Diseases of the Esophagus最新文献

Esophageal cancer represents a substantial global health challenge, marked by poor prognosis, even after curative treatment. Health-related quality of life is crucial for evaluating the treatment efficacy and long-term outcomes in patients with esophageal cancer. This state-of-the-art review and evidence gap map sought to identify existing research on the impact of interventions on health-related quality of life in adults with esophageal cancer, providing a comprehensive overview of various health-related quality of life aspects following diagnosis and treatment. This review entailed a systematic literature search, data extraction, and analysis, with the findings visualized in an evidence and gap map. The review synthesized key insights from the literature, focusing on clinical context, treatment, health-related quality of life outcomes, and interventions to enhance health-related quality of life. The evidence and gap map revealed that most studies concentrated on surgical interventions, chemotherapy/chemoradiotherapy, supportive care, and lifestyle interventions, primarily evaluating the overall quality of life, symptom burden, and emotional and psychological health. Several areas remain unexplored, including cognitive and existential well-being, social functioning, and the impact of specific interventions such as immunotherapy. This review underscores the need for high-quality longitudinal studies assessing long-term health-related quality of life, the inclusion of health-related quality of life as a primary or key secondary endpoint in future trials, and improved methodological quality of systematic reviews. Addressing these gaps will contribute to a more patient-centered, evidence-based approach to esophageal cancer care.

Post-esophagectomy chyle leak following injury to the thoracic duct and/or its tributaries is a rare but well-recognized complication with a reported incidence of 0.4-21% and a mortality of 0-50%. The aim of this study was to describe our experience as a tertiary esophagogastric cancer center in managing this complication over a 10-year period. This was a retrospective study, using an electronic database, to analyze our incidence and management of chyle leak in all patients who underwent elective esophagectomy between April 2009 and December 2019 in a tertiary upper gastrointestinal cancer center. Non-normally distributed data were presented as a median and range/interquartile range with analysis being conducted using the Mann-Whitney U test. A P-value <0.05 was considered statistically significant. Between 2009 and 2019, a total of 550 patients underwent esophagectomy. Chyle leak was identified in 24 patients (4.4%); all 24 patients had neoadjuvant chemotherapy and underwent an open 2 stage Ivor Lewis esophagectomy with routine ligation of the thoracic duct at the time of operation. 83.3% (n = 20) of chyle leak patients were managed surgically with a median length of stay of 20 days (Range 11 to 148) and mortality of 5% (n = 1). 16.7% (n = 4) were managed conservatively with a median length of stay of 31 days (Range 14 to 51) and mortality of 0%. Our data are consistent with the evidence in the literature, which suggests that early surgical intervention in high volume leaks is safe and effective and low mortality rates with chyle leak can be achieved with surgical intervention. This is crucial in reducing the length of stay in hospital and morbidity. Conservative management is suitable in low volume chyle leak and cases clinically responding to medical management.

Vonoprazan, a potassium competitive acid blocker (P-CAB), shows promise for gastroesophageal reflux disease (GERD). On-demand therapy may reduce costs and drug exposure. This study aimed to compare the efficacy of on-demand versus continuous vonoprazan treatment in the initial management of mild GERD. This observational cohort study enrolled patients with non-erosive reflux disease (NERD) and mild reflux esophagitis (LA grade A/B). Patients were allocated to either on-demand or continuous vonoprazan (20 mg/day) treatment for 4 weeks. Primary outcomes were changes in Gastroesophageal Reflux Disease Questionnaire (GerdQ) and Gastroesophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL) scores. Secondary outcomes included treatment satisfaction, complete mucosal healing rate, and 24-week relapse rate. The GerdQ score and GERD-HRQL score of the on-demand treatment group decreased significantly after initial treatment compared with the previous one, with statistical significance (P < 0.001). Moreover, there were no significant differences in GerdQ and GERD-HRQL scores between the two groups after the treatment (P = 0.363, P = 0.037; the significance level was P < 0.025). Satisfaction (75.9% vs. 74.3%), complete mucosal healing rates (61.8% vs. 38.8%), and relapse rates (10.2% vs. 8.9%) were comparable in the on-demand and continuous treatment groups. Age (OR = 1.08, 95% CI: 1.05-1.11, P < 0.001) and alcohol consumption (OR = 4.31, 95% CI: 1.06-17.41, P = 0.04) were influential factors for symptom burden improvement, and treatment allocation (P = 0.069) had no significant effect on symptom burden improvement. Age (OR = 0.94, 95% CI: 0.91-0.96, P < 0.001) and pre-treatment Los Angeles grade B (OR = 3.28, 95% CI: 1.46-7.34, P = 0.004) were predictors of improved quality of life. This study found on-demand vonoprazan demonstrates comparable efficacy to continuous therapy for mild GERD, offering a cost-effective strategy with minimized drug accumulation risks.

