BACKGROUND/AIMS: Spontaneous esophageal rupture is a life-threatening injury because of delay in diagnosis and rapid progression to septic condition. But acceptable standard treatment strategy has not been established yet. This may be due to its low incidence and lack of published literature. In this study, we evaluated the proper treatment strategy as to decide when and how to manage spontaneous esophageal rupture by analyzing our experiences. METHODS: Eleven patients who were diagnosed as spontaneous esophageal perforation in Dongsan Medical Center from 1993 to 2003 were analyzed. Patients were divided into survival and death group. Clinical manifestations, rupture site and size, treatment methods and complications were compared. RESULTS: All patients were male and alcoholics. Six patients had survived and five patients died. Age, sites and sizes of ruptures, operation methods were not different in both groups. Before operation, septic condition was present in all patients of death group and more common than survival group (p=0.015). Survival group showed shorter time interval from rupture to initial treatment (p=0.021) and to operation (p=0.019). CONCLUSIONS: Early diagnosis and initial aggressive treatments such as nothing per oral, pleural and mediastinal drainage are important factor for better prognosis. If possible, early operation such as primary repair must be done. Although any difference according to types of operation method was not found in this study, further study with larger groups seems to be necessary.
Adult ; Alcoholism/complications ; English Abstract ; Esophageal Diseases/complications/diagnosis/*surgery ; Humans ; Male ; Middle Aged ; Prognosis ; Rupture, Spontaneous

A systematic and effective welfare system for people with digestive system impairments is required. In Korea, an objective and scientific rating guideline does not exist to judge the digestive system impairments. Whether the impairments exist or not and the degree of it need to be examined. Thus, with these considerations we need a scientific rating guideline for digestive system impairments to fit our cultural and social background. In 2007, a research team, for the development of rating impairment guidelines, was organized under the supervision of Korean Academy of Medical Sciences. The rating guidelines for digestive system impairments was classified into upper and lower gastrointestinal tracts impairments and liver impairment. We developed objective rating guidelines for the upper gastrointestinal tract, the impairment generated after surgery for the stomach, duodenum, esophagus, and for the lower gastrointestinal tract, the impairment generated after construction and surgery for colon, rectum, anus, and intestinal stomas. We tried to make the rating impairment guidelines to include science, objectivity, convenience, rationality, and actuality. We especially emphasized objectivity as the most important value. We worked to make it easy and convenient to use for both the subjects who received the impairment ratings and the doctors who will give the ratings.
Digestive System Diseases/classification/*diagnosis ; *Disability Evaluation ; Duodenal Diseases/classification/diagnosis ; Esophageal Diseases/classification/diagnosis ; Humans ; Inflammatory Bowel Diseases/classification/diagnosis ; Korea ; Liver Diseases/classification/diagnosis ; Postoperative Complications/classification/diagnosis ; Program Development ; Severity of Illness Index ; Stomach Diseases/classification/diagnosis

Candidiasis ; diagnosis ; Cervical Vertebrae ; surgery ; Esophageal Diseases ; diagnosis ; microbiology ; Esophagus ; microbiology ; Humans ; Postoperative Complications ; microbiology ; Spinal Fusion ; adverse effects

BACKGROUND: Although patients may present with typical chest pain and exhibit ischemic changes on the cardiac stress test, they are frequently found to have a normal coronary angiogram. Thus, we wanted to determine which procedures should be performed in order to make an adequate diagnosis of the cause of chest pain. METHODS: 121 patients (males: 42, 34.7%) who had a normal coronary angiogram with typical chest pain were included in this study. All the patients underwent upper endoscopy, Bernstein's test and esophageal manometry. RESULTS: Among the 121 patients, clinically stable angina was noted in 107 (88.4%). Stress testing was done in 82 (67.8%); it was positive in 52 (63.4%). Endoscopic findings were erosive gastritis in 18 (14.8%), gastric ulcer in 4 (3.3%), duodenal ulcer in 5 (4.1%), and reflux esophagitis in 16 (13.2%). Positive results were observed on Berstein's test for 68 patients (56.2%); 59 (86.8%) of them had non-erosive reflux disease. On the esophageal manometry, 35 (28.9%) of these patients had motility disorders. Nutcracker esophagus was observed in 27 patients (22.3%), nonspecific esophageal motility disorder was observed in 5 (4.1%), and hypertensive lower esophageal sphincter was observed in 3 (2.5%). Among the 52 patients with positive cardiac stress testing and a negative coronary angiogram (this clinically corresponded to microvascular angina), 46 patients (85.1%) showed abnormal findings on the gastro-esophageal studies. CONCLUSIONS: In our study, 85.1% of the patients with microvascular angina revealed positive results of gastric or esophageal disease. In spite of any existing evidence of microvascular angina or cardiac syndrome X, it would be more advisable to perform gastro-esophageal studies to adequately manage chest pain.
Stomach Diseases/*complications/epidemiology ; Retrospective Studies ; Middle Aged ; Male ; Incidence ; Humans ; Female ; Esophageal Diseases/*complications/epidemiology ; Coronary Angiography ; Chest Pain/diagnosis/*etiology/radiography ; Aged ; Adult

