Esophagitis Grade Research Articles

S612 Diagnostic Accuracy and Grading of Esophagitis: A Cross-sectional Analytic Study

S612 Diagnostic Accuracy and Grading of Esophagitis: A Cross-sectional Analytic Study

Efficacy of Shugan Hewei formula combined with rabeprazole in refractory gastroesophageal reflux disease: randomized, double-blind, placebo-controlled trial

ObjectivesTo assess the efficacy of the Chinese herbal medication Shugan Hewei formula (SHF) combined with rabeprazole in patients with refractory gastroesophageal reflux disease (rGERD).MethodA total of 264 participants were randomly assigned to the treatment group (n = 132) receiving SHF granules (20 mg) combined with rabeprazole (10 mg) and the control group (n = 132) receiving placebo SHF granules (20 mg) combined with rabeprazole (20 mg). Both groups undergo 8 weeks of treatment and 2 weeks of follow-up.ResultsThe treatment group showed higher total clinical symptom efficacy and lower total symptom scores compared to the control group. The treatment group was superior to the control group in reducing rGERD major symptom scores, including heartburn, retrosternal pain, regurgitation and belching, and acid regurgitation. Additionally, treatment group (Z = 8.169, P < 0.001) and control group (Z = 9.800, P < 0.001) treatments were all significantly attenuated esophageal inflammation, demonstrating comparable efficacy. Patients with esophagitis grade A decreased from 40.34% to 17.23%, and those with grade B decreased from 11.76% to 3.78% in the treatment group. The results of the SF-36 scale showed that combination therapy was more effective in improving role limitations due to physical health, vitality, general health, total somato-physical health, and psychiatric mental health.ConclusionOur study reveals that the combined treatment of SHF with rabeprazole is more efficacious in managing patients with rGERD when contrasted with sole rabeprazole treatment.

Prevalence of peptic ulcers in cirrhotics at the Cocody and Angré University Hospitals in Côte d'Ivoire

Introduction: Cirrhosis, is the consequence of a chronic attack of the liver, is histologically defined as a diffuse process associating mutilating fibrosis (concentric), and regenerative hepatocyte nodules, it has formidable complications (hemorrhagic, cancerous and encephalopathies) essentially. Method: this was a retrospective descriptive study from June 01, 2021 to May 30, 2023, i.e. 2 years. Results: we identified 205 cases of cirrhosis, 36 of which had at least one gastric or duodenal ulcer, i.e. a prevalence of 17.56%. There were 12 women and 24 men, i.e. a sex ratio (M/F) = 2. The mean age was 47.22 years ± 14.7 years with extremes ranging from 28 to 81 years. The etiologies of cirrhosis are (HBV 72.22%, HCV 15%, HBV+HCV 8.33% and chronic alcoholism 5.6%). Civil servants, pensioners, shopkeepers and housewives occupy the first places of complications respectively (25%, 16.7%, 13.9%, 11.1%). Signs of portal hypertension are represented by esophageal varices grade III with a proportion of 61.11% and grade II of 27.8% with or without red signs and at the gastric level, 63.9% of patients had gastropathy of portal hypertension. Ulcerative lesions were single in 80.55%, double in 19.44%, and in order of frequency according to bulbar (44.4%), antral (36.1%), antrobulbar (11.1%) and fundic (8.3%) location. The prognosis was, CHILD C (50%), CHILD B (30.55%) and CHILD A (19.45%). Conclusion: the complications of cirrhosis are formidable, prevention through awareness raising on the avoidance of risky behaviour and universal vaccination against hepatitis B remain the preferred option. Keywords: cirrhosis, Peptic ulcer, Portal hypertension, Cocody University Hospital

Comparison of short-term clinical efficacy between modified Kamikawa anastomosis and double tract anastomosis after laparoscopic proximal gastrectomy.