Background: Eosinophilic esophagitis (EoE) frequently presents with dysphagia or food impaction (FI), although gastroesophageal reflux-like (GER-like) symptoms may also occur. Whether EoE patients diagnosed after an FI event may present esophageal symptoms before diagnosis that could raise clinical suspicion remains unclear. This study aimed to assess differences in symptoms occurrence before EoE diagnosis, endoscopic, and histological activity, and diagnostic delay, between patients diagnosed after an FI event and those diagnosed with no FI (NFI patients).

Methods: A retrospective study was conducted, including consecutive adult EoE patients (May 2023-February 2025). EoE was defined by a peak eosinophil count (PEC) ≥ 15 eos/high-powered field. All patients were evaluated within 2 weeks of diagnosis, and symptoms occurrence before EoE diagnosis was assessed using a structured questionnaire. FI and NFI patients were compared in terms of symptoms occurrence, clinical, endoscopic, and histological features, and diagnostic delay.

Results: 57 EoE patients (73.7% male; mean age 38.4 ± 15.0 years) were included. Among them, 19 (33.3%) were diagnosed after an FI event, and 38 (66.7%) in the absence of an FI event. No differences were observed in terms of gender, age, and allergic comorbidities. Prior proton pump inhibitor use was more frequently observed in NFI patients (65.8% vs. 36.8%, P = 0.0502). FI patients had a significantly longer diagnostic delay (14.4 ± 12.1 vs. 6.4 ± 7.3 years, P = 0.0030), and they more frequently reported the absence of esophageal symptoms before EoE diagnosis (47.4% vs. 2.6%, P = 0.0001). Before EoE diagnosis, dysphagia, heartburn, and reflux-like symptoms were significantly less frequent in FI patients (47.4% vs. 89.5%, P = 0.001; 15.8% vs. 63.2%, P = 0.0008; and 26.3% vs. 63.2%, P = 0.0119, respectively). The mean EoE Endoscopic Reference Score was higher in FI patients (5.5 ± 1.4 vs. 3.6 ± 2.1, P = 0.0008). EoE patients diagnosed after an FI event seem to be paucisymptomatic before EoE diagnosis, despite showing higher endoscopic activity, suggesting the need for greater awareness among clinicians of symptoms that may raise suspicion of EoE.

