Search

AbstractObjectiveMaterial and methodsResultsConclusionsEosinophilic esophagitis (EoE) is a chronic immune-mediated disease. The budesonide orodispersible tablet (BOT) is recommended as second-line treatment according to the Danish guideline. This study aimed to compare potential treatment disparities before BOT initiation, follow-up practices, clinico-histologic remission rates during BOT treatment, and adherence to the national guideline between the highly specialized EoE-Cph cohort and the population-based DanEoE cohort.This cohort study compared 65 adult patients from the EoE-Cph cohort with 65 patients from the DanEoE cohort. All patients were diagnosed between 2015-2021. The diagnosis of EoE was defined according to the AGREE consensus. Data were extracted manually from medical records and registries.In the EoE-Cph cohort, 88% were prescribed proton pump inhibitors (PPIs) before started on BOT compared to 100% in the DanEoE cohort (p = 0.0035). Symptomatic follow-up occurred in 89% of EoE-Cph patients compared to 97% of DanEoE patients after BOT treatment (p = 0.0841). No difference was found between patients who underwent histologic follow-up after topical steroid treatment (83% versus 82%, p = 0.8162). Complete clinico-histologic remission was frequently observed, and no significant difference was observed between the two cohorts (67% versus 80%, p =0.1789). One out of four patients had conflicting symptomatic and histological responses.This study did not provide conclusive evidence favoring the treatment of EoE patients exclusively at highly specialized EoE centers. However, the authors acknowledge that further evidence is necessary before considering changes in clinical practice. Conflicting treatment responses, and discontinuation of treatment due to side effects remains a notable concern. [ABSTRACT FROM AUTHOR]

Background: Eosinophilic oesophagitis (EoE) is a chronic immune-mediated disease. In Denmark, the budesonide orodispersible tablet (BOT) is recommended as a second-line treatment for proton pump inhibitor-refractory EoE patients. Aims: To evaluate the effectiveness of treatment with BOT in adult EoE patients in a population-based setting in Denmark. Methods: This was a retrospective, registry-based, DanEoE cohort study of all 76 adult EoE patients treated with BOT and diagnosed between 2007 and 2021 in the North Denmark Region. After medical record revision, the EoE diagnosis was defined according to the AGREE consensus. Symptomatic response was based on the information found in the patients' medical reports and histologic remission was defined as <15 eosinophils per high-power field (eos/hpf). Results: Histologic remission was achieved in 89% of the patients treated with BOT who underwent histologic evaluation. Clinicohistologic remission was achieved in 71% of the patients who underwent both symptomatic and histologic evaluation. Despite histologic remission, 18% of patients still experienced symptoms. Non-responders were found in 7% of the patients. Complications were rare, with dilation of strictures performed in 7% and food bolus obstruction (FBO) occurring in 3%. Discontinuation of the treatment due to unacceptable side effects was observed in 11% of the treated patients. Conclusions: Treatment with BOT effectively induced histologic remission in most of the EoE patients. Despite achieving histologic remission, approximately 1/5 of the patients were still symptomatic. Complications were rare. In non-responders and those with unacceptable side effects, alternative treatment options such as biologic agents might be needed. [ABSTRACT FROM AUTHOR]

Background: Clinical cancer registries are intended to reflect the reality of care through differentiated data analysis and, if necessary, to offer approaches for improving care. Methods: For the years 2000–2018, the data of the Clinical Epidemiological Cancer Registry Brandenburg-Berlin were examined separately for adenocarcinoma and squamous cell carcinoma with respect to epidemiology and health care reality. Results: Between 2000 and 2018 a total of 3207 esophageal cancers were documented in the cancer registry, of which 2182 were squamous cell carcinomas (ESCC), 843 adenocarcinomas (EAC) and 182 various others or missing histology. During the observation period there was a clear dominance of ESCC but with a significant increase in EAC in both sexes. Overall, the rate of new cases was 5 times higher for men than for women. The relative 5‑year survival probability of all esophageal cancers was 17.4% in men and 22.5% in women. Patients with EAC survived significantly longer than those with ESCC. Radiotherapy and chemotherapy, individually or in combination, were mainly used as treatment methods. Surgery was performed on 19% of ESCC and 42% of EAC. Conclusion: The proportion of ESCC in Brandenburg is still significantly higher than EAC, with a significant increase for the latter, especially in men. Although locally advanced tumors have been significantly more common, modern neoadjuvant concepts have rarely been documented, and although the quality of the surgery is comparable to the international standard, surgery is carried out in relatively few patients. [ABSTRACT FROM AUTHOR]

We investigate the flow dynamics within an elastic tube transporting a power-law fluid, where the tube is subject to a specified external forcing in the form of a progressive traveling wave. The oesophagus is cylindrical in shape and exhibits linear elastic properties. The flow is creeping, and the long wavelength and low Reynolds number approximations are employed for a solution. The relationship between the pressure distribution within the oesophagus and the radial variation of the tube characterizes the behavior of the tube. Findings reveal that the elasticity and the variations in the applied dilating forcing amplitude substantially impact pressure resulting from sinusoidal wave forcing. Notably, even a nominal increase in the inward radial force amplitude for dilatant fluid results in significant pressure changes compared with Newtonian fluid. We also observe a notable distinction between time-averaged volume flow rate and velocity in pseudo-plastic and dilatant forms. Our study also identifies that the radial velocity experiences either attenuation or enhancement due to the fluid's shear thickening and thinning characteristics. Moreover, our research uncovers a novel dimension by highlighting that in shifting from pseudo-plasticity to dilatancy, the fluid requires higher pressure to propel the bolus toward the hiatus. This observation has important implications, suggesting that feeding a more dilatant fluid to patients with pre-diagnosed swallowing disorders, such as sliding hiatus hernia, is not advisable, fearing increased pressure. [ABSTRACT FROM AUTHOR]

