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INTRODUCTION: Early neoplastic progression of Barretts esophagus (BE) is often treated with endoscopic therapy. Although effective, some patients are refractory to therapy or recur after apparent eradication of the BE. The goal of this study was to determine whether genomic alterations within the treated BE may be associated with persistent or recurrent disease. METHODS: We performed DNA sequencing on pre-treatment esophageal samples from 45 patients who were successfully treated by endoscopic therapy and did not recur as well as pre-treatment and post-treatment samples from 40 patients who had persistent neoplasia and 21 patients who had recurrent neoplasia. The genomic alterations were compared between groups. RESULTS: The genomic landscape was similar between all groups. Patients with persistent disease were more likely to have pre-treatment alterations involving the receptor tyrosine kinase pathway ( P = 0.01), amplifications of oncogenes ( P = 0.01), and deletions of tumor suppressor genes ( P = 0.02). These associations were no longer significant after adjusting for patient age and BE length. More than half of patients with persistent (52.5%) or recurrent (57.2%) disease showed pre-treatment and post-treatment samples that shared at least 50% of their driver mutations. DISCUSSION: Pre-treatment samples were genomically similar between those who responded to endoscopic therapy and those who had persistent or recurrent disease, suggesting there is not a strong genomic component to treatment response. Although it was expected to find shared driver mutations in pre-treatment and post-treatment samples in patients with persistent disease, the finding that an equal number of patients with recurrent disease also showed this relation suggests that many recurrences represent undetected minimal residual disease.

Background & aimsDiscerning whether laryngeal symptoms result from gastroesophageal reflux is clinically challenging and a reliable tool to stratify patients is needed. We aimed to develop and validate a model to predict the likelihood of gastroesophageal reflux disease (GERD) among patients with chronic laryngeal symptoms.MethodsThis multicenter international study collected data from adults with chronic laryngeal symptoms who underwent objective testing (upper gastrointestinal endoscopy and/or ambulatory reflux monitoring) between March 2018 and May 2023. The training phase identified a model with optimal receiver operating characteristic curves, and β coefficients informed a weighted model. The validation phase assessed performance characteristics of the weighted model.ResultsA total of 856 adults, 304 in the training cohort and 552 in the validation cohort, were included. In the training phase, the optimal predictive model (area under the curve, 0.68; 95% CI, 0.62-0.74), was the Cough, Overweight/obesity, Globus, Hiatal Hernia, Regurgitation, and male seX (COuGH RefluX) score, with a lower threshold of 2.5 and an upper threshold of 5.0 to predict proven GERD. In the validation phase, the COuGH RefluX score had an area under the curve of 0.67 (95% CI, 0.62-0.71), with 79% sensitivity and 81% specificity for proven GERD.ConclusionsThe externally validated COuGH RefluX score is a clinically practical model to predict the likelihood of proven GERD. The score classifies most patients with chronic laryngeal symptoms as low/high likelihood of proven GERD, with only 38% remaining as indeterminate. Thus, the COuGH RefluX score can guide diagnostic strategies and reduce inappropriate proton pump inhibitor use or testing for patients referred for evaluation of chronic laryngeal symptoms.

Introduction: The etiology of esophageal squamous papilloma (ESP) is largely unknown. Previous studies have shown a variable association with human papillomavirus (HPV) with conflicting data. The aim of this study was to further investigate the possible association of HPV in our ESP series using RNA in-situ hybridization (ISH) and compare study groups from the United States of America and China. Methods: Demographic and clinical data of patients with ESP were retrieved from the University of California Los Angeles (UCLA) (1/2016-3/2019) and Peking Union Medical College Hospital (PUMCH) (9/2014-3/2019) pathology databases. Hematoxylin and eosin slides were reexamined. Confirmed cases were examined by high- and low-risk HPV RNA ISH. Results: For the UCLA cohort, 13 429 upper endoscopies were performed and 78 biopsies from 72 patients were identified as ESP (F:M = 45:27, 66.7% > 45 years). Seventy-four (94.9%) biopsies were designated as polyps or nodules and 46.6% were located in the mid-esophagus. Other abnormal findings included gastroesophageal reflux disease (48.6%), hiatal hernia (38.9%), and esophagitis (36.1%). For the PUMCH cohort, 63 754 upper endoscopies were performed and 73 biopsies from 71 patients were identified as ESP (F:M = 48:23, 71.8% > 45 years). Sixty-four (87.7%) biopsies were designated as polyps or nodules and 57.5% were located in the mid-esophagus. Other abnormal findings included esophagitis (19.7%), and hiatal hernia (8.5%). No features of conventional cytologic dysplasia or viral cytopathic change were found. None of the cases was associated with squamous cell carcinoma, and none showed positive HPV RNA ISH results. Conclusions: No association was found between ESP and active HPV infection in our 2 cohorts. Other etiopathogenetic mechanisms, such as aging, might contribute to the development of these innocent lesions.

Squamous cell cancers (SCCs) of the head and neck, esophagus, and lung, referred to as aero-upper digestive SCCs, are prevalent in the United States and worldwide. Their incidence and mortality are projected to increase at alarming rates, posing diagnostic, prognostic, and therapeutic challenges. These SCCs share certain epigenetic, genomic, and genetic alterations, immunologic properties, environmental exposures, as well as lifestyle and nutritional risk factors, which may underscore common complex gene-environmental interactions across them. This review focuses upon the frequent shared epigenetic, genomic, and genetic alterations, emerging preclinical model systems, and how this collective knowledge can be leveraged into perspectives on standard of care therapies and mechanisms of resistance, nominating new potential directions in translational therapeutics. Henick et al. review aero-upper digestive squamous cell cancers (SCCs) emerging from the head/neck, esophagus, and lung. These SCCs share environmental exposures, dietary/lifestyle factors and genetic features. Patient-derived xenografts, 3D-culture systems, and genetically engineered models recapitulate cardinal disease features to drive translational applications. Emerging therapeutic strategies transcend standard-of-care for these patients. [ABSTRACT FROM AUTHOR]

Summary: Background: Chronic kidney disease (CKD) is one of the most prevalent comorbid conditions in the US. While prior studies have established a correlation between CKD and increased mortality and complications in surgery, its impact on esophagectomy outcomes remains underexplored. This study aimed to assess the effect of CKD on the 30-day outcomes of esophagectomy using data from a national registry. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) esophagectomy-targeted database was used in this retrospective study. The period considered was from 2016 to 2022. Patients with CKD were selected based on an estimated glomerular filtration rate (eGFR) ≤ 60 mL/min/1.73m2. A 1:2 propensity score matching was applied to CKD and non-CKD patients for demographics, baseline characteristics, neoadjuvant therapy, surgical approaches, tumor diagnosis, and staging of the malignancy. The 30-day postoperative outcomes were then compared. Results: There were 655 (8.30%) and 7232 patients with and without CKD who underwent esophagectomy, respectively, whereby 1310 non-CKD patients were matched to all CKD patients. After propensity score matching, CKD patients had higher mortality (6.72% vs. 3.44%, p < 0.01), pulmonary complications (28.85% vs. 23.21%, p = 0.01), renal complications (7.18% vs. 2.44%, p < 0.01), sepsis (16.03% vs. 12.14%, p = 0.02), and bleeding requiring transfusion (16.64% vs. 12.06%, p = 0.01). Conclusion: CKD can be an independent risk factor for adverse outcomes following esophagectomy. This underscores the importance of thorough preoperative risk stratification and the need for targeted management strategies for patients with CKD to potentially improve their surgical outcomes. [ABSTRACT FROM AUTHOR]

