Esophageal Patients Research Articles

Routine preoperative endoscopy in patients undergoing bariatricsurgery.

The role of routine preoperative endoscopy before primary weight loss surgery remains controversial. We reviewed our experience to determine the frequency of abnormal findings in patients undergoing routine preoperative endoscopy before bariatric surgery. A tertiary level, academic-affiliated bariatric surgery practice. A retrospective chart review was performed between July 2014 and June 2016 of patients undergoing routine preoperative endoscopy before primary bariatric surgery. Variables evaluated included preendoscopy symptoms, planned bariatric surgical procedure, abnormal findings on endoscopy, and changes in planned bariatric surgical procedure after endoscopy. A total of 631 patients met inclusion criteria. Of patients, 72% (457) were female. The median age was 44 (interquartile range 36-55). The median body mass index was 46 (interquartile range 42-51). Most patients had no preendoscopy clinical symptoms (61.3%). The most frequent abnormal findings included esophagitis (26.5%), hiatal hernia (27.1%), gastric ulcer (4.9%), and biopsy-proven Barrett's esophagus (4.6%). Although patients with preoperative symptoms were more likely to have abnormal findings on endoscopy, there were no significant differences in rates of Barrett's esophagus in patients with (5.3%) or without (4.1%) symptoms. Of the total cohort, 18.4% had a change in their planned operation after endoscopy results. The findings in our large series suggest selective screening in symptomatic patients only may lead to failure of discovery of foregut pathology that should prompt consideration for changes in the planned bariatric surgical procedure. Further study is necessary to see if our findings have broad applicability.

Polysaccharide from Gracilaria caudata protects the human esophageal mucosal barrier: A differential topical effect and structural dependence

This study aimed to evaluate the in vitro protective effect of topical treatment with a native sulfated polysaccharide of G. caudata (SP-Gc), hydrolyzed (H-SP-Gc), or desulfated (D-SP-Gc) polysaccharide of Gracilaria caudata in esophageal biopsies obtained from GERD patients. Biopsies were obtained from nonerosive reflux disease (NERD) patients and from erosive esophagitis patients. Then, the biopsies were mounted in an Ussing chamber to measure the basal transepithelial electrical resistance (TEER). The effect of mucosal exposure to an acid solution on TEER was analyzed with or without different concentrations (1, 0.3 or 1%) of SP-Gc, H-SP-Gc, or D-SP-Gc, precoated on the mucosa. Basal esophageal mucosal electrical resistance was significantly lower in erosive esophagitis than from NERD. Mucosal samples precoated with native SP-Gc (1%) significantly prevented TEER drop induced by an acidic solution in NERD, but this effect was not observed in erosive esophagitis. Topical application of D-SP-Gc showed no difference compared to native SP-Gc. However, when treated with chemically-modified SP-Gc, the protective effect observed with native SP-Gc was lost. The present study indicated that SP-Gc protects the human esophageal mucosal barrier in NERD patients. This effect is dependent on the structure but is independent of the presence of sulfate.

Delayed diagnosis of Eosinophilic Esophagitis in patients with IgE-mediated cow's milk allergy

Delayed diagnosis of Eosinophilic Esophagitis in patients with IgE-mediated cow's milk allergy

Identification of potential CD4+ T-cell pathways associated with epicutaneous milk desensitization of eosinophilic esophagitis patients

Identification of potential CD4+ T-cell pathways associated with epicutaneous milk desensitization of eosinophilic esophagitis patients

Desensitization Success Rates For IgE-mediated Cow's Milk Allergy In Eosinophilic Esophagitis Patients

Desensitization Success Rates For IgE-mediated Cow's Milk Allergy In Eosinophilic Esophagitis Patients

Lokal İleri Evre Meme Kanserli Hastalarda Konformal Radyoterapiye Bağlı Özofajit Gelişimi

Lokal İleri Evre Meme Kanserli Hastalarda Konformal Radyoterapiye Bağlı Özofajit Gelişimi

