Authors: Babi Žarko, Andabak Maja, Rob Zrinka, Kardum Duško, Bani Marko.
A 19 years old female patient presented with symptoms of dysphagia, esophageal retention and radiologic and endoscopic suspicion of esophageal stricture and achalasia in one other institution.
After extensive diagnostic procedure including upper gastrointestinal endoscopy with narrow-band imaging and histology of esophageal mucosa, Magnetic resonance imaging (MRI) of the thorax and abdomen, the 24h esophageal impedance pH monitoring and esophageal high-resolution monitoring. We have excluced eosinophilic oesophagitis 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 ballon-dilatation of 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. The patient remained well and gaining weight with minimal symptoms of dysphagia to solids, occasionally.
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, eosinophilic oesophagitis and gastroesophageal reflux disease. The complex diagnostic approach, including esophageal functional testing pointed to the presence of gastroesophageal reflux disease, 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.
View/Download pdf