OBJECTIVETo observe the clinical effect of unblocking the interior and purgation method on improving decreased gastrointestinal motility of post-operative esophageal cancer patients, and to study its mechanisms.

METHODS60 patients with post-operative esophageal cancer were randomly assigned to two groups, the treatment group and the control group, 30 in each group. Routine therapies were given to the two groups. Chinese drugs with unblocking the interior and purgation action was infused by enteral nutrition tube to patients in the treatment group, while normal saline was infused to those in the control group. The first flatus time, the first defecation time, the bowel tones recovery time after operation, and the total amount of the gastric juice draining between the first day and the third day after operation of all patients were recorded. Plasma motilin (MTL) and vasoactive intestinal peptide (VIP) contents were detected before operation and the fourth day after operation.

RESULTSThe first flatus time, the first defecation time, the bowel tones recovery time after operation, and the total amount of the gastric juice draining were less in the treatment group than in the control group, showing statistical difference (P<0.05, P<0.01). The post-operative MTL contents were higher and VIP contents lower in the treatment group than in the control group, showing statistical difference (P<0.05, P<0.01). There was no significant difference in plasmal MTL and VIP contents of the treatment group between before and after treatment (P>0.05). But there was significant difference in plasmal MTL and VIP contents of the control group between before and after treatment (P<0.01).

CONCLUSIONUnblocking the interior and purgation method could significantly promote the gastrointestinal motility recovery of post-operative esophageal cancer patients, showing good clinical effect.

Adult ; Aged ; Esophageal Neoplasms ; surgery ; Female ; Gastrointestinal Diseases ; drug therapy ; physiopathology ; prevention & control ; Gastrointestinal Motility ; Humans ; Male ; Middle Aged ; Phytotherapy ; Postoperative Complications ; drug therapy ; prevention & control

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

Acute esophageal necrosis (AEN) is a very rare disorder typically presenting as a diffuse black esophageal mucosa on upper endoscopy. For this reason, AEN is often considered to be synonymous with 'black esophagus'. The pathogenesis of entity is still unknown. We report a case of AEN with duodenal ulcer causing partial gastric outlet obstruction. A 53-year-old man presented with hematemesis after repeated vomiting. The upper gastrointestinal endoscopy revealed circumferential black coloration on middle 315 to lower esophageal mucosa that stopped abruptly at the gastroesophageal junction. Pyloric ring deformity and active duodenal ulceration with extensive edema was observed. After conservative management with NPO and intravenous proton pump inhibitor, he showed clinical and endoscopic improvement. He resumed an oral diet on day 7 and was discharged. In our case the main pathogenesis of disease could be accounted for massive esophageal reflux due to transient gastric outlet obstruction by duodenal ulcer and following local ischemic injury.
Acute Disease ; Duodenal Ulcer/drug therapy/etiology ; Endoscopy, Gastrointestinal ; Esophageal Diseases/complications/*diagnosis/drug therapy ; Esophagus/*pathology ; Gastric Outlet Obstruction/*complications/pathology ; Humans ; Ischemia/pathology ; Male ; Middle Aged ; Necrosis ; Proton Pump Inhibitors/therapeutic use ; Tomography, X-Ray Computed

Noncardiac chest pain (NCCP) is one of the most common esophageal symptoms and lacks a clearly defined mechanism. The most common cause of NCCP is gastroesophageal reflux disease (GERD). One of the accepted mechanisms of NCCP in a patient without GERD has been altered visceral sensitivity. Mast cells may play a role in visceral hypersensitivity in irritable bowel syndrome. In this case, a patient with NCCP and dysphagia who was unresponsive to proton pump inhibitor treatment had an increased esophageal mast cell infiltration and responded to 14 days of antihistamine and antileukotriene treatment. We suggest that there may be a relationship between esophageal symptoms such as NCCP and esophageal mast cell infiltration.
Adult ; Chest Pain/*etiology ; Esophageal Diseases/*complications/drug therapy ; Esophagus/cytology/pathology ; Female ; Histamine Antagonists/therapeutic use ; Humans ; Leukotriene Antagonists/therapeutic use ; Mast Cells/metabolism ; Mastocytosis/*complications/drug therapy

