Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy.
Clin Gastroenterol Hepatol. 2011 Dec;9(12):1104-6. doi: 10.1016/j.cgh.2011.08.002. Epub 2011 Aug 11.
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, on the basis of 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 because of improved esophageal motility and reduced eosinophilic infiltrate. It is therefore important to control the inflammatory process in patients with idiopathic achalasia, which is likely to result from an autoimmune reaction.
一位患者表现为慢性胸骨后不适和间歇性固体食物吞咽困难。食管高分辨率阻抗测压（HRIM）显示食管体无蠕动，但食管下括约肌不完全松弛和不完全食团通过，因此诊断为贲门失弛缓症。此外，可能由于食管淤滞，在食管的多次活检中观察到类似于嗜酸性食管炎的嗜酸性粒细胞浸润模式。患者给予 50 毫克泼尼松龙每日一次；症状显著改善，HRIM 显示食管蠕动完全恢复，食管下括约肌松弛更深，完全通过食团轮廓。因此，HRIM 可用于评估贲门失弛缓症和嗜酸性食管炎患者的运动障碍异常，类固醇可缓解这些症状。高剂量泼尼松龙治疗导致吞咽困难完全消失，因为食管运动得到改善，嗜酸性粒细胞浸润减少。因此，控制特发性贲门失弛缓症患者的炎症过程很重要，这可能是由于自身免疫反应引起的。