This study aimed to explore the short-term clinical efficacy of modified Kamikawa anastomosis and double tract anastomosis after laparoscopic proximal gastrectomy. A retrospective analysis was carried out by collecting the clinical and pathological data of 42 patients who underwent laparoscopic proximal gastrectomy after admission in our centre from May 2020 to October 2022. Among the 42 enrolled patients, 22 underwent modified Kamikawa anastomosis (modified Kamikawa group), and the other 20 underwent double tract anastomosis (double tract group). Outcome measures included intraoperative condition, postoperative recovery, postoperative quality of life, postoperative nutritional status and gastroesophageal reflux. The patients were followed up using outpatient examination and telephone interviews to identify their nutritional status, reflux esophagitis and anastomotic status. (1) Intraoperative condition: Compared with the double tract group, the modified Kamikawa group had significantly prolonged time for operation and digestive tract reconstruction. However, no statistically significant difference in intraoperative blood loss was found between the two groups. (2) Postoperative recovery: Compared with the double tract group, the modified Kamikawa group had a significantly shorter time for the first postoperative intake of fluids, drainage tube placement and postoperative hospital stay. No statistically significant difference in the time to first postoperative anal exhaust and postoperative complications was found between the two groups. (3) Postoperative quality of life: Compared with the double tract group, the modified Kamikawa group showed better quality of life at 12 months after surgery. (4) Postoperative nutritional status and gastroesophageal reflux: No statistically significant difference in hemoglobin, total serum albumin, albumin, body mass index, MUST score, PG-SGA score, grading of reflux esophagitis using the Los Angeles classification system and GERD score was found between the two groups at 6 and 12 months after surgery. All patients did not experience anastomotic stenosis and tumour recurrence or metastasis. Modified Kamikawa anastomosis is a safe and feasible treatment in laparoscopic proximal gastrectomy, which can ensure good postoperative anti-reflux effect and nutritional status. It has the advantage of better postoperative recorvery and quality of life compared with double tract anastomosis.

Laparoscopic revisional antireflux and hiatal hernia surgery results in a higher rate of complications and severity at 90 days than primary surgery

ObjectiveData on graded complications and their frequency after laparoscopic revisional antireflux and hiatal hernia surgery compared with primary surgery are lacking. We describe 30- and 90-day morbidity using the Clavien-Dindo classification. MethodsA total of 298 patients underwent revision surgery between 2003 and 2020 and were propensity matched to primary surgeries (1:2 ratio) based on age, sex, body mass index, American Society of Anesthesiology classification, Los Angeles grade esophagitis, presence of Barrett's, and indication for surgery. Complications were graded using the Clavien-Dindo classification, with the highest grade of complication reported per patient. ResultsAfter matching, both groups had a majority of female patients, with a median age of 60 years and a median body mass index of 29.5 kg/m2. Most were healthy, with nonerosive esophagitis and modest levels of Barrett's esophagus. A laparoscopic Nissen fundoplication was most common; however, a partial fundoplication was more common in revisions. Mesh, relaxing incisions, and Collis were more common in revisional surgery. At 30 days, total complications were similar (23.5% [70/298] vs 20.6% [123/596], P = .373) with 1 death in each group. Minor complications (less than Clavien-Dindo 3A) were comparable. Patients undergoing revisional surgery experienced Clavien-Dindo 3B complications (4.7% [14] vs 0.8% [5], P > .001) more frequently, with esophageal obstruction requiring revision and esophageal/gastric leak being most common. Grade Clavien-Dindo 4 A/B complications were comparable in both groups. At 90 days, patients undergoing revisional surgery experienced overall complications (7.1% [21] vs 2.0% [12], P = .003), and Clavien-Dindo 3B complications (1.0% [3] vs 0, P = .037) more frequently, with intra-abdominal abscess washout being the most common Clavien-Dindo 3B complication. ConclusionsRevisional surgery results in similar total complications at 30 days, but additional complications can occur out to 90 days.

Serum Prolactin as a Marker of the Severity of Liver Cirrhosis in a Tertiary Hospital in India: A Cross-Sectional Study.