We report a case of unusual bronchopulmonary foregut malformation composed of a mediastinal bronchogenic cyst with sequestrated lung tissue and communicating tubular esophageal duplication associated with complete pericardial defect. A 18-yrold man, who had suffered from dry cough and mild dyspnea, was admitted because of an incidentally detected chest mass. A computed tomography scan demonstrated a cystic mass with an air fluid level connected with esophagus in the middle mediastinum. The surgically resected mass was a pleural invested accessory lobe of the lung (8.0x7.0x4.5 cm) connected with the esophageal wall by a tubular structure (3.0 cm in length and 2.0 cm in diameter). A complete left pericardial defect was also identified. Histologically, the cystic wall was composed of fibrovascular connective tissue with a smooth muscle layer, mixed seromucous glands and cartilage, and the inner surface of the cyst was lined by ciliated pseudostratified columnar epithelium. The inner surface of the tubular structure was lined by non-keratinizing or keratinizing squamous epithelium, and the wall contained submucosal mucous glands, muscularis mucosa, and duplicated muscularis propria. This case is important in understanding the embryological pathogenesis of the variable spectrum of the bronchopulmonary foregut malformation.
Adolescent ; Bronchogenic Cyst/*complications/*diagnosis ; Digestive System/pathology ; Esophageal Cyst/diagnosis/pathology ; Esophageal Diseases/*complications/*diagnosis ; Esophagus/abnormalities/*pathology ; Humans ; Lung/abnormalities/pathology ; Male ; Pericardium/pathology ; Tomography, X-Ray Computed

Intramural esophageal dissection (IED) is a rare form of esophageal injury. We report a rare case of spontaneous IED complicated with pneumomediastinum and successfully improved by conservative management. A 46-year-old man presented to the emergency department with chest pain and hematemesis. The endoscopic diagnosis was suspicious of IED. Chest CT scan performed to rule out complication noted IED combined with pneumomediastinum. He was managed conservatively with nil per oral, intravenous antibiotics and parenteral nutrition. Follow up study after 2 weeks later showed near complete resolution of IED. IED should be included in the differential diagnosis for unexplained acute chest pain, especially, associated with dysphagia and hematemesis. IED with pneumomediastinum or mediastinitis require prompt surgery. So far, there is no case report of IED combined with pneumomediastinum which resolved without surgical treatment. In this case, IED combined with pneumomediastinum has improved by conservative management, so we present a case report.
Anti-Bacterial Agents/therapeutic use ; Esophageal Diseases/complications/*diagnosis/drug therapy ; Gastroscopy ; Hematemesis/complications/diagnosis ; Humans ; Male ; Mediastinal Emphysema/complications/*diagnosis/drug therapy ; Middle Aged ; Tomography, X-Ray Computed

Mediastinal tuberculous lymphadenitis is rare in adults, and it is even rarer for dysphagia to be the presenting symptom of mediastinal tuberculous lymphadenitis. Mediastinal tuberculous lymphadenitis with esophageal symptoms has been presented as esophageal ulceration, mucosal or submucosal mass with ulceration, fistula or sinus formation, extrinsic compression, or displacement of the esophagus. An exaggerated form of extrinsic compression may be presented as a submucosal tumor, radiologically or endoscopically. A barium esophagography of a 34 year-old woman with painful dysphagia revealed a large submucosal tumor-like mass on the mid-esophagus. The symptom was spontaneously improved over a 3-week period together with reduction of the mass size. A computed tomography of the chest disclosed an enlarged subcarinal lymph node and histologic examination of the specimen obtained by thoracoscopic biopsy brought about a diagnosis of tuberculosis. We herein report a case of mediastinal tuberculosis with unusual manifestations.
Adult ; Case Report ; Deglutition Disorders/*etiology ; Diagnosis, Differential ; Esophageal Neoplasms/*diagnosis ; Esophagoscopy ; Esophagus/pathology/radiography ; Female ; Human ; Mediastinal Diseases/*complications/*diagnosis ; Radiography, Thoracic ; Tomography, X-Ray Computed ; Tuberculosis, Lymph Node/*complications/*diagnosis

