Esophageal Ulcer Research Articles

Adverse events in cryoballoon ablation for pulmonary vein isolation: Insight from the Food and Drug Administration Manufacturer and User Facility Device Experience.

Real-world clinical data on the adverse events related to the use of cryoballoon catheter for pulmonary vein isolation remains limited. To report and describe the adverse events related to the use of Artic Front cryoballoon catheters (Arctic Front, Arctic Front Advance, and Arctic Front Advance Pro) reported in the Food and Drug Administration's (FDA) Manufacturers and User Defined Experience (MAUDE) database. We reviewed all the adverse events reported to the FDA MAUDE database over a 10.7-year study period from January 01, 2011 to September 31, 2021. All events were independently reviewed by two physicians. During the study period, a total of 320 procedural-related adverse events reported in the MAUDE database were identified. The most common adverse event was transient or persistent phrenic nerve palsy (PNP), accounting for 48% of all events. This was followed by cardiac perforation (15%), pulmonary vein stenosis (8%), transient ischemic attack or stroke (6%), vascular injury (4%), transient or persistent ST-elevation myocardial infarction (3%), hemoptysis (2%), pericarditis (2%), and esophageal ulcer or fistula (1%). There were six reported intra-procedural death events as a result of cardiac perforation. The two most common procedural adverse events associated with cryoballoon ablation were PNP and cardiac perforation. All cases of procedural mortality were due to cardiac perforation.

A case of ulcerative colitis complicated with esophageal ulcer

A case of ulcerative colitis complicated with esophageal ulcer

Combined treatment with surgery and immune checkpoint inhibitor extended survival in a case of gastric intramural metastasis from esophageal cancer: a case report

BackgroundIntramural metastasis (IM) of esophageal cancer is classified as distant metastasis according to the Japanese Classification of Esophageal Cancer, and it is well-known to be associated with a poor prognosis. We herein report a case of perforated gastric IM of esophageal cancer that was successfully controlled with nonradical surgery and subsequent immune checkpoint inhibitor (ICI) treatment.Case presentationA 72-year-old woman was referred to our department for the treatment of esophageal cancer and perforated gastric ulcer. A histological examination of the main tumor and gastric ulcer lesion revealed squamous cell carcinoma. Since the gastric wall tumor had invaded the celiac artery, complete resection was considered impossible. Chemotherapy was administered but led to severe adverse events, so palliative resection was performed. Two months after surgery, computed tomography revealed enlargement of the residual tumor around the celiac artery. However, after nivolumab monotherapy was started, the tumor diminished remarkably, and the quality of life of the patient dramatically improved. Nine months after nonradical surgery, she is surviving without any disease concern.ConclusionsWith the increased availability of ICIs, multidisciplinary treatment with surgery and ICIs can potentially lead to long-term survival, even in cases expected to have a poor prognosis.

Tacrolimus-Induced Esophageal and Colon Ulcers

ABSTRACT We report a case of a 44-year-old woman with a history of orthotopic heart transplant on tacrolimus (TC) for immunosuppression who developed large-volume hematochezia. She was found to have a large mid-esophageal ulcer and several large colon ulcers. Biopsies showed granulation tissue and inflammatory debris without an identifiable culprit. Extensive workup was performed, including for infectious causes, which was unrevealing. TC was ultimately considered to be a possible culprit, and after stopping it, all her symptoms improved. We suggest considering TC as the possible cause of gastrointestinal ulcers if no other culprit can be identified.

Nonhealing oesophageal ulcer: a case report.

This case report presents the case of a 50-year-old male with dysphagia and a burning sensation at the epigastrium. Endoscopy and histopathological examination showed ulceration at the esophagus and granulomatous inflammation, respectively. Computed tomography showed enlargement of the prevascular and paratracheal group of lymph nodes. However, the acid-fast bacilli stain at the ulcer site was negative. The diagnosis could be confirmed only after 2 months of the antitubercular treatment trial, which significantly potentiated ulcer healing. Esophageal tuberculosis may result from a secondary infection caused by systemic dissemination following a pulmonary disease or as a primary infection. In this case, it likely resulted from lymphatic dissemination via prevascular and paratracheal lymph nodes manifested mainly as dysphagia. Tuberculosis should be considered as one of the differential diagnoses in areas of limited resources. Clinicians may have to rely on clinical judgement and/or the patient's response to standard antitubercular treatment to make a definitive diagnosis.

