Esophageal Disease Research Articles

In vitro and in vivo evaluation of a novel wired transmission magnetically controlled capsule endoscopy system for upper gastrointestinal examination.

Magnetically controlled capsule endoscopy (MCCE) has recently increasingly been used for gastric examination. However, the image quality and esophageal observation is suboptimal. We developed a novel wired transmission magnetically controlled capsule endoscopy (WT-MCCE) system and evaluated its feasibility through in vitro and in vivo experiments. A plastic stomach model and a pathological upper gastrointestinal model were used to evaluate the performance of WT-MCCE in vitro experiments. Twice of examination in the two in vitro models by WT-MCCE were performed by 5 endoscopists who were experienced in performing wireless capsule endoscopy. The examination of traditional gastroscopy (Olympus, GIF-HQ290) in the pathological upper gastrointestinal model was set as the control. In vivo experiments were performed in a live canine model by 3 endoscopists, in which WT-MCCE was inserted with the assistance of gastroscopy. Measurements included maneuverability, examination time, visualization of gastric mucosa, image quality and diagnostic accuracy. WT-MCCE showed good performance in both in vitro and in vivo experiments with excellent visualization of mucosa (75-100%). The mean operation time is 17.6 ± 2.7min, 22.3 ± 1.9min and 29.3 ± 3.4min in three models, respectively. In pathological upper gastrointestinal model, all lesions, including esophageal varices, one polyp, one foreign body, two gastric ulcers and one duodenal ulcer, were detected by both WT-MCCE and traditional gastroscopy by all endoscopists. For the observation of esophagus and stomach in the canine model, WT-MCCE also showed excellent maneuverability and good image quality. The novel WT-MCCE system performed well in evaluating upper gastrointestinal landmarks and lesions in two in vitro models, and showed good performance in a canine model. WT-MCCE may be potentially useful for diagnosis of esophageal and gastric diseases.

Same-Day Home Recovery After Surgery for Benign Esophageal Diseases—Is It Really Good for Patients?

Same-Day Home Recovery After Surgery for Benign Esophageal Diseases—Is It Really Good for Patients?

Noncardiac Esophageal Chest Pain -A Comprehensive Review

Abstract Background and aim. Noncardiac chest pain (NCCP) is a medical condition described as acute, recurrent, or chronic chest pain, that is difficult to distinguish from ischemic heart pain, when the cardiac source has been excluded. Noncardiac chest pain represents a challenging clinical situation in gastroenterology practice, requiring sometimes a high amount of clinical investigation for a specific diagnostic. In some cases, the etiology is represented by esophageal diseases. This review aims to present the updated knowledge of the esophageal origin of NCCP. Methods. A search was performed in the main databases containing medical publications. The following search terms were used: noncardiac chest pain, esophageal chest pain (ECP), pathophysiology, noncardiac chest pain etiology, gastroesophageal reflux disease (GERD), motility esophagus disorders, functional chest pain. Observational studies were included. Studies that described only cardiac chest pain were excluded. Results. Noncardiac chest pain requires precise recognition of signs, symptoms and diagnostic testing in clinical practice. Due to financial constraints on subsequent care, an accurate algorithm based on clinical noncardiac chest pain guidelines should be followed. Esophageal chest pain represents a challenging diagnosis. Conclusions. Noncardiac chest pain is a prevalent and alarming symptom. Esophageal chest pain etiology should be considered once a cardiac source has been excluded.