Background: Achalasia is a rare esophageal motility disorder with an estimated annual incidence of 1–5/100.000 and a mean age at diagnosis > 50 years of age. Only a fraction of the patients has an onset during childhood (estimated incidence of 0.1–0.18/ 100.000 children per year). No curative treatment is currently available. Peroral Endoscopic Myotomy (POEM) is a widely accepted treatment option to improve symptoms in adults. Studies evaluating safety and efficacy of POEM in children are scarce and no data exist regarding the quality of life in patients after POEM. Methods: We evaluated the effectiveness and safety of POEM in a cohort of children that was treated for achalasia and we prospectively evaluated their quality of life. We compared the results to a previous cohort evaluating Pneumatic Dilation (PD) and Laparoscopic Heller's Myotomy (LHM) in children with achalasia. Results: Thirty-three achalasia patients (age at time of POEM 14.1(± 2.5) years, 54.5% female) were included. Twenty-nine (87.8%) percent had received previous treatment (PD (n = 20); LHM (n = 1); PD + LHM (n = 7); PD + Botox (n = 1). POEM was technically successful in all patients and no major complications occurred. Mean follow-up duration was 33 (± 25) months. Twenty three (70%) patients did not need retreatment after POEM during the follow up period. Quality of life after POEM did not differ from the population norms. Patients with an Eckardt score > 3 had a significantly worse general (Kidscreen-52: physical score 44.7 vs. 52.4; p = 0.011; mental score: 42.5 vs. 51.3; p = 0.038) and disease specific (35 vs. 16; p = 0.017) quality of life compared to those with an Eckardt ≤ 3. The SF-36 mental health component score was significantly lower (44.2 vs. 53.1; p = 0.036) in patients treated with POEM compared to those treated with PD and LHM. These lower scores could be related to a selection bias, as more severe patients received POEM, and other influences such as the Corona pandemic. However, the overall, quality of life after POEM was not significantly different to PD and LHM. Conclusion: POEM is an effective and safe treatment for achalasia in children. Quality of life after POEM is comparable to the results obtained after PD and Heller. [ABSTRACT FROM AUTHOR]

A 34-year-old male patient with recently diagnosed with medullary thyroid carcinoma underwent total thyroidectomy and radical neck dissection, requiring sharp dissection to separate the tumour from the trachea. He required post operative intubation due to bilateral vocal cord paralysis. He developed ischaemic necrosis of the upper two thirds of the trachea presenting with marked surgical emphysema and an infective wound. The wound was opened, drained and an endotracheal tube was negotiated through the sloughed trachea into the distal intrathoracic trachea with the cuff inflated just above the carina. This complication was managed with total pharyngo-laryngectomy, anterior deep mediastinal tracheostomy and construction of a neo-cervical oesophagus with a free lateral thigh fascio-cutaneous flap. This case highlights the potential complications of a procedure, perseverance, collaboration amongst various disciplines and teamwork for treating a rare and complex condition. The patient was discharged and has had an excellent recovery with good quality of life over two years of follow up. [ABSTRACT FROM AUTHOR]

Purpose: Synchronous esophageal (EC) and rectal carcinoma (RC) is a rare and challenging condition, particularly in curative-intended treatment. Especially locally advanced tumors may not be suitable for primary resection and require individual multimodal treatment. This review examines curative-intended management of synchronous EC and RC. Material and Methods: A systematic literature search across five electronic databases according to the PRISMA guideline was conducted. Individual patient data was analyzed, including two additional cases from our institution. Results: We identified 9 relevant cases from 1552 results. Additionally, two male patients (62 and 65 years old) from our institution were included. Both received 5-fluorouracil/cisplatin-based chemoradiotherapy (CRT) for EC. Sequential short-course radiation (SCRT) for RC was performed in one patient. After complete response (CR) in both tumors, no consecutive surgery was performed. He underwent resection for local recurrence of RC 11 months later and is currently considered as disease-free (30 months follow-up). The second patient underwent primary resection of RC and had early progression following resection of EC. We found that most patients had advanced EC (8/11), with the majority receiving neoadjuvant (5/11) or definitive treatment (3/11). Locally advanced RC was diagnosed in 5/11 patients, primarily treated with sequential resection. Pyrimidine-based systemic treatment was common. Four relapses and two deaths were reported, but median follow-up was 11 (range 1.5–30) months only. Conclusion: The review suggests that neoadjuvant multimodal approaches may offer curative potential for synchronous EC and RC, with individualized treatment protocols adapted from single-cancer protocols. Nevertheless, data on long-term outcome is limited. [ABSTRACT FROM AUTHOR]

Disorders and diseases present considerable challenges to human society, and among them, dysphagia stands out as a frequently observed disorder, notably affecting both the elderly and pediatric populations. Addressing this issue has been the focus of numerous clinical and medical research efforts. However, a comprehensive approach that investigates both the mechanical and biological aspects of dysphagia holds promise for proposing and implementing more effective solutions. By exploring the mechanobiology of the human digestive system, particularly focusing on swallowing and esophageal peristalsis, a deeper understanding of dysphagia can be gained. Studying the rheological behavior of food during the digestion process becomes crucial, allowing for the customization of food diets for individuals affected by this disorder. This review provides an overview of various mathematical and finite element analysis (FEA) models that have been proposed to address dysphagia. Additionally, it explores the rheological properties of the food bolus, offering acumens that can contribute to a more nuanced understanding of the disorder. This multidimensional approach holds the potential to improve both the diagnosis and treatment of dysphagia, ultimately enhancing the quality of life for individuals affected by this condition. [ABSTRACT FROM AUTHOR]

Background/Aims: Endoscopic vacuum-assisted closure (EVAC) is a novel technique used to repair esophageal perforation and leaks. Varying data have been reported on the overall success rate of EVAC. We aimed to conduct a meta-analysis of the available data on the clinical success rate of EVAC. Methods: Electronic databases were searched for publications addressing the efficacy of EVAC in esophageal luminal defects. Pooling was conducted using both fixed and random-effects models. The overall clinical success of EVAC therapy was considered the primary outcome, whereas, overall complication rates, need for adjunct therapy, and mortality were considered secondary outcomes. Results: In total, 366 patients were included in the study. On pooled analysis, the mean age was 66 years with 68.32% of patients being men. Overall pooled clinical success rate of EVAC therapy was 87.95%. Upon subgroup analysis, the pooled clinical success rate of postsurgical anastomotic leak and transmural esophageal perforation were found to be 86.57% and 88.89%, respectively. The all-cause hospital mortality was 14% and 4.2% in patients with esophageal perforation and EVAC, respectively. Conclusions: This study demonstrates that EVAC therapy has a high overall clinical success rate, with low mortality. EVAC therapy seems to be a promising procedure with excellent outcomes in patients with luminal esophageal defects. [ABSTRACT FROM AUTHOR]

Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease involving inflammation of the esophagus. Endoscopy is essential in the diagnosis and treatment of EoE and shows typical findings, including esophageal edema, rings, exudates, furrows, and stenosis. However, studies involving pediatric and adult patients with EoE suggest that even a normally appearing esophagus can be diagnosed as EoE by endoscopic biopsy. Therefore, in patients with suspected EoE, biopsy samples should be obtained from the esophagus regardless of endoscopic appearance. Moreover, follow-up endoscopies with biopsy after therapy initiation are usually recommended to assess response. Although previous reports of endoscopic ultrasonography findings in patients with EoE have shown diffuse thickening of the esophageal wall, including lamina propria, submucosa, and muscularis propria, its role in EoE remains uncertain and requires further investigation. Endoscopic dilation or bougienage is a safe and effective procedure that can be used in combination with medical and/or dietary elimination therapy in patients with esophageal stricture for the management of dysphagia and to prevent its recurrence. [ABSTRACT FROM AUTHOR]