Esophageal Stricture -Unusual Presentation of CMV

Esophageal stricture due to Cytomegalovirus (CMV) infection is an uncommon pathology, with most reported cases occurring in patients infected with human immunodeficiency virus. We report a case who presented with Odynophagia followed Dysphagia to solids gradually progressive from last 3 weeks with Total Dysphagia to solids and liquids on presentation. Endoscopic examination revealed a long esophageal stricture with a necrotic lesion but no typical CMV esophageal ulcers, with foreign body impaction in form of beans. Histology was positive for CMV. Dysphagia resolved after treatment with ganciclovir and serial esophageal dilations. We are presenting the first case of esophageal stricture due to CMV esophagitis in a young adult with chronic alcoholism and are reviewing current literature.

Oesophageal and Oral Ulcer Tuberculous Associated with Human T-cell Lymphotropic Virus Type 1 (HTLV-1) and SARS-COV-2 Infection

Oesophageal involvement due to tuberculosis (TB) and coinfection with HTLV-1 is rare and can be complicated by the presence of other infections that affect the mucosa of the upper respiratory tract, such as COVID-19. We present the case of a 27-year-old male patient, with 3 months of illness, weight loss, dysphagia, and ulcers in the oral cavity. Tomography showed oesophageal perforation and after oesophageal ulcer biopsy, TB was diagnosed, in addition to infection by HTLV-1 and severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). The patient responded satisfactorily to antituberculous treatment and corticosteroids. Considering the association between rare extrapulmonary tuberculosis and other immunosuppressive pathologies, it is crucial to identify these pathologies in such patients.

PO-02-074 A META-ANALYSIS TO EVALUATE THE EFFICACY OF ESOPHAGEAL COOLING IN PREVENTING ESOPHAGEAL INJURY DURING RADIOFREQUENCY ABLATION

Esophageal injury during radiofrequency (RF) ablation of atrial fibrillation (AF) is a known complication. It could range from mild esophagitis to esophageal ulcers. Atrio-esophageal fistula (AEF) is the most dreaded complication. It is rare but potentially life-threatening. Various measures to reduce esophageal injury including esophageal temperature monitoring, reducing ablation power on the posterior wall and esophageal deviation have been used. Esophageal cooling during RF ablation has been used as a strategy to reduce esophageal injury. We performed a meta-analysis evaluating the efficacy of esophageal cooling during RF ablation in reducing esophageal injury. We performed a systematic literature review in Embase, PubMed and SCOPUS for all the related articles until December 2022. The literature search yielded 28 publications, of which 6 studies fulfilled inclusion criteria. The Mantel- Haenszel random effects model was used to calculate odds ratio (OR) and 95% confidence intervals (CI). Outcomes analyzed were all esophageal lesions, mild to moderate and severe esophageal lesions as determined by post-procedure endoscopy. Esophageal cooling was performed in 469 patient and no esophageal cooling was used in 195 patients. Esophageal cooling significantly reduced severe esophageal injuries (OR = 0.37, 95% CI [0.18-0.79], P=0.01). There was no significant difference between the treatment groups in total number of esophageal lesion (OR = 0.60, 95% CI [0.22-1.64], P=0.32) and mild to moderate lesions (OR = 1.48, 95% CI [0.48-4.51], P=0.49). Esophageal cooling during RF ablation in the left atrium reduces the incidence of severe esophageal lesions.