Eosinophilic oesophagitis in Denmark: Population‐based incidence and prevalence in a nationwide study from 2008 to 2018

BackgroundEosinophilic oesophagitis (EoE) is a chronic immune‐mediated or antigen‐mediated oesophageal disease characterised by symptoms related to oesophageal dysfunction and eosinophil‐predominant inflammation.ObjectiveWe aimed to estimate the incidence and prevalence of EoE in Denmark during the period 2008–2018.MethodsBased on data from nationwide registers we identified cases of EoE using two definitions: a broad definition based solely on oesophageal biopsies registered in the Danish Pathology Register and a narrow definition also including symptoms of oesophageal dysfunction registered in the Danish National Patient Registry. The annual incidence and prevalence were standardised by sex and age in 5‐year intervals to the 2013 study population.ResultsFrom 2008 to 2011, the standardised incidence of EoE was stable, but from 2011 to 2018 it increased from 3.9 (95% CI 3.3–4.4) to 11.7 (95% CI 10.8–12.6) per 100,000 person‐years. Similar temporal trends were observed when using the narrow EoE definition. The increase in incidence was most pronounced in men and in individuals above 40 years of age. In children, the EoE incidence was a fourth of the incidence in adults aged 40–64 years: 4.4 (95% CI 3.2–5.6) versus 17.6 (95% CI 15.7–19.5) per 100,000 person‐years. The EoE incidence varied substantially across the five regions in Denmark. Overall, the biopsy rate as well as the proportion of oesophageal biopsies with detected eosinophilia increased during the study period.ConclusionThis study of the entire population of Denmark during the period 2008 to 2018 shows that the incidence and prevalence of EoE is not yet plateauing and that EoE could be severely underdiagnosed, especially in children.

Development of Bio-artificial Esophageal Tissue Engineering Utilization for Circumferential Lesion Transplantation: A Narrative Review.

The esophagus is the gastrointestinal tract’s primary organ that transfers bolus into the stomach with peristaltic motion. Therefore, its lesions cause a significant disturbance in the nutrition and digestive system. Esophageal disease treatment sometimes requires surgical procedures that involve removal and circumferential full-thickness replacement. Unlike other organs, the esophagus has a limited regeneration ability and cannot be transplanted from donors. There are various methods of restoring the esophageal continuity; however, they are associated with certain flaws that lead to a non-functional recovery. As an exponentially growing science, tissue engineering has become a leading technique for the development of tissue replacement to repair damaged esophageal segments. Scaffold plays a significant role in the process of tissue engineering, as it acts as a template for the regeneration of growing tissue. A variety of scaffolds have been studied to replace the esophagus. Due to the many tissue quality challenges, the results are still inadequate and need to be improved. The success of esophageal tissue regeneration will finally depend on the scaffold’s capability to mimic natural tissue properties and provide a qualified environment for regeneration. Thereby, scaffold fabrication techniques are fundamental. This article reviews the recent developments in esophageal tissue engineering for the treatment of circumferential lesions based on scaffold biomaterial engineering approaches.

Eosinophilic Esophagitis due to Aeroallergens: A Systematic Review and Update.

Eosinophilic esophagitis is a chronic antigen-mediated esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by TH2 inflammation (at least 15 eosinophils/high power field) when other secondary systemic and local causes of esophageal eosinophilia are excluded. Although this disease was initially ascribed to a delayed reaction to food allergens, emerging evidence suggests that aeroallergens may also play a role in pathogenesis and disease course. Some studies support seasonal variations in the diagnosis of eosinophilic esophagitis and disease exacerbations owing to the increase in aeroallergens to which patients are sensitized. It is also known that this disease can be caused by extensive, identifiable exposure to aeroallergens and after treatment with specific immunotherapy based on food or aeroallergens. It was recently postulated that treatment of allergic rhinoconjunctivitis can improve the symptoms of eosinophilic esophagitis, although data are limited to case reports and small series. Currently, biomarkers and biologic therapies are not helpful for diagnosis or inducing clinical and histological remission of the disease. Nevertheless, there are high hopes for dupilumab. This review aims to give visibility to the involvement of aeroallergens in the triggering and exacerbation of eosinophilic esophagitis, since many of them, in addition to being airborne and inhalant, can also be ingested as food. Clearly, we must try to identify the cause of the disease to ensure remission.

