1
|
Oldakovskiy V, Murashkin N, Lokhmatov M, Gusev A, Tupylenko A, Budkina T, Yatzik S, Dyakonova E, Abaykhanov R, Fisenko A. Our experience of using Losartan for esophageal stenosis in children with dystrophic form of congenital epidermolysis bullosa. J Pediatr Surg 2023; 58:619-623. [PMID: 36566169 DOI: 10.1016/j.jpedsurg.2022.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/03/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Dystrophic epidermolysis bullosa (DEB) is one of the most severe forms of congenital epidermolysis bullosa and characterized by the formation of many surgical complications. Esophageal stenosis is a common complication of DEB and occurs in almost 76% of cases. Balloon dilatation (BD) under X-ray control is the main therapeutic technique, however conservative treatment is necessary to prevent restenosis. The use of the drug losartan is promising due to its antifibrotic effect through the suppression of transforming growth factor-β1 (TGF-β1). PURPOSE To evaluate the efficacy of losartan in the prevention of restenosis after BD of esophageal stenosis in children with DEB. MATERIALS AND METHODS The study included 19 children from 2 to 16 years old (mean age 9.2 ± 3.58 years) with DEB and X-ray confirmed esophageal stenosis. All children underwent BD. In the main group 9 children after BD have received losartan, in the control group of 10 children - only standard therapy. The observation period was 12 months. RESULTS In the main group, 1 child (11.1%) required repeated dilatation, in the control group - 4 children (40%). Indicators of nutritional deficiency (THINC scale) and the disease severity index (EBDASI) were significantly lower in the group of children treated with losartan. No undesirable actions of the drug were recorded. CONCLUSIONS In this study losartan showed its safety, contributed to a decrease in the restenosis frequency and an improvement in the nutritional status of children with DEB after BD. However, further studies are required to confirm its effectiveness. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Vladislav Oldakovskiy
- The National Medical Research Center of Children's Health, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia
| | - Nikolay Murashkin
- The National Medical Research Center of Children's Health, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia
| | - Maksim Lokhmatov
- The National Medical Research Center of Children's Health, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia
| | - Aleksey Gusev
- The National Medical Research Center of Children's Health, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia; Peoples' Friendship University of Russia (RUDN University), Miklukho-Maklaya str. 6, 117198, Moscow, Russia.
| | - Artem Tupylenko
- The National Medical Research Center of Children's Health, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia
| | - Tatiana Budkina
- The National Medical Research Center of Children's Health, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia
| | - Sergey Yatzik
- The National Medical Research Center of Children's Health, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia
| | - Elena Dyakonova
- The National Medical Research Center of Children's Health, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia
| | - Rasul Abaykhanov
- The National Medical Research Center of Children's Health, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia
| | - Andrey Fisenko
- The National Medical Research Center of Children's Health, Lomonosovskiy prospect, 2/1, 119991, Moscow, Russia
| |
Collapse
|
2
|
Keshav N, Khalid S, Parasher G, Cassidy F, Thompson W, Shiehmorteza M. Dots, lines, contours, and ends: An image-based review of esophageal pathology. Eur J Radiol Open 2021; 8:100361. [PMID: 34141830 PMCID: PMC8187835 DOI: 10.1016/j.ejro.2021.100361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 05/29/2021] [Indexed: 11/25/2022] Open
Abstract
Learning Point #1: Small ulcers on esophagography are usually attributable to herpes esophagitis and drug-induced esophagitis. Although rare, Crohn’s disease may produce small apthoid ulcers. Large ulcers are usually attributable to CMV or HIV esophagitis. Learning Point #2: The early findings of candida are plaques that mimic glycogenic acanthosis. When plaques are seen, consider early candida or glycogenic acanthosis. When shaggy esophagus is identified, consider candidiasis. Learning Point #3: Varices and varicoid esophageal carcinoma may appear similar on imaging. The presence of obstruction and lack of change with time and position should sway the Radiologist to diagnosing varicoid esophageal carcinoma. Learning Point #4: Transverse esophageal lines should suggest the entities of feline esophagus and idiopathic eosinophilic esophagitis. Learning Point #5: Esophageal contour abnormalities may suggest extrinsic or intrinsic lesions. Extrinsic lesions include aberrant vessels. Intrinsic lesions include intramural pseudodiverticulosis, gastroesophageal reflux, Barrett’s esophagus, and esophageal cancer.