Background: Lichen planus (LP) is a chronic inflammatory disease that can present with significant morbidity, particularly in children. Erosive lichen planus (ELP), its rare destructive subtype, can be particularly difficult to diagnose and manage. We present a rare pediatric case of ELP with multisite involvement and discuss the differential diagnosis. Case Presentation: A 12-year-old boy presented with painful erosions and ulcers on the lateral tongue and dystrophic nails. His six-year history of tongue and nail lesions prompted several comprehensive examinations. Laboratory tests did not reveal any abnormalities. Histopathological examination of the tongue lesions was representative of ELP. Line-field confocal optical coherence tomography (LC-OCT) examination of the tongue lesions showed features that strongly correlated with histopathology. The patient was later hospitalized due to dysphagia and esophageal food impaction, during which esophageal ELP was confirmed. The patient was initially managed with topical corticosteroids. He was later started on systemic therapy in the form of methotrexate and low-dose naltrexone to address his symptoms and disease presentation. Conclusions: This case highlights the complexities of diagnosis and management of ELP in pediatric patients. A multidisciplinary approach and regular follow-up are necessary to manage symptoms, prevent complications, and improve quality of life. [ABSTRACT FROM AUTHOR]

Esophageal cancer is one of the common cancers. Risk factors are well recognized and lead most commonly to two distinct histological subtypes (squamous cell carcinoma and adenocarcinoma). The diagnosis is based on endoscopic evaluation. The most challenging aspect of management is accurate staging as it guides appropriate management. Endoscopic ultrasound, computed tomography (CT), positron emission tomography-CT, and magnetic resonance imaging are the imaging tests employed for the staging. Each imaging test has its own merits and demerits. Imaging is also critical to evaluate posttreatment complication and for response assessment. In this review article, we discuss in detail the risk factors, anatomical aspects, and role of imaging test in staging and evaluation of complications and response after treatment. [ABSTRACT FROM AUTHOR]

Purpose: Eosinophilic esophagitis (EoE) is the most well-known eosinophilic gastrointestinal disorder (EGID) characterized by the presence of a high number eosinophils within the esophageal epithelium and the clinical signs. Biopsies of patients with suspected EoE may not show a high number of eosinophils, however the presence of granules may help with the diagnosis. This study aims to evaluate the presence of cell-free eosinophil granules in the esophageal tissue of patients with suspected and confirmed EoE to accelerate the diagnosis and treatment of patients with low eosinophil count. Methods: Fifteen patients with confirmed EoE and 15 suspected of EoE were included in this study. Patients' esophageal tissue biopsies were stained using immunohistochemistry (IHC) to identify eosinophils and their cell-free granules. For testing, anti-major basic protein (MBP) and anti-chemokine receptor type 3 (CCR3) were used as primary antibodies and a double-staining kit containing secondary antibodies conjugated to the enzyme and related chromogens were used. Results: Cell-free granules with different degrees were observed in 53.3% and 93.3% of suspected and confirmed EoE samples, respectively. Furthermore, in esophageal biopsy of 73.3% of patients with suspected and 93.3% of patients with a definitive diagnosis of EoE, basal layer hyperplasia (BLH) was recognized. Conclusion: The results of the present study showed that IHC can be applied to detect cell-free eosinophil granules in esophageal tissue. Observation of granules and basal cell hyperplasia in biopsies of suspected EoE patients whose eosinophil count is below the threshold can be valuable findings to make a definitive diagnosis for these patients. [ABSTRACT FROM AUTHOR]

Background: Dysphagia is one of the most common complaints that gastroenterologists encounter in the outpatient setting. To evaluate this common complaint, patients are often sent for a barium esophagram, a test that is widely available, inexpensive, and easy to perform. This simple test provides a reliable method to evaluate esophageal anatomy and structural abnormalities. Purpose: This narrative reviews the history of the development and validation of the timed‐barium esophagram (TBE), along with its strengths and limitations, and discusses its use in the pre‐ and posttreatment assessment of patients with achalasia, esophagogastric junction outflow obstruction (EGJOO), and esophageal strictures. Providing excellent anatomic detail of the esophagus and an accurate assessment of esophageal emptying, over time, the TBE has become part of the standard workup in our Swallowing Center for patients with dysphagia. [ABSTRACT FROM AUTHOR]

Introduction: Eosinophilic esophagitis (EoE) is a chronic inflammatory condition that affects the esophagus. Previous studies have indicated a substantial increase of EoE over the last decades. The aim of the current study was to describe the incidence and prevalence of EoE over time and by geographical regions in Sweden, utilizing nationwide population-based registries. Material and methods: The number of hospital admissions (in-patient and out-patient) for patients were identified using ICD-10-SE code K20.9A from the National Patient Registry between 1st January 2011 and 31st December 2021. Crude incidence and prevalence numbers were presented per 100,000 person years and persons, respectively. Results: In 2011, no hospital visits of EoE were recorded. A total of 3,243 incident patients (2,379 (73.4%) men and 864 (26.6%) women) had a record of EoE between 2012 and 2021. The incidence increased over calendar year in where the incidence was from 1.59 per 100,000 person years in 2012 to 5.34 per 100,000 person years in 2021. The prevalence was 1.29 per 100,000 person years and 31.02 per 100,000 person years in 2012 and 2021, respectively. Major differences in the prevalence between geographical regions in Sweden were observed, e.g. in 2021, the prevalence was 12.24 in Västernorrland compared to 43.26 in Västra Götaland per 100,000 person years, which is similar to the prevalence in the Stockholm region. Conclusion: The incidence and prevalence of eosinophilic esophagitis has significantly increased over calendar year but differs between geographical regions in Sweden. These differences should be further investigated. [ABSTRACT FROM AUTHOR]

Septoplasty is among the most frequently performed procedures in the field of otorhinolaryngology. Adhesion is known to be the most common complication occurring after septoplasty. Post-surgical insertion of silicone splints is a widely used measure for the prevention of postoperative complications. Recently, we encountered a case where the silicone splint was dislocated and further displaced to the level of the upper esophageal sphincter. Although it was safely removed using fiberoptic gastroendoscopy, delayed removal could have induced other serious sequelae. Since no similar cases have been previously reported, we believe that this may be a very rare complication induced by a loose absorbable suture. Therefore, we suggest that otorhinolaryngologists should pay attention to the fixation of a silicone splint with sutures under appropriate tension to prevent the dislocation of the silicone splint and its subsequent sequelae. [ABSTRACT FROM AUTHOR]

Foreign bodies (FBs) in the digestive tract are common in children, we analyzed the clinical characteristics of children with FBs in the digestive tract and discuss the risk factors for serious complications. We retrospectively reviewed clinical data of 139 children with FBs in the digestive tract. Based on the severity of complications caused by FBs, the patients were divided into risk and general groups for analysis and comparison. Significant differences were observed in the retention sites of FBs, the diameter of FBs retained in the esophagus, FBs retention time exceeding 24 h, and the absence of witnesses between the 2 groups. Inadequate care, button batteries (BBs), ingested mmFBs, FBs retained in the esophagus, long-term retention, and giant gastric bezoars may cause serious complications. In addition to treating FBs and the complications, clinicians should emphasize the importance of childcare to prevent the ingestion of FBs. [ABSTRACT FROM AUTHOR]

