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Ollero Domenche L, Del Valle Sánchez ME, Abecia Martínez EI, Hörndler Argárate C. [Esophagitis dissecans superficialis: two cases of the same rare entity]. REVISTA ESPANOLA DE PATOLOGIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ANATOMIA PATOLOGICA Y DE LA SOCIEDAD ESPANOLA DE CITOLOGIA 2024; 57:133-136. [PMID: 38599734 DOI: 10.1016/j.patol.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/15/2023] [Accepted: 11/23/2023] [Indexed: 04/12/2024]
Abstract
Esophagitis dissecans superficialis (EDS) is a rare disease characterized by sloughing of the superficial esophageal mucosa and, histologically, by the bitonal appearance of the squamous epithelium secondary to necrosis of the most superficial layers. Etiology is uncertain, however, it has been associated with some medications, autoimmune diseases, esophageal stasis and endoscopic procedures. Here, two cases are presented, one of them which appeared in a woman after an episode of dysphagia and another one which occurred to a man with comorbidities and epigastric pain. This entity should be considered due to its self-limiting clinical course, compared to other entities with a more torpid evolution or that require more specific treatment.
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2
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Baran JV, O’Flanagan R, Trocchia C, Brown JM, Nguyen J, Karjoo S, Wilsey MJ. Peeling Back the Layers: Sloughing Esophagitis in a Teenager with Chronic Vomiting. JPGN REPORTS 2023; 4:e376. [PMID: 38034426 PMCID: PMC10684144 DOI: 10.1097/pg9.0000000000000376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/30/2023] [Indexed: 12/02/2023]
Abstract
Esophagitis dissecans superficialis (EsoDS) is a rare condition characterized by the shedding of superficial esophageal epithelium. Limited data exists on EsoDS in the pediatric population. We present a case of a 17-year-old female with chronic nausea and vomiting diagnosed with EsoDS. Endoscopy revealed esophageal mucosal sloughing, and histology confirmed esophagitis with mucosal necrosis. EsoDS is underrecognized, and its association with psychoactive medications remains unclear. Fortunately, EsoDS cases tend to resolve spontaneously without complications. Awareness of EsoDS is essential, and further research is needed to understand its prevalence and outcomes in pediatric patients.
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Affiliation(s)
- Jessica V. Baran
- From the Office of Medical Education, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL
| | - Rowan O’Flanagan
- Department of Biophysics, Johns Hopkins University, Baltimore, MD
| | - Carolena Trocchia
- Office of Medical Education, Johns Hopkins All Children’s Hospital, St. Petersburg, FL
| | - Jerry M. Brown
- From the Office of Medical Education, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL
| | - Johnny Nguyen
- Department of Pathology, Johns Hopkins All Children’s Hospital, St. Petersburg, FL
| | - Sara Karjoo
- Department of Pediatric Gastroenteroleogy, Johns Hopkins All Children’s Hospital, St. Petersburg, FL
| | - Michael J. Wilsey
- Department of Pediatric Gastroenteroleogy, Johns Hopkins All Children’s Hospital, St. Petersburg, FL
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3
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Senyondo G, Khan A, Malik F, Oranu A. Esophagitis Dissecans Superficialis: A Frequently Missed and Rarely Reported Diagnosis. Cureus 2022; 14:e21647. [PMID: 35233324 PMCID: PMC8881116 DOI: 10.7759/cureus.21647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 11/29/2022] Open
Abstract
Esophagitis dissecans superficialis (EDS) is a rare esophageal disease with a wide spectrum of presentations from asymptomatic to debilitating symptoms. There is a strong association of EDS with autoimmune diseases, smoking, and medications, but it can also be idiopathic. Due to the sporadic occurrence of EDS, identification requires a high index of suspicion to avoid frequent misdiagnoses. Herein, we present a case of EDS associated with the long-standing use of oral diclofenac with a favorable outcome after therapy with a proton pump inhibitor (PPI).