Background and Aims: Analysis of mean nocturnal baseline impedance (MNBI) and post‐reflux swallow‐induced peristaltic wave index (PSPWi) have been proposed to increase the diagnostic yield of pH‐impedance studies in reflux disease. However, routine use of these indices in clinical studies is yet to be established, particularly with PSPWi, which requires laborious manual analysis. Our study aimed to assess the utility of MNBI and PSPWi and their potential for future incorporation into clinical practice. Methods: pH‐impedance recordings from consecutive patients referred to the Motility Laboratory at Royal Adelaide Hospital for evaluation of gastro‐oesophageal reflux disease (GORD) were prospectively collected and manually analysed. Baseline demographic characteristics, symptoms, acid exposure time (AET), number of reflux episodes, and MNBI and PSPWi were collected. Results: Eighty‐nine patients were included in the study (age 50 ± 17 years, 35 males). MNBI and PSPWi inversely correlated with AET (R = −0.678, P < 0.0001 and R = −0.460, P < 0.0001 respectively) and with reflux episodes (R = −0.391, P = 0.0002 and R = −0.305, P = 0.0037 respectively). In patients with a negative pH study, but with typical reflux symptoms, 4/30 (13%) had pathologic MNBI and PSPWi. There was a positive correlation between MNBI and PSPWi values (R = 0.525, P < 0.0001). Performing analysis of PSPWi was substantially more laborious than MNBI. Conclusion: MNBI and PSPWi are both useful adjuncts in the diagnosis of reflux disease, although in our cohort MNBI showed stronger correlation with AET with less time to analyse. The role of these indices remains to be further explored, particularly in patients with inconclusive AET and in those with positive compared to negative symptom association. [ABSTRACT FROM AUTHOR]

Extra-abdominal desmoid fibromatosis arising from the oesophagus and the contemporaneous traction diverticula due to an oesophageal tumour is extremely rare. We present this complex situation in a 2-year-old girl which posed a surgical challenge requiring simultaneous management of multiple pathologies. Surgery addressed both the entities and the presence of the diverticulum facilitated achieving negative surgical margins.

An oesophageal diverticulum is a relatively rare disorder of the oesophagus which results in the outpouching of the oesophageal mucosa through a weak portion within the oesophageal lining. Oesophageal diverticula occur in

Introduction: Oesophageal cancer is the seventh most common cancer worldwide and the sixth highest cause of cancer-related mortality. Radiation plays an important role in the multimodality treatment of carcinoma of the oesophagus. Aim: To compare locoregional control and toxicity of two External Beam Radiation Therapy (EBRT) fractionation schedules of concurrent chemoradiotherapy and high-dose intraluminal brachytherapy in patients with oesophageal carcinoma at a single institute. Materials and Methods: The present study was a pilot study including a total of 33 participants with histologically confirmed oesophageal cancer. Patients were prospectively randomised into two groups. Arm I: EBRT with a total dose of 46 Gy delivered in 23 fractions at a rate of 2 Gy per fraction over 4.3 weeks, along with Concurrent Injection of Cisplatin (CDDP) 100 mg/m2 on days 1 and 22, followed by Intraluminal Radiation Therapy (ILRT) with 6 Gy per session weekly. Arm II: EBRT with a total dose of 30 Gy delivered in 10 fractions at a rate of 3 Gy per fraction over two weeks and CDDP 100 mg/m2 on day 1 only. The primary endpoint of this study was to compare the locoregional response and toxicities (both acute and late) in the two arms at the end of radiotherapy and six months. Results: At the end of the two-month follow-up, no statistically significant difference was found in the response between the two arms (p-value=0.2697). Dysphagia relief was comparable in both arms; however, this difference was not statistically significant (p-value=0.9235). Conclusion: The responses in both arms were comparable, and further randomised trials with larger sample sizes should be encouraged.

Adult female and male Gongylonema nematodes were found in the oesophagus of a free-living roe deer (Capreolus capreolus) in Slovenia during passive health surveillance of wildlife. The genus Gongylonema was determined by light microscopy based on the genus-specific cuticular bosses in the anterior part of the parasite. Molecular methods were used to confirm the species Gongylonema pulchrum, which has zoonotic potential. Although Gongylonema species are considered common and distributed worldwide, this is the first report of G. pulchrum in an animal on the territory of Slovenia and the first molecular report in a roe deer worldwide. The parasite is likely to be underdiagnosed, misdiagnosed or goes unnoticed as the animals show little or no clinical signs and minor pathological lesions. Slaughterhouse workers, hunters and veterinarians should be aware of this elusive parasite. Examination and evisceration of the upper digestive tract of animals should therefore be carried out more carefully. [ABSTRACT FROM AUTHOR]

An oesophageal diverticulum is a relatively rare disorder of the oesophagus which results in the outpouching of the oesophageal mucosa through a weak portion within the oesophageal lining. Oesophageal diverticula occur in <1% of the population and are found in approximately 1-3% of those presenting with dysphagia. A 75-year-old male patient came to the surgical Outpatient Department (OPD) with chief complaints of difficulty in swallowing for 2-3 months, initially with solids which later progressed to difficulty in swallowing liquids. He was diagnosed on a Contrast-Enhanced Computed Tomography (CECT) scan with a large oesophageal diverticulum arising from the right lower lateral thoracic oesophagus just proximal to the oesophagogastric junction in the retrocardiac region with no filling defect or mucosal thickening. The patient was treated with transhiatal laparoscopic oesophageal diverticulectomy with cardiomyotomy and Dor fundoplication. For symptomatic patients, most often, minimally invasive myotomy and removal of the pouch endoscopically are advised, which may pose a surgical challenge due to the rarity of the disease. [ABSTRACT FROM AUTHOR]