In India, cirrhosis is becoming a growing concern, leading to an unmet need for new non-invasive markers to assess the severity of liver disease. Serum prolactin is one such marker. To determine the association between serum prolactin, the severity of liver cirrhosis, and its complications such as ascites, hepatic encephalopathy, and esophageal varices. This cross-sectional study involved 117 patients with liver cirrhosis. They were evaluated for some complications such as ascites, esophageal varices, and hepatic encephalopathy, as well as for severity by using the Child-Turcotte-Pugh (CTP) score. Serum prolactin levels were measured, and their relationship with both the severity and complications of liver cirrhosis was determined. A P value of < 0.05 was considered significant. The mean age of the patients was 48.3 ± 12.08 years, and the majority (80.3%) were males. Seventy-one percent of the patients had elevated serum prolactin levels (>19.40 ng/mL). Elevated serum prolactin was found in approximately 95.0% and 86.8% of patients with hepatic encephalopathy and ascites, respectively. The median serum prolactin levels were significantly associated with esophageal varices grades (P = 0.043) and hepatic encephalopathy (P < 0.001). The sensitivity and specificity of serum prolactin for predicting severe CTP scores were 81.6% and 91.2%, respectively, with a diagnostic accuracy of 87.2%. On multivariate regression analysis, ascites (AOR = 3.8, 95%CI = 1.29-10.98, P = 0.015), hepatic encephalopathy (AOR = 6.1, 95%CI = 0.68-53.78, P = 0.012), CTP class B (AOR = 5.9, 95%CI = 1.39-24.68, P = 0.016), and CTP class C (AOR = 13.4, 95%CI = 2.25-82.21, P = 0.004) were significantly associated with elevated serum prolactin levels. There was a significant association between serum prolactin levels and CTP classes, esophageal varices, ascites, and hepatic encephalopathy in patients with liver cirrhosis.

Gastroesophageal reflux disease after laparoscopic sleeve gastrectomy

Background. GastroEsophageal Reflux Disease (GERD) is a common problem among obese and overweight people, including as a complication of bariatric surgery, Laparoscopic Sleeve Gastrectomy (LSG). Aim. To conduct a retrospective analysis of the frequency of GERD in patients with morbid obesity after laparoscopic sleeve gastrectomy. Materials and Methods. In this retrospective study, data from 152 patients who underwent LSG were analyzed. All patients were diagnosed with morbid obesity and were deemed suitable for surgery. The minimum follow-up period was twelve months. All patients were assessed preoperatively for the severity of GERD using 24-hour pH monitoring, and upper gastrointestinal tract examination via FibroGastroDuodenoScopy (FGDS) to identify signs of reflux disease, esophagitis and Barrett's esophagus and GERD-HRQL (Health-Related Quality of Life) questionnaire. Results. During the study, out of 152 patients without GERD (DeMeester Index (DMI) was 6.87±3.38), 23 (15.1%) of them within 12 months after LSG developed de novo GERD (DMI 9.12±8.87, p=0.04). In four patients with de novo GERD, esophagitis grade A was detected. The pathomechanism of GERD following LSG was multifactorial, caused by a combination of anatomical, physiological, and physical factors. Contributing factors included the shape of the sleeve, damage to the lower esophageal sphincter, and esophageal motility disorders. Conclusions. LSG is effective in promoting weight loss, but poses a significant risk of developing GERD. Our study found a 15.1% incidence of GERD after LRH, which is lower than other studies, probably due to the routine use of 24-hour pH monitoring to identify patients with asymptomatic GERD. Anatomical changes due to LSG, in particular resection of the gastric fundus and dissection in the area of the angle of His, increase the temporary relaxation of the lower esophageal sphincter, contributing to the development of GERD. Keywords: bariatric surgery, morbid obesity, GERD.

Gastroesophageal reflux disease after laparoscopic sleeve gastrectomy

Background. GastroEsophageal Reflux Disease (GERD) is a common problem among obese and overweight people, including as a complication of bariatric surgery, Laparoscopic Sleeve Gastrectomy (LSG). Aim. To conduct a retrospective analysis of the frequency of GERD in patients with morbid obesity after laparoscopic sleeve gastrectomy. Materials and Methods. In this retrospective study, data from 152 patients who underwent LSG were analyzed. All patients were diagnosed with morbid obesity and were deemed suitable for surgery. The minimum follow-up period was twelve months. All patients were assessed preoperatively for the severity of GERD using 24-hour pH monitoring, and upper gastrointestinal tract examination via FibroGastroDuodenoScopy (FGDS) to identify signs of reflux disease, esophagitis and Barrett's esophagus and GERD-HRQL (Health-Related Quality of Life) questionnaire. Results. During the study, out of 152 patients without GERD (DeMeester Index (DMI) was 6.87±3.38), 23 (15.1%) of them within 12 months after LSG developed de novo GERD (DMI 9.12±8.87, p=0.04). In four patients with de novo GERD, esophagitis grade A was detected. The pathomechanism of GERD following LSG was multifactorial, caused by a combination of anatomical, physiological, and physical factors. Contributing factors included the shape of the sleeve, damage to the lower esophageal sphincter, and esophageal motility disorders. Conclusions. LSG is effective in promoting weight loss, but poses a significant risk of developing GERD. Our study found a 15.1% incidence of GERD after LRH, which is lower than other studies, probably due to the routine use of 24-hour pH monitoring to identify patients with asymptomatic GERD. Anatomical changes due to LSG, in particular resection of the gastric fundus and dissection in the area of the angle of His, increase the temporary relaxation of the lower esophageal sphincter, contributing to the development of GERD. Keywords: bariatric surgery, morbid obesity, GERD.

