Images in clinical medicine. Corkscrew esophagus.
Images in clinical medicine. Corkscrew esophagus.
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临床医学中的图像。
DOI：
10.1056/nejmicm1402434
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Kyu
中科院分区：
文献类型：
--
作者：
C. Lim;Myung;M. Baeg;S. Moon;J. Kim;Yukiko Cho;J. Park;I. Lee;S. Kim;Kyu
n engl j med 371;21 nejm.org 2014 年 11 月 20 日 e33 一名 74 岁的男子有 30 年的间歇性吞咽困难和反流病史，他的医生最初将其称为“歇斯底里反应”。患者报告每 2 至 3 个月出现胸骨后饱胀症状，导致反流；在这 30 年间，他没有出现相关的胸痛、体重减轻或症状频率的变化。就诊前 3 年已服用质子泵抑制剂，但并未缓解症状。该患者被转诊进行评估。吞钡检查显示远端食管明显的螺旋形外观附近有两个憩室（图 A）。通过内窥镜检查确定了管腔，但由于食管弯曲，内窥镜无法前进（图 B）。建议进行测压来评估弥漫性食管痉挛，但无法进行。患者的症状没有变化，很少有吞咽困难。他在两次发作之间相对无症状，并且拒绝使用其他疗法，例如平滑肌松弛剂。
n engl j med 371;21 nejm.org november 20, 2014 e33 A 74-year-old man presented with a 30-year history of intermittent dysphagia and regurgitation, which his doctor had initially referred to as a “hysterical reaction.” The patient reported having symptoms of retrosternal fullness leading to regurgitation every 2 to 3 months; he had no associated chest pain, weight loss, or change in symptom frequency over this 30-year period. A protonpump inhibitor had been prescribed 3 years before presentation and did not provide relief. The patient was referred for evaluation. A barium-swallow examination showed two diverticula proximal to the marked corkscrew appearance of the distal esophagus (Panel A). The lumen was identified on endoscopy, but advancement of the endoscope was not possible owing to esophageal tortuosity (Panel B). Manometry was suggested to assess for diffuse esophageal spasm, but it could not be performed. The patient’s symptoms remain unchanged, with infrequent dysphagia. He is relatively asymptomatic between episodes and has declined the use of other therapies, such as smooth-muscle relaxants.