Diseases of the Esophagus最新文献

The proton pump inhibitors (PPIs) are extensively prescribed for the empirical treatment of epigastric pain and heartburn in cancer patients. However, they carry the potential for drug interactions with antineoplastic agents during active cancer therapy, and osteopenia, opportunistic infections, adverse cardiovascular outcomes, and altered gut microbiome in long-term users in survivorship. Herein, we examined the use of endoscopy with esophageal 96-hour ambulatory pH monitoring in guiding clinicians in safely prescribing PPI in 21 such patients. We retrospectively studied patients with active cancer or in survivorship, presenting with PPI-refractory heartburn. All underwent an endoscopy with esophageal ambulatory pH monitoring performed "off" PPI therapy for 96 hours, following a "liberal diet" for the first 48, and a "restrictive diet" for the latter 48 hours. Acid exposure time (AET) ≥ 6% per 24 hours was defined as abnormal. For each patient, the average AET from the first 2 days was considered as baseline and was compared with that from the latter 2 days (on restrictive diet). We concluded that ambulatory 96-hour pH monitoring, identifies 48% of patients with normal AET, who may not need PPI. Esophageal pH monitoring on restrictive diet normalizes AET in 73% of patients, thereby allowing esophageal acid control to be achieved with diet alone.

Esophageal squamous cell carcinoma is a major global health challenge in its locally advanced stages. Neoadjuvant chemoimmunotherapy aims to downstage tumors before surgery, but the optimal number of cycles remains uncertain. We performed a single-institution retrospective study of 208 consecutive patients with resectable, locally advanced esophageal squamous cell carcinoma treated between March 2020 and April 2024. Patients received either two (n = 84) or three (n = 124) cycles of platinum-based chemotherapy plus a programmed death-1 inhibitor, followed by esophagectomy without planned radiotherapy. Primary outcomes were pathologic complete response and disease-free survival; safety and clinical-to-pathologic downstaging were prespecified secondary end points. Three cycles yielded higher objective response (75.0% vs. 60.7%) and a higher pathologic complete response of the primary tumor (27.4% vs. 11.9%) than two cycles. Disease-free survival favored three cycles (hazard ratio, 0.52). Treatment-related adverse events occurred more often with three cycles, driven mainly by bone-marrow suppression (32.3% vs. 11.9%) but were generally manageable and compatible with timely surgery. Overall survival did not differ within the current median follow-up of 21 months. This retrospective analysis suggests that three cycles of neoadjuvant chemoimmunotherapy may provide greater tumor response and improved disease-free survival compared with two cycles in operable esophageal squamous cell carcinoma, with acceptable toxicity. However, neoadjuvant chemoradiation-which typically achieves higher pathologic complete response rates-remains the standard of care. Longer follow-up and prospective, stratified trials are needed to validate these findings and to define the role of a radiation-free strategy in appropriately selected patients.

Barrett's esophagus (BE) is the only recognized precursor to esophageal adenocarcinoma, but progression risk is highly heterogeneous. While most patients with nondysplastic BE have an annual cancer risk less than 0.5%, a subset with dysplasia or adverse molecular profiles carries markedly higher risk. This variability necessitates precision risk stratification to optimize surveillance and intervention. We review the evolution of BE risk stratification from historical consensus frameworks to contemporary clinical, histologic, and molecular models. Key clinical predictors, validated scoring systems, and recent advances in biomarker-based and imaging-driven surveillance are summarized, with emphasis on their validation and clinical applicability. Established clinical risk factors-age, male sex, smoking, segment length, and dysplasia-remain central to risk prediction. Biomarker assays, including p53 immunohistochemistry, tissue systems pathology and methylation-based assays may provide risk stratification beyond histology. Advances in endoscopic imaging, wide-area transepithelial sampling, and non-endoscopic capsule-based collection platforms could transform surveillance into a risk-adapted paradigm. The management of BE is shifting from a one-size-fits-all surveillance model toward personalized, biomarker-guided care. Integration of clinical, histologic, and molecular data-underpinned by artificial intelligence and real-world validation-promises to refine surveillance, reduce overtreatment, and improve early cancer detection in Barrett's esophagus.