Oesophageal fluoroscopy is a radiological procedure that uses dynamic recording of the swallowing process to evaluate morphology and function simultaneously, a characteristic not found in other clinical tests. It enables a comprehensive evaluation of the entire upper gastrointestinal tract, from the oropharynx to oesophagogastric bolus transport. The number of fluoroscopies of the oesophagus and the oropharynx has increased in recent decades, while the overall use of gastrointestinal fluoroscopic examinations has declined. Radiologists performing fluoroscopies need a good understanding of the appropriate clinical questions and the methodological advantages and limitations to adjust the examination to the patient's symptoms and clinical situation. This review provides an overview of the indications for oesophageal fluoroscopy and the various pathologies it can identify, ranging from motility disorders to structural abnormalities and assessment in the pre- and postoperative care. The strengths and weaknesses of this modality and its future role within different clinical scenarios in the adult population are discussed. We conclude that oesophageal fluoroscopy remains a valuable tool in diagnostic radiology for the evaluation of oesophageal disorders. [ABSTRACT FROM AUTHOR]

Aim: The primary objective was to assess the relationship between the citation number and the quality of the articles, as compared with the level of evidence and the MINORS score. This study's secondary objective was to characterize the 50 most cited articles in the field of oesophagectomy research. Background: There has been an increased need for an evaluation tool to indicate research quality. Available quality assessment tools include the Level of Evidence, the MINORS score, the Cochrane Risk of Bias 2.0 Tool, the Newcastle Ottawa Scale, CASP Appraisal Checklists, and Legend Evidence Evaluation tools. Methods: The Web of Science allowed evaluating and comparing articles on oesophagectomy research. The quality of the 50 most cited articles was assessed using the Oxford Centre level of evidence classification and the methodological index for non-randomized studies (MINORS). Results: Level of evidence II studies were cited more than level IV (P=0.008). There was a significant positive correlation between citation number and MINORS score (P=0.002). The median MINORS score was highest amongst level II studies, followed by levels III, IV, and I. The median MINORS score for level II evidence was significantly higher than for level IV (P=0.001). The study sample size is associated with higher levels of evidence but does not correlate with the citation number. Female authors contributed to 4 out of 50 articles. Recently published articles tended to be cited more frequently. More authors equated to more citations. Prospective studies are more likely to be cited. Conclusion: Citation analysis can be used as an indicator of quality when assessing articles. It should, however, be used with caution as highly cited work, famous authors, and journals are all more likely to be cited. Citation analysis should be used alongside other well-established tools. [ABSTRACT FROM AUTHOR]

Introduction: Oesophageal cancer is the seventh most common cancer worldwide and the sixth highest cause of cancer-related mortality. Radiation plays an important role in the multimodality treatment of carcinoma of the oesophagus. Aim: To compare locoregional control and toxicity of two External Beam Radiation Therapy (EBRT) fractionation schedules of concurrent chemoradiotherapy and high-dose intraluminal brachytherapy in patients with oesophageal carcinoma at a single institute. Materials and Methods: The present study was a pilot study including a total of 33 participants with histologically confirmed oesophageal cancer. Patients were prospectively randomised into two groups. Arm I: EBRT with a total dose of 46 Gy delivered in 23 fractions at a rate of 2 Gy per fraction over 4.3 weeks, along with Concurrent Injection of Cisplatin (CDDP) 100 mg/m2 on days 1 and 22, followed by Intraluminal Radiation Therapy (ILRT) with 6 Gy per session weekly. Arm II: EBRT with a total dose of 30 Gy delivered in 10 fractions at a rate of 3 Gy per fraction over two weeks and CDDP 100 mg/m² on day 1 only. The primary endpoint of this study was to compare the locoregional response and toxicities (both acute and late) in the two arms at the end of radiotherapy and six months. Results: At the end of the two-month follow-up, no statistically significant difference was found in the response between the two arms (p-value=0.2697). Dysphagia relief was comparable in both arms; however, this difference was not statistically significant (p-value=0.9235). Conclusion: The responses in both arms were comparable, and further randomised trials with larger sample sizes should be encouraged. [ABSTRACT FROM AUTHOR]

Objectives: Angico gum (AG) (Anadenanthera colubrina var. Cebil [Griseb.] Altschul) is utilized by some Brazilian communities to alleviate symptoms from gastroesophageal reflux disease. Here, we aimed to investigate the "in vitro" topical protective capacity of AG on human esophageal mucosa. Methods: Biopsies of the distal esophageal mucosa were collected from 35 patients with heartburn (24 non-erosive and 11 with erosive oesophagitis (EE)) and mounted in Üssing chambers. AG was applied topically, followed by exposure with acid solution (pH 2.0 or pH 1.0), where transepithelial electrical resistance (TER) and The transepithelial permeability for fluorescein was assessed. The incubation of the AG labeled with FITC in the esophageal mucosa was localized by fluorescence microscopy. Key findings: Pretreatment with AG prevented the drop in TER induced by acid solution, as well as significantly decreases the fluorescein permeability in non-erosive patients. The protective effect of AG was sustained for up to 120 min both in biopsies of non-erosive and erosive esophagitis. Confocal microscope images showed mucosal luminal adherence of FITC-labeled AG. Conclusion: AG had a prolonged topical protective effect against acid solution in mucosal biopsies of patients with non-erosive and erosive esophagitis. Graphical Abstract [ABSTRACT FROM AUTHOR]