Introduction: Proton pump inhibitors (PPIs) and potassium-competitive acid blockers (P-CABs) are widely used to manage gastric acid-related disorders by inhibiting hydrochloric acid (HCl) secretion from parietal cells in the stomach. Although PPIs are known to have anti-inflammatory properties beyond their role in inhibiting gastric acid secretion, research on P-CABs is lacking. In this study, we aimed to investigate whether all available P-CABs exhibit anti-inflammatory effects in gastroesophageal reflux-induced esophagitis and to elucidate the underlying mechanisms. Methods: Het-1A cells, normal esophageal epithelial cells, were treated with HCl (pH 4) for 30 min. Esomeprazole, a representative PPI, and three currently marketed P-CABs (vonoprazan, tegoprazan, and fexuprazan) were used for pretreatment. Total RNA sequencing was performed using Het-1A cells pretreated with 1% DMSO or fexuprazan, followed by exposure to HCl. Pyroptosis was measured using lactate dehydrogenase (LDH) release and Annexin V-FITC/PI staining. Western blotting, qRT-PCR, and ELISA were used to determine the expression of the related genes. Results: Pretreatment with esomeprazole, vonoprazan, tegoprazan, and fexuprazan significantly inhibited the HCl-induced pro-inflammatory cytokines, including IL-6, IL-8, IL-1β, and TNF-α. Fexuprazan and vonoprazan significantly attenuated the HCl-induced pyroptosis rate, as assessed by elevated LDH release and Annexin V-FITC/PI staining, whereas esomeprazole and tegoprazan did not. RNA sequencing revealed that NOD-like receptor (NLR) family pyrin domain-containing 1 (NLRP1) was significantly reduced in Het-1A cells pretreated with fexuprazan compared to those treated with DMSO. Fexuprazan and vonoprazan markedly reduced the HCl-induced transcriptional and translational expression of genes involved in the pyroptosis pathway, including NLRP1, Caspase-1, gasdermin D, and IL-1β. Notably, fexuprazan reduced the HCl-induced increase in pyroptosis and IL-1β using siRNA, even in the presence of NLRP1 knockdown. Fexuprazan, tested on inflammatory THP-1 macrophage cells, significantly reduced NLRP1 expression and inhibited lipopolysaccharide-induced pyroptosis. Conclusion: Our findings reveal that all p-CABs exhibit anti-inflammatory properties, while fexuprazan inhibits inflammation and pyroptosis of esophageal cells caused by the gastric acid. Therefore, it is presumed to have additional benefits in gastroesophageal reflux disease in addition to suppressing gastric acid secretion. [ABSTRACT FROM AUTHOR]

Backgroud: In the previous era of functional genomics, it was widely believed that the expression levels of housekeeping genes (HKGs) remained relatively constant and were unaffected by variations in tissue type, cell development stage, cell cycle state, as well as internal and external cellular environments. With the improvement of gene microarray technology and quantitative polymerase chain reaction (qPCR) technology for expression analysis of high-throughput differential genes, changes in the expression levels of HKGs have been found in certain human cancers. The present study aimed to experimentally validate the expression of Surfeit 4 gene (SURF4), a member of HKGs, in esophageal squamous cell carcinoma (ESCC). Methods: The experimental techniques employed in this study encompassed real-time fluorescence quantitative polymerase chain reaction (RT-qPCR), Western blot (WB), and immunohistochemistry (IHC) to assess the mRNA and protein expression of SURF4 in ESCC, and their clinicopathological significance was statistically analyzed. Results: All three tests showed significant differences between the three groups (Kruskal–Wallis test, P < 0.05). The results of the three methods indicated a significantly higher expression of SURF4 in the tumor group compared to both the adjacent paracancerous tissue group and the normal esophageal mucosal tissue group distant from the tumor. There was no significant difference between the latter two groups. Chi-square and Rank-sum test revealed the expression of SURF4 was significant statistical correlation with tumor cell differentiation, tumor progression and Ki-67 index, as well as the survival prognosis of patients (P < 0.05). Conclusions: The expression of SURF4 was up-regulated in ESCC and was associated with differentiation, proliferation, progression, and clinical prognosis of ESCC. This portended epigenetically that SURF4 may play a role in tumor progression in ESCC and could potentially serve as a novel therapeutic target. [ABSTRACT FROM AUTHOR]

Purpose: The segmentation of target volume and organs at risk (OAR) was a significant part of radiotherapy. Specifically, determining the location and scale of the esophagus in simulated computed tomography images was difficult and time-consuming primarily due to its complex structure and low contrast with the surrounding tissues. In this study, an Enhanced Cross-stage-attention U-Net was proposed to solve the segmentation problem for the esophageal gross tumor volume (GTV) and clinical tumor volume (CTV) in CT images. Methods: First, a module based on principal component analysis theory was constructed to pre-extract the features of the input image. Then, a cross-stage based feature fusion model was designed to replace the skip concatenation of original UNet, which was composed of Wide Range Attention unit, Small-kernel Local Attention unit, and Inverted Bottleneck unit. WRA was employed to capture global attention, whose large convolution kernel was further decomposed to simplify the calculation. SLA was used to complement the local attention to WRA. IBN was structed to fuse the extracted features, where a global frequency response layer was built to redistribute the frequency response of the fused feature maps. Results: The proposed method was compared with relevant published esophageal segmentation methods. The prediction of the proposed network was MSD = 2.83(1.62, 4.76)mm, HD = 11.79 ± 6.02 mm, DC = 72.45 ± 19.18% in GTV; MSD = 5.26(2.18, 8.82)mm, HD = 16.22 ± 10.01 mm, DC = 71.06 ± 17.72% in CTV. Conclusion: The reconstruction of the skip concatenation in UNet showed an improvement of performance for esophageal segmentation. The results showed the proposed network had better effect on esophageal GTV and CTV segmentation. [ABSTRACT FROM AUTHOR]

Simple Summary: For young patients with the rare entity primary mediastinal B-cell lymphoma, a differentiated description of effects and side effects of the different therapeutic opportunities is of immense interest. We therefore conducted a planning study to compare two different radiation therapy planning variants for a cohort of these patients who were treated in a hospital cancer center. We estimated normal tissue complication probabilities for radiation side effects for the heart, the lungs and the esophagus. Introduction: Primary mediastinal B-cell lymphoma (PMBCL) is a rare form of aggressive B-cell lymphoma with a predominant onset in young patients. The minimization of potential (late) side effects is of cardinal interest for these patients. An anticipation of the individual risk profile is desirable to counsel the patient on the putative impact of radiotherapy (RT). Methods: RT plans for a cohort of 25 patients with PMBCL were prospectively designed. One plan with two parallel- opposing fields (APPA) and another with volume-modulated arc therapy (VMAT) technique with 40 Gy in 2 Gy fractions each. Normal The normal tissue complication probability (NTCP) was calculated using the Lyman-–Kutcher-–Burman model for heart, lung and oesophageal toxicity. Results: APPA planning resulted in lower median doses (Dmedian) for the heart and lungs, whereas all other dose metrics for heart, lungs and esophagus were lower in VMAT planning. A significant difference in the mean NTCPs when comparing the APPA to VMAT plans was seen for increased cardiac mortality, pneumonitis and esophagitis. PTV size correlated with increased cardiac mortality and esophagitis in both plan variations and with pneumonitis for VMAT plans. Dmean, Dmedian, and V20Gy correlated with the risk for pneumonitis, and Dmean, Dmedian, and V1% with the risk for esophagitis in both variants. Conclusions: We showed decreased risk of different NTCPs for VMAT and APPA planning for thoracic toxicities. The use of an IMRT technique like VMAT showed advantages for several DVH metrics in organs at risk and should therefore be recommended for radiation treatment of PMBCL. [ABSTRACT FROM AUTHOR]