This study aimed to identify the clinicopathological features of esophageal squamous cell carcinoma (ESCC), detected at the stage of T1a-MM or deeper despite undergoing annual endoscopic surveillance. This retrospective study included cases of early ESCC treated with endoscopic resection at this hospital from January 2015 to October 2024. Inclusion criteria were: (i) A case identified as a high-risk patient for ESCC due to the presence of multiple Lugol-voiding lesions . (ii) Screening endoscopy performed at intervals of 12 months or less. (iii) The depth of lesions detected under appropriate screening and treated with endoscopic resection was pT1a-MM or deeper. Five cases met the criteria, with a median age of 68 years (range: 48-81); all patients were male. The prior endoscopic examination before the detection was performed 6 months earlier in two cases and 12 months earlier in three cases. Among the cases, three lesions were located in the cervical esophagus (Ce), one in the middle thoracic esophagus (Mt), and one in the lower thoracic esophagus (Lt); the Mt and Lt lesions were on the anterior wall. The three Ce lesions measured 5-10 mm, while the Mt and Lt lesions measured 6 mm and 10 mm, respectively. Four lesions were diagnosed as pT1a-MM, and the Ce lesion as pT1b-SM2 with positive vascular invasion. The patient diagnosed with submucosa lesion received additional chemoradiotherapy. None of the patients have experienced cancer recurrence. This case series suggests that the Ce and the anterior wall of the Mt and Lt may be areas that require particular attention during routine ESCC surveillance. These findings may help improve quality of surveillance endoscopy for ESCC high-risk patients.

Gastroesophageal reflux disease (GERD) imposes substantial global burden. Its recent trends and long-term projections have not been reassessed since the Global Burden of Disease (GBD) 2019 cycle. Using GBD 2021 data, incident and prevalent cases, years lived with disability, and age-standardized rates (ASRs) were estimated for 204 countries from 1990 to 2021. Decomposition analysis categorized changes into population aging, population growth, and epidemiological change. Projections to 2040 used a Bayesian age-period-cohort model, with Nordpred and ARIMA used to assess robustness. From 1990 to 2021, incident cases increased from 180.0 million to 324.1 million (+80.1%), and prevalent cases increased from 450.8 million to 825.6 million (+83.2%). The global age-standardized incidence rate (ASIR) reached 3882 per 100,000 with a peak at ages 30-39 years. ASRs varied by Socio-demographic Index (SDI) levels and exhibited a non-linear negative association overall: decreases at SDI <0.4 and > 0.6, with modest increases at 0.4-0.6. Decomposition analysis indicated population growth contributed most to the incidence increase (+95%), with smaller contributions from aging (+3%) and epidemiological change (+2%). Projections suggest that ASIR will increase to approximately 3939 per 100,000 and ASPR to approximately 9990 per 100,000, whereas ASYR is projected to increase only slightly. Projections were consistent across models. The global burden of GERD continues to rise, primarily associated with demographic expansion and modifiable lifestyle factors. In the absence of enhanced prevention, equitable diagnostic access, and obesity control, incidence and prevalence are anticipated to increase further through 2040. These findings provide region-specific evidence to inform resource allocation and targeted interventions.

Background: Empiric elimination diets remain a cornerstone of treatment for eosinophilic esophagitis (EoE). Immunoglobulin E (IgE) mediated allergic reactions have been sparsely reported during the food reintroduction phase, raising concerns both for patients and physicians. We aimed to assess the physician reported rates of new-onset IgE mediated reactions in EoE associated elimination diets (NIMREEDs), physician awareness of NIMREEDs, and how awareness impacts physician and patient treatment selection.

Methods: An international REDCap based questionnaire was distributed via interest groups, gastroenterologist server lists, and professional societies. Physicians were asked about their personal awareness and experience with NIMREEDs and how their knowledge affects physician and patient treatment decisions when contemplating elimination diets (ED) for treatment of EoE.

Results: Between January and July 2023, 145 responses were included in this analysis. Of the 12,698 patients with EoE cared for in all responding centers, 4903 (38.6%) had attempted ED. NIMREEDs were reported in 43/4903 (0.88% [95% CI 0.5-1.2%]). Ninety-six (66.2%) physicians were aware of potential reactions, however only 71/96 (73.9%) discussed them with patients. Knowledge of NIMREEDs deter 17/96 (17.7%) physicians from recommending ED for EoE, and 15/71 (21.1%) of those who informed patients, reported reluctance of patients to undertake ED.