Background: To comprehend the complex interplay of multiple risk factors impacting survival at a localized level is imperative. This study aimed to explore survival patterns and identify the underlying causal factors linked to mortality risk in the region. Methodology: Data from 200 patients with esophageal cancer treated at three prominent hospitals over the course of one year is collected for the study purpose. The Kaplan‒Meier curve and Cox proportional hazard regression model were employed. Results: This study identified smokeless tobacco consumption habits showing a 6-fold elevated mortality risk (HR 6.22, p

Summary Managing equine patients that require prolonged periods of nasogastric intubation can be difficult and may require the use of repeated intubation or use of an in‐dwelling nasogastric tube. Both approaches present potential risks for complications from nasal, pharyngeal and oesophageal trauma. Diagnosis and treatment of cranial oesophageal lesions can be particularly challenging due to the anatomy of this region. [ABSTRACT FROM AUTHOR]

The present study focused on the histogenesis of the crop in quail embryos. The developmental sequence was recorded from day 10 of incubation to the hatching day (17th day) by gross anatomy, morphometric analysis and by using light and scanning electron microscope (SEM). Grossly, the crop was distinguished as an enlarged pouch of the cervical oesophagus on the 12th day of incubation. Histologically, the development of the crop began on the 10th day of incubation. The muscularis mucosae was observed as a small, thin layer of myoblast cells on the 10th day, then it appeared as longitudinally arranged smooth muscle fibres with progression of the developmental age till hatching day. The submucosal layer was also observed on the 10th day, while the lamina propria, muscular layer (inner circular and outer longitudinal layers of smooth muscle fibre) and glandular primordia were detected on the 12th day. The epithelial cells of crop revealed affinity for PAS stain and AB‐PAS on the 10th day of incubation till the 17th day, while the affinity for AB stain appeared on the 14th day of incubation. Additionally, the glandular cells showed the positive for AB, PAS and AB‐PAS on the 12th day of incubation. SEM sections showed variable sizes of the openings of the oesophageal glands. In conclusion, the present study provided a detailed overview of the histogenesis of the crop in quail embryos. [ABSTRACT FROM AUTHOR]

Background: Despite deprescribing initiatives to curb overutilization of proton pump inhibitors (PPIs), achieving meaningful reductions in PPI use is proving a challenge. Summary: An international group of primary care doctors and gastroenterologists examined the literature surrounding PPI use and use-reduction to clarify: (i) what constitutes rational PPI prescribing; (ii) when and in whom PPI use-reduction should be attempted; and (iii) what strategies to use when attempting PPI use-reduction. Key Messages: Before starting a PPI for reflux-like symptoms, patients should be educated on potential causes and alternative approaches including dietary and lifestyle modification, weight loss, and relaxation strategies. When commencing a PPI, patients should understand the reason for treatment, planned duration, and review date. PPI use at hospital discharge should not be continued without a recognized indication for long-term treatment. Long-term PPI therapy should be reviewed at least annually. PPI use-reduction should be based on the lack of a rational indication for long-term PPI use, not concern for PPI-associated adverse events. PPI use-reduction strategies involving switching to on-demand PPI or dose tapering, with rescue therapy for rebound symptoms, are more likely to succeed than abrupt cessation. [ABSTRACT FROM AUTHOR]

Copyright of Summa, Animali da Compagnia is the property of Point Veterinaire Italie s.r.l. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Summa, Animali da Compagnia is the property of Point Veterinaire Italie s.r.l. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introperative nerve monitoring (IONM) of the recurrent laryngeal nerve (RLN) is a well-established technique to aid in thyroid/parathyroid surgery. However, there is little evidence to support its use in non-thyroid or non-parathyroid surgery. The aim of this paper was to review the current evidence regarding the use of IONM in non-thyroid/non-parathyroid surgery in the head and neck and thorax. A literature search was performed from their inception up to January 2024, including the term "recurrent laryngeal nerve monitoring". IONM in non-thyroid/non-parathyroid surgery has mainly been previously described in oesophageal surgery and in tracheal resections. However, there is little published evidence on the role of IONM with other resections in the vicinity of the RLN. Current evidence is low-level for the use of RLN IONM in non-thyroid/non-parathyroid surgery. However, clinicians should consider its use in surgery for pathologies where the RLN is exposed and could be injured. [ABSTRACT FROM AUTHOR]

Summary: Background: Laryngopharyngeal reflux has classically referred to gastroesophageal reflux leading to chronic laryngeal symptoms such as throat clearing, dysphonia, cough, globus sensation, sore throat or mucus in the throat. Current lack of clear diagnostic criteria significantly impairs practitioners' ability to identify and manage laryngopharyngeal reflux. Aims: To discuss current evidence‐based diagnostic and management strategies in patients with laryngopharyngeal reflux. Methods: We selected studies primarily based on current guidelines for gastroesophageal reflux disease and laryngopharyngeal reflux, and through PubMed searches. Results: We assess the current diagnostic modalities that can be used to determine if laryngopharyngeal reflux is the cause of a patient's laryngeal symptoms, as well as review some of the common treatments that have been used for these patients. In addition, we note that the lack of a clear diagnostic gold‐standard, as well as specific diagnostic criteria, significantly limit clinicians' ability to determine adequate therapies for these patients. Finally, we identify areas of future research that are needed to better manage these patients. Conclusions: Patients with chronic laryngeal symptoms are complex due to the heterogenous nature of symptom pathology, inconsistent definitions and variable response to therapies. Further outcomes data are critically needed to help elucidate ideal diagnostic workup and therapeutic management for these challenging patients. [ABSTRACT FROM AUTHOR]

Adult female and male Gongylonema nematodes were found in the oesophagus of a free-living roe deer (Capreolus capreolus) in Slovenia during passive health surveillance of wildlife. The genus Gongylonema was determined by light microscopy based on the genus-specific cuticular bosses in the anterior part of the parasite. Molecular methods were used to confirm the species Gongylonema pulchrum, which has zoonotic potential. Although Gongylonema species are considered common and distributed worldwide, this is the first report of G. pulchrum in an animal on the territory of Slovenia and the first molecular report in a roe deer worldwide. The parasite is likely to be underdiagnosed, misdiagnosed or goes unnoticed as the animals show little or no clinical signs and minor pathological lesions. Slaughterhouse workers, hunters and veterinarians should be aware of this elusive parasite. Examination and evisceration of the upper digestive tract of animals should therefore be carried out more carefully.

