Raymond Mallory J, McColloch Nancy L, Hatcher Jeanne L
Department of Otolaryngology, Head and Neck Surgery, Emory University, Atlanta, GA, USA.
Ear Nose Throat J. 2019 Oct-Nov;98(9):NP142-NP143. doi: 10.1177/0145561319842511. Epub 2019 Apr 15.
Dermatomyositis is a rare multisystem autoimmune disorder occasionally accompanied by dysphagia. It is typically treated with immune modulating agents; however, dysphagia is often unresponsive to these. Previous reports have demonstrated the utility of videoflouroscopy and manometry in understanding the etiologies of dysphagia to inform a procedural target, historically the cricopharyngeus muscle. We present a case of dermatomyositis and dysphagia resistant to medical management in a patient found by videoflouroscopy and manometry to have severe oropharyngeal dysphagia, esophageal dysmotility and a cricopharyngeal web. We demonstrate the utility and safety of upper esophageal sphincter dilation by transnasal esophagoscopy even in the setting of multifactorial dysphagia.
皮肌炎是一种罕见的多系统自身免疫性疾病，偶尔伴有吞咽困难。其通常采用免疫调节剂进行治疗；然而，吞咽困难往往对这些治疗无反应。既往报告已证明，视频荧光吞咽造影和测压在了解吞咽困难的病因以确定治疗靶点方面具有实用性，传统上该靶点为环咽肌。我们报告了一例皮肌炎伴吞咽困难的病例，该患者对药物治疗无效，经视频荧光吞咽造影和测压发现存在严重的口咽吞咽困难、食管动力障碍和环咽肌蹼。我们证明了经鼻食管镜检查进行食管上括约肌扩张的实用性和安全性，即使在存在多因素吞咽困难的情况下也是如此。
