1/29. Complete dysphagia after thrombolytic treatment for myocardial infarction.An 82 year old man was admitted to hospital with unstable angina pectoris. There was a long history of minor symptoms suggesting reflux disease, with a small diaphragmatic hernia. One day after admission the patient complained of severe chest pain. An acute inferior-posterior myocardial infarction was diagnosed on ECG, and thrombolytic treatment with alteplase (rt-PA) was initiated. Within a few hours total dysphagia occurred, caused by haemorrhagic oesophagitis. The haematoma resolved spontaneously within about 10 days. The patient was discharged three weeks later after full resolution of the dysphagia.- - - - - - - - - - ranking = 1keywords = chest pain, chest, pain (Clic here for more details about this article) |
2/29. Esophageal inflammatory pseudotumor mimicking malignancy.A 54-year-old man with a complaint of dysphagia was found to have a prominent stricture in the proximal esophagus. A biopsy of the stenotic area indicated sarcoma, leading to subtotal esophagectomy. The surgically removed esophagus demonstrated a well-defined intramural mass, consisting of a mixture of fibroblastic cells with bland cytological appearances and inflammatory cells. Reflux esophagitis which was present distal to the stricture seemed to play a role in the development of this inflammatory pseudotumor.- - - - - - - - - - ranking = 0.0012464032780072keywords = area (Clic here for more details about this article) |
3/29. Reflux complaints, symptom score and the use of medication in patients with reflux esophagitis: results of a long term follow-up study.Reflux esophagitis requires maintenance treatment. A cross-sectional descriptive study was done to assess the use of medication and prevalence of complaints in patients with esophagitis more than 4.5 years after diagnosis. All patients diagnosed with reflux esophagitis in 1995 received a questionnaire on reflux complaints and use of medication. A symptom score was assessed. esophagitis was diagnosed in 173 patients; the questionnaire was sent to 130 patients, of whom 95 (74%) responded. Four groups of responders were identified: patients in clinical remission with (group 1, n=18) or without (group 2, n=20) maintenance therapy, and patients suffering from reflux complaints with (group 3, n=48) or without (group 4, n=9) medication. There was no statistically significant difference with respect to initial severity of esophagitis. Seventeen patients (94%) from group 1 and 32 patients (67%) from group 3 used medication on a daily basis (P=0.04). The mean symptom score /- SD, on a scale ranging from 0 to 80, was 7.8 /-5.3 in group 3 patients and 8.6 /-8.6 in group 4 patients (not significant). patients in group 3 had a higher prevalence of retrosternal pain and nocturnal heartburn. It is concluded that most patients still use acid suppressive therapy more than 4.5 years after diagnosis. Only a small number are in clinical remission, although the symptom score is rather low.- - - - - - - - - - ranking = 0.010221021922336keywords = pain (Clic here for more details about this article) |
4/29. Barrett's esophagus and reflux esophagitis: is there a missing link?OBJECTIVES: Barrett's esophagus (BE) is associated with esophageal reflux. The development stage of BE is not well described. Epidemiological evidence indicates that the columnar epithelium in BE is acquired and reaches its full length rapidly. We tested the hypothesis that BE might result from direct replacement of erosions in reflux esophagitis (RE). methods: At endoscopy, we compared the length and distribution of esophageal erosions in 50 patients with RE with the length and distribution of columnar epithelium in 50 patients with BE. RESULTS: The median length of erosions in RE was 2 cm, less than the median length of columnar epithelium in BE, 5 cm (p < 0.001). Erosions in RE were usually multiple and scattered, involving the entire circumference of the esophagus in only 10% of cases, but circumferential involvement by columnar epithelium was found in 68% of BE cases (p < 0.001). Circumferential involvement, 3 cm or longer, was found in 0% of cases of RE versus 56% of BE cases (p < 0.001). Two patients without RE or BE had large areas of epithelial loss of uncertain etiology. CONCLUSIONS: The length and distribution of erosions in RE differ greatly from the length and distribution of columnar epithelium in BE. It is unlikely that BE arises directly from areas of esophagitis. We suggest that BE may develop after loss of a long segment of squamous epithelium, with columnar replacement in the presence of continuing acid reflux.- - - - - - - - - - ranking = 0.0024928065560144keywords = area (Clic here for more details about this article) |