A novel tetra-PEG based hydrogel for prevention of esophageal stricture after ESD in a porcine model

Endoscopic submucosal dissection (ESD) is an accepted treatment for early esophageal cancer and precancerous lesions, but resection of a large mucosal area often leads to postoperative esophageal stricture. Biomaterials provide a new option for the treatment of post-ESD ulcers. In this study, we developed a well-defined ammonolysis-based tetra-armed poly (ethylene glycol) (Tetra-PEG) hydrogel and investigated its efficacy and related mechanisms for preventing esophageal ESD-induced stricture in a porcine model. In terms of material properties, Tetra-PEG hydrogel present great biocompatibility，great capability to retain moisture, strong tissue adhesion and high mechanical strength. Then, six domestic female pigs were randomly divided into PEG (n = 3) and control groups (n = 3). A 3/4 of the esophageal circumference ESD was performed in all pigs. In PEG group, Tetra-PEG hydrogel was easily delivered via endoscopy and adhered to the ulcer bed tightly. Compared to control group, Tetra-PEG hydrogel accelerated esophageal ulcer healing at an early stage with enhanced epithelium regeneration, milder inflammation and lesser fibrosis by regulating TGF-β/Smad2 signaling. Taken together, our findings reveal Tetra-PEG hydrogel is a promising and attractive candidate for preventing the formation of fibrotic stricture in the process of esophageal ESD-induced ulcer repair.

Biochemical and Physiological Effects of Food-Induced Gastro-Esophageal Reflux Disease (GERD) in our Population. A Comparative Clinical Study

Background: Gastroesophageal reflux disease (GERD) can lead to significant medical complications such as esophageal ulcerations, peptic stenosis and esophageal adenocarcinoma. Aims and Objectives: The aims and objectives of current study was to evaluate the biochemical and physiological parameters associated with daily food which caused gastroesophageal reflux disease in population of Pakistan. Study Design: This was a comparative clinical study designed to investigate the effect of different dietary interventions on the symptoms of gastroesophageal reflux disease (GERD). Place and Duration: Current study was conducted medical units of Jinnah Hospital Lahore and Jinnah Hospital Karachi from June 2022 to February 2023 comparatively. Statistical analysis: Raw data was analyzed by using SPSS software (version 26.0). Descriptive statistics were used to summarize demographic and clinical characteristics of the study population. Methodology: A total of 100 adult patients with confirmed GERD diagnosis were randomized to either a standard GERD diet. The primary outcome measure was the change in GERD symptom severity, as assessed by the Gastroesophageal Reflux Disease Questionnaire (GERDQ) score after 12 weeks of dietary intervention. Secondary outcome measures included changes in esophageal inflammation, measured by endoscopy, and patient-reported improvement in quality of life. Practical Implications: Current study focuses on evaluation of the biochemical and physiological parameters associated with daily food which caused gastroesophageal reflux disease in population of Pakistan which will spread awareness among community for the prevention of GERD. Results: Demographic characteristics of the study population are presented in Table 1. The mean age of the patients was 48.7 years, and there were slightly more females (60%) than males (40%). The majority of patients (60%) reported a history of smoking, and 10% reported regular alcohol consumption. There was a significant (P≤0.05) difference between the two groups with respect to age, sex, smoking history and alcohol consumption. The findings of this study suggest that dietary interventions, particularly a modified Mediterranean diet, can significantly improve the symptoms and quality of life of patients with GERD. Conclusion: In conclusion, our study found that a modified Mediterranean diet may be more effective than a standard GERD diet in reducing the severity of GERD symptoms and improving quality of life in patients with GERD. This was evidenced by a significantly greater reduction in GERD score in Group B compared to Group A, as well as a higher proportion of patients reporting improved quality of life in Group B. In addition, the incidence of esophageal inflammation was lower in Group B, although this difference was not statistically significant. Keywords: dietary intervention, Mediterranean diet, symptom severity, quality of life, esophageal inflammation,

