Turshudzhyan Alla, Abbasi Abu Fahad, Banerjee Promila
Internal Medicine, University of Connecticut Health, Farmington, USA.
Internal Medicine, Loyola University Medical Center, Maywood, USA.
Cureus. 2022 Mar 16;14(3):e23208. doi: 10.7759/cureus.23208. eCollection 2022 Mar.
Among the patients who present to the emergency room or a primary care office with symptoms of dysphagia, chest pain, and reflux, approximately 9% have an underlying rheumatological condition. It is not surprising that many emergency and internal medicine clinicians frequently overlook this etiology and investigate other causes first. However, an overwhelming number of patients with rheumatological conditions (61.1%) have some form of esophageal dysmotility that ranges from ineffective esophageal motility (IEM) to achalasia. We present a case of systemic lupus erythematosus (SLE) with absent contractility that was initially overlooked. Missing and/or absent contractility or other forms of esophageal dysmotility leads to delayed treatment and interventions. Prolonged food bolus transit and stasis promote mucosal inflammation and remodeling, subsequently leading to neoplastic changes. We hope to increase awareness among emergency and internal medicine physicians of the prevalence of esophageal dysmotility disorders among patients with rheumatologic disease, and SLE specifically, to improve timing of diagnosis and interventions.
在因吞咽困难、胸痛和反流症状前往急诊室或初级保健诊所就诊的患者中，约9%患有潜在的风湿性疾病。许多急诊和内科临床医生经常忽略这一病因并首先调查其他病因，这并不奇怪。然而，绝大多数患有风湿性疾病的患者（61.1%）存在某种形式的食管动力障碍，范围从无效食管动力（IEM）到贲门失弛缓症。我们报告一例最初被忽视的无收缩力的系统性红斑狼疮（SLE）病例。收缩力缺失和/或缺乏或其他形式的食管动力障碍会导致治疗和干预延迟。食物团块运输和淤滞时间延长会促进黏膜炎症和重塑，随后导致肿瘤性改变。我们希望提高急诊和内科医生对风湿性疾病患者，特别是SLE患者中食管动力障碍疾病患病率的认识，以改善诊断和干预的时机。