Upper Gastrointestinal Fluoroscopic Examination: A Traditional Art Enduring into the 21st Century.

Upper Gastrointestinal Fluoroscopic Examination: A Traditional Art Enduring into the 21st Century.

The Utility of the Marshmallow Barium Swallow Esophagogram for Investigation of Ineffective Esophageal Motility: A Systematic and Narrative Review

Abstract Objectives Current gold standard investigations to determine the pathology of ineffective esophageal motility (IEM) are invasive and resource-intensive. Marshmallow barium swallow esophagogram (MBSE) is emerging as a more feasible modality; however, our understanding of its role in the clinical setting is limited. Our aim was to appraise the current literature and describe the effectiveness and limitations of MBSE as a potential diagnostic tool when investigating the pathological cause of IEM. Methods A search in PubMed was conducted on May 23, 2021. Search terms included “marshmallow” AND “barium.” We included all studies which examined MBSE in the context of esophageal disease. The primary outcome of interest was to characterize the use of MBSE in current literature. Results A total of 12 studies were retrieved after initial search with 9 studies meeting final inclusion criteria. A total of 375 patients were included, with 296 patients (79%) having a relevant diagnosis or symptom prompting investigation with MBSE. The most common diagnoses included referral to a gastroenterology clinic for a barium swallow (44%), post-Angelchik insertion (23%), and dysphagia (13%). Esophageal disease was identified in both the MBSE and other screening tests in 63% participants, whereas in 27% participants abnormalities were only seen using the MBSE. Conclusion There is currently limited high-quality evidence on the use of MBSE to diagnose IEM. Further large-scale studies comparing its use in patients with different pathologic causes of IEM and of older age are required to further delineate the optimal delivery of this emerging diagnostic modality.

Epidemiological review on Gastric cancer

The mortality rate of the patients with gastric cancer is reduced dramatically from past few years. Still the gastric cancer the major concern that is in front of health care professionals and is the second leading cause of cancer death across the world. But the trend of infection and the severity of infection differ as per location and histology. While there has been a marked decline in distal, intestinal type gastric cancers, the incidence of proximal, diffuse gastric carcinoma has been increasing, particularly in the Western countries. The severities of gastric cancer infection also differ by change in geographical location, social and economic status of the respective race as well. The main risk factors for distal gastric cancer include Helicobacter pylori infection and dietary factors; whereas gastro esophageal reflux disease and obesity play important roles in the development of proximal stomach cancer. The main aim of this review is to determine the epidemiology of gastric cancer and to discuss about available strategies for its prevention.

SP6.1.3 A Decision-Analysis Study of Endoscopic, Surgical and Pharmacological Treatment Options for Chronic Gastro Oesophageal Reflux Disease

Abstract Aims To compare emerging endo-luminal interventions for the treatment of chronic gastro-esophageal reflux disease (GORD) to pharmacological and surgical interventions. Methods An advanced decision-tree model was constructed and populated with data from 19 randomised controlled trials to compare competing treatment pathways that included: Laparoscopic Fundoplication, Stretta, Transoesophageal Incisionless Fundoplication (TIF) and medical management with proton pump inhibitor (PPI). Model transition probabilities were calculated using weighted pooled estimates of proportions calculated using Freeman-Tukey arcsine square root transformation under random effects model to account for heterogeneity. Model uncertainties for all included components were tested with one-way deterministic sensitivity analysis. Monte Carlo Probabilistic Sensitivity Analysis (PSA) was set to 10000 iterations with model probabilities sampled from the entirety of the data distribution of each variable. Results Base-case analysis at 12months follow-up showed that Laparoscopic Fundoplication had the highest probability of treatment success followed by TIF, Stretta and PPI respectively. Conclusion Endo-luminal interventions, although not shown to be superior to surgery, may have an emerging role in the management of GORD, but data on long-term follow-up and cost-effectiveness is lacking.

Esophageal disease and loss to follow-up are common among patients who experience non-endoscopic resolution of food impaction.

Many patients who experience esophageal food impaction (EFI) will have non-endoscopic resolution (NER) of their EFI, but this population is poorly defined. The purpose of this study is to describe the outcomes of patients with NER of EFI. A retrospective chart review from 2007 to 2017 was performed at a single tertiary care center. There were 593 patients who presented to the emergency department with EFI, defined as recent soft food ingestion and inability to tolerate oral secretions. Adequate follow-up was defined as a gastroenterology clinic visit or EGD within 6months of EFI. Out of these, 149 patients (25.1%) had NER of their EFI. Patients with NER were less likely to have adequate follow-up than those with ER (45.0% vs. 59.5%, P = 0.003). Of those without established esophageal disease and NER, 92.5% had significant esophageal pathology on endoscopy, including stricture (34.0%), features of eosinophilic esophagitis (30.2%), and esophagitis (22.6%). Recurrent EFI occurred at a similar rate between patients with NER and ER (9.4% vs. 14.6%, P = 0.14). Patients with established esophageal disease (odds ratio [OR]: 1.51, P = 0.04) and recommendation to follow-up at time of EFI (OR: 6.06, P < 0.001) were most likely to follow up after EFI. Approximately, a quarter of patients with EFI will experience NER of their EFI. Virtually, all patients (92.5%) were found to have esophageal disease warranting longitudinal care. Importantly, follow-up rates are significantly lower in those with NER than their counterparts requiring EGD. Our study highlights the need to develop standardized protocols that improve follow-up for patients after NER of EFI.

Formulation and Characterization of Sustained Release Matrix Tablet of Pantoprazole

Pantoprazole is a proton pump inhibitor prodrug used in the treatment of gastric, duodenal ulcers and gastro esophageal reflux disease (GERD), Zollinger- Ellison syndrome. This is the most popular drug used in cure and maintenance therapy of peptic ulcer along with antibiotics. It suppresses the acid production by inhibiting the H+ K+ ATPase. Pantoprazole must be absorbed in the gastrointestinal tract and because it is unstable under acidic conditions, enteric delivery systems are required. The purpose of this study was to prepare matrix tablet using eudragit Rs 100, eudragit S100, and HPMC. On the basis of above result the formulation showed satisfactory result as it has the maximum release i.e. F5 66.50%in 10 hrs. Result of our study suggest that the matrix tablet containing pantoprazole may be suitable for the anti ulcer drug.

Dysphagia: Clinical Evaluation, Assessment and Management

Dysphagia is a common problem affecting all ages. It’s divided into oropharyngeal dysphagia and esophageal dysphagia. Oropharyngeal dysphagia manifests as difficulty initiating swallowing, coughing, choking, or aspiration, and it is most commonly caused by chronic neurologic conditions such as stroke, Parkinson disease, or dementia, and Obstructive (oropharyngeal) symptoms that seem to originate in the throat or neck may actually be caused by distal esophageal lesions. Patients with esophageal dysphagia may report a sensation of food getting stuck after swallowing. This condition is most caused by gastro esophageal reflux disease and functional esophageal disorders. Eosinophilic esophagitis is triggered by food allergens and is increasingly prevalent. Careful history taking remains the first and most important step in evaluating dysphagia, and it is especially important to distinguish an oropharyngeal versus esophageal origin, which helps to guide further investigation and therapy. The three main investigations for dysphagia remain endoscopy, barium study and manometry, with endoscopy also offering therapeutic potential. Management is largely determined according th the eventual diagnosis, often in a multi-disciplinary setting.

First Therapeutic Approval for Eosinophilic Esophagitis.

Eosinophilic esophagitis (EE) is a chronic, immune-mediated or antigen-mediated esophageal disease. Treatment for patients with EE can be challenging with no previously approved medications. Current management strategies follow the four D’s paradigm of drugs, dietary elimination, dilation, and disease anxiety and hypervigilance therapy. On 20 May 2022, dupilumab was approved by FDA for EE. A dose of 300 mg dupilumab weekly significantly improved signs and symptoms of EE compared to placebo in a phase 3 trial. The approval of dupilumab will fulfill an unmet need for the increasing number of patients with EE.

Clinical Results of Peroral Endoscopic Myotomy in Patients with Achalasia, Esophageal Diverticular Disease, and Refractory Gastroparesis: A Single-Center Experience

Clinical Results of Peroral Endoscopic Myotomy in Patients with Achalasia, Esophageal Diverticular Disease, and Refractory Gastroparesis: A Single-Center Experience

The contribution of V.Kh. Vasilenko to the development of internal diseases propedeutics (to the 125th anniversary of his birth)

The article presents the contribution of V.Kh. Vasilenko to the development of internal diseases propedeutics, which consists in defining the concepts of “symptom” and “syndrome”, describing the IV tone of the heart, creating a classification of circulatory insufficiency and highlighting its forms and stages, clarifying the features of angina pectoris attacks, improving abdominal palpation, developing clinical aspects of esophageal diseases, peptic ulcer, cholelithiasis.

Eosinophilic esophagitis: Immune mechanisms and therapeutic targets.

Eosinophilic esophagitis (EoE) is an emerging chronic inflammatory disease of the oesophagus and is clinically characterized by upper gastrointestinal (GI) symptoms including dysphagia and esophageal food impaction. Histopathologic manifestations, which include intraepithelial eosinophilic inflammation and alterations of the esophageal squamous epithelium, such as basal zone hyperplasia (BZH) and dilated intercellular spaces (DIS), are thought to contribute to esophageal dysfunction and disease symptoms. Corroborative clinical and discovery science-based studies have established that EoE is characterized by an underlying allergic inflammatory response, in part, related to the IL-13/CCL26/eosinophil axis driving dysregulation of several key epithelial barrier and proliferative regulatory genes including kallikrein (KLK) serine proteases, calpain 14 (CAPN14) and anoctamin 1 (ANO1). The contribution of these inflammatory and proliferative processes to the clinical and histological manifestations of disease are not fully elucidated. Herein, we discuss the immune molecules and cells that are thought to underlie the clinical and pathologic manifestations of EoE and the emerging therapeutics targeting these processes for the treatment of EoE.

The Nissen-Hill Hybrid Repair: Experience With the First 500.

A new repair for gastroesophageal reflux and hiatal hernia, the Nissen-Hill hybrid repair, was developed to combine the relative strengths of its component repairs with the aim of improved durability. In several small series, it has been shown to be safe, effective, and durable for paraesophageal hernia, Barrett esophagus, and gastroesophageal reflux disease. This study represents our experience with the first 500 consecutive repairs for all indications. Retrospective study of prospectively collected data for the first 500 consecutive Nissen-Hill hybrid repairs from March 2006 to December 2016, including all indications for surgery. Three quality of life metrics, manometry, radiographic imaging, and pH testing were administered before and at defined intervals after repair. Five hundred patients were included, with a median follow-up of 6.1 years. Indications for surgery were gastroesophageal reflux disease in 231 (46.2%), paraesophageal hernia in 202 (40.4%), and reoperative repair in 67 (13.4%). The mean age was 59, with body mass index of 30 and 63% female. A minimally invasive approach was used in 492 (98%). Thirty-day operative mortality was 1 (0.2%), with a 4% major complication rate and a median length of stay of 2 days. Preoperative to postoperative pH testing was available for 390 patients at a median follow-up of 7.3 months, with the median DeMeester score improving from 45.9 to 2.7. At long-term follow-up (229 responses), all median quality of life scores improved: Quality Of Life in Reflux And Dyspepsia 4 to 6.9, Gastroesophageal Reflux Disease-Health Related Quality of Life 22 to 3, and Swallowing 37.5 to 45 and proton pump inhibitor use dropped from 460 (92%) to 50 (10%). Fourteen (2.8%) underwent reoperation for failure. The combined Nissen-Hill hybrid repair is safe and effective in achieving excellent symptomatic and objective outcomes and low recurrence rates beyond 5 years.

