Real world management of esophageal ulcers : analysis of their presentation, etiology, and outcomes

Background and study aims : Esophageal ulcers are a rare cause of upper gastrointestinal morbidity and may be due to different etiologies. We sought to systematically evaluate patients with esophageal ulcers and describe their presentations, endoscopic findings, etiologies, treatments, and outcomes. Patients and methods : Patients diagnosed with esophageal ulcers over an 11-year period were retrospectively identified from our institution’s electronic medical records. Results : We identified 100 patients with esophageal ulcers (0.49% of patients undergoing upper endoscopy). Half of them presented due to gastrointestinal bleeding and three-quarters were admitted to the hospital. The majority were in the lower esophagus. Twenty-two unique etiologies, including multiple iatrogenic causes, were diagnosed in 91 of the cases. The most common etiology was gastroesophageal reflux disease (57%), followed by non-steroidal anti-inflammatory drug use (7%), malignancies (3%), vomiting (3%), caustic ingestion (2%), pill esophagitis (2%) and radiation (2%). Many etiologies showed a predilection for specific segments of the esophagus. Nine ulcers required endoscopic intervention and all were treated successfully. Repeat endoscopies were performed 5 times for diagnostic or “second look” reasons, none of which changed the patients’ diagnosis or treatment. No patients required surgery or stricture dilation. One patient’s ulcer was complicated by perforation and he subsequently died. Four other patients died from non-ulcer related causes. Conclusions : While the majority of ulcers were due to gastro-esophageal reflux disease, 22 different etiologies were identified. Many were due to medication or iatrogenic causes. Repeat endoscopy did not appear to be helpful. While the incidence was low, they were frequently associated with significant morbidity.

EFFICACY OF ENDOSCOPIC TOPICAL MITOMYCIN C APPLICATION IN CAUSTIC ESOPHAGEAL STRICTURES IN THE PEDIATRIC POPULATION: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

ABSTRACT BACKGROUND: Caustic ingestion and development of esophageal strictures are recognized major public health problems in childhood. Different therapeutic methods have been proposed in the management of such strictures. OBJECTIVE: To evaluate efficacy and risk of endoscopic topical application of mitomycin C in the treatment of caustic esophageal strictures. METHODS: We searched MEDLINE, EMBASE, Central Cochrane, and LILACS databases. The outcomes evaluated were dysphagia resolution rate, number of dilations performed in resolved cases, and the number of dilations performed in all patients. RESULTS: Three randomized clinical trials were included for final analysis with a total of 190 patients. Topical mitomycin C application group showed a significant increase in dysphagia resolution rate, corresponding to a 42% higher dysphagia resolution as compared to endoscopic dilation alone, with statistical significance between the two groups (RD: 0.42 - [CI: 0.29-0.56]; P-value <0.00001). The mean number of dilations performed in resolved cases were significantly less in the topical mitomycin C application group, compared to endoscopic dilations alone, with statistical significance between the two groups (MD: 2.84 [CI: 1.98-3.69]; P-value <0.00001). When comparing the number of dilations in all patients, there was no statistical difference between the two groups (MD: 1.46 [CI: -1.53-4.44]; P-value =0.34). CONCLUSION: Application of topical mitomycin C with endoscopic dilations in caustic esophageal strictures was more effective in dysphagia resolution than endoscopic therapy alone in the pediatric population. Moreover, topical mitomycin C application also reduced the number of dilation sessions needed to alleviate dysphagia without rising morbidity.

Ingestione di corpi estranei e di caustici nei bambini

Foreign bodies or caustic ingestion is a frequent occurrence in children and can result in significant morbidity. Managing these conditions requires different levels of experience and expertise. An en-doscopy is often necessary but an incorrect use of this procedure is common. Indications and timing of endoscopy mainly depends on the clinical conditions of the child, the type of object and its posi-tion or the type of substance. The Italian Society of Gastroenterology, Hepatology and Pediatric Nutrition (SIGENP) together with the Italian Association of Gastroenterologists and Hospital En-doscopists (AIGO) has produced the first Italian guidelines for the management of the ingestion of foreign and caustic bodies in children.

Trauma of the Larynx and Cervical Esophagus

Upper aerodigestive tract trauma is rare occurrence, but can have devastating consequences. Immediate complications including airway compromise can be life threatening and complicate resuscitative efforts. Long-term sequelae can significantly affect a patient’s quality of life by limiting one’s ability to breathe, phonate, and/or swallow. This review provides an overview of upper aerodigestive trauma, where many of these injuries occur concomitantly, but this text is divided into three main categories of: laryngeal framework, upper aerodigestive perforation, and adult caustic ingestion. The initial management of these injuries can be reflexive and mundane, but also are frequently nuanced and challenging, where personal experiences in management of these patients results in mastery. This review contains 9 figures, 4 tables and 82 references. Keywords: Laryngeal trauma, laryngeal facture, esophageal perforation, caustic ingestion