Esophageal pathologies encountered on fluoroscopic examination may pose a diagnostic challenge to the interpreting Radiologist. Understanding the varied imaging appearances of esophageal pathology requires a thorough understanding of barium esophagography. This article reviews the various fluoroscopic imaging findings of different esophageal pathologies by describing an approach to image interpretation centered on dots, lines, contours, and ends. By utilizing this approach, the Radiologist will be better positioned to reconcile seemingly disparate pathologies into a cogent and succinct differential diagnosis.
Collapse
Affiliation(s)
- Nandan Keshav
- University of New Mexico Health Sciences Center, Department of Diagnostic Radiology, MSC10 5530, 1 University of New Mexico, Albuquerque, NM, 87131, United States
| | - Sameen Khalid
- University of New Mexico Health Sciences Center, Division of Gastroenterology, Department of Internal Medicine, MSC 10 5550, 1 University of New Mexico, Albuquerque, NM, 87131, United States
| | - Gulshan Parasher
- University of New Mexico Health Sciences Center, Division of Gastroenterology, Department of Internal Medicine, MSC 10 5550, 1 University of New Mexico, Albuquerque, NM, 87131, United States
| | - Fiona Cassidy
- University of California San Diego School of Medicine, Department of Radiology, 8929 University Center Ln #101, San Diego, CA, 92122, United States
| | - William Thompson
- University of New Mexico Health Sciences Center, Department of Diagnostic Radiology, MSC10 5530, 1 University of New Mexico, Albuquerque, NM, 87131, United States
| | - Masoud Shiehmorteza
- University of New Mexico Health Sciences Center, Department of Diagnostic Radiology, MSC10 5530, 1 University of New Mexico, Albuquerque, NM, 87131, United States
| |
Collapse
|
3
|
Tang JY, Marinkovich MP, Lucas E, Gorell E, Chiou A, Lu Y, Gillon J, Patel D, Rudin D. A systematic literature review of the disease burden in patients with recessive dystrophic epidermolysis bullosa. Orphanet J Rare Dis 2021; 16:175. [PMID: 33849616 PMCID: PMC8045359 DOI: 10.1186/s13023-021-01811-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/31/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND/OBJECTIVE Recessive dystrophic epidermolysis bullosa (RDEB) is a genetic collagen disorder characterized by skin fragility leading to blistering, wounds, and scarring. There are currently no approved curative therapies. The objective of this manuscript is to provide a comprehensive literature review of the disease burden caused by RDEB. METHODS A systematic literature review was conducted in MEDLINE and Embase in accordance with PRISMA guidelines. Observational and interventional studies on the economic, clinical, or humanistic burden of RDEB were included. RESULTS Sixty-five studies were included in the review. Patients had considerable wound burden, with 60% reporting wounds covering more than 30% of their body. Increases in pain and itch were seen with larger wound size. Chronic wounds were larger and more painful than recurrent wounds. Commonly reported symptoms and complications included lesions and blistering, anemia, nail dystrophy and loss, milia, infections, musculoskeletal contractures, strictures or stenoses, constipation, malnutrition/nutritional problems, pseudosyndactyly, ocular manifestations, and dental caries. Many patients underwent esophageal dilation (29-74%; median dilations, 2-6) and gastrostomy tube placement (8-58%). In the severely affected population, risk of squamous cell carcinoma (SCC) was 76% and mortality from SCC reached 84% by age 40. Patients with RDEB experienced worsened quality of life (QOL), decreased functioning and social activities, and increased pain and itch when compared to other EB subtypes, other skin diseases, and the general population. Families of patients reported experiencing high rates of burden including financial burden (50-54%) and negative impact on private life (79%). Direct medical costs were high, though reported in few studies; annual payer-borne total medical costs in Ireland were $84,534 and annual patient-borne medical costs in Korea were $7392. Estimated annual US costs for wound dressings ranged from $4000 to $245,000. Patients spent considerable time changing dressings: often daily (13-54% of patients) with up to three hours per change (15-40%). CONCLUSION Patients with RDEB and their families/caregivers experience significant economic, humanistic, and clinical burden. Further research is needed to better understand the costs of disease, how the burden of disease changes over the patient lifetime and to better characterize QOL impact, and how RDEB compares with other chronic, debilitating disorders.