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4
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Ng J, Sabat N, Pretorius CF. Oesophagitis dissecans superficialis: role of oesophageal biopsies in early diagnosis. ANZ J Surg 2021; 91:2849-2851. [PMID: 33830608 DOI: 10.1111/ans.16855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/07/2021] [Accepted: 03/25/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Jessica Ng
- Surgical Division, Mackay Base Hospital, Mackay, Queensland, Australia.,School of Medicine, Griffith University Queensland, Gold Coast, Queensland, Australia
| | - Nestor Sabat
- Surgical Division, Mackay Base Hospital, Mackay, Queensland, Australia.,Department of Health, School of Medicine, James Cook University, Townsville, Queensland, Australia
| | - Casper F Pretorius
- Surgical Division, Mackay Base Hospital, Mackay, Queensland, Australia.,Department of Health, School of Medicine, James Cook University, Townsville, Queensland, Australia
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5
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Tao X, Yu G, Guo W, Kan B, Song L, Li H, Jian X. Esophagitis dissecans superficialis associated with acute transoral paraquat poisoning: Clinical study of 15 cases. Sci Prog 2021; 104:368504211019647. [PMID: 34019441 PMCID: PMC10454878 DOI: 10.1177/00368504211019647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
To analyze the clinical characteristics and therapeutic effects of transoral paraquat poisoning combined with Esophagitis dissecans superficialis (EDS). A retrospective observational study was conducted on paraquat poisoning patients between January 1, 2011 and August 30, 2016 in Qilu hospital. Fifteen patients with EDS were enrolled in this study. The clinical characteristics, prognosis, and pathological features of esophageal necrosis mucosa of these patients were retrospectively analyzed and summarized. Esophageal mucosal dissection occurs mainly within 3-8 days after transoral paraquat poisoning in 15 patients. Dosage of paraquat is range from 50 to 100 ml. Most patients have physical problems with swallowing before the intramural esophageal dissection occurred. And there are other symptoms, including sore throat or dysphagia (100%), nausea and vomiting (86.7%), heartburn or upper abdominal pain (73.3%), hematemesis (60%), abdominal distension (20%) and cough frequently (6.7%). In death group, most patients demonstrate features of the multiple organ failure when the esophageal mucosal stripping happened, including lung injury, renal failure, and hepatic failure. The shape of esophageal dissection was tubular in 60%, irregular in 40%, and they vary in size. Pathological examination showed extensive injury, necrosis and hemorrhage of digestive tract epithelium, and obvious inflammatory reaction of epithelial tissue. Transoral paraquat poisoning has certain damage to the patient's esophageal mucosa, and some may be complicated with EDS, and the prognosis is poor, especially when combined with multiple organ dysfunction. Esophageal damage is mainly located in the esophageal mucosa and have different degrees. Special attention should be paid on such patients.
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Affiliation(s)
- Xiaogen Tao
- Department of Poisoning and Occupational Disease, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
- Department of Intensive Care Medicine (ICU), The First Affiliated Hospital of the University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui Province, China
| | - Guangcai Yu
- Department of Poisoning and Occupational Disease, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Wei Guo
- Department of Poisoning and Occupational Disease, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
- Department of Intensive Care Medicine (ICU), The First Affiliated Hospital of the University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui Province, China
| | - Baotian Kan
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Lingli Song
- Department of Poisoning and Occupational Disease, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Hai Li
- Department of Poisoning and Occupational Disease, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Xiangdong Jian
- Department of Poisoning and Occupational Disease, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
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Esophagitis dissecans superficialis (EDS) secondary to esophagogastric junction outflow obstruction (EGJOO): a case report and literature review. Clin J Gastroenterol 2020; 14:26-31. [PMID: 33001361 DOI: 10.1007/s12328-020-01247-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
Esophageal dissecans superficialis (EDS) is a rare disease with endoscopic findings of sloughing squamous tissue with underlying normal mucosa and had no known cause. The literature does support possible causality between the presence of an esophageal stricture and EDS however there has been no association to date between EDS and esophagogastric junction outflow obstruction (EGJOO). We present a case of newly diagnosed EGJOO in a patient with long standing gastroesophageal reflux disease who presented with dysphagia. Evaluation identified endoscopically normal mucosa and a diagnosis of esophagogastric junction outflow obstruction on high resolution impedance manometry. A month later, repeat endoscopy identified diffusely sloughing mucosa consistent with EDS. Endoscopic dilation followed by a robotic Heller myotomy with Dor fundoplication to relive the outflow obstruction resulted in resolution of EDS in this case.
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7
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Mastracci L, Grillo F, Parente P, Unti E, Battista S, Spaggiari P, Campora M, Valle L, Fassan M, Fiocca R. Non gastro-esophageal reflux disease related esophagitis: an overview with a histologic diagnostic approach. Pathologica 2020; 112:128-137. [PMID: 33179617 PMCID: PMC7931579 DOI: 10.32074/1591-951x-156] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/24/2020] [Indexed: 02/07/2023] Open
Abstract
Several pathological conditions, other than gastro-esophageal reflux disease and its complications, can affect the esophagus. While some of these can present with unspecific lesions (i.e. ulcers and epithelial damage) and require clinico-pathological correlation for diagnosis (i.e. drug-induced esophagitis and corrosive esophagitis) other conditions show distinctive histological lesions which enable the pathologist to reach the diagnosis (i.e. some specific infectious esophagites and Crohn's disease). In this context eosinophilic esophagitis is the condition which has been increasingly studied in the last two decades, while lymphocytic esophagitis, a relatively new entity, still represents an enigma. This overview will focus on and describe histologic lesions which allow pathologists to differentiate between these conditions.