Behçet’s Disease - A Rare Form of Small Vessel Vasculitis

Behçet’s disease is a rare vasculitis of unknown aetiology though there is a strong genetic association with HLA-B51 characteristically targets small arteries and venules. Multiple deep oral ulcer and genital ulcer is a common presentation. Ocular involvement is also commonly occurs in the form of anterior or posterior uveitis or retinal vasculitis. Neurological manifestation occurs in the form of brainstem or pyramidal tract symptom. Thrombosis can occur but renal involvement is unlikely. Our patient Mrs X, 47 year old has been suffering from recurrent episode of oral ulcer, genital ulcer, redness of eye and dysphagia for the last 12 years. T here was relapse and remission of the symptoms. Her Ophthalmoscopic examination was normal. Upper GI endoscopy revealed multiple esophageal ulcers. ANA, Anti CCP, cANCA, pANCA, HSV 1&2- IgM, CMV- IgM, TPHA, Anti -HIV 1&2 were negative. She was treated with oral steroid and azathioprine and all the lesions resolved completely. J MEDICINE 2023; 24: 56-58

Differential Diagnosis of Esophageal Ulcers

Differential Diagnosis of Esophageal Ulcers

A134 THE PEDIATRIC ENDOSCOPY POCKET GUIDE – DEVELOPMENT OF A NOVEL “IN-THE-MOMENT” ELECTRONIC RESOURCE FOR PEDIATRIC ENDOSCOPY

Abstract Background Endoscopy is vital to pediatric gastroenterology. Performing endoscopic procedures safely, effectively and with age-specific considerations requires integration of technical and cognitive competencies. There are many guidelines for endoscopic diagnosis, classification, and management of pediatric gastrointestinal conditions. To date, there are few collated resources for pediatric endoscopists. Subspecialty trainee feedback at McMaster University identified the need for an accessible, consolidated resource to improve knowledge and competence. The literature shows a lack of exposure in subspeciality training to uncommon yet high acuity procedures such as gastrointestinal bleeding. In an apprenticeship-based learning model, this poses a challenge for both trainees and trainers. Evidence suggests use of multimedia tools is more effective for learning procedural skills than text alone, which guided the creation of this resource. Purpose To develop an “in-the-moment” electronic resource to supplement training of pediatric endoscopic procedures. Method A subspeciality trainee and two pediatric gastroenterologists with expertise in medical education and program development identified existing knowledge gaps. An electronic pocket guide with links to relevant guidelines and instructional resources was developed. The guide underwent six rounds of revision to ensure it contained relevant and updated guidelines. A copyright and e-learning expert reviewed the content to certify it complied with copyright laws and McMaster University’s accessibility guidelines. The guide will be uploaded to Pressbooks © which allows for export to multiple formats for distribution. Result(s) Based on knowledge gaps identified by local experts, the following six domains were incorporated into the pocket guide: 1. Logistics: safety procedures, colonoscopy preparation regimens, equipment specifications, considerations for urgent endoscopy and reporting guidelines 2. Troubleshooting: patient positioning, loop recognition/management strategies 3. Special tests: method of collection, collection media and lab protocols 4. Scoring systems: validated scoring tools for eosinophilic esophagitis, Barrett’s esophagus, esophageal varices, caustic esophageal injury, bleeding ulcers, and inflammatory bowel disease 5. Endoscopic emergencies: guidelines for esophageal burns, foreign body ingestions and upper gastrointestinal bleeds 6. Endoscopic tools: instructions for tools used in the categories of hemostasis, polypectomy, foreign body removal, esophageal varices, and strictures Conclusion(s) This novel teaching tool provides an electronic guide that can be used at all levels of pediatric gastroenterology training to gain familiarity and/or rapidly access resources for complex or infrequently encountered endoscopy techniques. Future studies will aim to evaluate the pocket guide from two aspects – ease of use/accessibility and whether implementation of this guide leads to increased competence with various endoscopic tools and techniques. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Esophageal Lichen Planus Unusual Presentations: A Case Series.

Esophageal Lichen Planus (ELP)is a rare manifestation of Lichen Planus(LP). We present a case series of 2 patients with oral mucosal involvement who presented with dysphagia. On endoscopy, one patient revealed proximal esophageal stricture and the other patient had proximal esophageal ulcer. LP considered as a differential diagnosis in middle aged women with dysphagia.