Abstract Background Food bolus obstruction (FBO) leading to hospital treatment is often associated with eosinophilic oesophagitis (EoE), stenosis, or oesophageal cancer (1). Danish national guidelines recommend that patients with FBO undergo a diagnostic upper endoscopy within two weeks of presentation to exclude possible malignancy, and histological evaluation of eight biopsies (2, 3). Aims The aims of this study were to (1) report the incidence and describe the causes and treatment of FBO in the North Denmark Region (NDR), (2) determine the proportion of patients who underwent upper endoscopy and biopsy according to regional and national guidelines, and (3) identify International Classification of Diseases 10th Revision (ICD-10) diagnosis and procedure codes applied to the hospital visits due to FBO in the NDR. Methods Among all acute hospital visits in the NDR in 2021, all visits with ICD-10 codes possibly reflecting FBO, as well as a random sample of 14,400 visits with unspecific ICD-10 codes (R and Z codes), were screened manually for possible FBO. Diagnosis, follow-up, and treatment of all patients with FBO were recorded. Results The median patient age was 66.0 (Q1-Q3: 49.8–81.0) years, and half of the patients had experienced FBO before. Two thirds of patients (66.0%) were never diagnosed with a cause of FBO, followed by 17.3% with EoE. 30% of patients did not undergo upper endoscopy within two weeks of the hospital visit, and 50.7% were never biopsied in the oesophagus. Of 1886 hospital visits with registry ICD-10 codes that possibly reflected FBO, 8.4% were due to FBO, while FBO was present in 0.028% of the random sample of unspecific ICD-10 codes. Conclusions Most hospitalized FBO patients in the NDR in 2021 were never diagnosed with a cause. In these patients there is a high risk of overlooked EoE or upper gastrointestinal cancers. The area needs immediate focus and changed routines to improve treatment and prevent new FBO.

Introduction: Leiomyoma of the oesophagus, although rare, is the most common benign tumour to occur in the organ. Surgical approaches have evolved over time from an open thoracotomy or laparotomy to video-assisted thoracoscopic or laparoscopic and now robotic enucleation. We report a series of 19 cases of leiomyoma of the middle- and lower-third oesophagus treated by minimally invasive surgery. Patients and Methods: A retrospective analysis of 19 cases operated at a single tertiary care centre in India was performed. After the diagnosis of a benign oesophageal neoplasm on computed tomography (CT) and endosonography, laparoscopic transhiatal enucleation of the tumour for lower third (n = 16) and right-sided video-assisted thoracoscopic excision for middle-third tumours (n = 3) were performed. Dor fundoplication was done after the excision of leiomyomas from the lower oesophagus. Results: The most common symptom at presentation was retrosternal burning in lower oesophageal tumours, while tumours in the middle third of the oesophagus were asymptomatic and incidentally detected. The size of the tumour ranged from 3 cm to 8 cm in the largest dimension on contrast-enhanced CT scan. The mean operative time was 93 min ranging from 61 to 137 min. The average blood loss was 53 ml. No patient had an iatrogenic oesophageal mucosal injury. There were no conversions to open surgery or major complications including post-operative leak or death. Post-operative recovery was uneventful. Conclusion: The transhiatal approach to lower oesophageal leiomyomas is strategic to avoid complications of thoracoscopy, minimally invasive, cost-effective as compared to robotic surgery, suitable for adequate exposure and safe in the hands of an experienced laparoscopic surgeon.

White vinegar which contains high concentrations (~85 %) of acetic acid is a staple ingredient used in food preparation in many Mediterranean cuisines but in small amounts. Being corrosive, it can cause ulcerative injury to the oropharynx and oesophagus and upset the stomach with resulting nausea and vomiting. This study presents 11 cases of paediatric patients (five boys and six girls, aged between 11 and 89 months) with oesophageal strictures who drank white vinegar by accident. They all received endoscopic oesophageal dilation (with a bougie) ranging from one to 28 per patient, depending on the severity of the injury. Follow-up showed uneventful healing in eight patients, who at the time of the telephone call were able to swallow solids and liquids normally. Two patients who could not be reached by telephone were found healthy by consulting the national database (e-Nabız). Unfortunately, one patient, who was discharged without any symptoms after the first dilation, suffered massive gastrointestinal bleeding 24 hours after the dilation and died. The loss of this patient shows that ingesting white vinegar can be very dangerous in children, especially if parents delay seeking medical help. We believe that controlling the production and sales of highly concentrated white vinegar and selling it in child-proof containers can help to prevent accidental ingestions by children and tragic outcomes such as the one reported here.