Identification of plasma proteins associated with oesophageal cancer chemotherapeutic treatment outcomes using SWATH-MS

Oesophageal adenocarcinoma (OAC) is an aggressive cancer with a five-year survival of <15%. Current chemotherapeutic strategies only benefit a minority (20‐30%) of patients and there are no methods available to differentiate between responders and non-responders. We performed quantitative proteomics using Sequential Window Acquisition of all THeoretical fragment-ion spectra-Mass Spectrometry (SWATH-MS) on albumin/IgG-depleted and non-depleted plasma samples from 23 patients with locally advanced OAC prior to treatment. Individuals were grouped based on tumour regression (TRG) score (TRG1/2/3 vs TRG4/5) after chemotherapy, and differentially abundant proteins were compared. Protein depletion of highly abundant proteins led to the identification of around twice as many proteins. SWATH-MS revealed significant quantitative differences in the abundance of several proteins between the two groups. These included complement c1q subunit proteins, C1QA, C1QB and C1QC, which were of higher abundance in the low TRG group. Of those that were found to be of higher abundance in the high TRG group, glutathione S-transferase pi (GSTP1) exhibited the lowest p-value and highest classification accuracy and Cohen's kappa value. Concentrations of these proteins were further examined using ELISA-based assays. This study provides quantitative information relating to differences in the plasma proteome that underpin response to chemotherapeutic treatment in oesophageal cancers. SignificanceOesophageal cancers, including oesophageal adenocarcinoma (OAC) and oesophageal gastric junction cancer (OGJ), are one of the leading causes of cancer mortality worldwide. Curative therapy consists of surgery, either alone or in combination with adjuvant or neoadjuvant chemotherapy or radiation, or combination chemoradiotherapy regimens. There are currently no clinico-pathological means of predicting which patients will benefit from chemotherapeutic treatments. There is therefore an urgent need to improve oesophageal cancer disease management and treatment strategies. This work compared proteomic differences in OAC patients who responded well to chemotherapy as compared to those who did not, using quantitative proteomics prior to treatment commencement. SWATH-MS analysis of plasma (with and without albumin/IgG-depletion) from OAC patients prior to chemotherapy was performed. This approach was adopted to determine whether depletion offered a significant improvement in peptide coverage. Resultant datasets demonstrated that depletion increased peptide coverage significantly. Additionally, there was good quantitative agreement between commonly observed peptides. Data analysis was performed by adopting both univariate as well as multivariate analysis strategies. Differentially abundant proteins were identified between treatment response groups based on tumour regression grade. Such proteins included complement C1q sub-components and GSTP1. This study provides a platform for further work, utilising larger sample sets across different treatment regimens for oesophageal cancer, that will aid the development of ‘treatment response prediction assays’ for stratification of OAC patients prior to chemotherapy.

Automated Chicago Classification for Esophageal Motility Disorder Diagnosis Using Machine Learning.

The goal of this paper is to provide a Machine Learning-based solution that can be utilized to automate the Chicago Classification algorithm, the state-of-the-art scheme for esophageal motility disease identification. First, the photos were preprocessed by locating the area of interest—the precise instant of swallowing. After resizing and rescaling the photos, they were utilized as input for the Deep Learning models. The InceptionV3 Deep Learning model was used to identify the precise class of the IRP. We used the DenseNet201 CNN architecture to classify the images into 5 different classes of swallowing disorders. Finally, we combined the results of the two trained ML models to automate the Chicago Classification algorithm. With this solution we obtained a top-1 accuracy and f1-score of 86% with no human intervention, automating the whole flow, from image preprocessing until Chicago classification and diagnosis.