Ichita C, Sasaki A, Shimizu S. Clinical features of acute esophageal mucosal lesions and reflux esophagitis Los Angeles classification grade D: A retrospective study. World J Gastrointest Surg 2023; 15(3): 408-419 [PMID: 37032792 DOI: 10.4240/wjgs.v15.i3.408]
Corresponding Author of This Article
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
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
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
ARTICLE HIGHLIGHTS
Research background
Recently, the concept of acute esophageal mucosal lesions (AEML), which encompasses both Black Esophagus and its milder variant, has been proposed, particularly in the Asian region.
Research motivation
The clinical manifestations of AEML remain inadequately understood and have been misdiagnosed as reflux esophagitis Los Angeles classification grade D (RE-D).
Research objectives
This study aimed to differentiate AEML from RE-D and to elucidate the clinical features of AEML.
Research methods
We selected emergency endoscopic cases of upper gastrointestinal bleeding characterized by circumferential esophageal mucosal injury and classified them into AEML and RE-D groups based on the shape of mucosal injury observed on the oral side. We subsequently examined patient demographics, blood sampling data, comorbidities at onset, endoscopic characteristics, and outcomes in each group.
Research results
Among the emergency cases, the incidence of AEML and RE-D were 3.1% and 1.4%, respectively. A comparison of multiple variables revealed significant differences, suggesting that these two conditions are distinct. The clinical features of AEML were characterized by a higher prevalence of comorbidities [risk ratio (RR): 3.10; P < 0.001] and a lower rate of endoscopic hemostasis compared with RE-D (RR: 0.25; P < 0.001). Additionally, in-hospital mortality was higher in the AEML group (RR: 3.43; P = 0.094), and stenosis was observed exclusively in the AEML group.
Research conclusions
AEML and RE-D were clearly distinct diseases with different clinical features. AEML may be more prevalent than previously thought, and the potential for its presence should be taken into account in cases of upper gastrointestinal bleeding accompanied by comorbidities.
Research perspectives
In the future, we aim to conduct studies on a larger sample size across multiple institutions.