Preliminary results of a randomized controlled, open-label, multi-center phase II study of camrelizumab combined with chemotherapy followed by concurrent chemoradiotherapy and camrelizumab consolidation therapy versus standard chemoradiotherapy as first-line treatment for limited-disease small cell lung cancer.

e20132 Background: Immune checkpoint inhibitors combined with chemotherapy have significant clinical benefits in extensive-stage small cell lung cancer (SCLC). However, for patients with limited-disease SCLC (LD-SCLC), the data on immunotherapy combined with chemoradiotherapy is insufficient. Methods: In this open-label, multi-center, phase 2 trial, we randomly 1:1 assigned patients with previously untreated LD-SCLC to receive camrelizumab combined with chemotherapy followed by concurrent chemoradiotherapy (CCRT) and camrelizumab consolidation therapy or standard chemoradiotherapy. Patients with ECOG performance status of 0 to 1, and adequate organ function were eligible. For thoracic radiation, 45 Gy in 3 weeks (1.5 Gy, BID) was given on the first day of the third cycle of chemotherapy. An etoposide plus platinum-based regimen was given 4 cycles in total. Patients who had a good response to initial treatment were offered prophylactic cranial irradiation. The primary endpoint was the 1-year progression-free survival rate. We assumed that the 1-year PFS rate in the experimental group was expected to reach 65% compared to chemoradiotherapy alone group 45%, and planned to enroll 112 patients with 56 in each group. Results: Up to date, we have enrolled 40 patients. The median follow-up was 10.6 months. Safety was evaluated in all treated patients. No Grade 5 adverse event was observed. Grade 3 or 4 treatment-related adverse events occurred in 58.8% of the patients in the camrelizumab plus chemoradiotherapy and in 52.9% of those in the chemoradiotherapy alone group. The most frequent grade 3 or 4 adverse events were hematologic toxicities (70.6% vs. 58.8%). Acute esophagitis and pneumonitis of grade 3 occurred in both groups were 1/17 (5.9%) and 1/17 (5.9%), respectively. In the experimental group, only one patient was developed grade 3 immune pneumonia 1/17 (5.9%). The 1-year PFS rate was 54.5% (95% confidence interval [CI] 19.5%-89.6%) with camrelizumab plus chemoradiotherapy and 44.4% (95% CI 3.9%-88.0%) with chemoradiotherapy alone. Among the 17 patients who received camrelizumab, the median PFS time was not reached, as compared with 14.35 (95% CI, 8.15-20.91) months among the 17 patients with chemoradiotherapy alone. Conclusions: In patients with LD-SCLC, the addition of camrelizumab to chemoradiotherapy did not increase the incidence of adverse events. Camrelizumab plus chemoradiotherapy resulted in an encouraging 1-year PFS rate. Larger sample sizes and longer follow-up times are required to validate our preliminary results. Clinical trial information: ChiCTR2000032275.

Cystine and theanine for chemoradiotherapy-induced esophagitis in non-small cell lung cancer: a prospective observational study.

