predominant upper esophageal injury as a result of corrosive intake is stage 0 injury, and the least common is found to be stage 1 injury. The predominant lower esophageal injury as a result of corrosive intake is stage 2B injury, whereas the least common is found to be stage 4 injury.

Esophageal Baseline Impedance From High-resolution Impedance Manometry Correlates With Mean Nocturnal Baseline Impedance From pH-impedance Monitoring.

Background/Aims: Esophageal baseline impedance (BI) can be extracted from pH-impedance tracings as mean nocturnal baseline impedance (MNBI), and from high-resolution impedance manometry (HRIM), but it is unknown if values are similar between acquisition methods across HRIM manufacturers. We aim to assess correlations between MNBI and BI from HRIM (BI-HRIM) from 2 HRIM manufacturers in the setting of physiologic acid exposure time (AET). Methods: HRIM and pH-impedance monitoring demonstrating physiologic AET (< 4%) off proton pump inhibitors were required. BI-HRIM was extracted as the average from 5 cm and 10 cm above the lower esophageal sphincter. Distal BI-HRIM (DBI-HRIM) was also extracted from the most distal channel (Medtronic studies). MNBI was extracted from 6 channels. Concordance between BI-HRIM across manufacturers with MNBI was analyzed. Results: Thirty-six patients met the inclusion criteria (59.6 ± 1.7 years; 22% female; body mass index 30.5 ± 0.7; AET 1.6 ± 0.2%). Although MNBI was similar at all channels (P ≥ 0.18), Diversatek BI-HRIM was lower than Medtronic BI-HRIM (P = 0.003). Overall, BI-HRIM correlated with MNBI at corresponding recording sites, 7 cm and 9 cm (P < 0.05), but not at other sites (P ≥ 0.19). Pearson's correlations > 0.5 were seen at MNBI at 7 cm for both systems, and at 9 cm for Medtronic. DBI-HRIM correlated with MNBI at 3 cm and 5 cm (P < 0.03), but not at other locations (P > 0.1). Conclusions: While numeric differences exist between manufacturers, BI-HRIM correlates with MNBI from corresponding channels in patients with physiologic AET. Comparison with AET elevation is needed to determine correlations between pathologic MNBI with BI-HRIM across manufacturers. The optimal HRIM channels from which BI values should be extracted also warrants further study.

Measurement of Esophageal Nocturnal Baseline Impedance: A Simplified Method.

BACKGROUND/AIMS: Mean nocturnal baseline impedance (MNBI) during multichannel intraluminal impedance pH-monitoring (MII-pH) reflects the status of esophageal mucosal integrity. MNBI is suggested as an adjunctive method to distinguish patients with true gastroesophageal reflux disease (GERD) from functional heartburn (FH) and might predict outcomes for anti-reflux treatment. However, current methodology for calculation of MNBI is time-consuming and subject to operator-dependent selection bias. We aim to simplify and provide a more objective method to calculate MNBI. METHODS: We retrospectively analyzed 100 MII-pH tracings from 20 patients with erosive reflux disease, 20 with non-erosive reflux disease (NERD), 20 with reflux hypersensitivity, 20 with functional heartburn (FH), and 20 healthy asymptomatic volunteers. We compared the current "conventional" MNBI analysis with our "simple" MNBI analysis measured by selecting the whole supine period using the impedance average calculation function in the MII-pH software. RESULTS: Absolute values were very similar and there was a strong correlation between conventional and simple MNBI values in the most distal channel in all groups (r ≥ 0.8, P < 0.001) including patients with increased supine acid reflux. Distal esophageal simple MNBI negatively correlated with acid exposure time (r = -0.695, P < 0.001). Patients with erosive reflux disease and NERD had lower simple MNBI values in the most distal channel compared to other groups (P < 0.001). With a cutoff value of 1785 ohms, simple MNBI can discriminate patients with GERD from those with reflux hypersensitivity and FH (sensitivity 80.0% and specificity 89.7%). CONCLUSION: Simple MNBI analysis provides very similar values and has an excellent correlation with conventional MNBI analysis.