Out of View: A Large Esophageal Ulcer With Fistula to the Spine.

Out of View: A Large Esophageal Ulcer With Fistula to the Spine.

Aetiology and Pattern of Presentation of Upper Gastrointestinal Tract Ulcers among Patients Attending the Gastroenterology Department of BSMMU-A Tertiary Level Hospital

Background: Upper gastrointestinal endoscopy is the most common procedure performed in Gastroenterology department for numerous indications and ulceration of the upper GI tract is one of the major pathological findings during endoscopy. Early diagnosis of upper GI ulcers with definite cause is the mainstay of therapy for patient’s cure and prevention of complications. Different clinical features are observed in different types of ulcer. Objective: The objective of this study is to find out the causes of different types of ulceration in the upper gastrointestinal tract along with their clinical presentation. Methods: This cross-sectional study was conducted in the Department of Gastroenterology, BSMMU, Dhaka, Bangladesh during the period of July 2016 to April 2017. Patients referred for upper GI endoscopy for different indications were primarily selected. Consecutive 220 patients having ulcers anywhere in the upper GIT were finally included in the study. Ulcer diseases were diagnosed through analysis of morphology of the ulcers, histopathology of biopsy materials, relevant clinical history and further investigations if required. All the findings were documented in predesigned data collection sheet. Any association between various types of ulcers with age, gender, BMI, lifestyle, location of ulcer, different signs and symptoms was assessed. Results: Out of 220 patients duodenal ulcer was found in 45.9%, gastric ulcer in 30.0%, oesophageal ulcer in 7.7%, ulceration at multiple sites in 13.6%, and stomal ulcer in 2.7% cases. Among the aetiologies H. pylori infection (62.8%), NSAIDs (14.6%) and malignant ulcers (9.1%) were found in majority of cases. Less common causes were tubercular ulcer, lymphoma, GIST, Crohn’s disease and caustic injury. Aetiology could not be identified in 6.8% cases. Among various presenting complaints epigastric pain, early satiety, anorexia, vomiting and GI bleeding were the symptoms that differ significantly in patients with ulcers ...........

Long-term (18 Years) Results of Patients With Long-segment Barrett Esophagus Submitted to Acid Suppression-duodenal Diversion Operation: Better Than Nissen Fundoplication?

To determine late results of AS-DD procedure in long-segment (LSBE) and extralong-segment BE (ELSBE) using subjective and objective measurements to ascertain the histological impact over intestinal metaplasia (IM) and progression to EAC. Barrett esophagus (BE) is a known precursor of esophageal adenocarcinoma (EAC), and Nissen fundoplication has proven to be unable to stop mixed reflux among them. Our group proposed a surgical procedure that handles pathophysiological changes responsible for BE. This prospective study included 127 LSBE and ELSBE subjects submitted to clinical and functional analyses. They were presented to selective vagotomy, fundoplication, partial gastrectomy with Roux-en-Y reconstruction. The changes in IM were determined in both groups. Follow-up was completed at a mean of 18 years in 81% of the cases. Visick I-II scores were seen in 88% of LSBE and 65% in ELSBE ( P < 0.01). There was significant healing of erosive esophagitis and esophageal peptic ulcers, and strictures were resolved in 71%. There was 38% of IM regression in LSBE. Two cases in each group progressed to EAC at a mean of 15 years. Pathologic acid reflux was abolished in 91% and duodenal in 100%. There was a regression of low-grade dysplasia to IM in 80%. AS-DD permanently eliminates pathologic refluxate to the esophagus. The progression to HGD/EAC is lower compared to medical treatment, with an 8-fold reduction in LSBE and 2.2-fold in ELSBE. AS-DD seems to influence IM behaviors, and it is a tool that could reduce and delay progression to EAC.

Herbal Combination 'HAGE-101912' Ameliorates Gastroesophageal Reflux Disease in Rats.