Conclusion: NIMREEDs following food re-introduction in the treatment of EoE are uncommon, nevertheless they are not widely recognized by physicians. Knowledge concerning NIMREEDs may affect both patient and physician treatment decisions and preferences, as they have potential to negatively affect quality of life, emphasizing the need for increased awareness to NIMREEDs in EoE patients.

Achalasia treatment outcomes are often assessed using the Eckardt score, which has not been formally validated and is not designed as a patient-reported outcome (PRO) tool. To address this unmet clinical need, a group of healthcare providers developed the International Patient-oriented tool for Achalasia Symptom Score (I-PASS), which aims to record both symptom severity and frequency in a patient-oriented manner. Using the RAND/ University of California, Los Angeles, Appropriateness Methodology, a 16-member international, multidisciplinary panel identified key symptomatic domains through three Delphi rounds. Dysphagia, regurgitation (daytime and nocturnal), and chest pain were selected as primary domains, with weight loss included as an additional factor. Severity and frequency scoring were agreed upon, resulting in a maximum composite score of 53. The pretreatment I-PASS was pilot-tested in 118 treatment-naïve achalasia patients in the UK and Italy. Comprehension, completion time, acceptability, and correlation with the standard Eckardt score were assessed. All the patients completed the I-PASS. Most (96.5%) reported full comprehension, the median completion time was 10 minutes, and 98% expressed willingness to complete it again. The median I-PASS score was 29 (IQR 20-36), compared with a median Eckardt score of 7 (IQR 5-9). A strong correlation was observed between I-PASS and Eckardt (ρ = 0.68, P < 0.0001). Regression analysis confirmed that each one-point increase in Eckardt corresponded to a 3.1-point increase in I-PASS. The I-PASS questionnaire is feasible, well accepted, and provides a more comprehensive assessment of achalasia symptoms than the Eckardt score. Future studies will evaluate its reliability, responsiveness, and validity as a standardized PRO instrument.

Esophageal food impaction (EFI) is a gastrointestinal emergency that often requires urgent endoscopy. Predictors of recurrence and adverse events remain understudied and inconsistently reported. We conducted a systematic review and meta-analysis to identify predictors of recurrence and adverse events in EFI. We systematically searched PubMed, Embase, and the Cochrane Library on March 1, 2025. We included any observational studies or clinical trials that evaluated EFI outcomes in adults. The primary outcomes were EFI recurrence and adverse events, assessed according to underlying esophageal pathology, biopsy practices, follow-up, and timing of endoscopy. Effect sizes were evaluated using odds ratios (ORs), and a random-effects model was applied. A total of 14 studies were included with 3116 patients. Male gender was modestly associated with a higher risk of EFI recurrence (OR 1.45; 95% CI 1.01-2.10; P = 0.05), and patients with eosinophilic esophagitis (EoE) had a markedly increased risk of recurrence (OR 3.28; 95% CI 2.09-5.14; P < 0.001). No significant associations with recurrence were observed for biopsy (OR 1.44; 95% CI 0.98-2.11; P = 0.06), those who underwent follow-up (OR 1.10; 95% CI 0.37-3.32; P = 0.74), gastroesophageal reflux disease (GERD) (OR 1.22; 95% CI 0.46-3.23; P = 0.68), or hiatal hernia (OR 1.84; 95% CI 0.51-6.65, P = 0.35). For any adverse events, neither a history of prior EFI (OR 1.80; 95% CI 0.26-12.26) nor the timing of endoscopy (OR 0.89; 95% CI 0.49-1.64) was significantly associated with increased risk. Similarly, gender, EoE, and GERD were not associated with increased risk of adverse events. Only the male gender and EoE were significantly associated with a higher risk of EFI recurrence. Other factors, including GERD, hiatal hernia, follow-up, and biopsy status, were not. Delayed endoscopy and prior EFI were not associated with increased adverse events. Large-scale studies are needed to define risk factors better and strengthen the risk-stratification guide for preventive strategies.