scholarly journals Radiation Esophagitis in a Patient with Oral Carcinoma and Bone Metastasis

2020 ◽  
Vol 14 (3) ◽  
pp. 453-457 ◽  
Author(s):  
Toshimi Chiba ◽  
Yu Ohashi ◽  
Naoko Tsunoda ◽  
Kei Onodera ◽  
Tadashi Kawai ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Chest Pain ◽  
Bone Metastasis ◽  
Bone Metastases ◽  
Gastrointestinal Endoscopy ◽  
Acute Radiation ◽  
Oral Carcinoma ◽  
Upper Gastrointestinal Endoscopy ◽  
Upper Gastrointestinal ◽  
Radiation Esophagitis

Radiation esophagitis requiring endoscopic evaluation occurs quite rarely, affecting <1% of patients undergoing radiation treatment. Acute radiation esophagitis develops within 3 weeks of radiation therapy. We describe herein a case of radiation esophagitis in a patient with oral carcinoma with multiple general bone metastases. Cisplatin, fluorouracil, and cetuximab were given for 3 cycles. Radiation therapy (30 Gy) to the thoracic vertebrae and lumbar vertebrae was prescribed to prevent worsening of bone metastases and relieve pain. Neutropenia was also observed due to chemotherapy. After the end of radiation therapy, the patient experienced chest pain, heartburn, and dysphagia. Upper gastrointestinal endoscopy revealed severe radiation esophagitis of endoscopic Fukui Acute Radiation Esophagitis grade 4. Oral food was discontinued and an intravenous proton-pump inhibitor was administered. After 3 weeks, upper gastrointestinal endoscopy showed improvement of radiation esophagitis, with scars. The symptoms of chest pain, heartburn, and dysphagia had also disappeared. This is the first case to be reported of acute radiation esophagitis in a patient with oral carcinoma with bone metastasis who experienced dramatic improvement of endoscopic findings. Neutropenia appears to be associated with more severe acute radiation esophagitis.

scholarly journals Manometrically jackhammer esophagus with fluoroscopically/endoscopically distal esophageal spasm: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Apichet Sirinawasatien ◽  
Pallop Sakulthongthawin
Keyword(s):  
Chest Pain ◽  
High Resolution ◽  
Gastrointestinal Endoscopy ◽  
Motility Disorder ◽  
Upper Gastrointestinal Endoscopy ◽  
Channel Blockers ◽  
Esophageal Motility Disorder ◽  
High Resolution Manometry ◽  
Esophageal Spasm ◽  
Upper Gastrointestinal

Abstract Background Jackhammer esophagus is a rare esophageal motility disorder that can result in dysphagia, chest pain, and gastro-esophageal reflux symptoms. High-resolution manometry is the gold standard for diagnosis, while corkscrew esophagus on upper gastrointestinal endoscopy is an uncommon manifestation. Case presentation 72-year-old man who presented with progressive dysphagia for three months without symptoms of chest pain or heartburn. Initial workup showed a corkscrew esophagus on upper gastrointestinal endoscopy; subsequently, high-resolution manometry revealed an esophago-gastric junction outflow obstruction with hypercontractile (jackhammer) esophagus. Treatment with calcium channel blockers and proton pump inhibitors was successful and relieved his symptoms near completion. Conclusions Even though the corkscrew esophagus is typically for distal esophageal spasm, the hypercontractile (jackhammer) esophagus can appear. The high-resolution manometry can help to distinguish each specific motility disorder.

scholarly journals Necessity of Upper Gastrointestinal Endoscopy in Patients with Noncardiac Chest Pain

