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.