BACKGROUND/AIMS: Terlipressin and somatostatin decrease portal venous pressure and they are used for the treatment of variceal bleeding. However, only a few studies have compared the efficacy of these drugs in combination with other procedures for hemostasis. Therefore, we performed a prospective study to compare the efficacy of terlipressin and somatostatin for controlling acute variceal bleeding when used in combination with other procedures for hemostasis. METHODS: A total of 98 patients, who presented with variceal bleeding from September 2003 to May 2005, were randomly divided into the somatostatin group or terlipressin group. We compared the 5-day failure rate (defined as failure to control bleeding, rebleeding or death within 5 days of admission) and the 6-week mortality. The prognostic factors for 5-day failure and 6-week mortality were also evaluated. RESULTS: There were no differences in baseline characteristics between the two groups. The overall 5-day failure rate and the cumulative 6-week mortality were 16.3% and 15.8%, respectively. The five-day failure rate and the cumulative 6-week mortality were not significantly different between the somatostatin and terlipressin groups. Hepatocellular carcinoma, the baseline serum creatinine level and endoscopic treatment for hemostasis were the significant predictors of 5-day failure; the baseline serum creatinine level was the predictor of 6-week mortality. CONCLUSIONS: Both somatostatin and terlipressin were effective and showed comparable efficacy for the control of the acute variceal bleeding in the setting of a combined therapeutic approach. The baseline serum creatinine level may be a significant predictor for patient failure at 5 days and the 6-week mortality.
Acute Disease ; Aged ; Carcinoma, Hepatocellular/complications ; Esophageal and Gastric Varices/complications/*drug therapy ; Female ; Gastrointestinal Hemorrhage/complications/*drug therapy ; Hemorrhage/complications/drug therapy ; Hemostasis, Endoscopic ; Humans ; Liver/*blood supply ; Liver Cirrhosis/*complications ; Liver Diseases/drug therapy ; Liver Neoplasms/complications ; Lysine Vasopressin/administration & dosage/*analogs & derivatives/therapeutic use ; Male ; Middle Aged ; Multivariate Analysis ; Somatostatin/administration & dosage/*therapeutic use ; Varicose Veins/complications/drug therapy ; Vasoconstrictor Agents/administration & dosage/*therapeutic use

OBJECTIVETo investigate the clinical efficacy of Shenzhe Zhuyun mixture (SZM) in treating esophageal lesion in patients with systemic sclerosis.

METHODSSixty-four patients conforming to the inclusion criteria were randomly divided into 2 groups, the treated group and the control group treated respectively by SZM and cisapride, with the blank preparation imitating the contrast one, the treatment course to both groups was 2 months. The clinical efficacy, the changes in symptom scores of esophageal lesion, the orthostatic and clinostatic time of barium passing through esophagus, the clinostatic esophageal emptying index of barium, and the widest transverse diameter of ectatic esophageal segment, as well as the influence of treatment on patients' quality of life were observed.

RESULTSThe total effective rate in the treated group was superior to that in the control group (96.9% vs 56.2%, P < 0.01). Symptom of esophageal lesion was significantly improved after treatment in both groups (P<0.01), and the improvement in the treated group was better than that in the control group (P <0.01). The time of Barium passing through esophagus, both orthostatic and clinostatic, and the esophageal emptying index of barium were improved in the treated group (P < 0.01), but the change of the widest transverse diameter of ectatic esophagus was insignificantly improved. While in the control group, excepting the clinostatic time of barium passing through was improved (P<0.01), the other indexes showed no obvious change. Patients' quality of life was significantly improved in the treated group, but improvement didn't revealed in the control group.

CONCLUSIONSZM can reinforce esophageal dynamic function in patients with systemic sclerosis, it can be an effective TCM prescription in treating esophageal lesion for them.

Adolescent ; Adult ; Aged ; Double-Blind Method ; Drugs, Chinese Herbal ; therapeutic use ; Esophageal Diseases ; drug therapy ; etiology ; physiopathology ; Esophagus ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Phytotherapy ; Scleroderma, Systemic ; complications ; drug therapy