Simple Summary: Digestive cancers are still important contributors to the global burden of cancer in our society, and diet may play a role in their development. In our study, we observed an association between dairy products, especially fermented ones, and a lower risk of esophageal and stomach cancers, whereas high intake of sugary dairy desserts was linked to a higher risk of stomach cancer. Fermented dairy products, which contain beneficial compounds, such as probiotics, appear to offer a protective effect, particularly at higher levels of consumption. In contrast, high consumption of sugary dairy desserts, commonly rich in free sugars and unhealthy fats, was associated with a higher risk of stomach cancer. No significant association was found with milk consumption. These findings suggest that the risk of upper digestive tract cancers may be mitigated by consuming fermented dairy, while high intake of sugary dairy desserts could elevate this risk. Background/Objectives: This study explored the association between dairy products consumption (total and subgroups) and cancer of the esophagus, stomach, and pancreas within the PANESOES case–control study. Methods: Data from 1229 participants, including 774 incident cases of cancer and 455 controls matched by age, sex, and region, were analyzed. Dietary intake was assessed using a validated Food Frequency Questionnaire, categorizing dairy intake by total and subgroups (fermented dairy, sugary dairy desserts, and milk). Multinomial logistic regression was used to estimate relative risk ratios (RRRs), adjusting for confounders. Results: We found an inverse association between moderate dairy consumption (T2) and esophageal cancer (RRR T2 vs. T1 = 0.59 (95%CI: 0.37–0.96)). The highest tertile (T3) of fermented dairy was associated with a lower risk of esophageal (RRR T3 vs. T1 = 0.55 (0.33–0.90)) and stomach cancers (RRR T3 vs. T1 = 0.68 (0.47–0.97)). By contrast, the highest tertile of consumption of sugary dairy desserts was associated with a higher risk of stomach cancer (RRR T3 vs. T1 = 1.85 (1.30–2.64)). No association was found for milk. Conclusions: This study suggests that fermented dairy may reduce the risk of esophageal and stomach cancers, while sugary dairy desserts may increase the risk of stomach cancer. [ABSTRACT FROM AUTHOR]

No study has unequivocally proven that chemotherapy prolongs overall survival (OS) in advanced esophageal cancer. We conducted a Phase III randomized study in first‐line advanced unresectable/metastatic esophageal/GEJ cancer. Patients aged 18–70 years, with performance status 0–2, were randomized to best supportive care (BSC) alone, or BSC with weekly paclitaxel 80 mg/m2. BSC comprised, as indicated, education, counselling, radiation, stenting, feeding tube placement, nutritional supplementation, medications like analgesics, and referral to a support group and palliative care. The primary endpoint was OS; secondary endpoints included progression free survival (PFS), response, toxicity, and QoL. Between May 2016–December 2020, we recruited 281 patients: 143 to chemotherapy and 138 to BSC. Histopathology was squamous in 269 (95.7%) patients. Median number of paclitaxel doses was 12 (IQR, 7–23). Median OS was 4.2 months (95% CI, 3.42–5.32) in BSC, and 9.2 months (95% CI, 8.02–10.48) in chemotherapy; HR, 0.49 (95% CI, 0.39–0.64); p <.001. As compared to BSC, chemotherapy increased response (2.9% to 39%), median PFS (2.1 to 4.2 months), 1‐year OS (11% to 32%), 2‐year OS (0 to 9%), median dysphagia‐free survival (2.9 to 14.8 months), and global and esophagus‐specific QoL, without significantly increasing all‐grade or grade ≥3 toxicities. Using ESMO clinical benefit scale and ASCO Value Framework, palliative chemotherapy scored as having "substantial value." Our study provides the first level 1 evidence that chemotherapy prolongs survival in advanced esophageal/GEJ carcinoma. BSC alone is no longer appropriate. Weekly paclitaxel is an attractive option, especially in LMICs with limited access to immunotherapy. [ABSTRACT FROM AUTHOR]

Background: Esophageal embryonal rhabdomyosarcoma (ERMS), a rare pediatric cancer, mimicked achalasia in a case involving dysphagia and vomiting. Diagnosis and chemotherapy necessitate careful monitoring due to potential complications. Case presentation: A 12‐year‐old girl with no prior medical history presented with progressive dysphagia and vomiting. Initial diagnosis suggested achalasia, but further evaluation revealed a large mediastinal mass causing esophageal compression. Biopsies confirmed primary ERMS of the esophagus with metastases. Despite chemotherapy, she developed complications, including neutropenic enterocolitis and posterior reversible encephalopathy syndrome (PRES). Unfortunately, she succumbed to neutropenic sepsis. Conclusion: In this case study, we presented our experience regarding the clinical course of this disease, treatment strategy, and prognosis, in addition to the limited previous information in the literature. [ABSTRACT FROM AUTHOR]

Background: The coexistence of two or more distinct neoplasms within the same anatomical site characterizes collision tumors. While the presence of dual tumors is frequently observed in esophageal cases, the simultaneous occurrence of three distinct tumor types is extremely rare, posing significant challenges for pathological evaluation and diagnosis. Surgical resection remains the primary treatment, with generally favorable outcomes. Case presentation: A 58-year-old male with a two-month history of progressively worsening dysphagia over the past 10 days underwent a gastrointestinal barium meal examination, which revealed an irregular filling defect measuring approximately 89×50 mm in the mid-thoracic esophagus. Subsequent gastroscopic biopsy confirmed undifferentiated pleomorphic sarcoma in the mid-esophageal tissue. As the dysphagia advanced, a partial esophagectomy with lymph node dissection was performed. Postoperative pathology revealed a composite tumor consisting of adenoid cystic carcinoma, undifferentiated pleomorphic sarcoma, and focal squamous cell carcinoma. Squamous cell carcinoma metastasis was identified in one lymph node. No adjuvant therapies, such as chemotherapy, radiotherapy, targeted therapy, or immunotherapy, were administered following surgery. The patient had been under monitoring for 101 months, with no signs of recurrence or metastasis. Conclusion: This case represents the first documented instance of a tripartite collision tumor in the esophagus, composed of undifferentiated pleomorphic sarcoma, squamous cell carcinoma, and adenoid cystic carcinoma, with clear histological distinction. A thorough review of the literature was performed to summarize clinicopathological features. Surgical resection leads to a favorable prognosis. Tumors containing both carcinomatous and sarcomatous elements tend to have a more favorable prognosis compared to those composed entirely of carcinomatous tissue, providing valuable insights for future diagnostic and therapeutic strategies. [ABSTRACT FROM AUTHOR]