Although several potential radioprotectants have been explored, radiation esophagitis is still difficult to control. Further development of supportive therapies is required. Our purpose was to investigate the efficacy and safety of cystine and theanine for esophagitis in non-small cell lung cancer (NSCLC) patients undergoing chemoradiotherapy (CRT). This study is a prospective observational study. The participants were recruited from unresectable locally advanced NSCLC who had scheduled to receive weekly paclitaxel or nab-paclitaxel/carboplatin plus radiation therapy (60Gy in 30 fractions) for 6weeks. They took an oral amino acid supplement containing 700mg cystine and 280mg theanine once daily regardless of CRT timing from the start of CRT until completion. The primary endpoint was the incidence of any grade esophagitis. The secondary endpoints were quality of life (QoL) and adverse events (AEs). A total of 26 patients were evaluated. All participants completed 60Gy of RT in 30 fractions. The overall incidence of esophagitis was 73%; however, no ≥ grade 3 was reported. There were no AEs likely to be related to cystine and theanine. The mean EuroQoL 5-Dimension 5-Level health index score before and after chemoradiotherapy was 0.952 ± 0.0591 and 0.952 ± 0.0515 (P = 0.89), and the mean Visual Analogue Scale scores before and after treatment were 67.9 ± 15.4 and 79.4 ± 13.2 (P = 0.0047), respectively. Our study showed no severe esophagitis, any AEs, nor QoL decrease in NSCLC patients receiving CRT. Cystine and theanine are potentially effective to reduce severe CRT-induced esophagitis. UMIN000052622, 26 October 2023, retrospectively registered.

Association of Radiation-Induced Acute Esophagitis With Dosimetric Parameters of Oesophagus in Breast Carcinoma Patients Receiving Supraclavicular Nodal Irradiation.

We conducted this investigation to ascertain the dosimetric properties such as the mean and maximum radiation dosage during radiotherapy as well as the extent of radiation exposure to the esophagus. These factors can potentially impact the development of esophagitis in breast cancer patients undergoing supraclavicular radiation. From January to June 2023, an observational study was conducted at Bangabandhu Sheikh Mujib Medical University in Bangladesh. The patients received radiation therapy (40.05 Gy in 15 parts) to the chest wall and supraclavicular node for three weeks. We were able to guess the following from the dose volume histogram (DVH) data: the length of the esophagus in the treatment area (i.e., the size of the esophagus that was visible on the planning CT scan), the maximum dose (Dmax), the mean dose (Dmean), and the volume of the 10Gy (V10Gy) and 20Gy (V20Gy) doses that were given to the esophagus. During radiotherapy, patients were checked on once a week, and the radiotherapy oncology group was used to evaluate and grade esophagitis Results: Patients with left-sided breast cancer showed a higher Dmean, Dmax, and length of the esophagus compared to those with right-sided breast cancer. Specifically, the Dmean was 6.7 (±2.1) Gy, the Dmax was 39.2 (±1.5) Gy, and the length of the esophagus was 6.1 (±1.2) Gy. Patients with left breast cancer had elevated V10Gy and V20Gy values for the esophagus, but the difference was not statistically significant. The incidence of V10Gy for right-sided breast cancer and left-sided breast cancer was 4.2% (±2.6%) and 19.8% (±9.2%), respectively. The V20Gy was 2.4% (±0.9%) for right-sided breast cancer and 13.09% (±5.0%) for left-sided breast cancer Conclusion: In conclusion, there is a strong association between the mean oesophageal dose and radiation to the left supraclavicular region following surgery in women with breast cancer and acute esophagitis. We can reduce esophageal toxicity by prescribing dose restrictions and performing precise delineation of the esophagus.

Thrombocytopenia and Grading of Esophageal Varices in Patients With Chronic Liver Disease.

Background Chronic liver disease (CLD) is associated with a variety of consequences, including thrombocytopenia and esophageal varices, which significantly impact patient prognosis and management. Thrombocytopenia, frequently observed in patients with CLD, may correlate with the severity of esophageal varices, a critical complication leading to variceal bleeding. Methodology A cross-sectional study was carried out in the Department of Medicine and Gastroenterology, Pak Emirates Military Hospital, Rawalpindi, from October 2021 to March 2022. The study enrolled 94 patients, aged 18-70 years, diagnosed with CLD, regardless of the cause. These patients were categorized into four groups based on platelet count: <50,000/uL, 50,000-99,999/uL, 100,000-150,000/uL, and >150,000/uL. Pearson's correlation was utilized to evaluate the association between the severity of thrombocytopenia and the grading of esophageal varices. Results A total of 94 patients were enrolled in the study, with 53 (56.4%) males and 41 (43.6%) females. The mean age of patients was 51.06 ±11.09 years. Seventeen (18.1%) had no esophageal varices, 16 (17.0%) were diagnosed with Grade I varices, 35 (37.2%) with Grade II varices, and 26 (27.7%) had Grade III varices. Most patients without varices had a platelet count above 150 x 103 (17, 18.1%). Conversely, most patients with Grade III varices (19, 20.2%) had platelet counts below 50 x 103. Patients with no esophageal varices had a mean platelet count of 173.70 ± 37.48 x 103. Among the patients, those with Grade III esophageal varices exhibited the lowest mean platelet count, recorded at 78.54 ± 24.14 x 103. These findings indicate a statistically significant difference in mean platelet counts across the various esophageal varices grades (P = 0.000). There was an inverse correlation of platelet count with the grading of esophageal varices (r= -0.645, P < 0.000). Conclusions Anegative correlation was observed between the platelet count and the grading of esophageal varices, implying that as the severity of esophageal varices increased, the platelet counts proportionally decreased.