Background: Up to 70% of people diagnosed with upper gastrointestinal (GI) tract or hepato-pancreato-biliary (HPB) cancers experience substantial reductions in quality of life (QoL), including high distress levels, pain, fatigue, sleep disturbances, weight loss and difficulty swallowing. With few advocacy groups and support systems for adults with upper GI or HPB cancers (i.e. pancreas, liver, stomach, bile duct and oesophageal) and their carers, online supportive care programs may represent an alternate cost-effective mechanism to support this patient group and carers. iCare is a self-directed, interactive, online program that provides information, resources, and psychological packages to patients and their carers from the treatment phase of their condition. The inception and development of iCare has been driven by consumers, advocacy groups, government and health professionals. The aims of this study are to determine the feasibility and acceptability of iCare, examine preliminary efficacy on health-related QoL and carer burden at 3- and 6-months post enrolment, and the potential cost-effectiveness of iCare, from health and societal perspectives, for both patients and carers. Methods and analysis: A Phase II randomised controlled trial. Overall, 162 people with newly diagnosed upper GI or HPB cancers and 162 carers will be recruited via the Upper GI Cancer Registry, online advertisements, or hospital clinics. Patients and carers will be randomly allocated (1:1) to the iCare program or usual care. Participant assessments will be at enrolment, 3- and 6-months later. The primary outcomes are i) feasibility, measured by eligibility, recruitment, response and attrition rates, and ii) acceptability, measured by engagement with iCare (frequency of logins, time spent using iCare, and use of features over the intervention period). Secondary outcomes are patient changes in QoL and unmet needs, and carer burden, unmet needs and QoL. Linear mixed models will be fitted to obtain preliminary estimates of efficacy and variability for secondary outcomes. The economic analysis will include a cost-consequences analysis where all outcomes will be compared with costs. Discussion: iCare provides a potential model of supportive care to improve QoL, unmet needs and burden of disease among people living with upper GI or HPB cancers and their carers. Australian and New Zealand Clinical Trials Registry: ACTRN12623001185651. This protocol reflects Version #1 26 April 2023. [ABSTRACT FROM AUTHOR]

Copyright of Hungarian Medical Journal / Orvosi Hetilap is the property of Akademiai Kiado and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Food bolus obstruction (FBO) leading to hospital treatment is often associated with eosinophilic oesophagitis (EoE), stenosis, or oesophageal cancer (1). Danish national guidelines recommend that patients with FBO undergo a diagnostic upper endoscopy within two weeks of presentation to exclude possible malignancy, and histological evaluation of eight biopsies (2, 3). Aims: The aims of this study were to (1) report the incidence and describe the causes and treatment of FBO in the North Denmark Region (NDR), (2) determine the proportion of patients who underwent upper endoscopy and biopsy according to regional and national guidelines, and (3) identify International Classification of Diseases 10th Revision (ICD-10) diagnosis and procedure codes applied to the hospital visits due to FBO in the NDR. Methods: Among all acute hospital visits in the NDR in 2021, all visits with ICD-10 codes possibly reflecting FBO, as well as a random sample of 14,400 visits with unspecific ICD-10 codes (R and Z codes), were screened manually for possible FBO. Diagnosis, follow-up, and treatment of all patients with FBO were recorded. Results: The median patient age was 66.0 (Q1-Q3: 49.8–81.0) years, and half of the patients had experienced FBO before. Two thirds of patients (66.0%) were never diagnosed with a cause of FBO, followed by 17.3% with EoE. 30% of patients did not undergo upper endoscopy within two weeks of the hospital visit, and 50.7% were never biopsied in the oesophagus. Of 1886 hospital visits with registry ICD-10 codes that possibly reflected FBO, 8.4% were due to FBO, while FBO was present in 0.028% of the random sample of unspecific ICD-10 codes. Conclusions: Most hospitalized FBO patients in the NDR in 2021 were never diagnosed with a cause. In these patients there is a high risk of overlooked EoE or upper gastrointestinal cancers. The area needs immediate focus and changed routines to improve treatment and prevent new FBO. [ABSTRACT FROM AUTHOR]

Introduction: Leiomyoma of the oesophagus, although rare, is the most common benign tumour to occur in the organ. Surgical approaches have evolved over time from an open thoracotomy or laparotomy to video-assisted thoracoscopic or laparoscopic and now robotic enucleation. We report a series of 19 cases of leiomyoma of the middle- and lower-third oesophagus treated by minimally invasive surgery. Patients and Methods: A retrospective analysis of 19 cases operated at a single tertiary care centre in India was performed. After the diagnosis of a benign oesophageal neoplasm on computed tomography (CT) and endosonography, laparoscopic transhiatal enucleation of the tumour for lower third (n = 16) and right-sided video-assisted thoracoscopic excision for middle-third tumours (n = 3) were performed. Dor fundoplication was done after the excision of leiomyomas from the lower oesophagus. Results: The most common symptom at presentation was retrosternal burning in lower oesophageal tumours, while tumours in the middle third of the oesophagus were asymptomatic and incidentally detected. The size of the tumour ranged from 3 cm to 8 cm in the largest dimension on contrast-enhanced CT scan. The mean operative time was 93 min ranging from 61 to 137 min. The average blood loss was 53 ml. No patient had an iatrogenic oesophageal mucosal injury. There were no conversions to open surgery or major complications including post-operative leak or death. Post-operative recovery was uneventful. Conclusion: The transhiatal approach to lower oesophageal leiomyomas is strategic to avoid complications of thoracoscopy, minimally invasive, cost-effective as compared to robotic surgery, suitable for adequate exposure and safe in the hands of an experienced laparoscopic surgeon. [ABSTRACT FROM AUTHOR]

This article discusses the outcomes of salvage neck dissection for recurrent or residual cervical lymph nodes in patients with esophageal cancer. The study found that neck dissection was performed safely in all cases, and metastatic lymph nodes were identified in the central compartment in the majority of cases. The most common perioperative complication was vocal fold paralysis, which occurred most often in cases with central compartment dissection. The study also compared the oncological outcomes of surgery versus chemoradiotherapy and found that surgery had better rates of overall survival, progression-free survival, and locoregional control. The presence of extra nodal extension or multiple metastatic lymph nodes did not significantly impact progression-free survival. The study concludes that salvage neck dissection is an important therapeutic option for recurrent or residual lesions, especially after surgery. [Extracted from the article]