Collapse
Affiliation(s)
- Jean Yuh Tang
- Department of Dermatology, Stanford Universixsty School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - M Peter Marinkovich
- Department of Dermatology, Stanford Universixsty School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Eleanor Lucas
- Pharmerit - An OPEN Health Company, 4350 East West Highway, Suite 1100, Bethesda, MD, 20814, USA
| | - Emily Gorell
- Department of Dermatology, Stanford Universixsty School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Albert Chiou
- Department of Dermatology, Stanford Universixsty School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Ying Lu
- Department of Dermatology, Stanford Universixsty School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Jodie Gillon
- Abeona Therapeutics Inc, 1330 Avenue of the Americas, New York, NY, 10019, USA
| | - Dipen Patel
- Pharmerit - An OPEN Health Company, 4350 East West Highway, Suite 1100, Bethesda, MD, 20814, USA
| | - Dan Rudin
- Abeona Therapeutics Inc, 1330 Avenue of the Americas, New York, NY, 10019, USA.
| |
Collapse
|
4
|
Petrea OC, Stanciu C, Muzica CM, Sfarti CV, Cojocariu C, Girleanu I, Huiban L, Trifan A. Idiopathic Cervical Esophageal Webs: A Case Report and Literature Review. Int J Gen Med 2020; 13:1123-1127. [PMID: 33235485 PMCID: PMC7679475 DOI: 10.2147/ijgm.s278999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/16/2020] [Indexed: 02/05/2023] Open
Abstract
An esophageal web is a thin and smooth extension of normal esophageal tissue consisting of mucosa and submucosa that can occur anywhere along the length of the esophagus but is typically located in the cervical segment. The webs can be congenital or acquired, commonly associated with Plummer-Vinson syndrome and rarely with celiac disease, dermatological disorders or graft-versus-host disease. A 54-year-old man was referred to our hospital with a history of high non-progressive dysphagia to solid food, meat impaction and weight loss over last ten months. His medical history and family history were unremarkable nor was the physical examination. Complete blood count and basic biochemical tests were normal. Antigliadin and antiendomysial antibodies for celiac disease were negative. Barium swallow esophagography and upper endoscopy detected cervical esophageal webs. The treatment consisted of endoscopic balloon dilation. The patient's dysphagia resolved shortly after dilation, and the endoscope passed easily through the esophagus showing normal esophageal, gastric and duodenal mucosa. This report is consistent with a case of esophageal webs rarely documented in males and that is not related with common causes like Plummer-Vinson syndrome. Thus, the pathogenesis and treatment of esophageal webs are evolving.
