Abstract:
BACKGROUND: Eosinophilic esophagitis (EoE) is detected frequently in dysphagia and noncardiac chest pain. Management of patients with EoE may be complicated because EoE is associated frequently with esophageal motility disorders. We present the rare case of esophageal achalasia (EA) associated with eosinophilic infiltration and a literature review. MATERIAL AND METHODS: A patient with dysphagia and eosinophilic infiltration referred to our clinic underwent standardized diagnostic work-up including symptom questionnaire, esophagogastroduodenoscopy (EGD) with esophageal biopsies, barium swallow, high-resolution esophageal manometry, and combined intraluminal 24-hour pH-impedance testing (pH/MII). RESULTS: The patient had an Eckardt score of 8. EGD and mucosal biopsies showed typical EoE with > 15 eosinophil leucocytes per high-power field. Barium swallow revealed typical sign of achalasia. HREM indicated EA type 2 according to the Chicago classification. PH/MII was normal. Oral and systemic corticoid therapy were without effect. After successful treatment by pneumatic dilation of the cardia, symptoms relieved and eosinophilic infiltration returned to normal. CONCLUSION: The results suggest that the patient had primary EA associated with eosinophilic infiltration and that the combined occurrence of these rare diseases is not just a coincidence. HINTERGRUND: Die eosinophile Ösophagitis (EoE) ist häufig Ursache von Schluckstörungen und nichtkardialen Brustschmerzen (NCCP). Das Management von Patienten mit EoE kann kompliziert werden, da die EoE häufig mit Ösophagusmotilitätsstörungen assoziiert sind. Wir stellen den seltenen Fall einer Achalasie (EA) assoziiert mit einer eosinophilen Infiltration und eine Literaturübersicht vor. MATERIAL UND METHODE: Ein Patient mit Dysphagie und eosinophiler Infiltration wurde in unserer Klinik vorgestellt und durch einen standardisierten Symptomenfragebogen, Ösophagogastroduodenoskopie (EGD) mit Biopsien, Röntgen-Breischluck, hochauflösende Ösophagusmanometrie (HREM) und kombinierte 24-Std.-pH-Metrie-Impedanzmessung untersucht (pH/MII). ERGEBNISSE: Der Patient hatte einen Eckardt-Score von 8. EGD und die Mukosabiopsien zeigten die typischen Befunde einer EoE mit > 15 eosinophilen Leukozyten pro HPF. Der Röntgen-Breischluck erwies die typischen Befunde einer EA. Die HREM konnte eine EA Typ 2 nach der Chicago-Klassifikation nachweisen. Die PH/MII war unauffällig. Die lokale und systemische Kortisontherapie waren ohne Effekt. Nach der pneumatischen Kardiadilatation waren die Beschwerden rückläufig und die eosinophilen Infiltrate normalisiert. SCHLUSSFOLGERUNG: Die Ergebnisse lassen vermuten, dass bei dem Patienten primär eine EA mit assoziierter eosinophiler Infiltration vorlag und dass das Zusammentreffen dieser beiden seltenen Erkrankungen nicht zufällig ist.
journal_name
Z Gastroenteroljournal_title
Zeitschrift fur Gastroenterologieauthors
Frieling T,Heise J,Kreysel C,Blank M,Hemmerlein B,Beccu L,Kuhlbusch-Zicklam Rdoi
10.1055/a-0808-5043subject
Has Abstractpub_date
2019-02-01 00:00:00pages
151-155issue
2eissn
0044-2771issn
1439-7803journal_volume
57pub_type
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