Rupture of the esophagus due to carbonate use—a case report

Background: Rupture of the esophagus which is not iatrogenic or due to carcinoma, Mallory Weiss syndrome, or foreign body is called a spontaneous rupture of esophagus or Boerhaave syndrome. Symptoms are not specific and include back or retrosternal chest pain, crepitus on chest wall palpation, or mediastinal crackle. Esophagus rupture could have dyspnea, tachypnea, tachycardia, and dullness in the chest exam due to pleural effusion beside the pain. Case presentation: In this report, we had two cases with rupture of the esophagus due to soda (bicarbonate) use with no remarkable past medical history. Both patients had stable vitals when they came to the Emergency Department. Diagnosis was confirmed by chest CT scan. One of the patients did not take any invasive treatment and there was no need for operation. The other patient underwent thoracotomy and esophageal repair. Both of them had good general condition after some days. Conclusion: We recommend not englutting excessive amounts of soda why it can cause rupture of the esophagus in patients with unknown esophageal wall weakness or healthy esophagus.

Epiphrenic diverticulum of the lower third of the esophagus after previous antireflux surgery

In this article is described a rare postoperative complication: epiphrenal diverticulum of the esophagus of the lower third of the esophagus in patient after antireflux surgery. Brief description of the main stages of surgical treatment. 96 patients with cardiofundal, subtotal or total hiatal hernias underwent operation. There were complications of I-II degree according to Clavien-Dindo in the early postoperative period in 11 patients (11.4%). Complications of IIIb degree were revealed in 2 patients (2.1%) in the early postoperative period and in 1 patient (1.0%) in the late postoperative period (2 months after hospitalization) - epiphrenal diverticulum of the esophagus. Laparotomy, the sagittal diafragmalnaya, diverticulectomy, valisesta pyloroplasty were performed. Postoperative period without complications. The patient's nutrition through the mouth is restored on the 5-th day. No dysphagia and reflux esophagitis were detected radiologically and endoscopically.

PECULIARITIES OF THE COURSE AND TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE IN PATIENTS WITH SYNDROME OF UNDIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA. (SYSTEMATIC LITERATURE REVIEW)

PECULIARITIES OF THE COURSE AND TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE IN PATIENTS WITH SYNDROME OF UNDIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA. (SYSTEMATIC LITERATURE REVIEW)

Systematic Assessment of Adult Patients’ Satisfaction with Various Eosinophilic Esophagitis Therapies

Background and Aims: The treatment options for eosinophilic esophagitis (EoE) patients include drugs (proton pump inhibitors [PPIs], swallowed topical corticosteroids [STCs]), elimination diets, and dilation. Given the lack of data, we aimed to assess adult EoE patients’ satisfaction with different EoE-specific treatment modalities. Patients and Methods: We evaluated therapy satisfaction recalled over a 12-month period using the validated Treatment Satisfaction Questionnaire for Medication that assesses effectiveness, side effects, convenience, and overall satisfaction. The score for each scale ranges from 0 (dissatisfied) to 100 (satisfied). To evaluate satisfaction with nonpharmacologic therapies, the questionnaire was modified and debriefed into three focus groups. The final questionnaire was sent to 147 patients. Results: The patient response rate was 74%. In the last 12 months, 24, 75, 19, and 9% were treated with PPIs, STCs, elimination diet, and dilation, respectively. Patients identified the following considerations as important for therapy choice: effect on symptoms (89%), effect on esophageal inflammation (76%), side effects (69%), and ease of use (58%). Patients found STCs to be effective (83 points), convenient (83 points), and experienced no side effects when using this therapy. When using STCs alone (43%), overall patient satisfaction was high (86 points). Patients judged PPIs to be most convenient (89 points), STCs to be a bit less convenient (83 points), and diet to be most inconvenient (46 points) of the three therapies examined. Conclusions: Adult EoE patients consider both therapy effect on symptoms and esophageal inflammation as important criteria when choosing EoE therapy and appear to be satisfied with STC use.