Collapse
Affiliation(s)
- Oana Cristina Petrea
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Institute of Gastroenterology and Hepatology, Iasi, Romania
| | - Carol Stanciu
- Institute of Gastroenterology and Hepatology, Iasi, Romania
- Correspondence: Carol Stanciu Institute of Gastroenterology and Hepatology, “St Spiridon” Emergency Hospital, Iași700111, RomaniaTel +40722306020 Email
| | - Cristina Maria Muzica
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Institute of Gastroenterology and Hepatology, Iasi, Romania
| | - Catalin Victor Sfarti
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Institute of Gastroenterology and Hepatology, Iasi, Romania
| | - Camelia Cojocariu
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Institute of Gastroenterology and Hepatology, Iasi, Romania
| | - Irina Girleanu
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Institute of Gastroenterology and Hepatology, Iasi, Romania
| | - Laura Huiban
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Anca Trifan
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Institute of Gastroenterology and Hepatology, Iasi, Romania
| |
Collapse
|
5
|
Lee MH, Lubner MG, Peebles JK, Hinshaw MA, Menias CO, Levine MS, Pickhardt PJ. Clinical, Imaging, and Pathologic Features of Conditions with Combined Esophageal and Cutaneous Manifestations. Radiographics 2019; 39:1411-1434. [PMID: 31419189 DOI: 10.1148/rg.2019190052] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A variety of clinically significant conditions can affect both the esophagus and the skin. Esophageal and cutaneous manifestations may directly reflect the underlying disease process, as in infections such as herpes simplex virus, bullous diseases such as epidermolysis bullosa and mucous membrane pemphigoid, connective tissue diseases such as systemic sclerosis, and inflammatory diseases such as lichen planus. Alternatively, esophageal and cutaneous findings may result from conditions that are closely associated with and potentially pathognomonic for but distinct from the underlying disease process, as in genetic diseases such as Cowden syndrome or paraneoplastic syndromes such as acrokeratosis paraneoplastica. Other diseases such as Crohn disease may have cutaneous manifestations that directly reflect the same underlying inflammatory process that affects the gastrointestinal tract or cutaneous manifestations that represent reactive or associated conditions distinct from the underlying inflammatory process. The cutaneous manifestations of disease may precede, coincide with, or follow the esophageal manifestations of disease. The authors present the characteristic clinical features and imaging findings associated with common and uncommon conditions that have esophageal and cutaneous manifestations. Each condition is presented with a brief overview, discussion of salient clinical and cutaneous manifestations, and description of the typical esophageal imaging findings, with particular attention to implications for diagnosis, prognosis, and treatment. Recognition of potential associations between cutaneous lesions and esophageal imaging findings is important for establishing a specific diagnosis or generating a meaningful differential diagnosis.
Collapse
Affiliation(s)
- Matthew H Lee
- From the Department of Radiology, Naval Medical Center Camp Lejeune, Camp Lejeune, NC (M.H.L.); Departments of Radiology (M.G.L., P.J.P.) and Dermatology (J.K.P., M.A.H.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.S.L.)
| | - Meghan G Lubner
- From the Department of Radiology, Naval Medical Center Camp Lejeune, Camp Lejeune, NC (M.H.L.); Departments of Radiology (M.G.L., P.J.P.) and Dermatology (J.K.P., M.A.H.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.S.L.)
| | - J Klint Peebles
- From the Department of Radiology, Naval Medical Center Camp Lejeune, Camp Lejeune, NC (M.H.L.); Departments of Radiology (M.G.L., P.J.P.) and Dermatology (J.K.P., M.A.H.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.S.L.)
| | - Molly A Hinshaw
- From the Department of Radiology, Naval Medical Center Camp Lejeune, Camp Lejeune, NC (M.H.L.); Departments of Radiology (M.G.L., P.J.P.) and Dermatology (J.K.P., M.A.H.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.S.L.)
| | - Christine O Menias
- From the Department of Radiology, Naval Medical Center Camp Lejeune, Camp Lejeune, NC (M.H.L.); Departments of Radiology (M.G.L., P.J.P.) and Dermatology (J.K.P., M.A.H.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.S.L.)
| | - Marc S Levine
- From the Department of Radiology, Naval Medical Center Camp Lejeune, Camp Lejeune, NC (M.H.L.); Departments of Radiology (M.G.L., P.J.P.) and Dermatology (J.K.P., M.A.H.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.S.L.)
| | - Perry J Pickhardt
- From the Department of Radiology, Naval Medical Center Camp Lejeune, Camp Lejeune, NC (M.H.L.); Departments of Radiology (M.G.L., P.J.P.) and Dermatology (J.K.P., M.A.H.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.S.L.)
| |
Collapse
|