Balancing robustness and adaptation rate for proton therapy of lung cancer patients

IntroductionAn increase in plan robustness leads to a higher dose to organs-at-risk (OARs), and an increased chance of post-treatment toxicities. In contrast, more conformal plans lead to sparing of healthy surrounding tissue at the expense of a higher sensitivity to anatomical changes, requiring costly adaptations. In this study, we assess the trade-off and impact of treatment plan robustness on the adaptation rate. MethodTreatment planning was performed for 40 lung cancer patients, each having a planning 4DCT and up to eight weekly repeated 4DCTs (reCTs). For each patient, plans were made with three different levels of robustness based on setup uncertainty of 3, 6 and 9 mm. These plans were robustly re-evaluated on all reCTs to assess whether the clinical constraints were met. ResultsFor the 3, 6 and 9 mm robustness levels, adaptation rates of 87.5 %, 70.0 % and 57.5 %, respectively, were observed. A mean absolute normal tissue complication probability (NTCP) gain of 2.9 percentage points (pp) was calculated for pneumonitis grade ≥ 2 when transitioning from 9 mm plans to 3 mm plans, 7.6 pp for esophagitis grade ≥ 2, and 2.5 pp for mortality risk 2 years post-treatment. ConclusionThe lowered risk of post treatment toxicities at lower robustness levels is clinically relevant but comes at the expense of more treatment adaptations, particularly in cases where meeting our clinical goals is not compromised by having a dose that is more conformal to the target. The trade-off between workload and reduced NTCP needs to be individually assessed.

Cytokine-determined mechanisms of the pathomorphological realization of gastroesophageal reflux disease against the background of autoimmune thyroiditis in young persons

The aim: to study the features of proinflammatory cytokine status and pathomorphological realization of gastroesophageal reflux disease (GERD) against the background of autoimmune thyroiditis (AIT) in young people.&#x0D; Materials and methods. Examinations involved 120 patients with GERD and AIT and 45 people with isolated GERD. The control group consisted of 20 volunteers matched by age, gender, and social status. All patients underwent esophagogastroduodenoscopy, histological study, comparative morphometry of the esophageal mucosa, and determination of proinflammatory cytokines’ levels: interleukin‑1β (IL‑1β), IL‑18, tumor necrosis factor‑α (TNF‑α).&#x0D; Results. The frequency of erosive GERD in the examined groups of patients did not statistically differ. At the same time, analysis of the structure of erosive GERD forms revealed a significant redistribution of esophagitis grades towards its enhancement in patients with comorbid pathology. The histological study showed that in patients with nonerosive GERD and AIT all the studied morphometric parameters had significantly deeper changes and exceeded similar indicators of the group with isolated GERD: epithelium total thickness 319.3±9.1 µm against 286.1±8.2 µm (p &lt;0.01), epithelium basal layer thickness 79.6±3.2 µm versus 49.7±2.1 µm (p &lt;0.01), connective tissue papillae height 224.8±7.3 µm against 172.7±4.6 µm (p &lt;0.01), intercellular space 1.55±0.11 µm versus 1.12±0.09 µm (p &lt;0.01). The presence of concomitant AIT was associated with a significant redistribution towards increased degrees of hyperplasia of the basal layer of the epithelium, elongation of the papillae, and leukocyte infiltration. The comorbidity of GERD and AIT in young people was associated with significant increase in the blood serum levels of proinflammatory cytokines in compared to isolated GERD: IL‑1β — 29.6 pg/ml versus 17.7 pg/ml (p &lt;0.01), IL‑18—1763.4 pg/ml versus 614.6 pg/ml (p &lt;0.01), TNF‑α — 7.6 pg/ml versus 5.2 pg/ml (p &lt;0.01). Correlation analysis of the cytokine content and expressivity of certain morphometric parameters of the esophageal mucosa revealed the direct correlations.&#x0D; Conclusions. GERD and euthyroid AIT comorbidity in the student population is accompanied by significant redistribution of esophagitis grades towards its aggravation. The presence of concomitant AIT in patients with non‑erosive GERD leads to the significant intensification of the degree of epithelium basal layer hyperplasia, connective tissue papillae elongation, and polymorphic cellular inflammatory infiltration in comparison with isolated GERD, while these deviations demonstrate direct correlations with the levels of IL‑1β, IL‑18, and TNF‑α.&#x0D;