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Affiliation(s)
- Luca Mastracci
- Correspondence Luca Mastracci Anatomic Pathology Section, University of Genova and Ospedale Policlinico San Martino, largo Rosanna Benzi 10, 16132 Genova, Italy Tel. +39 010 5555954 Fax: +39 010 5556932 E-mail:
| | | | - Paola Parente
- Pathology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy
| | - Elettra Unti
- UOC Anatomia Patologica, ARNAS Ospedali Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Serena Battista
- SOC di Anatomia Patologica, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Paola Spaggiari
- Department of Pathology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Michela Campora
- Anatomic Pathology, San Martino IRCCS Hospital, Genova, Italy
| | - Luca Valle
- Anatomic Pathology, San Martino IRCCS Hospital, Genova, Italy
| | - Matteo Fassan
- Surgical Pathology Unit, Department of Medicine (DIMED), University of Padua, Italy
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Jaben I, Schatz R, Willner I. The Clinical Course and Management of Severe Esophagitis Dissecans Superficialis: A Case Report. J Investig Med High Impact Case Rep 2020; 7:2324709619892726. [PMID: 31818144 PMCID: PMC6904778 DOI: 10.1177/2324709619892726] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Esophagitis dissecans superficialis is a rare clinical endoscopic finding with poorly understood pathogenesis and ill-defined management. A 71-year-old man is admitted with progressively worsening dysphagia and odynophagia with endoscopic features most consistent with severe esophagitis dissecans superficialis. Extensive workup did not reveal an etiology, and he was subsequently treated with steroids, resulting in rapid, almost complete clinical and endoscopic recovery.
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Affiliation(s)
- Isaac Jaben
- Medical University of South Carolina, Charleston, SC, USA
| | - Richard Schatz
- Medical University of South Carolina, Charleston, SC, USA
| | - Ira Willner
- Medical University of South Carolina, Charleston, SC, USA
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9
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Morel-Cerda EC, Priego-Parra BA, Grube-Pagola P, Remes-Troche JM. Late-onset 'sloughing esophagitis' (esophagitis dissecans superficialis) associated with bullous pemphigoid. BMJ Case Rep 2020; 13:13/7/e235135. [PMID: 32641304 DOI: 10.1136/bcr-2020-235135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pemphigus is a rare autoimmune disease that causes blistering of the skin and oral mucosa. In bullous pemphigoid (BP), skin involvement is predominant, whereas oesophageal involvement is rare, compared with other blistering diseases. We present, herein, the case of a 67-year-old man with a history of successfully treated BP that 2 years later developed progressive dysphagia, unintentional weight loss and iron deficiency anaemia. An endoscopy with biopsies was performed, and its findings were consistent with 'sloughing esophagitis' (esophagitis dissecans superficialis) associated with BP. Oesophageal involvement was present during the first weeks, making our case unusual due to the isolated oesophageal symptoms that developed 24 months later.
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Affiliation(s)
- Eliana Carolina Morel-Cerda
- Laboratorio de Fisiologia Digestiva y Motilidad, Instituto de Investigaciones Medico Biologicas, Veracruz, Mexico
| | - Bryan Adrian Priego-Parra
- Laboratorio de Fisiologia Digestiva y Motilidad, Instituto de Investigaciones Medico Biologicas, Veracruz, Mexico
| | - Peter Grube-Pagola
- Laboratorio de Fisiologia Digestiva y Motilidad, Instituto de Investigaciones Medico Biologicas, Veracruz, Mexico
| | - Jose Maria Remes-Troche
- Laboratorio de Fisiologia Digestiva y Motilidad, Instituto de Investigaciones Medico Biologicas, Veracruz, Mexico
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Esophagitis in patients without gastroesophageal reflux disease or eosinophilic esophagitis: diagnostic considerations. Curr Opin Gastroenterol 2019; 35:379-386. [PMID: 33216485 DOI: 10.1097/mog.0000000000000539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
PURPOSE OF REVIEW A multitude of inflammatory diseases other than gastroesophageal reflux disease (GERD) and eosinophilic esophagitis can affect the esophagus. Despite the deceptively simple organization of squamous mucosa and its limited number of inflammatory responses, a wide array of histologic patterns can be seen in inflammatory disorders involving the esophagus. Each such histologic pattern is associated with a limited number of underlying conditions, and the clinician can use this information to narrow the differential diagnosis. The purpose of this review is to review and discuss the pathologic diagnosis of esophagitis caused by conditions other than GERD or eosinophilic esophagitis, with an emphasis on recent developments in the field. RECENT FINDINGS Recent studies suggest that lymphocytic esophagitis may be a histologic manifestation of esophageal motility disorders. Immunophenotypic features of infiltrating lymphocytes may be helpful in this scenario. immunoglobulin G4-related disease has been implicated as a cause of esophageal inflammation with ulceration, strictures, and mass-forming fibrosis, whereas epidermoid metaplasia has been linked molecularly to the squamous cell neoplasia pathway. SUMMARY Improved knowledge and appreciation of the pathology of esophageal inflammation are needed to better understand the pathogenesis of various types of esophagitis, and to inform new approaches to the therapy and management of inflammatory esophageal diseases.