Notch Intracellular Domain (NICD) Expression and Clinical Manifestations of Second Primary Tumor at Esophagus in Patients with Head and Neck Squamous Cell Carcinoma.

IntroductionSecond primary tumor (SPT) is a major factor that affects the survival of head and neck squamous cell carcinoma (HNSCC) patients, and the esophagus is a common site. Detection of SPT is essential for optimal HNSCC treatment planning and follow-up. Mutation of the NOTCH1 gene is common in head and neck cancer. However, details relating to Notch signaling and clinical outcomes among different primary tumors are still inconclusive. This study aimed to identify the role of the Notch signaling pathway in HNSCC, and to compare NOTCH1 expression in HNSCC compared between those with and without SPT at esophagus while focusing on the Notch intracellular domain (NICD).MethodsTwenty-three cases of esophageal SPT and 47 non-SPT controls that were treated at Siriraj Hospital during 2006–2017 were included. Patient information and clinical outcomes were analyzed. NICD expression demonstrated by immunohistochemistry technique in formalin-fixed paraffin-embedded specimens was studied.ResultsMean age of SPT and non-SPT was 55.13 and 62.09 years, respectively, and 94.3% of patients were male. Regarding SPT detection, 82.6% were synchronous and 17.4% were metachronous. There was significantly more active smoking among SPT than among non-SPT (87.0% vs 51.1%, p=0.01). Active alcohol use was also significantly greater among SPT than among non-SPT (87.0% vs 61.7%; p=0.04). Hypopharynx was the most common primary tumor site among SPT. Three-year and 5-year survival among SPT patients was 38.0% and 25.3%, respectively. NICD expression was absent in 52.2% of SPT, and in 53.3% of non-SPT. NICD expression intensity was mostly weak or moderate.ConclusionActive smoking and alcohol use were found to be significantly associated with SPT development. A high percentage of NICD inactivation was noted in HNSCC with no significant difference between groups. The Notch signaling pathway is involved in HNSCC tumorigenesis, but may not be a suitable molecular marker for SPT development.

The relationship between Helicobacter pylori infection in the stomach and reflux esophagitis in patients referring to Khorramabad Shohada Hospital, Lorestan province, southwest Iran between 2014 and 2018

IntroductionGastroesophageal reflux disease is a common disorder of the digestive tract. Esophageal mucosa exposure to gastric acid can lead to mucosal damage such as esophagitis.ObjectiveThe aim of this study was to determine the relationship between Helicobacter pylori infection in the stomach and reflux esophagitis in patients referring to the endoscopy units of hospitals in Khorramabad between 2014 and 2018.Materials and MethodsIn this cross-sectional study, all patients who referred for endoscopy to the Endoscopy Units of Shohadaye Ashayer and Shahid Rahimi Hospitals of Khorramabad during 2014-2018 were studied. H. pylori infection was diagnosed based on pathological specimens. All patientschr('39') information including age, sex, presence of esophagitis (its grade), and H. pylori infection were recorded in the questionnaires and their relationship with esophagitis and its grade as well as H. pylori infection was statistically analyzed. Tables and charts were used to describe the data. t-test and Chi-squared test were used to investigate the relationship between variables.ResultsThe frequency of esophagitis in our patients was 52.8%, with the highest frequency obtained for grade B esophagitis (48%). In this study, the prevalence of H. pylori infection was 57.5%. This rate was 55.4% in patients with esophagitis, with a statistically significant difference to the group without esophagitis (P=0.0009). There was a significant relationship between grade A esophagitis and H. pylori infection (P=0.0002).ConclusionThis study suggests a significant relationship between H. pylori infection and esophagitis in affected patients.

