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
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.