Objective: To investigate trends in incidence and histological distribution of oesophageal carcinoma in Kingston and St Andrew (KSA), Jamaica, over the 30-year period 1978-2007. Methods: All oesophageal carcinomas registered in residents of KSA during the study period were extracted from the Jamaica Cancer Registry, and the following were collected for each case: gender, age, basis of diagnosis, year of diagnosis, histological subtype and subsite. The data were used to calculate age-specific incidence rates and age-standardized incidence rates (ASRs). The results were compared to those from other countries. Results: Oesophageal carcinoma was more common among males than females, and both genders showed decreasing incidence over the 30-year period. The highest ASRs (males, 4.0 per 100 000; females 2.6 per 100 000 per year) were recorded in the 1978-1982 reporting period and the lowest (males, 1.7 per 100 000 per year; females 0.6 per 100 000 per year) in the 2003-07 period. The leading histological subtype among both genders was squamous cell carcinoma (SCC), and this subtype showed a decrease in incidence in both genders over the period of review. Adenocarcinomas, the second commonest histological subtype, showed a decrease in ASR over time in females and a rise in males. Conclusion: Incidence rates of oesophageal carcinomas overall have decreased in KSA, Jamaica, and this trend is mirrored by the SCC subtype. However, while adenocarcinoma ASR is decreasing in females, it is increasing in males. These data support the need for investigation into the risk factors for oesophageal adenocarcinoma in Jamaica. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Industrial Hygiene & Toxicology / Arhiv za Higijenu Rada I Toksikologiju is the property of Sciendo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Lymphocytic oesophagitis is a rare inflammatory condition that was first described in 2006. Although it is being increasingly diagnosed, it remains poorly described and characterised. There is limited research on the natural history, diagnosis and management of this condition. The most common presenting symptoms are dysphagia, chest pain and heartburn. Endoscopic features can mimic eosinophilic oesophagitis. International consensus is needed to secure a histological definition, to agree on an endoscopic severity scoring system and to determine an appropriate management algorithm. This review summarises the main evidence for the diagnosis and management of lymphocytic oesophagitis, thus setting the scene for the future directions needed to improve the management of this condition. [ABSTRACT FROM AUTHOR]

The oesophagus is the part of the digestive tract between the pharynx and stomach. The oesophagus is susceptible to several pathological conditions, both congenital and acquired, which may require surgical management. These include congenital oesophageal atresia, functional disorders such as achalasia cardia and hiatus hernia, corrosive strictures, traumatic oesophageal perforation, and oesophageal cancer. This article describes, in detail, those aspects of the topographical anatomy of the oesophagus which are of relevance to clinical diagnosis and surgical management. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to measure the surface dose in breast cancer patients undergoing supraclavicular irradiation using a thermoluminescent dosimeter (TLD) and compare the measurements to calculated doses determined by the treatment planning system (TPS). The results of in vivo patients' measurements were verified using a phantom. Materials and Methods: The oesophageal surface dose of 30 breast cancer patients undergoing supraclavicular lymph node irradiation was measured by TLD and TPS. For each patient, two TLDs were positioned on the oesophageal surface. The TLD and TPS results were verified using a phantom that covered from the oesophagus to the supraclavicular area. The TLD was positioned within or outside the treatment field on the phantom depending on the patient. Results: The average oesophagus surface dose was 9.04 ± 5.07 Gy and 8.06 ± 6.17 Gy for TLD and TPS, respectively (p=0.09). Oesophagus surface doses were greater for the left than for the right side. The calculated and measured dose values at the surface for the phantom were 0.78 Gy and 0.96 Gy, respectively, with the TLD placed inside the radiation field (p=0.02). The calculated and measured dose values at the surface for the phantom were 0.024 Gy and 0.10 Gy, respectively, with the TLD placed outside the radiation field (p=0.01). Conclusion: The results showed a good agreement between TLD measurements and TPS calculations, except when the TLD was placed outside the radiation field. Therefore, dose calculations in peripheral regions should be used with caution. [ABSTRACT FROM AUTHOR]

Simple Summary: This is a review that provides an overview of neoadjuvant therapy, landmark clinical trials, and further prospective management options which can be considered for adenocarcinoma of the oesophagus and gastro-oesophageal junction. Historically, oesophageal and gastro-oesophageal junction adenocarcinomas were associated with a poor prognosis. The advent of neoadjuvant therapy has transformed the management of oesophageal and gastro-oesophageal junction adenocarcinomas further and offers the possibility to reverse disease progression, eliminate micrometastasis, and offer potentially better outcomes for these patients. This review provides an overview of landmark clinical trials in this area, with different treatment regimens considered over the years as well as potential therapeutic agents on the horizon that may transform the management of oesophageal and gastro-oesophageal junction adenocarcinomas further. [ABSTRACT FROM AUTHOR]

This article reports an innovative and unprecedented use of Holmium: YAG laser in the extraction of a foreign body impacted in the upper oesophagus without complications. Hence, Holmium-YAG laser can be a safe, efficient and successful aid to fragment the impacted foreign bodies to assist in their removal. [ABSTRACT FROM AUTHOR]

Abstract A 9‐year‐old castrated male Kaninchen dachshund dog weighing 4.18 kg was referred to our institution and presented with occasional vomiting and dysphagia. The radiographic examination revealed a long radiopaque foreign body located throughout the thoracic oesophagus. Endoscopic removal was attempted using laparoscopic forceps but was unsuccessful as the foreign body was too large to be grasped. A gastrotomy was therefore performed, and long paean forceps were gently and blindly inserted into the cardia of the stomach. The bone foreign body was grasped with the long paean forceps under fluoroscopy and withdrawn from the oesophagus while checking with an endoscope. A gastrotomy approach using long forceps, endoscopy and fluoroscopy should be considered for removal of oesophageal foreign bodies from patients in which an endoscopic approach has been unsuccessful.

