Esophageal Diseases ; complications ; Esophagus ; pathology ; Female ; Foreign Bodies ; complications ; Hematoma ; complications ; Humans ; Middle Aged ; Pharyngeal Diseases ; complications ; Pharynx ; pathology

Bullous pemphigoid is a subepidermal blistering skin disease, usually occurred in the elderly. It is an autoimmune disease associated with circulating autoantibodies directed against structural components of hemodesmosome. Rarely, it can involve the esophagus, which can be complicated by upper gastrointestinal hemorrhage. We report a case of bullous pemphigoid with esophageal mucosal desquamation and hemorrhage in patient with chronic renal failure.
English Abstract ; Esophageal Diseases/*complications/pathology ; Female ; Gastrointestinal Hemorrhage/*etiology ; Humans ; Middle Aged ; Mucous Membrane/pathology ; Pemphigoid, Bullous/*complications/pathology

Adolescent ; Dermatitis Herpetiformis ; complications ; Esophageal Diseases ; etiology ; Humans ; Male ; Mucous Membrane ; pathology

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

OBJECTIVETo explore the significance of laryngopharyngeal reflux (LPR) and gastroesophageal reflux (GER) in patients with vocal cord leukoplakia and early glottic cancer.

METHODSPatients with vocal cord leukoplakia and early glottic cancer encountered in Nanfang Hospital between December 2012 to January 2014 were included in this study. Ambulatory 24 hour multichannel intraluminal impedance-pH monitoring (MII-pH) was applied to obtain LPR and GER events, as well as the reflux properties of substances. Tobacco and alcohol history was also evaluated. Sixteen healthy volunteers were recruited as normal controls.

RESULTSThere were 26.3% (5/19) LPR patients in glottic cancer group, 35.3% (6/17) LPR patients in vocal cord leukoplakia group and 12.5% (2/16) LPR volunteers in normal controls. There was no statistically significant difference in the positive rate of LPR between early glottic cancer patients and normal controls as well as between vocal cord leukoplakia patients and normal controls (P > 0.05). There was statistically significance in numbers of acid reflux events, time of acid exposure, and time of acid clearance between vocal cord leukoplakia patients and normal controls as well as between glottic cancer patients and normal controls (P < 0.05). GER was found in 26.3% (5/19) patients in glottic cancer group and 23.5% (4/17) patients in vocal cord leukoplakia group and 6.3% (1/16) volunteer in normal controls. There was no statistically significant difference in the positive rate of GER between early glottic cancer patients and normal controls as well as between vocal cord leukoplakia patients and normal controls (P > 0.05). However, there was statistically significance in DeMeester scores between glottic cancer patients and normal controls (P < 0.05), while no statistically significance between vocal cord leukoplakia patients and normal controls (P > 0.05). Reflux events were dominated by acid and weakly acidic reflux in upright position. Weakly alkaline reflux events in upright position, acid reflux events in supine position, and weakly alkaline reflux events in supine position in vocal cord leukoplakia patients were significantly more than those in normal controls (P < 0.05). No statistically significant difference existed in positions and contents between early glottic cancer patients and normal controls (P > 0.05). There was also no statistically significant correlation between happening LPR and GER, smoking and drinking in patients with vocal cord leukoplakia and early glottic cancer (P > 0.05).

CONCLUSIONSReflux events are more in vocal cord leukoplakia patients and early glottic cancer patients, however, the relationship between laryngopharyngeal reflux and canceration of the vocal cord is still needed to be investigated. The significance of mucosal injury induced by nonacid refluxes is needed to be further studies.

