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Acute esophageal necrosis (AEN) is an uncommon but fatal cause of upper gastrointestinal bleeding with an incidence of 0.01%–0.2%. Endoscopically, it is characterized by circumferential or diffuse black pigmentation of the esophageal mucosa, conditioned by mucosal necrosis. Risk factors include gender (male), advanced age, cardiovascular disease, hemodynamic insufficiency, alcohol consumption, diabetic ketoacidosis, malnutrition, kidney disease, and trauma. Diagnosis is based on esophagogastroduodenoscopy (EGD). Treatment of AEN consists of intravenous fluids, proton pump inhibitors (PPIs), sucralfate, parenteral nutrition, and antacids. We report a rare case from our hospital, emphasizing the importance of prompt diagnosis and intervention in case management. A 64-year-old man with a history of heavy drinking was hospitalized for severe bleeding (melena) caused by a condition called acute esophageal necrosis. He underwent an emergency procedure to examine his esophagus (EGD) and found significant damage. This case illustrates a rare etiology of AEN due to active alcohol consumption that may be overlooked. The early recognition of this clinical entity is an essential factor in the therapeutic management of the disease.

Background Screening esophagogastroduodenoscopy (EGD) is recommended for all cirrhotic patients at the time of diagnosis, however, non-invasive screening practices for varices have been emerging. CT scans have demonstrated high sensitivity in the detection of esophageal varices. The purpose of this study was to evaluate the sensitivity of CT scans in detecting esophageal and gastric varices when compared to the gold standard of EGD. Methods After institutional board review was obtained, patients from any University of Florida- Jacksonville location with esophageal varices, gastric varices, or both seen on CT abdomen and pelvis, CT chest, CT chest and abdomen pelvis, or EGD were included ( n  = 470). Exclusion criteria comprised cases where medical record numbers were invalid ( n  = 239), if esophageal or gastric varices were not reported ( n  = 25), varices other than esophageal or gastric were present ( n  = 5) and if CT scans were performed after an EGD. 201 total patients were included in the analysis. Results Compared to EGD-verified varices, CT scans demonstrated a sensitivity of 38.3% (95% CI [0.312–0.457]), with scans performed within 7 days of each other improving sensitivity to 39.51% (95% CI [0.294–0.501]), and 40.1% (95% CI [0.327–0.478]), in contrasted studies. CT scans correctly detected varices in 45.90% of thrombocytopenic patients (95% CI [36.85%- 55.16%]). Conclusion Although this study’s sensitivity differs markedly from that reported in prior literature, the findings can be understood in the context of methodological limitations. More than the absolute percentages, the observed trends highlight which patient groups may derive the greatest benefit from CT scan surveillance of varices. Overall, routine CT scans may not be surrogates for dedicated radiographic variceal screening. By presenting real-world data on variceal detection rates with CT, this study underscores the potential role of routine imaging not only in risk stratification but also in guiding resource allocation, such as identifying patients who may safely defer endoscopic evaluation versus those who warrant earlier interventions. Trial registration Retrospectively registered.

BackgroundBarrett’s esophagus (BE) is the premalignant lesion of esophageal adenocarcinoma (EAC) and is the target of early detection and prevention efforts for EAC.AimsWe sought to evaluate what proportion and temporal trends of EAC patients had missed opportunities for screening and surveillance of BE.MethodsOur study included 182 patients with EAC at the Michael E. DeBakey VA Medical Center in Houston, Texas, between 02/2005 and 09/2017. We conducted a retrospective audit of patients’ medical records for any previous upper endoscopies (EGDs) for screening or surveillance of BE prior to their EAC diagnosis.ResultsThe mean age of the cohort was 67.3 years (SD = 9.5); 99.5% of patients were male, and 85.2% were white. Only 45 patients (24.7%) had EGD at any time prior to the cancer diagnosing EGD, of whom 29 (15.9% of all EAC cases) had an established BE diagnosis. In the 137 patients with no prior EGD, most (63.5%) had GERD or were obese or ever smokers. There were no changes in patterns over time. For the 29 patients with prior established BE, 22 (75.8%) were diagnosed with EAC as a result of surveillance EGD. Patients with prior established BE were more likely to be diagnosed at 0 or I stage (p < 0.001) and managed with endoscopic or surgical modalities (p < 0.001) than patients without prior BE.ConclusionsDespite having established risk factors for BE, the majority of EAC patients had no prior EGD to screen for BE. BE screening may represent the largest missed opportunity to reduce EAC mortality.