Vonoprazan (Voquezna) for erosive esophagitis.

The FDA has approved vonoprazan (Voquezna – Phathom), a potassium-competitive acid blocker, for healing and maintenance of healing of all grades of erosive esophagitis and relief of associated heartburn in adults. Vonoprazan is also available copackaged with amoxicillin (Voquezna Dual Pak) and with amoxicillin and clarithromycin (Voquezna Triple Pak) for treatment of Helicobacter pylori infection in adults.

Results of laparoscopic Heller-Toupet operation for achalasia

Objectives: This study was carried out to evaluate surgical outcomes of laparoscopic Heller-Toupet surgery for achalasia. Methodology: This is a retrospective case series implemented at the Gastrointestinal Department, Hanoi Medical University Hospital between January 2015 and August 2022, including 71 patients with achalasia who underwent laparoscopic Heller-Toupet. Results: 52.1% of patients in the study are male (more than female 47.9%). The average age of the cohort was 44.9±13.9 years. The incidence of dysphagia was 100%. Most patients report esophageal dilatation grade II (76.1%) and disease severity stage I (57.7%). The mean muscle opening length was 7.4±1.3 cm, the operative time was 135±25 minutes. There was no conversion, no intra-and postoperative adverse events. Long-term outcomes: good (no or very mild dysphagia) was 90.1%, moderate (moderate dysphagia) was 9.9% and clinical incidence of reflux syndrome was 17%. There was no case requiring intervention or re-operation. Conclusions: Laparoscopic Heller-Toupet is a safe, low rate of intra- and postoperative complication, and brings good long-term outcomes in the treatment of achalasia.

IBC-Oxford University2023_BJSOral_11Video Presentation: Laparoscopic Total Gastrectomy after Single Anastomosis Sleeve Jejunal Bypass

Abstract Introduction Amongst today's bariatric surgery procedures is the single anastomosis jejunal bypass operation (SASJ), which was first introduced by Professors Abdolreza Pazouki and Mohammad Kermansaravi. Single anastomosis sleeve ileal bypass (SASI) is a combined bariatric metabolic technique, in which few studies have shown its outcomes efficacy. However, this technique has a high risk of malnutrition due to long biliopancreatic limb. Single anastomosis sleeve jejunal bypass (SASJ) has a shorter limb. Therefore, it seems to have a lower risk of nutrient deficiency. Furthermore, this technique is relatively new, and little is known about the efficacy and safety of SASJ. Obesity is a significant risk factor for cancer incidence and mortality. The number of patients with obesity who undergo bariatric surgery is increasing; however, the impact of such a procedure in affecting the risk of cancer is not completely understood yet. The association between obesity and malignancies has been identified epidemiologically. Meanwhile, the increasing global number of bariatric surgeries is reported annually; bariatric surgery’s effect on different types of cancers is not well understood. Unfortunately, nonspecific presentations and difficulties regarding investigations make diagnosis challenging. Methods In this video case report, the patient was 62-year-old female with an initial BMI 44.2 kg/m2, weight: 116 kg and Height: 162 cm at the time of SASJ 6 years ago, upper gastrointestinal Endoscopy from 2017 before SASJ operation showed reflux esophagitis grade A and erosive erythematous hyperaemic mucosa gastritis. She underwent primary laparoscopic SASJ bypass in 2017. However, she had adequate weight loss for 5 years post-operative, and then she had excessive weight loss during past year. According to the patient history she suffers heart burn, anorexia, nausea and vomiting since1 year back, usually vomiting is present 2 hours postprandial with dark and black coloured content, and now her BMI is 21kg/m2. She had an upper GI endoscopy during past year, the last endoscopy report in 2023 commented on active and focally ulcerative mucosa with some atypical cells with signet ring pattern and chronic inflammatory responses, and biopsy showed adenocarcinoma of the stomach. Thorax, abdomen and pelvic CT scans were normal with no pathology is seen in upper GI contrast study. Laboratory findings were normal. A Laparoscopic Roux-en Y oesophago-jejunal bypass with a 75cm biliopancreatic limb and 75cm alimentary limb were performed. The patient was under complete screening for all over the last 1 so surgery is performed in first after confirmation of histopathology report before chemoradiotherapy (CRT). Results The operative time was 210 min and blood loss were 150ml. There were no intraoperative or postoperative complications. The patient had an uneventful postoperative course and was discharged on postoperative day 8. Conclusion Laparoscopic total gastrectomy with dissection of all lymph node from gastric stations is performed prior to the chemoradiotherapy for reaching the purpose of early malignancy control.