RETROSPECTIVE AND PROSPECTIVE STUDY OF CORROSIVE POISONING AND ITS EFFECT ON UPPER GASTRO INTESTINAL TRACT AND SURGICAL MANAGEMENT IN TERTIARY CARE CENTRE

Background: Corrosive injury to the upper gastrointestinal tract is an insufferable experience for both the patient and surgeon. Corrosive ingestion may usually responsible for wide spread injury to the lips, oral cavity, oropharynx and the upper air way, upper gastrointestinal tract.
 Results: in our study more common patients were in the age group 21-30 years. Majority of the patients had consumed toilet cleaner. Majority of the patients had consumed substance of <=30 ml. Majority of the patients had consumed HCL. Majority of the patients had consumed the substance with a suicidal Intention, [ 42.9%] consumed corrosive under influence of alcohol, In 5 (14.3%) patients had oropharynx involvement, in 8 (22.9%) patients had lower esophagus involvement, in 8 (22.9%) patients had middle esophagus involvement and 17 (48.6%) patients had upper esophagus involvement. In 18 (51.4%) patients had pylorus (stomach) involvement and in 5 (14.3%) patients duodenum (first part) involvement. In 11 (31.4%) patients esophagus was involved at 2A level, in 17 (48.6%) patients esophagus was involved at 2B level and in 2 (5.7%) patients esophagus was involved at 3A level. In 9 (26.5%) patients dilatation was not possible, in 2 (5.9%) patients it was not done. In 9 (26.5%) dilatation was done 2 times and in 14 (41.1%) patients dilatation was done 3 times .In 34 (97.1%) patients feeding jejunostomy insertion was done in 1 (2.9%),most common sequels esophageal stricture [65.7%] and GOO[40%], patient laparotomy Bilroth II gastrectomy was done as a primary intervention. Majority of the patients complained of dysphagia and chest pain and cough at first visit. In 11 (32.4%) patients gastrojejunostomy was done, in 7 (20.6%) patients esophagectomy with gastric pull-up was done, in 4 (11.8%) patient’s thoracoscopic esophagectomy with colonic interposition was done. There were 3 (8.6%) deaths and 32 (91.4%) patients were discharged successfully in our study there was a significant improvement seen in the weight from follow-up at 2 months till the end of follow-up at 12 months (p<0.05).
 Conclusion: In our study corrosive ingestion common in young age decrees, with increase age, (HCL) toilet cleaner found to be the commonest corrosive chemical used esophags most common than pylorus affected by the ingestion, oropharynx and duodenum less likely,2Bgrade of injury was affected the most in esophagus, stomach or duodenum, with a very high incidence of stricture formation. Dysphagia, throatpain, excessive salivation and hoarseness of voice were the commonest presenting symptoms. The first line of performed surgery at presentation was insertion of feeding jejunostomy and improvement in diet intake and strength of feeding jejunotomy patients underwent gastrojejunostomy, esophagectomy with gastric pull-up or thoracoscopic esophagectomy with colonic interposition. Dilatation was required in majority of the patients. There was a significant improvement in the weight of these patients over various follow-up periods. The overall success rate of management of these patients was found to be very high with only a very few deaths recorded in our study.
 Keywords: Corrosive injury, Esophagealstricture, Gastric outlet obstruction, Upper GI endoscopy.

Risk of progression to eosinophilic esophagitis in patients with asymptomatic esophageal eosinophilia: A retrospective pilot study.

Background and AimAs the number of patients with eosinophilic esophagitis (EoE) has increased worldwide, the likelihood of diagnosing esophageal eosinophilia (EE) in screening endoscopy has also increased. Many of these EE patients do not display any symptoms (i.e. they display asymptomatic EE: aEE), and the risk of aEE patients developing EoE has yet to be demonstrated.MethodsA total of 62 250 cases were found in the endoscopic registries of two digestive disease centers in the context of gastric cancer screening from April 2016 to August 2018, and these were reviewed.ResultsThirty‐seven aEE patients (0.059%) were found in the registries, and the histories of endoscopic findings and symptoms were successfully traced for 29 of them. While 11 aEE (37.9%) patients did not show any change in endoscopic findings, 18 (62.1%) exhibited exacerbation. A comparison of the two groups showed both relative youth and diffuse disease distribution to be independent risk factors for progression (P = 0.0034 and 0.0078, respectively). Of the 18 aEE patients whose findings showed progression, 6 developed EoE (5 (17.2%) developed proton‐pump inhibitor (PPI)‐responsive EoE, and only 1 (3.4%) developed PPI‐resistant EoE). A comparison of the non‐EoE and EoE groups showed relative youth to be an independent risk factor for progression to EoE (P = 0.0146).ConclusionsWhile some aEE patients developed symptomatic EE, the existence among them of PPI‐resistant EoE was extremely rare. Younger age and diffuse disease distribution at first detection in endoscopic findings are risk factors for progression to symptomatic EE in aEE patients.