Aims Methods and Results Conclusions Esophageal submucosal gland duct adenoma is an extremely rare benign tumour, with only a few reported cases. We conducted the largest single‐centre clinical study of esophageal submucosal gland duct adenoma, examining its molecular mechanisms and clinicopathological features.Between 2018 and 2023, seven cases of esophageal submucosal gland duct adenoma were identified at a tertiary medical centre; two were female and five were male, aged between 51 and 75 years (mean = 63.8 years). Comprehensive evaluations of clinicopathological, immunohistochemical and molecular characteristics were conducted. Histologically, tumours showed papillotubular and cystic patterns lined with double layers of cells arranged in ducts, papillary folds and microcysts. The inner luminal tall columnar cells had eosinophilic cytoplasm and did not show mucin production and the basal cells showed myoepithelial differentiation. Immunohistochemically, inner luminal  layer cells were positive for CK7, CK19 and CK5/6 and outer basal layer cells were positive for SMA and P40. Both layers were negative for CK20, CDX2, MUC5AC, MUC6, MUC2, GCDFP15 and Alcian blue‐periodic acid–Schiff (AB‐PAS). Genomic analyses revealed the presence of BRAF V600E mutations in five of seven tumours (71.43%).This study delineates a distinct subtype of benign adenoma arising from the esophageal submucosal gland duct, characterised by multiple lobulated cystic proliferation of benign epithelial layers within the submucosa. BRAF V600E mutations were present, similar to in sialadenoma papilliferum. We determined the genetic mutation present in esophageal submucosal gland duct adenoma, providing further evidence that it is an esophageal counterpart of minor salivary gland tumours. [ABSTRACT FROM AUTHOR]

Radiation therapy (RT) is a typical treatment for head and neck cancers. However, prolonged irradiation of the esophagus can cause esophageal fibrosis due to increased reactive oxygen species and proinflammatory cytokines. The objective of this study was to determine whether myogenic gene-transfected mesenchymal stem cells (MSCs) could ameliorate damage to esophageal muscles in a mouse model of radiation-induced esophageal fibrosis. We cloned esophageal myogenic genes (MyoD, MyoG, and Myf6) using plasmid DNA. Afterward, myogenic genes were transfected into Human Mesenchymal Stem Cells (hMSCs) using electroporation. Gene transfer efficiency, stemness, and myogenic gene profile were examined using flow cytometry, quantitative polymerase chain reaction, and RNA sequencing. In vivo efficacy of gene-transfected hMSCs was demonstrated through histological and gene expression analyses using a radiation-induced esophageal fibrosis animal model. We have confirmed that the gene transfer efficiency was high (∼75%). Pluripotency levels in gene-transfected MSCs were significantly decreased compared with those in the control (vector). Particularly, myogenesis-related genes such as OAS2, OAS3, and HSPA1A were overexpressed in the group transfected with three genes. At 4 weeks after injection, it was found that thickness collagen layer and esophageal muscle in MSCs transfected with all three genes were significantly reduced compared to those in the saline group. Muscularis mucosa was observed prominently in the gene combination group. Moreover, expression levels of myogenin, Myf6, calponin, and SM22α known to be specific markers of esophageal muscles tended to increase in the group transfected with three genes. Therefore, using gene-transfected MSCs has the potential as a promising therapy against radiation-induced esophageal fibrosis. [ABSTRACT FROM AUTHOR]

The aim of the present study was three folds; (i) to correlate clinical case history with objective findings of a client presented with sternal discomfort along with odynophagia; (ii) to evaluate the cause for retrosternal discomfort using Functional Esophagoscopy (FE); and (iii) to reaffirm the Cook's (2008) algorithm for clinical diagnosis of esophageal dysphagia in single sitting using Transnasal Esophagoscopy (TNE). A 72 years old male (named 'G') visited a tertiary health care hospital with a complaint of imbalance for past 2 months. Also, had a complaint of pain while swallowing for the past 15 days along with left arm weakness (for past 2 days) and got admitted for treatment. Pertaining to swallowing, a detailed case history was taken and Fiber-optic endoscopic evaluation of swallowing (FEES) was performed to evaluate swallowing safety functions using digital swallowing workstation (KAYPENTAX, New Jersy, USA). A large growth was noticed in the lower border of esophagous using TNE in this patient. The oral, oro-pharyngeal, and pharyngeal phase of swallowing was intact. Esophageal phase of swallowing revealed reduced peristaltic movement including a mass lesion observed in client 'G' from TNE procedure. Clinical correlation of objective findings in this client corroborated well with history. Visualization studies including TNE can be used safely, comfortably in OPD basis without any anesthesia would be few advantages of TNE procedure. Even lesions at lower end of esophagus can be detected using TNE and it is concluded that the symptom retro-sternal discomfort might be clinically correlated with history and objectively determined by TNE procedure as esophageal dysphagia due to structural lesion. Also, algorithm of Cook's (2008) guides the investigation procedure quickly in a single sitting. Therefore, clinical history about patient is imperative that accurately guides further in terms of patient's care for assessment and treatment. Highlights: • Complaint of Retrosternal bolus hold up suggestive of oesophagus is the site of lesion. • Sudden brief history of swallowing problem, consistent and progressive symptom and weight loss are indicative more of esophageal dysphagia (cancer). • Transnasal Esophagoscopy (TNE) is the most widely used objective assessment tool in the field of otolaryngology to identify lesions in esophagus. • Thorough case history clinically would guide further accurate evaluation procedures. • Cook's (2008) algorithm to diagnose dysphagia at esophageal phase of localized origin in single sitting can be established by using TNE. [ABSTRACT FROM AUTHOR]

In homeostatic conditions, the basal progenitor cells of the esophagus differentiate into a stratified squamous epithelium. However, in the setting of acid exposure or inflammation, there is a marked failure of basal cell differentiation, leading to basal cell hyperplasia. We have previously shown that lysyl oxidase (LOX), a collagen crosslinking enzyme, is upregulated in the setting of allergic inflammation of the esophagus; however, its role beyond collagen crosslinking is unknown. Herein, we propose a non-canonical epithelial-specific role of LOX in the maintenance of epithelial homeostasis using 3D organoid and murine models. We performed quantitative reverse transcriptase PCR, Western blot, histologic analysis, and RNA sequencing on immortalized non-transformed human esophageal epithelial cells (EPC2-hTERT) with short-hairpin RNA (shRNA) targeting LOX mRNA in both monolayer and 3D organoid culture. A novel murine model with a tamoxifen-induced Lox knockout specific to the stratified epithelium (K5CreER; Loxfl/fl) was utilized to further define the role of epithelial LOX in vivo. We found that LOX knockdown decreased the proliferative capacity of the esophageal epithelial cells in monolayer culture, and dramatically reduced the organoid formation rate (OFR) in the shLOX organoids. LOX knockdown was associated with decreased expression of the differentiation markers filaggrin, loricrin, and involucrin, with RNA sequencing analysis revealing 1224 differentially expressed genes demonstrating downregulation of pathways involved in cell differentiation and epithelial development. Mice with Lox knockout in their stratified epithelium demonstrated increased basaloid content of their esophageal epithelium and decreased Ki-67 staining compared to the vehicle-treated mice, suggesting reduced differentiation and proliferation in the Lox-deficient epithelium in vivo. Our results demonstrate, both in vivo and in vitro, that LOX may regulate epithelial homeostasis in the esophagus through the modulation of epithelial proliferation and differentiation. Understanding the mechanisms of perturbation in epithelial proliferation and differentiation in an inflamed esophagus could lead to the development of novel treatments that could promote epithelial healing and restore homeostasis. [ABSTRACT FROM AUTHOR]

