Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2023; 15(3): 408-419
Published online Mar 27, 2023. doi: 10.4240/wjgs.v15.i3.408
Clinical features of acute esophageal mucosal lesions and reflux esophagitis Los Angeles classification grade D: A retrospective study
Chikamasa Ichita, Akiko Sasaki, Sayuri Shimizu
Chikamasa Ichita, Akiko Sasaki, Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
Chikamasa Ichita, Sayuri Shimizu, Department of Health Data Science, Yokohama City University, Yokohama 236–0027, Kanagawa, Japan
Author contributions: Ichita C, Sasaki A, and Shimizu S contributed equally to this work; Ichita C contributed to the planning, data gathering, literature review, as well as writing and editing of this article; Shimizu S provided epidemiological advice and reviewed the statistical analysis; Sasaki A contributed to this study as an expert endoscopist; All authors commented on draft versions and approved the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the institutional review board of the Future Medical Research Center Ethical Committee, No. TGE01484-024.
Informed consent statement: Due to the observational nature of the study based on medical records without using samples taken from the human body, informed consent was not required. Instead, an opt-out method was used on our hospital website.
Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at ichikamasa@yahoo.co.jp.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chikamasa Ichita, MD, Doctor, Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura 247-8533, Kanagawa, Japan. ichikamasa@yahoo.co.jp
Received: November 25, 2022
Peer-review started: November 25, 2022
First decision: January 23, 2023
Revised: January 27, 2023
Accepted: March 3, 2023
Article in press: March 3, 2023
Published online: March 27, 2023
Processing time: 121 Days and 22.1 Hours
Abstract
BACKGROUND

Acute esophageal mucosal lesions (AEMLs) are an underrecognized and largely unexplored disease. Endoscopic findings are similar, and a higher percentage of AEML could be misdiagnosed as reflux esophagitis Los Angeles classification grade D (RE-D). These diseases could have different pathologies and require different treatments.

AIM

To compare AEML and RE-D to confirm that the two diseases are different from each other and to clarify the clinical features of AEML.

METHODS

We selected emergency endoscopic cases of upper gastrointestinal bleeding with circumferential esophageal mucosal injury and classified them into AEML and RE-D groups according to the mucosal injury’s shape on the oral side. We examined patient background, blood sampling data, comorbidities at onset, endoscopic characteristics, and outcomes in each group.

RESULTS

Among the emergency cases, the AEML and RE-D groups had 105 (3.1%) and 48 (1.4%) cases, respectively. Multiple variables exhibited significantly different results, indicating that these two diseases are distinct. The clinical features of AEML consisted of more comorbidities [risk ratio (RR): 3.10; 95% confidence interval (CI): 1.68–5.71; P < 0.001] and less endoscopic hemostasis compared with RE-D (RR: 0.25; 95%CI: 0.10–0.63; P < 0.001). Mortality during hospitalization was higher in the AEML group (RR: 3.43; 95%CI: 0.82–14.40; P = 0.094), and stenosis developed only in the AEML group.

CONCLUSION

AEML and RE-D were clearly distinct diseases with different clinical features. AEML may be more common than assumed, and the potential for its presence should be taken into account in cases of upper gastrointestinal bleeding with comorbidities.

Keywords: Acute esophageal mucosal lesion; Comorbidities; Esophageal reflux; Black esophagus; Acute necrotizing esophagitis

Core Tip: The pathogenesis of acute esophageal mucosal lesion (AEML) is uncertain and is frequently misdiagnosed as reflux esophagitis Los Angeles classification grade D (RE-D). Therefore, we compared the clinical features of AEML and RE-D using a single-center retrospective study. These esophageal diseases were distinguished based on the oral shape of the esophageal mucosal injury. Our results suggest AEML cases may be more prevalent than previously thought, as twice as many AEML cases were observed than RE-D cases. We found clear differences between these diseases and recommend that AEML is considered in cases of upper gastrointestinal bleeding.