Impedance and Histologic Characteristics of the Sub-Laryngeal Esophagus Distinguish Eosinophilic Esophagitis From Other Esophageal Disorders

The region of the esophagus 15-17 cm below the incisors, called the sub-upper esophageal sphincter (sub-UES), has not been characterized in adults with eosinophilic esophagitis (EoE) but appears different during endoscopy. We investigated how the sub-UES differs from the remaining esophagus in patients with EoE and aimed to determine whether these differences be used to distinguish patients with EoE from those with lichen planus. We performed a prospective study of 14 patients with EoE, 7 patients with lichen planus (based on presence of Civatte bodies, dysphagia, and/or narrow esophagus with thin esophageal mucosa without signs of EoE), and 20 patients undergoing upper endoscopy for upper gastrointestinal or with dysphagia but without features of EoE (controls) at a single medical center from 2015 through 2018. Biopsies from the distal, middle, and sub-UES regions of the esophagus were analyzed by histology, quantitative PCR, and immunohistochemistry. We measured mucosal impedance (MI) in all subjects at the sub-UES and 2 cm, 5 cm, and 10 cm from the gastro-esophageal junction. Patients with EoE had significantly fewer eosinophils (median, 2 eosinophils/high-powered field [HPF]; range, 0-8 eosinophils/HPF) in sub-UES tissues compared with distal esophagus (median, 50 eosinophils/HPF; range, 22.5-60.8 eosinophils/HPF; P < .0001) or middle esophagus (median, 32 eosinophils/HPF; range, 19.3-60; P < .0001). Sub-UES tissues from patients with EoE had significantly less basal cell hyperplasia (P < .01), papillary elongation (P < .01), and dilated intercellular spaces (P < .01) than middle or and distal esophagus. MI in the sub-UES did not differ significantly between patients with EoE vs controls (P= .24), but was significantly lower in patients with lichen planus (median, 1344 ohms; range, 1046-1488) than patients with EoE (median, 2880 ohms; range, 2149-4858) (P < .001). mRNA and protein expression patterns did not differ significantly in the sub-UES of patients with EoE vs controls, except for expression of desmoglein-1, which was increased in sub-UES tissues from patients with EoE. Sub-UES tissues from patients with EoE differ in numbers of eosinophils, histologic features, and MI compared to controls or patients with lichen planus. These features might help to distinguish these 2 diseases.

1807P - A randomized trial of sodium alginate prevention of radiation-induced esophagitis in patients with locally advanced NSCLC receiving concurrent chemoradiotherapy: OLCSG1401

1807P - A randomized trial of sodium alginate prevention of radiation-induced esophagitis in patients with locally advanced NSCLC receiving concurrent chemoradiotherapy: OLCSG1401