Abstract Background VISION is a randomised, phase 4, open-label, parallel-group, multicentre study conducted in 33 centres in Japan. The aim of this study was to assess the long-term safety of vonoprazan for maintenance treatment of healed erosive oesophagitis versus lansoprazole. Methods Patients with endoscopically diagnosed erosive oesophagitis were randomised 2:1 to once-daily vonoprazan 20 mg or lansoprazole 30 mg, for a 4- to 8-week healing phase. Patients with endoscopically confirmed healing entered a 260-week maintenance phase with a once-daily starting dose of vonoprazan 10 mg or lansoprazole 15 mg. Primary endpoint was change in gastric mucosal histopathology. Results Of 208 patients (vonoprazan, n = 139; lansoprazole, n = 69) entering the healing phase, 202 entered the maintenance phase (vonoprazan, n = 135; lansoprazole, n = 67). At 3 years, 109 vonoprazan-treated and 58 lansoprazole-treated patients remained on treatment. Histopathological evaluation of gastric mucosa showed that hyperplasia of parietal, foveolar and G cells was more common with vonoprazan than lansoprazole at week 156 of the maintenance phase. There was no marked increase in the occurrence of parietal, foveolar and G cell hyperplasia among patients in the vonoprazan group from week 48 to week 156. Histopathological evaluation of the gastric mucosa also showed no neoplastic changes in either group. No new safety issues were identified. Conclusions In this interim analysis of VISION, no new safety concerns were identified in Japanese patients with healed erosive oesophagitis receiving vonoprazan or lansoprazole as maintenance treatment for 3 years. (CT.gov identifier: NCT02679508; JapicCTI-163153; Japan Registry of Clinical Trials: jRCTs031180040).

Con el objeto de establecer el estado del esófago en relación a la noxa chagásica en la región central de Argentina, estudiándolo en pacientes con Chagas, de diferentes edades, se investigó el tiempo de vaciamiento esófago (T.V.E.) así como su calibre, mediante una prueba radiologica estardardizada. Metodología: Se trabajó sobre una muestra de 87 pacientes coR pruebas serológicas positivas para Chagas a los que se practicó TVE, en Hospi- tal Rawson. El estudio se realizó retrospectivamente sobre los registros originales. Se consideró TVE retardado cuando se vió bario retenido en esófago mas allá de 1 minuto desde la in-esta. Como controles se utilizó el estudio de TVE efectuado en Hospital Rawson, a 120 personas con serologías negativas para Chagas. Por otra parte, se estudiaron muestras de esófago obtenidos mediante autopsias de pacientes chagásicos que fallecieron por cardiopatía o por otras causas (cuatro casos del Hospital San Roque. Córdoba, y se efectuaron estudios mediante técnicas histológicas clásicas e inmunohístoquimicas. El 63 % de los pacientes mostraron TVE retardado, en porcentajes crecientes con la edad. En el grupo control no chagásico, sólo el 3 % fueron positivos paraTVE retardado. El interrogatorio mostró síntomas de disfunción esofágica en el 35 % de los casos chagásicos. El número de megaesófagos fue bajo (tres), correspondientes al grado II. Los resultados histopatológicos mostraron infiltración de linfocitos T PAS +, entorno a estructuras neurales del plexo de Auerbach, y disminución del número de las mismas, en los tres casos. El músculo se vio conservado, aunque hubo también algunas áreas con infiltración T linfocitaria. Surge de los presentes resultados una alta incidencia de trastornos de la función esofágica en estos pacientes chagásicos de Argentina (87 casos), reflejada en el TVE retardado, creciente con la edad. No obstante, el número de megaesófagos fue bajo y la dilatación de los mismos de grado 2. En el aspecto histopatológico, los casos estudiados mostraron evidencias compatibles con proceso chagásico. Se interpreta que en la producción de grandes megaesófagos frecuentes en otras regiones chagásicas, es posible que intervengan otros factores, en relación con las patologías geográficas.

BackgroundThoracoscopic repair of esophageal atresia (EA) and tracheoesophageal fistula (TEF) poses significant technical challenges. This study aimed to develop an inexpensive, reusable, high-fidelity synthetic tissue model for simulating EA/TEF repairs and to assess the validity of the simulator.MethodsBy using 3D printing and silicone casting, we designed an inexpensive and reusable inanimate model for training in thoracoscopic EA/TEF repair. The objective was to validate the model using a 5-point Likert scale and the Objective Structured Assessment of Technical Skills (OSATS) to evaluate participants' surgical proficiency.ResultsA total of 18 participants (7 medical students, 4 pediatric surgery trainees, and 7 experienced surgeons), after being instructed and trained, were asked to perform TEF ligation, dissection, as well as esophageal anastomosis using six sliding knots on the EA/TEF simulator. All participants in the expert group completed the task within the 120-minute time limit, however only 4 (57%) participants from the novice/intermediate completed the task within the time limit. There was a statistically significant difference in OSATS scores for the “flow of task” (p = 0.018) and scores for the “overall MIS skills” (p = 0.010) task distinguishing between novice and intermediates and experts. The simulator demonstrated strong suitability as a training tool, indicated by a mean score of 4.66. The mean scores for the model's realism and the working environment were 4.25 and 4.5, respectively. Overall, the face validity was scored significantly lower in the expert group compared to the novice/intermediate groups (p = 0.0002).ConclusionsOur study established good face and content validity of the simulator. Due to its reusability, and suitability for individual participants, our model holds promise as a training tool for thoracoscopic procedures among surgeons. However, novices and trainees struggled with advanced minimally invasive surgical procedures. Therefore, a structured and focused training curriculum in pediatric MIS is needed for optimal utilization of the available training hours.