INTRODUCTION:To investigate the efficacy and safety of preprocedural simethicone (S) and pronase (P) for optimal mucosal visualization during esophagogastroduodenoscopy with sedation. The effect of postural change combined with premedication on mucosal visibility was also examined.METHODS:The study randomized 496 patients into 8 groups based on the type of premedication provided and whether a postural change occurred. The premedication in the control group was 100 mL of normal saline solution (NS). The remaining 3 intervention groups were administered 100 mL of simethicone alone (S), pronase solution alone (P), and simethicone plus pronase solution (S + P). Each group was classified into subgroups according to whether there was a postural change (PC). The mucosal visibility score (MVS), total mucosal visibility score (TVS), procedure time, water consumption for mucosal cleansing, and proportion of patients with diminutive lesions <5 mm were recorded.RESULTS:The P and S groups had a significantly better TVS than the NS group (11.86 ± 3.36 in group P vs 14.52 ± 2.57 in group NS, P < 0.001; 12.36 ± 2.93 in group S vs 14.52 ± 2.57 in group NS, P = 0.006). The TVS was better in the P group than in the S group (11.86 ± 3.36 vs 12.36 ± 2.93, P = 0.037). The MVS was significantly better in the esophagus and duodenum and worse in the upper and lower gastric body in the S group than in the P group. The P + S group had a significantly better TVS than the P and S groups (9.81 ± 2.90 in group P + S vs 11.86 ± 3.36 in group P and 12.36 ± 2.93 in group S, respectively, P < 0.001),\\ and had a reduced amount of flushing water during the procedure (0 [interquartile range [IQR]: 0-33] mL in group P + S vs 40 [IQR: 0-70] mL in group P, P < 0.01; 0 [IQR: 0-33] mL in group P + S vs 50 [IQR: 20-98] mL in group S, P < 0.001). The TVS was significantly better in the P + S + PC group than in the P + S group (8.44 ± 2.10 vs 9.81 ± 2.90, P = 0.003). The MVS was significantly better in the gastric antrum, fundus, and upper and lower gastric body in the P + S + PC group than in the P + S group. There was no significant difference in the detection rate of diminutive lesions among the different groups during an endoscopic examination (P > 0.05).DISCUSSION:The combination of preprocedural administration with simethicone and pronase achieved superior mucosal visualization compared with saline, simethicone, or pronase alone in patients receiving upper endoscopy. Postural change maneuvers performed before endoscopy further improved the mucosal visibility in most parts of the stomach when used with preprocedural simethicone and pronase.

Background Egypt faces a significant public health burden due to chronic liver diseases (CLD) and peptic ulcer disease. CLD, primarily caused by Hepatitis C virus (HCV) infection, affects over 2.9% of the population nationwide, with regional variations. Steatotic liver disease is rapidly emerging as a significant contributor to CLD, especially in urban areas. Acid-related disorders are another widespread condition that can significantly impact the quality of life. These factors and others significantly influence the indications and findings of gastrointestinal endoscopic procedures performed in Egypt. Aim We aimed to evaluate the clinico-demographic data, indications, and endoscopic findings in Egyptian patients undergoing gastrointestinal endoscopic procedures in various regions of Egypt. Methods This study employed a retrospective multicenter cross-sectional design. Data was collected from patients referred for gastrointestinal endoscopy across 15 tertiary gastrointestinal endoscopy units in various governorates throughout Egypt. Results 5910 patients aged 38–63 were enrolled in the study; 75% underwent esophagogastroduodenoscopy (EGD), while 25% underwent a colonoscopy. In all studied patients, the most frequent indications for EGD were dyspepsia (19.5%), followed by hematemesis (19.06%), and melena (17.07%). The final EGD diagnoses for the recruited patients were portal hypertension-related sequelae (60.3%), followed by acid-related diseases (55%), while 10.44% of patients had a normally apparent endoscopy. Male gender, old age, and the presence of chronic liver diseases were more common in patients from upper than lower Egypt governorates. Hematochezia (38.11%) was the most reported indication for colonoscopy, followed by anemia of unknown origin (25.11%). IBD and hemorrhoids (22.34% and 21.86%, respectively) were the most prevalent diagnoses among studied patients, while normal colonoscopy findings were encountered in 18.21% of them. Conclusion This is the largest study describing the situation of endoscopic procedures in Egypt. our study highlights the significant impact of regional variations in disease burden on the utilization and outcomes of GI endoscopy in Egypt. The high prevalence of chronic liver disease is reflected in the EGD findings, while the colonoscopy results suggest a potential need for increased awareness of colorectal diseases.

With the rise in glucagon-like peptide 1 receptor agonist (GLP-1RA) medication usage for Type 2 diabetes mellitus and weight loss, concerns have been raised regarding safety and primary aspiration risk when undergoing anesthesia procedures. Given the paucity of evidence, there is concern whether patients on GLP-1RA are at higher risk of retained gastric contents and subsequent adverse outcomes during routine esophagogastroduodenoscopy (EGD). This study aims to investigate whether patients on GLP-1RA are at higher risk of retained gastric contents during routine EGD. In this retrospective study, we examined 1,368 adult patients who underwent EGDs in the outpatient setting at a tertiary care center. A multivariable analysis was conducted to predict the presence of retained gastric contents on EGD, with the primary predictor being GLP-1RA use. Covariates thought to contribute to delayed gastric emptying were used as secondary predictors. Retained gastric contents were seen in 18 out of 128 cases in the GLP-1RA users (14.1%), which was statistically significant when compared to 45 out of the 1,156 non-users (3.8%) ( < 0.001, LR 18.323). There was no significant increase in adverse outcomes associated with this finding. GLP-1RA use ( < 0.001, OR = 5.4), history of gastroparesis ( < 0.001, OR = 4.55), chronic kidney disease ( = 0.036, OR = 3.47) and hemiplegia ( = 0.048, OR = 2.9) increased risk of retained gastric contents. In contrast, bowel prep ( = < 0.001, OR = 0.157) for same day lower GI procedures decreased risks. Our results show an increase in retained gastric contents in GLP-1RA users undergoing EGD. Other mitigating factors and whether the increase results in aspiration complications should be further studied.