1743 From Red to Black: A Deadly Case of Acute Esophageal Necrosis

INTRODUCTION: Black Esophagus, or acute esophageal necrosis (AEN), is a rare but deadly clinical syndrome appearing as diffuse circumferential black necrotic mucosa on esophagogastroduodenoscopy (EGD). It is associated with comorbidities that cause hypoperfusion and ischemia to the esophageal mucosa. It has a reported incidence rate of about 0.001% to 0.2%. We report a case of black esophagus in a patient with fulminant hepatic failure related to nonalcoholic steatohepatitis (NASH) cirrhosis. CASE DESCRIPTION/METHODS: A 75-year-old female with a history of diabetes mellitus, hypertension, gastroesophageal reflux disease, NASH-related cirrhosis, and GI bleeding due to esophageal varices presented to the hospital with altered mental status and increased lethargy of 2 weeks’ duration. Her initial lab workup revealed a calculated MELD score of 36. She was diagnosed with an NSTEMI and hepatic encephalopathy in the setting of fulminant hepatic failure. During her hospital stay, she developed coffee ground emesis and melena with resultant drop in hemoglobin requiring transfusion with multiple units of blood. An EGD performed in order to find the source of her apparent upper GI bleeding revealed diffuse circumferential black discoloration of the mucosa at the middle and inferior third of the esophagus demarcated clearly from the normal-appearing mucosa of the cardia at the gastroesophageal junction (Figure 1). Unfortunately, she developed hepatorenal syndrome due to worsening liver function. Due to the poor prognosis, the patient’s family chose to request “do not resuscitate” (DNR) status. Severe hypoxia failing noninvasive positive-pressure ventilation ultimately led to cardiac arrest and death. DISCUSSION: This case emphasizes the need to include black esophagus on the differential of upper GI bleeding in a patient with a history of esophageal varices and NASH cirrhosis and highlights the high mortality rate, estimated at about 32%, associated with this condition. Documented cases exist of black esophagus in patients with alcohol-related cirrhosis, but we found no others reporting this condition in a patient with NASH-related cirrhosis. There is no direct treatment for black esophagus; recommendations are to treat comorbidities, suppress acid production, and optimize vascular perfusion. Complications include stricture, infection, perforation and death. This case clearly demonstrates that early detection through endoscopy and active management of its underlying cause is critical to improving patient outcomes.

382 Esophageal Mucosal Impedance Measurement During Endoscopy: A New Approach to Diagnosis and Confirmation of Complete Remission of Intestinal Metaplasia Following Radiofrequency Ablation in Barrett’s Esophagus

INTRODUCTION: Mucosal impedance (MI), measured with a specialized balloon catheter at the time of upper endoscopy reveals a distinct pattern within the esophagus in patients with eosinophilic esophagitis and GERD. This novel technology may also be able to identify a unique profile in Barrett’s esophagus (BE) and confirm Endoscopic Complete Remission of Intestinal Metaplasia (ECRIM) following Radiofrequency energy ablation (RFA). AIM: Explore utility of MI in identification of BE and confirmation of ECRIM following RFA. METHODS: Patients (pts) with endoscopic and biopsy proven BE, most dysplasia undergoing RFA were prospectively enrolled. All were maintained on BID PPI. EGD noted top of gastric folds, SCJ, Prague criteria, hernia size and presence of nodules. Pts with nodular disease were excluded. RFA was performed per standard protocol and repeated until ECRIM achieved. Measurements were obtained with an MI balloon (Diversatek Healthcare, CO) 10 cm x 5 mm with two axial arrays of 10 sensors, throughout the entire BE segment and 5 cm above at pre-ablation EGD and following achieving ECRIM. At ECRIM endoscopic surveillance biopsies (q 1 cm; 4 quadrant) and WATS brushings were obtained to confirm CRIM. RESULTS: 16 pts 11M/5F, ages 26-71 years, all Caucasian were enrolled. BE length from 1-15 cm. (adenoca 1, LGD 5, HGD 5, indefinite1, Non dysplastic 4. To date, 7 pts have been studied prior to the initial RFA ablation and at ECRIM. 2 pts were studied only at end of RFA with ECRIM. 7 are in active treatment. MI measured within the BE segment ranged from 350-980 ohms pre RFA. (Normal &gt;2500, EoE, GERD &gt;1000). Post RFA MI measurements ranged from 1800- &gt;5000 ohms. 5/7 pts that achieved ECRIM had normalization of the MI pattern visualized (all values &gt;2500). The 2 pts that did not achieve normalization of the MI pattern demonstrated MI values consistent with inflammation in squamous tissue but no values suggestive of BE. Pathology confirmed absence of IM in all 9 pts. CONCLUSION/SUMMARY: 1) BE exhibits MI consistently &lt; 500 ohms and always below 1000 ohms, a unique MI profile not evident in GERD or EoE. 2) In pts who achieved ECRIM and biopsy and WATS proven CRIM following RFA ablation, the neosquamous esophageal mucosa exhibits a MI pattern similar to normal native squamous epithelium. Balloon catheter MI measurements can reliably identify BE epithelium and may be a valuable tool in assessment of post-RFA reversion to neosquamous epithielium and therefore successful BE ablation.