While esophagogastric varices are common manifestations of portal hypertension, variceal bleeding from the jejunum is a rare complication of liver cirrhosis. In addition, ectopic variceal bleeding occurs in the duodenum and at sites of previous bowel surgery in most cases, including of stomas. We report a case of obscure overt gastrointestinal bleeding from jejunal varices in a 55-year-old woman who had not previously undergone abdominal surgery, who had liver cirrhosis induced by the hepatitis C virus. Emergency endoscopy revealed the presence of esophageal varices without stigmata of recent bleeding, and no bleeding focus was found at colonoscopy. She continued to produce recurrent melena with hematochezia and received up to 21 units of packed red blood cells. CT angiography revealed the presence of jejunal varices, but no active bleeding was found. Capsule endoscopy revealed fresh blood in the jejunum. The patient submitted to embolization of the jejunal varices via the portal vein, after which she had a stable hemoglobin level and no recurrence of the melena. This is a case of variceal bleeding from the jejunum in a liver cirrhosis patient without a prior history of abdominal surgery.
Angiography ; Capsule Endoscopy ; Embolization, Therapeutic ; Esophageal and Gastric Varices/complications/diagnosis ; Female ; *Gastrointestinal Hemorrhage ; Humans ; Hypertension, Portal ; Jejunal Diseases/*diagnosis/therapy ; Liver Cirrhosis/*diagnosis ; Melena/complications ; Middle Aged ; Tomography, X-Ray Computed

OBJECTIVETo investigate the proportions of functional dyspepsia (FD) and structural diseases within the dyspeptic outpatients in hospitals of different ranking in central area Shaanxi province, and to explore the safety in adopting "symptom and treatment" algorithm used in Western countries.

METHODSA clinical epidemiology survey was carried out by means of a stratified sample of 3 019 dyspeptic outpatients through standardized questionnaire. All of the patients were followed for 4 - 24 weeks, and finally received their diagnoses through a consistent criteria.

RESULTSProportionally, FD in all the outpatients took up 44.8% with 44.7% benign organic causes and 10.5% malignant diseases. In the patients who had marked alarm symptoms, the proportion of benign and malignant diseases rose to 52.1% and 29.2%, respectively. They were significantly higher than those without alarm symptoms (39.2%, 2.9%) (P < 0.01). All of the dyspeptic patients were divided into 7 groups according to different ages. 64.5% of FD patients were younger than 25 years and the rate of FD declined with age. It was found that only four patients below 35 years old had malignance. The number of cases increased significantly in age 35 - 45 group and reached 30.8% in 65 - 74 group.

CONCLUSIONThere were some differences noticed within dyspeptic patterns between local area in China and Western countries, and the "symptom and treatment" approach was not entirely suitable to the local area in China.

Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Child ; China ; epidemiology ; Dyspepsia ; diagnosis ; epidemiology ; etiology ; Esophageal Motility Disorders ; complications ; diagnosis ; epidemiology ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prevalence ; Stomach Diseases ; complications ; diagnosis ; epidemiology

BACKGROUND/AIMS: Upper gastrointestinal endoscopy is usually recommended for the evaluation of esophageal varices in patients with liver cirrhosis. However, the prevalence of varices is extremely variable. We performed this study to determine the predictive values for esophageal varices and to select eligible patients for screening endoscopy. METHODS: Fifty-two patients were enrolled in this study. Laboratory tests including liver biochemistry and complete blood count along with ultrasonography with Doppler measurements and endoscopy were performed. RESULTS: Esophageal varices were present in 25 patients (48%). Variables associated with the presence of esophageal varices on univariate analysis were serum albumin, total bilirubin, prothrombin time and platelet count (p<0.05). Significant variables in ultrasonography with Doppler measurement were diameter of spleen (13.04+/-2.1 cm vs. 10.39+/-1.6 cm, p<0.001), peak velocity of portal vein (30.2+/-7.5 cm/sec vs. 36.1+/-8.0 cm/sec, p<0.01) and portal vein diameter (1.26+/-0.28 cm vs. 1.13+/-0.18 cm, p<0.05). On multivariate analysis, independent variables were platelet count (odds ratio (OR) 0.922; 95% confidence interval (CI), 0.86-0.99), diameter of spleen (OR 5.4; 95% CI, 1.63-17.88) and platelet count/spleen diameter ratio (OR 1.007; 95% CI, 1.01-1.02). The optimal critical value for the diameter of spleen was 11 cm. The sensitivity and specificity with this value were 84% and 63%, respectively. CONCLUSIONS: Doppler measurement was not helpful in distinguishing the presence of varices. However, clinical tests including biochemistry and ultrasonography would be useful in selecting eligible patients for screening endoscopy. Endoscopic screening for esophageal varices is recommended in cirrhotic patients with splenomegaly.
Adult ; Aged ; Blood Chemical Analysis ; Blood Flow Velocity ; Chronic Disease ; Esophageal and Gastric Varices/complications/*diagnosis/ultrasonography ; Female ; Humans ; Liver Cirrhosis/complications ; Liver Diseases/*complications ; Male ; Middle Aged ; ROC Curve ; Severity of Illness Index ; *Ultrasonography, Doppler