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What is new in esophageal injury (infection, drug-induced, caustic, stricture, perforation)?
Fabio Pace1, Spinello Antinori, Alessandro Repici
1Gastroenterology Unit, IRCSS Hospital Humanitas, Milan, Italy. fabio.pace@unimi.it
Purpose Of Review:
We will focus separately on infectious, drug-induced and caustic injury of the esophagus and their possible complications such as stricture and perforation.
Recent Findings:
There has been a decrease in opportunistic esophageal infection in HIV-positive patients, in particular candidiasis, which remains an important cause of inpatient charges, length of stay and total hospital costs, and new antifungal therapy are currently explored. As far as drug-induced esophageal injury is concerned, more than 1000 cases of all cases due to nearly 100 different medications have been described during the last 10 years. However, the estimated case frequency is probably much higher and the related literature is of low quality, as cases are reported selectively and stimulated by clustering of cases, newly implicated pills or unusual complications. Finally, in the field of caustic ingestion-related injury, there has been greater understanding of geographical differences in prevalence and more frequently involved substances, choice of optimal timing for endoscopy, relationship between symptoms and severity of lesions and appropriate role of steroids and other therapies, such as the topical application of mytomicin C.
Summary:
This update covers the most relevant papers published on the three areas of interest during the last year.
Insights
This review examines esophageal injuries from infections, drugs, and caustic substances, noting decreased HIV-related infections but ongoing challenges with drug-induced and caustic injuries. New therapies are being explored for these conditions.
Area of Science:
- Gastroenterology
- Internal Medicine
- Toxicology
Background:
- Esophageal injuries present significant clinical challenges.
- Understanding infectious, drug-induced, and caustic etiologies is crucial for patient management.
- Complications like stricture and perforation require specialized attention.
Purpose of the Study:
- To review recent advancements in the understanding and management of infectious, drug-induced, and caustic esophageal injuries.
- To highlight key findings from the past year's literature in these specific areas.
- To discuss potential complications and emerging therapeutic strategies.
Main Methods:
- Literature review of papers published within the last year.
- Focus on infectious, drug-induced, and caustic esophageal injuries.
- Analysis of complications such as stricture and perforation.
Main Results:
- Opportunistic esophageal infections in HIV-positive patients, particularly candidiasis, have decreased, though new antifungal therapies are under investigation.
- Over 1000 cases of drug-induced esophageal injury from nearly 100 medications have been reported in the last decade, with potentially higher actual frequencies.
- Enhanced understanding of caustic ingestion injuries includes geographical prevalence, common substances, optimal endoscopy timing, symptom-severity correlation, and the role of steroids and topical mytomycin C.
Conclusions:
- This review synthesizes the most pertinent research from the past year on infectious, drug-induced, and caustic esophageal injuries.
- It provides an update on current understanding and therapeutic considerations for these conditions.
- The findings emphasize the evolving landscape of esophageal injury management.
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