Determining the efficacy of vitamin B12 mixed oral liquid in the treatment of radiation-induced esophagitis*

Abstract Objective This study aimed to investigate the effects of vitamin B12 mixed oral liquid in the treatment of radiation-induced esophagitis in patients with esophageal cancer. Methods Seventy-five patients with esophageal cancer who met the enrollment criteria were randomly divided into the vitamin B12 mixed oral liquid group (39 patients in the study group) and the gentamicin mixed oral liquid group (36 patients in the control group). The effects of the two treatment methods on esophagitis grading, pain degree, body weight loss, and Karnofsky performance status (KPS) score in patients with radiation esophagitis were observed. Results In the control group, grade 1 radiation esophagitis accounted for 27.8% of the total patients, grade 2 accounted for 41.7%, and grades 3 and 4 accounted for 30.6%. In the vitamin B12 treatment group, grade 1 radiation esophagitis accounted for 66.7% of the total patients, grade 2 accounted for 25.6%, and grades 3 and 4 accounted for 7.7%; there was a significant difference between the vitamin B12 treatment group and control group (P &lt; 0.01). Similarly, pain caused by radiation esophagitis was significantly improved in the vitamin B12 group compared with the control group (P &lt; 0.05). After treatment, the average weight loss of the control group was (2.18 ± 0.36) kg, while that of the vitamin B12 treatment group was (0.90 ± 0.43) kg (P &lt; 0.05). The KPS scores of the vitamin B12 group were higher than those of the control group, which were 86.2 ± 1.2 and 85.6 ± 1.5, respectively, but there was no statistical difference (P &gt; 0.05). Conclusion Vitamin B12 mixed oral liquid can effectively reduce the severity of radiation esophagitis, relieve pain, improve patients' quality of life, and increase treatment compliance.

Radiation-induced oesophagitis in breast cancer: Factors influencing onset and severity for patients receiving supraclavicular nodal irradiation.

The aim of this study was to determine dosimetric factors, such as mean dose and oesophageal length, which may influence the incidence and severity of oesophagitis in breast cancer patients receiving radiotherapy to the supraclavicular nodes. This was a single-arm prospective observational study. Toxicity grading was undertaken twice weekly to determine the onset of grade 2 oesophagitis in consecutive patients prescribed IMRT to the breast or chest wall and supraclavicular fossa (SCF) nodes. Recorded variables included mean and maximum doses to the oesophagus, oesophageal length and pharynx length within the treatment area. Multivariate logistic regression and Fishers' exact test were used with a 0.05 significance level to compare the onset of grade 2 oesophagitis with these variables. A total of 77 patients were included in the study. Twenty-four (31%) patients reported grade 2 oesophagitis. There was a higher incidence of grade 2 oesophagitis in patients receiving a mean oesophageal dose of ≥31Gy compared to those receiving <31Gy (18/24 versus 6/24, respectively, P=0.025). There was a significant difference in the onset of grade 2 toxicity in patients who had ≥1cm of pharynx included in SCF fields compared with those with <1cm (15/24 versus 9/24, respectively, P=0.0116). The odds ratios for developing grade 2 oesophagitis were 3.2 (95% CI=1.05-9.62, P=0.04) for a mean dose of ≥31Gy and 3.4 (95% CI=1.19-9.5, P=0.022) for ≥1cm of pharynx in the SCF field. By limiting the mean dose to the irradiated oesophagus to <31Gy during the planning process and ensuring that <1cm of pharynx is included in the radiation field, oesophageal toxicity may be minimised.