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Gopal P, Gibson JA, Lisovsky M, Nalbantoglu ILK. Unique causes of esophageal inflammation: a histopathologic perspective. Ann N Y Acad Sci 2018; 1434:219-226. [PMID: 29766506 DOI: 10.1111/nyas.13732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/16/2018] [Accepted: 03/20/2018] [Indexed: 12/18/2022]
Abstract
Gastroenterologists frequently perform endoscopic esophageal mucosal biopsies for pathologic diagnosis in patients experiencing symptoms of esophagitis. The more common causes of esophagitis diagnosed on esophageal mucosal biopsy include reflux esophagitis, eosinophilic esophagitis, and infectious esophagitis caused by Candida albicans, herpes simplex virus, and/or cytomegalovirus. However, there are several causes of esophagitis seen less frequently by pathologists that are very important to recognize. We discuss unique types of esophageal inflammation, including acute bacterial esophagitis, esophageal manifestations of dermatologic diseases, medication-induced esophageal injury, and sloughing esophagitis; and we review their clinical and histopathologic features.
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Affiliation(s)
- Purva Gopal
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joanna A Gibson
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Mikhail Lisovsky
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - ILKe Nalbantoglu
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
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Acero Brand FZ, Suter N, Adam JP, Faulques B, Maietta A, Soulières D, Blais N. Severe immune mucositis and esophagitis in metastatic squamous carcinoma of the larynx associated with pembrolizumab. J Immunother Cancer 2018; 6:22. [PMID: 29548299 PMCID: PMC5857140 DOI: 10.1186/s40425-018-0332-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 02/28/2018] [Indexed: 12/29/2022] Open
Abstract
Background Pembrolizumab is an anti–programmed death 1 (PD-1) receptor monoclonal antibody that has shown activity as second line treatment for metastatic head and neck squamous cell carcinoma (HNSCC). Immune-related adverse events are now well described complications of PD-1 inhibitors and most organ sites have been shown to be potentially affected. Case presentation We describe a 69-year old patient with a relapsed squamous cell carcinoma of the supraglottic larynx with lung metastasis after receiving adjuvant concurrent cisplatin and radiotherapy. This patient was treated with pembrolizumab and benefitted from therapy with major radiological improvement of disease. After 14 cycles of pembrolizumab 200 mg IV each 3 weeks, he experienced dysphagia that evolved to a grade 4 oral cavity and pharynx mucositis and esophagitis. Histologic analysis showed ulcerative esophagitis associated with granulation tissue. Pembrolizumab was discontinued and IV methylprednisolone 2 mg/kg/day was initiated. Two days later, the patient reported a 50% recovery in his symptoms which were completely resolved after 2 weeks. Methylprednisolone was switched to oral prednisone and a taper was planned over 8 weeks. During the fourth week of taper, the patient presented recurrence of grade 1 oral mucositis. Prednisone was increased 2 mg/kg/day for 2 weeks followed by slower tapering over a period of 5 months. Pembrolizumab was not reinitiated. Conclusion This is the first described case of grade 4 immune mucositis and esophagitis associated with pembrolizumab. Because the use of pembrolizumab is increasing in oncology, pharmacists and physicians should be aware of this rare manifestation.
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Affiliation(s)
- Fanny Zulay Acero Brand
- Faculty of Medicine, Department of Internal Medicine, Université de Montréal, Montréal, QC, Canada
| | - Nicolas Suter
- Faculty of Medicine, Department of Internal Medicine, Université de Montréal, Montréal, QC, Canada
| | - Jean-Philippe Adam
- Department of Pharmacy, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Bernard Faulques
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.,Department of Gastroenterology, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Antonio Maietta
- Department of Pathology, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Denis Soulières
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.,Department of Medicine, Service of Hematology, Oncology and Blood Bank, Centre Hospitalier de l'Université de Montréal, 1051 rue Sanguinet, Montréal, QC, H2X 0C1, Canada
| | - Normand Blais
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada. .,Department of Medicine, Service of Hematology, Oncology and Blood Bank, Centre Hospitalier de l'Université de Montréal, 1051 rue Sanguinet, Montréal, QC, H2X 0C1, Canada.
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