Treatment of esophageal cancer in the remnant esophagus after esophagectomy is highly invasive, therefore, early detection and minimally invasive treatment are considered necessary. Consequently, we aimed to clarify the safety and efficacy of endoscopic submucosal dissection (ESD) for residual esophageal cancer compared to that for esophageal cancer in a normal cervical esophagus. This study involved 47 patients with 59 residual esophageal cancers and 92 patients with 107 cervical esophageal cancers in normal esophagus who underwent ESD between January 2008 and December 2023. Their clinicopathological findings and long-term outcomes were retrospectively collected and evaluated. The median tumor diameter was 13 mm, and the median procedure time was 31 minutes in remnant esophagus group, with no significant difference between the two groups. No serious complications such as perforation, massive intraoperative bleeding, and pneumonia were observed in the remnant group, except for one case of postoperative bleeding. The rates of complete resection and disease specific survival were not significantly different between two groups, with complete resection rate of 86.4% and 5-year disease-specific survival rate of 95.7% in the remnant esophagus group. No local recurrence was observed during the median observation period of 43 months in the remnant esophagus group. ESD for superficial cancer of the remnant esophagus showed a high complete resection rate without serious complications and good local-regional control with no evidence of local recurrence. This indicates that ESD is a safe and useful treatment for superficial cancer of the remnant esophagus. [ABSTRACT FROM AUTHOR]

A 48-yr-old female red-eared slider (Trachemys scripta elegans) presented for a chronically swollen neck and tongue with variable severity of about 6–8 months duration, and tongue swelling for approximately 20 yr. Physical examination revealed an ulcerated, erythematous tongue and an irregular mass in the caudal oropharyngeal region. The hyoid region was markedly enlarged. Initial diagnostics included complete blood count (CBC), plasma chemistry, cytology, and serial computed tomography (CT) scans. The CBC showed signs of basophilia and a regenerative response suggestive of prior anemia. The CT revealed an ill-defined thickening of the tongue base and pulmonary changes consistent with pneumonia. Chelonian herpesvirus PCR was negative. The patient was started on antibiotics and other medications without resolution of signs. Endoscopic evaluation revealed a prolapsed esophagus. A biopsy was taken with subsequent histologic analysis that revealed an ulcerative esophagitis with a fibrovascular polyp. Chronic trauma from the prolapse was the likely cause of these changes. The patient initially did well, but eventually declined and was euthanized after several months. [ABSTRACT FROM AUTHOR]

Background: Disorders of primary peristalsis are associated with a higher percent time pH <4 in the esophagus suggesting poor acid clearance. However, there are no studies of secondary peristalsis and its relationship to microscopic or erosive esophagitis. The goal of this study was to determine the relationship between secondary peristalsis using functional luminal imaging probes (EndoFLIP) and the presence or absence of esophagitis. Methods: We reviewed the endoscopic and EndoFLIP 2.0 tracings for 103 consecutive patients including those with a history of upper gastrointestinal surgery undergoing upper endoscopy. Esophagogastric junction (EGJ) distensibility and diameter, repetitive antegrade contraction (RACs) presence and frequency, and occlusive diameters were measured. Measurements were then compared between patients with and without microscopic and/or erosive esophagitis. Means were compared using t‐tests. Proportions were compared using Chi‐Squared analyses. Key Results: One hundred and three patients were included (mean age: 14.4 + 6.4 years). Ten patients had erosive esophagitis and 28 patients had microscopic esophagitis. Erosive and microscopic esophagitis were associated with abnormal or absent of RACs (p < 0.001). Occlusive diameters were higher in patients with esophagitis compared to those without (p < 0.001). There was no relationship between EGJ distensibility and the presence of erosive or microscopic esophagitis (p = 0.4). The absence of RACs was the only independent predictor of esophagitis (erosive and microscopic), after controlling for age, proton pump inhibitors (PPI) use and EGJ distensibility (p < 0.001). Conclusions & Inferences: Abnormal secondary peristalsis is associated with microscopic and gross esophagitis, suggesting that EndoFLIP should be part of the diagnostic algorithm for esophagitis. [ABSTRACT FROM AUTHOR]

Background: Understanding the relationship between distal contractile integral (DCI) and mean nocturnal baseline impedance (MNBI) could shed light on new diagnostic and treatment strategies, specifically concerning nocturnal reflux. This study aimed to assess this relationship to enhance our comprehension of the interplay between esophageal contractility and mucosal permeability. Methods: We identified adult patients who had high resolution esophageal manometry and pH‐impedance tests performed within a 30‐day period between December 2018 and March 2022. A random forest model was used to identify significant predictors of MNBI, assisting with variable selection for a following regression analysis. Subsequently, both univariable and multivariable regression models were utilized to measure the association between predictors and MNBI. Key Results: Our study included 188 patients, primarily referred for testing due to reflux. The most common motility diagnoses were normal (62%) followed by possible esophagogastric junction outflow obstruction (22%). The mean DCI was 2020 mmHg∙s∙cm and MNBI was 3.05 kΩ. The random forest model identified 12 significant predictors for MNBI, key variables being acid exposure time (AET), total proximal reflux events, intraabdominal lower esophageal sphincter length, hiatal hernia presence, and DCI. Subsequent multivariable regression analyses demonstrated log AET (β = −0.69, p = <0.001), total proximal reflux events (β = −0.16, p = 0.008), hiatal hernia presence (β = −0.82, p = 0.014), log DCI (β = 1.26, p < 0.001), and age (β = −0.13, p = 0.036) as being significantly associated with MNBI. Conclusions and Inferences: DCI is a key manometric predictor of MNBI emphasizing the role of manometry in detecting reflux risk and the need for its consideration in reflux management. [ABSTRACT FROM AUTHOR]

Background: The functional relationship of striated esophagus (St.Eso) motor function with pharyngeal deglutitive biomechanical events has not been systematically studied. The aim of this study was to determine the spatio‐temporal characteristics of St.Eso function and its correlation with pharyngeal biomechanics and bolus transport. Methods: We studied 50 healthy volunteer subjects (age range: 21–82 years, 31 female) by digital videofluoroscopy. All subjects were studied in a seated, upright position. Thirteen of these 50 volunteers also underwent high‐resolution manometry (HRM) concurrent with fluoroscopy. We used laryngeal excursion as a surrogate for St.Eso excursion. Key Results: Median duration of St.Eso excursion was 2.35 [1.93,2.85, 5th and 95th percentile] seconds. Mean maximum extent of St.Eso excursion was 2.84 ± 0.72 cm. We identified four distinct periods in deglutitive St.Eso motor function: P1. Anterosuperior ascent without bolus or peristaltic activity, P2. Non‐peristaltic bolus receiving at the apogee of St.Eso excursion concurrent with UES opening and pharyngeal peristalsis P3. Peristaltic bolus transport as St.Eso descends and P4. Continued peristalsis in resting position. Conclusions and Inferences: 1. St.Eso motor function spans both pharyngeal and esophageal phases of swallowing for receiving and transporting the bolus, 2. Pressure signatures in HRM recordings currently attributed to St.Eso deglutitive motor activity does not represent the entirety of St.Eso peristalsis, only the part that occurs in its resting position. St.Eso peristalsis that occurs during its descent is recorded by pressure sensors initially in the pharynx. This finding needs to be considered when interpreting HRM recordings of the pharynx and proximal esophagus. [ABSTRACT FROM AUTHOR]