Adult ; Aged ; Case-Control Studies ; Esophageal pH Monitoring ; Female ; Humans ; Laryngeal Diseases ; complications ; Laryngeal Neoplasms ; complications ; Laryngopharyngeal Reflux ; complications ; Leukoplakia ; complications ; Male ; Middle Aged ; Vocal Cords ; pathology

Esophageal involvement in Behcet's disease is very rare, and normally is observed as aphtosis and esophagitis, but serious complications such as erosions, perforations, and stenosis may occur. We carried out this prospective study to evaluate the prevalence of esophageal involvement in Behcet's disease and to establish if routine endoscopy and/or manometry are necessary. Twenty-three patients who fulfilled the diagnostic criteria of the international study group for Behcet's disease were enrolled. None were taking drugs or had disease that might produce esophageal abnormalities or alter any existing changes due to the Behcet's disease itself. Twenty- three patients underwent esophagogastroduodenoscopy by a single observer. Esophageal biopsies were performed in thirteen patients and esophageal manometry in twenty. At the beginning of the study, the disease activity was defined by the presence of more than one symptom related to Behcet's disease, and upon the classification of Behcet's disease. Of the twenty three patients enrolled two were excluded from final analysis because of the presence of hiatus hernia. Thus, 13 men and 8 women, ranging in age from 20 to 63 years with a mean age of 36.2 years were included. Ten patients (47.6%) had active disease and four (19%) complained of upper gastrointestinal symptoms at the time of the study. Fourteen patients had endoscopic, manometric and/or microscopic abnormalities. Esophageal manometry was performed in twenty patients and was abnormal in 7 cases (35%). Esophageal biopsies were done in 13 patients and revealed histopathological abnormalities in 5 cases. Microscopic findings showed vasculities in one case, and non-specific inflammatory infiltration mainly consisting of neutrophils in 4 cases. Our results suggest that the prevalence of esophageal involvement in Behcet's disease is rather high and occur even in asymptomatic patients, but that this usually does not result in specific abnormalities.
Adult ; Behcet Syndrome/*complications ; Esophageal Diseases/*epidemiology ; Esophagoscopy ; Esophagus/pathology ; Female ; Human ; Male ; Manometry ; Middle Age ; Prevalence ; Prospective Studies

Oesophageal ulcerations are generally rare occurrences that are most commonly associated with gastro-oesophageal reflux disorder. Other causes include medications and infections in immunocompromised patients. Among the medications used in daily practice, doxycycline is most commonly implicated. Multiple aetiologies are generally uncommon. We report a case of mid-oesophageal ulcerations secondary to doxycycline and herpes simplex virus infection in an immunocompetent patient.
Anti-Bacterial Agents ; adverse effects ; Doxycycline ; adverse effects ; Endoscopy, Gastrointestinal ; Esophageal Diseases ; etiology ; pathology ; Esophagus ; pathology ; virology ; Female ; Herpes Simplex ; complications ; Humans ; Middle Aged ; Ulcer ; etiology ; pathology

Aortoesophageal fistula is a rare and lethal disorder that may result from primary diseases of aorta or esophagus, aortic bypass graft, ingestion of foreign body, trauma, surgical procedure or instrumentation. Tuberculous fistula is extremely rare. We present a 27-yr-old female patient with aortoesophageal fistula associated with tuberculous mediastinitis. The patient experienced massive hematemesis and esophagoscopy revealed a small mucosal defect with exudate-coated blood vessel like Dieulafoy 's lesion on about 25 cm from the incisor teeth. Despite two sessions of endoscopic hemostatic procedures, active massive hemorrhage recurred and was controlled effectively with a prompt insertion of Sengstaken-Blakemore tube. The patient underwent open thoracotomy, which revealed aortoesophageal fistula. Numerous white-yellowish, millet seed-like tubercles were scattered in pleural and abdominal cavity. Division of fistular tract and esophageal resection with Ivor-Lewis anastomosis were performed. Histopathologic study confirmed tuberculous pleuritis and peritonitis. The patient died of postoperative pulmonary complication.
Adult ; *Aorta, Thoracic/pathology/surgery ; Aortic Diseases/*etiology/pathology/surgery ; Esophageal Fistula/*etiology/pathology/surgery ; *Esophagus/pathology/surgery ; Fatal Outcome ; Female ; Hematemesis/etiology/pathology/surgery ; Humans ; Mediastinitis/pathology ; Tuberculosis, Miliary/*complications

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

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