esophageal necrosis

食管坏死
  • 文章类型: Journal Article
    目的:胃扭转急性食管坏死(AEN)是一种罕见的疾病,仅报道了少数病例。扭转可能通过限制组织灌注和促进食管粘膜受损的胃内容物的大量回流来促进AEN。
    方法:我们审阅了225篇原创文章,文献综述,案例系列,简短的报告,病例报告,并讨论了共发生食管坏死和胃扭转的6例。
    结论:我们对迄今为止所有文献报道的病例进行了首次综合分析,并制定了AEN和肠扭转的治疗策略。AEN的管理应针对纠正潜在的医疗条件,提供血液动力学支持,启动nil-per-os限制,并给予大剂量质子泵抑制剂治疗。手术干预通常适用于食管穿孔伴纵隔炎和脓肿形成的病例。
    Acute esophageal necrosis (AEN) in the setting of gastric volvulus is a rare condition with only a handful of cases reported. Volvulus may contribute to AEN by limiting tissue perfusion and promoting massive reflux of gastric contents on compromised esophageal mucosa.
    We reviewed 225 original articles, literature reviews, case series, brief reports, case reports, and discuss six total cases of co-occurring esophageal necrosis and gastric volvulus.
    We present the first comprehensive analysis of all reported cases in the literature to date and formulate management strategies for the co-occurrence of AEN and volvulus. Management of AEN should be directed at correcting underlying medical conditions, providing hemodynamic support, initiating nil-per-os restriction, and administering high-dose proton pump inhibitor therapy. Surgical intervention is typically reserved for cases of esophageal perforation with mediastinitis and abscess formation.
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  • 文章类型: Journal Article
    背景:回顾所有关于急性食管坏死的文献。
    方法:使用特殊医学主题标题(MeSH)术语检索数据库。对所有可用的急性食管坏死病例进行分析。
    结果:共确定154例,分析130例。演示的平均年龄是61岁,70%的病例是男性。最常见的症状是66%的呕血,36%的冲击,黑便占33%,28%的腹部或胸骨后疼痛。报告的最常见的合并症是38%的糖尿病,高血压占37%,25%的酒精滥用,慢性肾病占16%。在上内窥镜检查中,51%患有远端疾病,36%有泛食道,只有2%患有近端疾病。84%的患者接受了静脉注射质子泵抑制剂治疗,22%接受输血,23%的人接受了抗生素治疗潜在的败血症,14%还接受了硫糖铝,4%需要手术治疗。死亡率为32%,5%的患者报告穿孔,9%的患者报告狭窄形成。
    结论:如果治疗得当,急性食管坏死患者可以获得良好的预后。
    BACKGROUND: To review all the reported literature on acute esophageal necrosis.
    METHODS: Databases were searched using the special Medical Subject Heading (MeSH) terms. All the available reported cases of acute esophageal necrosis were analyzed.
    RESULTS: A total of 154 cases were identified and 130 cases were analyzed. The mean age of presentation was 61 years, and 70% of cases were males. The most common presenting symptoms were hematemesis in 66%, shock in 36%, melena in 33%, abdominal or substernal pain in 28%. The most common comorbidities reported were diabetes in 38%, hypertension in 37%, alcohol abuse in 25%, and chronic kidney disease in 16%. On upper endoscopy, 51% had a distal disease, 36% had pan esophageal, and only 2% had a proximal disease. 84% of patients were treated with IV Proton Pump Inhibitors, 22% received transfusions, 23% got antibiotics for underlying sepsis, 14% also received sucralfate, and 4% required surgery for treatment. The mortality rate was 32%, while perforation was reported in 5% and stricture formation reported in 9% of patients.
    CONCLUSIONS: Patients with acute esophageal necrosis can have a favorable outcome if treated appropriately.
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