Introduction: Transoral incisionless fundoplication (TIF) is a minimally invasive endoscopic procedure used for the management of gastroesophageal reflux disease (GERD) in patients with a hiatal hernia <>2 cm. Because TIF involves transmural fasteners placed across the gastroesophageal junction, there is a theoretical risk of vagal nerve injury leading to gastroparesis. Whether this risk differs from that seen with traditional anti-reflux surgery (ARS) remains unclear. Using the TriNetX multi-institutional database, we conducted a retrospective cohort study of adult patients with GERD who underwent either TIF or ARS. Patients with a prior history of gastroparesis or prior use of prokinetic agents were excluded. The primary outcome was the incidence of new-onset gastroparesis within 1 month to 1 year after the procedure; secondary outcome was the use of prokinetic agents. Propensity score matching was applied to balance baseline characteristics, including age, sex, race, BMI, diabetes, PPI, and opioid use. A total of 668 TIF and 53,996 ARS patients were identified. Before matching, gastroparesis incidence was similar between TIF (1.48%) and ARS (1.46%) (adjusted odds ratio [aOR] 1.01, 95% CI 0.54-1.9). After matching, the incidence remained comparable between TIF (0.7%) and ARS (1%) (aOR 1.0, 95% CI 0.22-2.26). The 1-year incidence of prokinetic agent use was lower in the TIF group (3.2%) than in the ARS group (6%) (aOR 0.51, 95% CI 0.3-0.9). In summary, post-surgical gastroparesis is rare after both TIF and ARS, with no significant difference between the two procedures. However, the need for prokinetic therapy was lower following TIF, suggesting a potentially lower burden of postoperative gastric motility symptoms. These findings may help guide counseling and individualized decision-making in GERD management.

Understanding patients' beliefs about their medical condition is of significant importance as they drive individuals' attempts to cope with that condition. This study aimed to examine the beliefs patients with supragastric belching (SGB) have about their condition and the relationship between these beliefs, symptom report, and clinical and demographic variables. One hundred eight patients (67.6% female, mean age 44.07, range 18-80), with a consultant confirmed diagnosis of SGB following high resolution oesophageal manometry and 24-hour pH monitoring studies completed the Brief-Illness Perceptions Questionnaire, which assesses beliefs about the symptoms, chronicity, consequences, personal and treatment control, illness coherence, perceived causes, and patients' emotional response to their SGB. A range of demographic and illness-related variables was also collated. Template analysis was undertaken on the 324 free-text responses relating to patients' perceived causes of SGB. Fourteen percent of patients reported not knowing what had caused their SGB. The top four causes identified by the remaining 93 patients were dietary, behavioral, other GI conditions, and psychological. Only 34% considered behavioral factors of importance. There were no significant associations between gender and age in relation to illness beliefs. Patients who believed in a behavioral cause of their SGB had significantly stronger beliefs in having personal control over their SGB (U = 980, z = -2.18, P = 0.03). This study has progressed our understanding of patients' personal beliefs about SGB and provides insights into important cognitive components to address in any intervention. Simple messages around the cause of SGB and correction of misinformation may help in the effective management of this condition.

Non-obstructive esophageal dysphagia (NOD) is a benign condition frequently encountered in clinical practice, often associated with motility disorders, with consequences surpassing the physical dimension and extending to the patient's personal life. However, its characterization, particularly focusing on its impact on quality of life (QoL), remains limited. This prospective study aimed to characterize this population regarding epidemiological, clinical, and manometric aspects. From September 2021 to February 2024, 250 NOD patients were recruited from seven centers. All subjects underwent a comprehensive diagnostic work-up, including upper endoscopy with biopsies, high-resolution esophageal manometry, and timed barium esophagogram, when applicable. Epidemiological and clinical data were collected using the Eckardt, Gerd-Q, and the Portuguese versions of Euro-Qol-5D-3L (EQ-5D) and PROMIS Gastrointestinal Disrupted Swallowing (PDS) scales. Patients were predominantly female (60.8%) with a median age of 63 years [IQR 20]. According to Chicago v4.0, normal esophageal motility was the most frequent diagnosis (n = 93, 37.2%), followed by esophagogastric junction (EGJ) outflow disorders (79 achalasia, 4 EGJ outflow obstruction). Among motility disorders, Eckardt and PDS scores were higher in EGJ outflow disorders (median 5 and mean T-score 64.1, respectively; P < 0.001), although their ability to primarily identify these conditions was limited. Regarding patient-reported QoL, no significant differences were found in EQ-5D, both for time trade-off and visual analog scale values. In summary, normal esophageal motility was the most frequent manometric finding in NOD patients. Although symptom severity was worse in EGJ outflow disorders, QoL appeared equally affected across all motility profiles.