Esophageal squamous cell carcinoma (ESCC) remains the most common malignancy of the esophagus worldwide. Environmental and lifestyle exposures such as alcohol and tobacco have been well defined in the pathogenesis of ESCC, acting in concert with cell intrinsic epigenomic, genomic and transcriptomic changes. However, a variety of nonenvironmental etiologies including Fanconi anemia, lichen planus, chronic mucocutaneous candidiasis, esophageal epidermoid metaplasia, epidermolysis bullosa, tylosis, esophageal atresia, and achalasia receive minimal attention despite a high risk of ESCC in these diseases. The goal of this review was to promote clinical recognition and suggest a diagnostic framework for earlier detection of ESCC in patients with these rare diseases. In all the discussed conditions, a change in symptoms should trigger a prompt endoscopic evaluation, and endoscopic surveillance programs with advanced imaging techniques and chromoendoscopy should be considered. Moreover, we leverage the convergence of these diseases on ESCC to identify common mechanisms underlying malignant transformation including aberrant proliferation, mucosal barrier dysfunction, increased inflammation, and genome instability. In this study, we summarize the clinical presentation, pathologic findings, potential screening strategies, and common mechanisms of malignant transformation associated with these rare diseases that drive ESCC. [ABSTRACT FROM AUTHOR]

The list of standard abbreviations for JDS is available at adsa.org/jds-abbreviations-24. Nonstandard abbreviations are available in the Notes. We aimed to evaluate performance, body development, metabolism, and expression of genes related to skeletal muscle hypertrophy in uncastrated male dairy kids fed with different levels of milk replacer (MR) during the preweaning period. Sixty newborn male kids, not castrated, from Saanen and Swiss Alpine breeds, with an average BW of 3.834 ± 0.612 kg, were distributed in a randomized block design. Breeds were the block factor in the model (random effect). Kids were allocated into 2 nutrition plans (n = 30 kids/treatment) categorized as follows: low nutritional plan (LNP; 1 L of MR/kid per day) or high nutritional plan (HNP; 2 L of MR/kid per day). All kids were harvested at 45 d of life. The majority of nitrogen balance variables were affected by the nutritional plan (P < 0.050). Morphometric measures and BCS (2.99 for LNP vs. 3.28 for HNP) were affected by nutritional plan (P < 0.050), except hip height, thoracic depth, and hip width. The nutritional plan affected the body components (P < 0.050), except esophagus and trachea. Animal performance and carcass traits were influenced by nutritional plan (P < 0.050), except carcass dressing (48.56% on average). Nutritional plan affected (P < 0.050) some blood profile variables as the total cholesterol (141.35 vs. 113.25 mg/dL), triglycerides (60.53 vs. 89.05 mg/dL), LDL (79.76 vs. 33.66 g/mL), and IGF-1 (17.77 vs. 38.55 ng/mL) for LNP and HNP, respectively. Hypertrophy was greater in HNP than LNP animals (P < 0.050), being represented by the proportion of sarcoplasm (39.76% vs. 31.99%). LNP had a greater mTOR abundance than HNP (P = 0.045), but AMPK was not affected by the nutritional plan. Our findings show that a higher milk replacer allowance enhances animal performance, body development, metabolic parameters, and cellular hypertrophy in preweaning dairy kids. [ABSTRACT FROM AUTHOR]

Background: Standardized values for esophageal diameter on fluoroscopy have not been established. These values may help in the diagnosis of long-segment and diffuse esophageal narrowing, which can sometimes be subtle and difficult to diagnose. Objective: Our objective was to establish normal values for esophageal diameter based on age for patients between 1 and 17 years old. Materials and methods: Our retrospective study included 160 patients separated into eight groups by age with documented normal upper gastrointestinal fluoroscopic examination and normal esophageal biopsy. Three readers measured esophageal diameters in the three locations and two projections. Intra-class correlation coefficients were calculated in order to gauge reader measurement agreement. Student's t-tests were used to evaluate for statistically significant differences between male and female patients. Finally, overall means and 95% confidence intervals were calculated at each esophageal level by age group. Results: Our readers demonstrated excellent measurement agreement (ICCs > 0.75). Three individual esophageal measurements varied between the biological sexes, but there was no reliable statistically significant difference. There was a linear upward trend in esophageal diameter with age. For each age group, the means, standard deviations, and 95% confidence intervals were calculated for esophageal diameter in each location and projection. Across all included ages, the mean esophageal diameter ranged from 11–21 mm on the anteroposterior projection and 8–17 mm on the lateral. Conclusion: The provided ranges of normal esophageal diameters at each age and location in the pediatric population are quantitative metrics which can be used in the interpretation of fluoroscopic examinations. New reference values may lead to earlier diagnosis of esophageal pathology in the pediatric population. [ABSTRACT FROM AUTHOR]

Accidental swallowing of fish bone is one of the most common emergencies in the otolaryngology department. The impacted fish bones are usually found in the palatine tonsil, base of the tongue, valleculae, pyriform sinus, and esophagus, which can be successfully removed after a thorough examination. However, in some cases, the fish bone may penetrate into the neck soft tissue and migrate to extraluminal organs, causing infection, abscess formation, or rupture of vessels. In such cases, prompt recognition and immediate removal of the impacted fish bone are necessary. Herein, we report a rare case of a 60-year-old woman who had accidently swallowed a fish bone 10 days prior to visiting the outpatient department. The fiberoptic scope and head and neck computed tomography scans were obtained from the outpatient department. The fish bone was found to migrate from the upper esophagus to the left thyroid gland. First, a rigid esophageal endoscopy was performed in the operating room, but no obvious fish bone was noted over the esophagus. Finally, the fish bone was removed via exploratory cervicotomy with left-sided total lobectomy of the thyroid. The patient recovered after the operation, and there were no further complications during the 3 years of follow-up. [ABSTRACT FROM AUTHOR]

Herein, we investigated the positional relationship between the cervical esophagus and trachea using computed tomography (CT) images in dogs with tracheal flattening. From these CT images, the ratio of the tracheal diameters in the short (vertical) and long (horizontal) axes of the tracheal ring (S/L ratio) and the vertebra--trachea--esophagus (VTE) angle were measured at the point from the 3rd cervical (C3) to the 3rd thoracic vertebra (T3) levels. The VTE angle in dogs with tracheal flattening with an S/L ratio under 0.24 tended to be smaller than the angles at the level from C4 to T2 in dogs with an S/L ratio over 0.25. The positional relationship between the esophagus and trachea seems to be possibly related to tracheal cross-sectional shape. [ABSTRACT FROM AUTHOR]

Identifying children needing endoscopic evaluation for suspected eosinophilic esophagitis (EoE) is crucial for prompt diagnosis and management. We aimed to develop a clinical prediction tool to distinguish children with EoE from children without the disease before endoscopy. We conducted a retrospective case-control study of children undergoing upper endoscopy at a tertiary care center. Clinical characteristics before endoscopy were extracted from 380 EoE cases and 380 controls without EoE. We built a predictive model for case-control status and performed age-stratified analyses. After multivariable analysis, history of adaptive eating behaviors, food allergy, food impaction, male sex, and regurgitation were independently associated with EoE, and abdominal pain and failure to thrive with control status (AUC 0.81). Food allergy and male sex were predictors of EoE across all ages. Regurgitation and adaptive eating behaviors were specific to EoE in early (0–5 years) (AUC 0.74) and middle childhood (6–11 years) (AUC 0.82), while dysphagia and food impaction were specific to EoE in the adolescence (12–17 years) (AUC 0.87). We determined age-specific clinical features that predict EoE with good discrimination in a pediatric population before endoscopy. Validation of this model in an independent population can confirm the utility of this tool. [ABSTRACT FROM AUTHOR]