Gastroesophageal reflux disease (GERD) is a chronic, relapsing disorder. In this era of modern and fast-track lifestyle and food habits, the incidence of GERD is rapidly increasing. Currently, proton pump inhibitors (PPIs) are the primary choice of treatment. However, the associated side effects and a high relapse rate give rise to the need to explore alternative therapies. The study aimed to evaluate HAGE-101912, an herbal combination, in different experimental models of GERD. Antacid activity was assessed based on H+/K+ATPase inhibitory activity of parietal cells using artificial gastric juice. Tonic contraction of the lower esophageal sphincter (LES) was evaluated using an AD Instrument. A GERD model of the pylorus and fundus ligation (preventive and curative models) in rats was selected to assess the efficacy of HAGE-101912 at a dose of 250 mg/kg body weight, and various parameters such as the gastric pH, gastric volume, total acidity, gross esophageal ulcer index, and histopathological changes were evaluated. The prokinetic activity was assessed using the phenol red method. HAGE-101912 increased the acid-neutralizing capacity (P < 0.001), decreased H+/K+ATPase activity (P < 0.01), and increased the contraction of the LES. In the preventive model, HAGE-101912 significantly reduced the gastric acid volume (P < 0.01), total acidity (P < 0.001), and gross esophageal ulcer index (P < 0.01); increased the gastric acid pH (P < 0.01); and protected the esophageal epithelium. In addition, HAGE-101912 increased gastric emptying and gastrointestinal transit through its prokinetic activity (P < 0.05). HAGE-101912 has a beneficial effect in GERD as it effectively inhibits the H+/K+ATPase, increases the gastric pH, restores the LES function, protects the esophageal epithelium, and increases gastric emptying and transit.

The comparison of alpha lipoic acid with methylprednisolone and sucralfate in subacute wound healing corrosive esophagus-induced rats: An experimental study.

This study aims to compare methylprednisolone frequently used in the therapeutic practices of corrosive esophagus burns, sucralfate, a protective material of mucosal surfaces, and alpha lipoic acid, the most potent antioxidant in a rat model. A total of 40 female Sprague-Dawley rats were used in this study. The rats were equally divided into control, alpha lipoic acid, methylprednisolone, and sucralfate groups (n=10). A corrosive esophagus burn was created by using 10% pH:12 sodium hydroxide. No treatment was applied to the control group, and each group was given their own treatment. The treatment was continued regularly until the eighth day, when they were sacrificed. The corrosive esophagus burn lines were removed and tissue sections were stained with hematoxylin and eosin. The difference in ulceration in the group treated with alpha lipoic acid was significant, compared to the other groups. The most excellent complete epithelialization and complete re-epithelialization were observed in the alpha lipoic acid group. The difference between the groups was significant, with complete re-epithelialization being the lowest in the control and methylprednisolone groups (42.9% and 12.5%, respectively) and the highest in the alpha lipoic acid group (77.8%). In terms of ulceration and re-epithelialization, comparable values were found in the alpha lipoic acid group. The main difference was that the inflammation levels in the sucralfate group were lower and more favorable than the other groups in this period. The glutathione level was significantly higher in the alpha lipoic acid group and decreased the tissue hydroxyproline level. Alpha lipoic acid reduces esophageal ulceration, severity and prevalence of inflammation, severity and prevalence of fibrosis, decreases tissue damage by increasing blood glutathione level, and also reduces stricture in corrosive esophagus burns in rats.

Herpes Simplex Esophageal Ulcer in an Immunocompetent Adult With Hematemesis.

A 61-year-old man with pharyngitis and stomatitis for 2 months was admitted due to difficulty in swallowing solids. Laryngoscopy demonstrated multiple laryngopharyngeal ulcers with exudative laryngopharyngitis (Figure A). He had elevated IgM antibody for herpes simplex virus (HSV). Acyclovir (750 mg daily) was orally administered soon after admission. After 2 days, he had hematemesis and tarry stool. Hemoglobin level decreased to 4.9 g/dL with hemorrhagic shock and required blood transfusion. Urgent upper gastrointestinal endoscopy showed multiple erosions and ulcers with spurting bleeding in the upper esophagus (Figure B).