Association Between Esophagitis Severity and GERDQ Score, Sleep, Life Quality among GERD Patients

Background: Gastroesophageal reflux disease (GERD) is characterized with acid reflux, therefore may lead to esophagitis. Acid reflux may cause night symptom of GERD, therefore resulting in decreased sleep and life quality. Gastroesophageal reflux disease questionnaire (GERDQ) is a simple and validated questionnaire for diagnosing GERD. This article aims to investigate association between esophagitis severity and GERDQ score, sleep, life quality among GERD patients at Prof. Dr. R.D. Kandou Hospital.Method: An analytic-cross-sectional study was conducted in gastroenterology clinic of Prof. Dr. R.D. Kandou Hospital between May–June 2021. We included all patients with reflux esophagitis that proven by esophagoduodenoscopy and the severity was graded using Los-Angeles criteria. The GERDQ score was calculated in all patients. The analysis of sleep and life quality was assessed using validated Indonesian version of Pittsburgh-Sleep-Quality-Index (PSQI) and WHO-quality-of-life-BREF (WHOQOLBREF) questionnaire. Independent T-test was used to compare GERDQ, PSQI, WHOQOLBREF score with esophagitis severity degree.Results: Among 30 patients with esophagitis, 70% was male. We found 22 patients with Los-Angeles-grade-A and 8 patients with Los-Angeles-grade-B. The analysis showed no significant different between GERDQ score with esophagitis grade (p = 0.753). There was no association between esophagitis grade with sleep quality (p = 0.125), physical health (p = 0.161), psychological health (p = 0.728), and environmental health (p = 0.133). But we found significant association between esophagitis grade with social relationship life quality (p = 0.028).Conclusion: Patients with higher esophagitis degree had lower social relationship, but not associated with another domain of WHOQOLBREF, sleep quality, and GERDQ score.

Uncertainty-aware network for fine-grained and imbalanced reflux esophagitis grading

Computer-aided diagnosis (CAD) assists endoscopists in analyzing endoscopic images, reducing misdiagnosis rates and enabling timely treatment. A few studies have focused on CAD for gastroesophageal reflux disease, but CAD studies on reflux esophagitis (RE) are still inadequate. This paper presents a CAD study on RE using a dataset collected from hospital, comprising over 3000 images. We propose an uncertainty-aware network with handcrafted features, utilizing representation and classifier decoupling with metric learning to address class imbalance and achieve fine-grained RE classification. To enhance interpretability, the network estimates uncertainty through test time augmentation. The experimental results demonstrate that the proposed network surpasses previous methods, achieving an accuracy of 90.2% and an F1 score of 90.1%.

Tailoring follow-up endoscopy in patients with severe oesophagitis

ObjectiveWe aimed to investigate the clinical utility of follow-up oesophagogastroduodenoscopy (OGD2) in patients with severe oesophagitis (Los Angeles grades C or D) through evaluating the yield of Barrett’s oesophagus (BO),...