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著者: Makoto Sohda, Hiroshi Saeki, Hiroyuki Kuwano, Makoto Sakai, Akihiko Sano, Takehiko Yokobori, Tatsuya Miyazaki, Yoshihiro Kakeji, Yasushi Toh, Yuichiro Doki, Hisahiro Matsubara
雑誌名: Esophagus. 2021 Jul;18(3):663-668. doi: 10.1007/s10388-020-00802-0. Epub 2021 Jan 1.
Abstract/Text
BACKGROUND: n our previous nationwide survey report on esophageal perforation, we proposed the existence of cases with idiopathic esophageal perforation at a certain rate.
AIMS: To elucidate the clinical characteristics of idiopathic esophageal perforation, we performed a comparative analysis between cases with idiopathic type and post-emetic type esophageal perforation.
METHODS: This study enrolled 139 patients with esophageal perforation (post-emetic type: idiopathic type = 115:24) as the subjects of nationwide survey on esophageal perforation. We conducted detailed studies on chief complaints, inflammatory responses, initial diagnosis, location and situation of the perforation site, time to therapeutic intervention, and prognosis between the two groups.
RESULTS: Compared with post-emetic type, cases of idiopathic type tended to exhibit rear-side perforation (p = 0.052) and significantly less presented chest pain (p = 0.002). Consequently, cases of idiopathic type significantly missed to diagnose as esophageal perforation compared with post-emetic type (p = 0.042). With regard to inflammatory response, cases of post-emetic type experienced hyperthermia compared with idiopathic type (p = 0.033). On the other hand, cases of idiopathic type exhibited significantly higher level of C-reactive protein than post-emetic type (p = 0.004). In addition, it took longer time until starting treatment in the cases of idiopathic type (p < 0.0001) and the cases of idiopathic type showed significantly worse prognosis than the cases of post-emetic type (p = 0.009).
CONCLUSION: This study first focused on the characteristics of idiopathic esophageal perforation that have been included in so-called Boerhaave's syndrome. The pathophysiology of the idiopathic type should be separately understood from post-emetic type, because the diagnostic and prognostic features largely differ.
PMID 33386506 Esophagus. 2021 Jul;18(3):663-668. doi: 10.1007/s10388-020-00802-0. Epub 2021 Jan 1.
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