In both classic and late-onset AFD, mutations of the GLA gene cause deficient activity of the alpha-galactosidase enzyme resulting in intracellular accumulation of the undigested substrate. Gastrointestinal symptoms (GI) are common but non-specific and imputed to the AFD, irrespective of the demonstration of substrate accumulation in GI cells. We demonstrate substrate accumulation in gastric epithelial, vascular, and nerve cells of patients with classic AFD and, vice versa, absence of accumulation in late-onset AFD and controls.

Background: Upper Gastrointestinal Bleed (UGIB) is a common and potentially life-threatening condition with an annual incidence of 80–150 per 100,000 individuals and a mortality rate of 2–10%. Esophagogastroduodenoscopy (EGD) is the gold standard for both diagnosis and treatment, but post-discharge outcomes, including readmissions, remain underexplored. Methods: This study utilized the 2021 National Readmission Database (NRD) to analyze 30-day readmission rates following EGD for UGIB. Adult patients (≥18 years) admitted for UGIB and undergoing EGD were included; those who died during the index hospitalization were excluded. Demographic, clinical, and socioeconomic factors associated with readmission were examined using multivariate logistic regression. Results: Among 34,257 patients admitted for UGIB and undergoing EGD, 11,088 (32.4%) were readmitted within 30 days, with 5423 (49%) due to recurrent UGIB. Readmitted patients had a higher mean age (68.46 vs. 67.63 years) and greater prevalence of cirrhosis (16.71% vs. 13.84%). Hospital resource utilization was significantly higher among readmissions, with increased total hospital charges (USD 82,544.82 vs. USD 61,521.17) and longer hospital stays (5.38 vs. 4.97 days). Mortality was lower among readmitted patients (1.46% vs. 3.53%). Multivariate analysis identified cirrhosis (OR 7.20, 95% CI: 6.45–8.02), untreated H. pylori infection (OR 3.43, 95% CI: 2.15–4.30), atrial fibrillation (OR 1.52, 95% CI: 1.36–1.69), and chronic antithrombotic therapy (OR 1.63, 95% CI: 1.41–1.89) as significant predictors of recurrent UGIB readmission. Lower socioeconomic status was also associated with increased readmission risk (OR 1.15, 95% CI: 1.05–1.25). Conclusions: Readmission following EGD for UGIB is common and driven primarily by recurrent bleeding. Cirrhosis, untreated H. pylori infection, atrial fibrillation, and chronic anticoagulation therapy are key risk factors. These findings highlight the need for targeted interventions, including improved post-discharge management and optimization of anticoagulation strategies, to reduce readmission rates and improve patient outcomes.

Background Esophageal granular cell tumor (eGCT) is a rare, usually benign, neoplasm of neuroectodermic origin. Eosinophilic esophagitis (EoE) is a relatively uncommon, immune-mediated, chronic disease. Both diseases commonly present with dysphagia. One case has been reported of simultaneous occurrence of both diseases. Aims To determine the association between diseases. Methods The present study was an IRB-approved, retrospective review of esophagogastroduodenoscopies (EGDs) with esophageal biopsies from two large hospitals, 1999–2014. Results Among 29,235 EGDs with esophageal biopsies for 16 years (167,434 total EGDs), 16 patients had pathologically diagnosed eGCT, and 1225 patients had pathologically diagnosed EoE. Five (31%) of 16 patients with eGCT had concomitant EoE ( p  = 0.001, OR 10.43, 95% ORCI 3.16–32.44, Fisher’s exact test). Patients with simultaneous eGCT and EoE were young (mean age = 33.6 ± 12.9 years). Three were female. Dysphagia was presenting symptom in 4 (80%) of patients. Three had asthma. All five patients had > 20 eosinophils/hpf in esophageal biopsy specimens. Three patients had endoscopic esophageal abnormalities suggesting EoE. Four patients were treated with a PPI (before and after diagnosis of EoE), and 2 patients underwent six-food-elimination diet with partial symptomatic improvement. The eGCTs averaged 13.4 ± 4.2 mm in maximal diameter and were located in upper-2, middle-2, and lower esophagus-2 (1 patient had 2 eGCTs). eGCTs were endoscopically resected-3 patients, and monitored-2 patients. Surveillance endoscopies revealed no recurrence or growth of eGCTs after resection (mean follow-up = 4.6 years). Conclusions This novel report of 5 patients with simultaneous EoE and eGCT adds to one, previously published case and suggests these two diseases are associated, and have a common pathophysiologic link, despite apparently different pathogenesis. Large, prospective, endoscopic and pathologic studies are warranted to further investigate this association.