Esophagopericardial fistala is a rare and usually life threatening complication of both benign and malignant esophageal disease. A case of pyopneumopericarduim in 45 year-old female is reported. Streptocoeeus viridana in pas celtore was isolated from pericardial pus. The disorder resulted from eaqyhagoyericardial fistula which probably developed as a complication of esophageal diverticnlum. The diagnasis of the fistula was established preoperatively on the basis of chest X-ray, esophagogram and. endoeeopic findings. The treatment was thoracotorny with drainage of pericardium, diverticulectomy and antimicrobial chemotherapy. The patieat improved postoperatively.
Drainage ; Drug Therapy ; Esophageal Diseases ; Female ; Fistula* ; Humans ; Middle Aged ; Pericardium ; Suppuration ; Thorax

Objective: To investigate the clinical characteristics of abnormal liver function in patients with advanced esophageal squamous carcinoma treated with programmed death-1 (PD-1) antibody SHR-1210 alone or in combination with apatinib and chemotherapy. Methods: Clinical data of 73 patients with esophageal squamous carcinoma from 2 prospective clinical studies conducted at the Cancer Hospital Chinese Academy of Medical Sciences from May 11, 2016, to November 19, 2019, were analyzed, and logistic regression analysis was used for the analysis of influencing factors. Results: Of the 73 patients, 35 had abnormal liver function. 13 of the 43 patients treated with PD-1 antibody monotherapy (PD-1 monotherapy group) had abnormal liver function, and the median time to first abnormal liver function was 55 days. Of the 30 patients treated with PD-1 antibody in combination with apatinib and chemotherapy (PD-1 combination group), 22 had abnormal liver function, and the median time to first abnormal liver function was 41 days. Of the 35 patients with abnormal liver function, 2 had clinical symptoms, including malaise and loss of appetite, and 1 had jaundice. 28 of the 35 patients with abnormal liver function returned to normal and 7 improved to grade 1, and none of the patients had serious life-threatening or fatal liver function abnormalities. Combination therapy was a risk factor for patients to develop abnormal liver function (P=0.007). Conclusions: Most of the liver function abnormalities that occur during treatment with PD-1 antibody SHR-1210 alone or in combination with apatinib and chemotherapy are mild, and liver function can return to normal or improve with symptomatic treatment. For patients who receive PD-1 antibody in combination with targeted therapy and chemotherapy and have a history of long-term previous smoking, alcohol consumption and hepatitis B virus infection, liver function should be monitored and actively managed in a timely manner.
Humans ; Esophageal Squamous Cell Carcinoma/drug therapy* ; Esophageal Neoplasms/pathology* ; Prospective Studies ; Programmed Cell Death 1 Receptor/therapeutic use* ; Antineoplastic Combined Chemotherapy Protocols/adverse effects* ; Liver Diseases/etiology*

Actinomycosis is a chronic suppurative disease and caused by Actinomycosis species, principally Actinomyces israelii, which are part of the normal inhabitant on the mucous membrane of the oropharynx, gastrointestinal tract, and urogenital tract. It usually affects cervicofacial, thoracic and abdominal tissue. Cervicofacial type has the highest percentage of occurrence with 50%. Actinomycosis frequently occurs following dental extraction, jaw surgery, chronic infection or poor oral hygiene. It may also be considered as an opportunistic infection in immunocompromised patients such as malignancy, human immunodeficiency virus infection, diabetes mellitus, steroid usage or alcoholism. But, actinomycosis rarely occurs in adults with normal immunity and rare in the esophagus. We report an unusual case of esophageal actinomycosis which was developed in a patient with normal immunity and improved by therapy with intravenous penicillin G followed oral amoxicillin, and we also reviewed the associated literature.
Actinomycosis/*diagnosis/drug therapy/immunology ; Adult ; Amoxicillin/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Esophageal Diseases/*diagnosis/drug therapy/immunology ; Esophagoscopy ; Female ; Humans ; Immunity ; Penicillin G/therapeutic use

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

Heterotopic gastric mucosa in the upper esophagus is frequently found during endoscopic examination. Although most patients with heterotopic gastric mucosa of the upper esophagus, referred as inlet patch, are asymptomatic, symptomatic patients with complications resulting from this ectopic mucosa have also been reported. Acid secretion by the inlet patch has been suggested in some reports. We report a case of heterotopic gastric mucosa in the upper esophagus, with secretion of acid, demonstrated by continuous ambulatory pH monitoring, and the improvement of pharyngeal symptoms after the use of a proton pump inhibitor.
Adult ; Ambulatory Care ; Anti-Ulcer Agents/administration & dosage ; Case Report ; Choristoma/diagnosis* ; Esophageal Diseases/drug therapy ; Esophageal Diseases/diagnosis* ; Esophagoscopy ; Gastric Acid/secretion* ; Gastric Mucosa/secretion* ; Human ; Hydrogen-Ion Concentration ; Male ; Monitoring, Physiologic/methods ; Prognosis

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

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

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

Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Squamous Cell ; drug therapy ; radiotherapy ; Combined Modality Therapy ; Esophageal Diseases ; etiology ; Esophageal Neoplasms ; drug therapy ; radiotherapy ; Female ; Fluorouracil ; administration & dosage ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Particle Accelerators ; Platinum Compounds ; administration & dosage ; Radiation Injuries ; etiology ; Radiotherapy, High-Energy ; adverse effects