Naslov
A young patient with dysphagia: eosinophilic esophagitis, achalasia, or atypical course of gastroesophageal reflux disease- a case report

Autori
Babić, Žarko ; Andabak , Maja ; Rob, Zrinka ; Medić, Barbara ; Banić, Marko

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Acta clinica Croatica. Supplement, 60 (2021), 2 / Ljubičić, Neven ; Virović Jukić, Lucija - Zagreb : Hrvatsko gastroenterološko društvo, 2021, 73-73

Skup
9. kongres Hrvatskog gastroenterološkog društva = 9th congress of the Croatian society of gastroenterology

Mjesto i datum
Zagreb, Hrvatska, 28.10.2021. - 30.10.2021

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
atypical GERD ; esopghageal monitoring ; esophageal manometry ; 24-h impedance pH metry ; GERD therapy

Sažetak
Introduction and Aim: The differential diagnosis of esophageal symptoms, especially dysphagia with suspicion of esophageal obstruction in young patients may represent a challenge to clinical practice. Methods: A 19 years old female patient presented with symptoms of dysphagia, esophageal retention and endoscopic suspicion of esophageal stricture. This initial evaluation was performed in another institution and the patient was advised to undergo peroral endoscopic myotomy – POEM, because of the diagnosis of achalasia. Due to a long-lasting symptoms, loss of weight and anxiety, and facing the complex endoscopic procedure, the young patient and her family decided to seek the second evaluation and opinion in our institution. The control evaluation included upper gastrointestinal endoscopy with narrow-band imaging and histology of esophageal mucosa, MR of the thorax and abdomen, the 24h esophageal impedance pH monitoring and esophageal high- resolution monitoring, as well. The results of diagnostic work-up excluded the presence of eosinophilic esophagitis and achalasia, indicating to the atypical course of gastroesophageal reflux disease. The patient underwent the intense and combined pharmacologic (PPIs, H2 blockers, antacids) and endoscopic (repeated balloon- dilatation of esophagogastric junction stricture) therapy, over a period of two years. With this combined and long-lasting therapy, the patient significantly improved, clinically. The esophageal peristaltic activity was also recovered, thus incompletely. Conclusion: In presented case of a young female patient, we witnessed the overlapping nature of different criteria denoting the distinct entities, linked to esophageal dysphagia and esophageal motility disorder, such as achalasia, EoE and GERD. The complex diagnostic approach, including esophageal functional testing pointed to the presence of GERD, as to underlying condition for this complex clinical situation. The combined therapeutic approach, including antisecretory agents and repeatied balloon dilatations led to significant clinical improvement. Reference: 1.Vissagi P, Savarino E, Sciume G, Di Chio T, Bronzini F, Tolone S et al. Eosiniphilic esophagitis: clinical endoscopis, histologic and therapeutic differences and similarities between children and adults. Ther. Adv Gastroenterol 2020 ; 14:1-17 DOI: 10.1177/1756284820980860. 2.Nijhuis RAB, Zaninoto G, Roman S et al. European guidekines on achalasia: United European Gastroenterology and European Society of Neurogastroenterology and Motiliity recomandations. Unut Eur Gastroenterol Journal 2020 ; 8(1):13-33. 3.Herbella FA, Patti MG. Gastroesophageal reflux disease: From pathophysiology to treatment. World J Gastroenterol 2010 Aug 14 ; 16(30):3745-9. doi: 10.3748/wjg.v16.i30.3745. e-mail: zarko.babic@zg.t-com.hr

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA