Document Detail


A Case of Achalasia with Dense Eosinophilic Infiltrate Responding To Steroidal Treatment.
MedLine Citation:
PMID:  21839711     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
A patient presented with chronic substernal discomfort and intermittent dysphagia for solids. High-resolution impedance manometry (HRIM) of the esophagus showed that there was no peristalsis in the esophageal body, but incomplete relaxation of the lower esophageal sphincter and incomplete bolus transit, so the patient was diagnosed with achalasia. Moreover, probably because of esophageal stasis, eosinophilic infiltration that mimicked a pattern of eosinophilic esophagitis was observed, based on multiple biopsies of the esophagus. The patient was given 50 mg prednisolone, once daily; the symptoms improved dramatically and HRIM showed complete recovery of esophageal peristalsis, deeper relaxation of the lower esophageal sphincter, and complete bolus transit profile. HRIM can therefore be used to assess dysmotility abnormalities in patients with achalasia and eosinophilic-like esophagitis, and steroids relieve these symptoms. Treatment with a high dose of prednisolone resulted in a complete disappearance of dysphagia, due to improved esophageal motility and reduced eosinophilic infiltrate. It is therefore important to control of the inflammatory process in patients with idiopathic achalasia, which is likely to result from an autoimmune reaction.
Authors:
Edoardo Savarino; Lorenzo Gemignani; Patrizia Zentilin; Nicola De Bortoli; Alberto Malesci; Luca Mastracci; Roberto Fiocca; Vincenzo Savarino
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-8-10
Journal Detail:
Title:  Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association     Volume:  -     ISSN:  1542-7714     ISO Abbreviation:  -     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-8-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101160775     Medline TA:  Clin Gastroenterol Hepatol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.
Affiliation:
Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy.
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