Diagnostic gastroscopy – Esophageal papillomatosis
Live endoscopy from the HSK Dr. Horst Schmidt Hospitals in Wiesbaden in collaboration with „Video Journal and Encyclopedia of GI Endoscopy“.
©2013 Elsevier. All rights reserved. Wirth the friendly assistance of Falk Foundation e.V., Freiburg.
Angelika Behrens/Neumann and Jürgen Pohl, HSK Dr.-Horst-Schmidt-Kliniken Wiesbaden, Germany
Presentation of the case of a 73-year-old woman with dysphagia and heartburn. A diagnostic gastroscopy showed irregular and suspicious mucosa within the esophagus and the patient was referred for further diagnostic work-up. Here, the performance of a diagnostic gastroscopy with the diagnosis esophageal papillomatosis is presented.
Take home messages:
- Esophageal papillomatosis is an extremely rare disease that is associated with papilloma virus infection.
- Only very few cases were reported in the literature so far and several of these cases developed a squamous cell carcinoma within the mucosal changes.
- In the present case, a diagnostic resection of the neoplastic lesion was performed and, indeed, histological work-up showed an early carcinoma.
- Because of the extensive changes within the esophagus, esophagectomy was performed.
- After surgery, non-neoplastic papillomatous changes that extended to the upper sphincter of the esophagus were ablated with argon plasma coagulation.
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Ananthakrishnan AN et al, Inflamm Bowel Dis. 2013;19(9):1921–7
Low plasma 25(OH) vitamin D is associated with increased risk of surgery and hospitalizations in both Crohn’s disease and ulcerative colitis, and normalization of 25(OH) vitamin D status is associated with a reduction in the risk of Crohn’s disease related surgery.
Pedersen N et al, Aliment Pharmacol Ther. 2013;38(5):501–12
The prospective ECCO-EpiCom Study: Pregnant women with Crohn’s disease had a similar disease course both during pregnancy and after delivery as the non-pregnant women. In contrast, pregnant women with ulcerative colitis were at higher risk of relapse during pregnancy and in the postpartum than non-pregnant ulcerative colitis women.
Deshpande A et al, J Antimicrob Chemother. 2013;68(9):1951–61
A metaanalysis: Antibiotic exposure is an important risk factor for community-associated Clostridium difficile infection, but the risk is different amongst different antibiotic classes. The risk is greatest with clindamycin followed by fluoroquinolones and cephalosporins, whereas tetracyclines are not associated with an increased risk.
Zeuzem S et al, N Engl J Med. 2013;369(7):630–9
The rate of a sustained virologic response 12 weeks after the completion of therapy was 52% to 69% among patients who received interferon-free treatment with faldaprevir in combination with deleobuvir plus ribavirin.
Osinusi A et al, JAMA. 2013;310(8):804–11
In a population of patients with a high prevalence of unfavorable traditional predictors of treatment response, a 24-week regimen of sofosbuvir and weight-based or low-dose ribavirin resulted in sustained virological response rates after 24 weeks of 68% and 48%, respectively.
Spada E et al, Clin Infect Dis. 2013;57(6):803–11
Self-limiting acute hepatitis C was independently associated with CC genotype. The correlation between IL28B.rs12979860 genotypes and cell-mediated immunity is suggestive of a possible important role of cell-mediated immunity in favoring hepatitis C virus clearance in CC patients.
Chen Y et al, Gut. 2013;62(9):1262–9
These findings suggest that Helicobacter pylori has a mixed role in human health (increase of gastric cancers, decrease of strokes), but is not a major risk factor for all-cause mortality.
Vazquez-Elizondo G et al, Aliment Pharmacol Ther. 2013;38(10):1312–9
In this study, more than 50% of patients with documented eosinophilic esophagitis improved when treated with a double-dose proton-pump inhibitor (PPI) trial for 8 weeks. These findings support the published guidelines recommending a PPI trial prior to diagnosing eosinophilic esophagitis, and confirm the existence of an eosinophilic esophageal infiltration PPI-responsive population.
Wueppenhorst N et al, J Antimicrob Chemother. 2013;68(7):1562–6
Resistance rates to levofloxacin/ciprofloxacin and triple resistance (chinolones, metronidazole, clarithromycin) have continuously risen and reached worrying numbers. Hence the authors strongly advise against the use of quinolones in empirical second-line therapies for Helicobacter pylori without prior susceptibility testing and/or a carefully taken patient medical history.
Douros A et al, Aliment Pharmacol Ther. 2013;38(7):825–34
This study quantified the pancreatotoxic risk of different drugs and phytotherapeutics. The findings corroborate previous results from the literature but also indicate risks for substances not previously reported, highlighting the need for further controlled studies on pancreatic toxicity.
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