5/29. Double lumen esophagus due to reflux esophagitis with fibrous septom formation.The unique endoscopic finding of a double lumen esophagus due to the development of a fibrous septum within an area of peptic reflux esophagitis is presented. The pathogenesis of this septum was felt to represent adherence to granulation tissue from opposing esophageal walls. This abnormality was easily managed by esophageal bouginage.- - - - - - - - - - ranking = 0.0012464032780072keywords = area (Clic here for more details about this article) |
6/29. Sandifer syndrome misdiagnosed as refractory partial seizures in an adult.We report a 27 year-old man with intellectual disability and no prior history of seizures who presented with episodes of abdominal pain, head/eye version and unresponsiveness that were misdiagnosed and treated as partial seizures. Associated vomiting and haematemesis led to the correct diagnosis and treatment of reflux oesophagitis. The episodes immediately resolved and a diagnosis of Sandifer syndrome was made. This is only the second report of Sandifer syndrome in adult, a movement disorder of unknown mechanism that occurs almost exclusively in young children, often misdiagnosed as epilepsy or episodic dystonia. (Published with videosequences).- - - - - - - - - - ranking = 0.010221021922336keywords = pain (Clic here for more details about this article) |
7/29. Successful treatment of esophageal cancer with transhiatal esophagectomy after heart transplantation.A 55-year-old heart transplant recipient with reflux esophagitis presented for routine endoscopic surveillance of an area of Barrett's metaplasia initially seen 3 years previously. Esophagogastroduodenoscopy revealed adenocarcinoma at 33 cm from the incisors. The preoperative clinical stage was T1N0M0 by endoscopic ultrasound. Transhiatal esophagectomy was performed with R0 resection of the cancer, and the patient recovered uneventfully. Pathologic examination confirmed esophageal adenocarcinoma (T1N0M0) in Barrett's mucosa. The patient is doing well, and has no evidence of disease after 18 months.- - - - - - - - - - ranking = 0.0012464032780072keywords = area (Clic here for more details about this article) |
8/29. When is a pneumothorax not a pneumothorax?The authors report on a 13-year-old boy who, after exercise, had respiratory distress and left upper quadrant abdominal pain. Initially, a mistaken diagnosis of pneumothorax was made, and a chest tube was inserted. A nasogastric tube was then visualized on chest x-ray in the left hemithorax. He underwent a laparotomy and had herniation of spleen, stomach, and large and small bowel in the left pleural space passing through a traumatic defect in the hemidiaphragm. The laparoscopic Nissen fundoplication 3 years prior was felt to have contributed. A timely and correct diagnosis is essential to avoid the sequelae associated with these injuries and with inappropriate tube thoracostomy.- - - - - - - - - - ranking = 0.0774919021656keywords = chest, pain (Clic here for more details about this article) |
9/29. Tortuous aorta--a new cause for esophageal chest pain?Three patients (average age 61 years) presenting with retrosternal pain were evaluated with barium studies of the upper gastrointestinal tract. In each case, the esophagus was significantly displaced by a tortuous aorta. All patients had sliding hiatal hernias; these hiatal hernias, and the esophagitis and disordered motility seen in our patients, could be a consequence of esophageal displacement by the tortuous aorta. Two patients were relieved symptomatically with antacids and metoclopramide. Thus, tortuosity of the thoracic aorta can cause esophageal chest pain.- - - - - - - - - - ranking = 5.0102210219223keywords = chest pain, chest, pain (Clic here for more details about this article) |
10/29. esophageal perforation at a Barrett's ulcer.An alcoholic man with known reflux esophagitis and Barrett's esophagus developed fever, epigastric pain, subcutaneous crepitus, and leukocytosis from an esophageal perforation at a Barrett's ulcer. Possible risk factors for perforation in this patient included alcoholism, severe gastroesophageal reflux, corticosteroid therapy, noncompliance with antacid and H2 blocker therapy, and the presence of acid-secreting parietal cells in the Barrett's epithelium. Five cases of this complication have previously been reported in a review of the literature, which included 536 cases of Barrett's esophagus or esophageal perforation. This entity may present with a clinical triad of a patient (a) in acute distress with fever and epigastric or noncardiac chest pain and without signs of peritonitis, (b) with symptoms of or known gastroesophageal reflux, and (c) with chest examination revealing subcutaneous crepitus, or chest roentgenogram revealing subcutaneous emphysema, pneumomediastinum, or hydropneumothorax.- - - - - - - - - - ranking = 1.0774919021656keywords = chest pain, chest, pain (Clic here for more details about this article) |
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