2013 ◽  
Vol 84 (4) ◽  
pp. 515 ◽  
Author(s):  
Jin Sil Pyo ◽  
Sun Moon Kim ◽  
Yoo Jin Um ◽  
Joo Ah Lee ◽  
Hoon Sup Koo ◽  
...  
Keyword(s):  
Chest Pain ◽  
Gastrointestinal Endoscopy ◽  
Upper Gastrointestinal Endoscopy ◽  
Noncardiac Chest Pain ◽  
Upper Gastrointestinal

scholarly journals Complete closure of a colo-duodenal fistula in a patient with advanced ascending colon cancer after pembrolizumab combined with radiation therapy: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Tetsuro Tominaga ◽  
Takashi Nonaka ◽  
Akiko Fukuda ◽  
Masaaki Moriyama ◽  
Shosaburo Oyama ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Radiation Therapy ◽  
Gastrointestinal Endoscopy ◽  
Immune Checkpoint Inhibitor ◽  
Checkpoint Inhibitor ◽  
Locally Advanced ◽  
Upper Gastrointestinal Endoscopy ◽  
Duodenal Fistula ◽  
Advanced Colon Cancer ◽  
Upper Gastrointestinal

Abstract Background A colo-duodenal fistula is a very rare complication of colon cancer that presents with not only severe clinical symptoms, but a poor prognosis due to locally advanced cancer. A novel immune checkpoint inhibitor for colon cancer patients provides a high objective response rate. Recently, radiation therapy combined with immune checkpoint inhibitor therapy has been reported to have a synergistic antitumor effect. A case of complete closure of a colo-duodenal fistula in a patient with locally advanced colon cancer after combined pembrolizumab and radiation therapy is reported. Case presentation A 66-year-old man presented with abdominal distention. Abdominal contrast-enhanced computed tomography (CT) showed a 80-mm bulky mass in the right upper quadrant. The tumor created a fistula to the second portion of the duodenum. Upper gastrointestinal endoscopy showed a colo-duodenal fistula. Gastro-jejunal bypass and ileostomy were performed to prevent bowel obstruction, followed by systemic chemotherapy. MSI-high was diagnosed on examination of the biopsy specimen. Treatment was then changed to immunotherapy using pembrolizumab; after six courses, the tumor markers were decreased to within normal ranges, but the main tumor increased. Radiation therapy was then given for local control of the main tumor, after which CT showed that all of the tumor, including the main tumor, lymph node metastases, and the colo-duodenal fistula, had gradually shrunk. Follow-up upper gastrointestinal endoscopy showed that the colo-duodenal fistula had closed completely. PET–CT showed no abnormal uptake in all tumors, and clinical complete response was diagnosed. Now, 21 months after diagnosis, the tumor is well controlled without evidence of regrowth. Conclusions Pembrolizumab combined with radiation therapy has a potentially dramatic therapeutic effect for advanced colon cancer.

scholarly journals Severe Chest Pain due to N-Acetylcysteine-Induced Esophagitis

2019 ◽  
Vol 2019 ◽  
pp. 1-2 ◽  
Author(s):  
Weihong Wang ◽  
Yu Zhang ◽  
Yi Liu ◽  
Lei Xu ◽  
Dingmei Shi
Keyword(s):  
Chest Pain ◽  
Gastrointestinal Endoscopy ◽  
Unusual Case ◽  
Upper Gastrointestinal Endoscopy ◽  
Shortness Of Breath ◽  
Severe Chest Pain ◽  
History Of ◽  
Upper Gastrointestinal ◽  
Powdered Form

We report an unusual case of severe chest pain caused by N-acetylcysteine-induced esophagitis. An 81-year-old Chinese man with a history of interstitial lung disease was admitted to our hospital with intermittent arrhythmia that began 5 days ago. The patient presented with complaints of cough, sputum, and shortness of breath. Cefminox injections and N-acetylcysteine tablets were prescribed to improve respiratory symptoms. The patient developed severe chest pain and odynophagia 4 hours after swallowing the N-acetylcysteine tablet while in the decubitus position. Upper gastrointestinal endoscopy revealed four discrete areas of ulcerations measuring approximately 1 cm at the midesophageal level. The distance between the foci and the incisors was approximately 24 cm. The patient continued the N-acetylcysteine orally, which was administered in powdered form with more water while in the upright position. Pantoprazole and hydrotalcite were also administered to the patient. The symptoms subsided, and a follow-up endoscopy after 20 days showed that the ulcers healed. This case highlights that seemingly safe drugs such as N-acetylcysteine can lead to severe chest pain if ingested inappropriately.

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