Cosme A, Horcajada J P, Ojeda E, González F, Torrado J, Arenas J I
Servicio de Digestivo, Hospital de Nuestra Señora de Aránzazu, San Sebastián.
Med Clin (Barc). 1994 May 7;102(17):661-3.
The involvement of the esophagus in amyloidosis secondary to rheumatoid arthritis is rare. The case of a female patient with rheumatoid arthritis and secondary esophageal amyloidosis (type AA) with a radiologic and endoscopic clinical picture compatible with achalasia is presented. In the manometry carried out after two cardiomyotomies, abundant non propulsant tertiary waves were seen, as were two primary waves, intraesophageal pressure higher than that of the gastric fundus and lower hypertensive esophageal sphincter which was completely relaxed on one occasion, resulting in a manometric pattern which was different to that of the other two cases published with the same disease. Endoscopic cardiomyotomies and dilatations were performed. The patient died after 2 years due to post dilatation esophageal perforation. The manometric findings are compared with those of the two previous similar cases with emphasis being made in that the anarchic arrangement of the amyloid in the esophagus produces different unforeseen and uncharacteristic motility patterns. The authors only found in the literature two cases of esophageal amyloidosis secondary to rheumatoid arthritis simulating achalasia.
类风湿关节炎继发淀粉样变性累及食管的情况罕见。本文报道了一例患有类风湿关节炎和继发性食管淀粉样变性（AA型）的女性患者，其放射学和内镜检查的临床表现与贲门失弛缓症相符。在两次贲门肌切开术后进行的测压中，可见大量非推进性第三波，以及两个原发性波，食管内压力高于胃底，食管下括约肌高血压且有一次完全松弛，导致测压模式与另外两例报道的相同疾病病例不同。进行了内镜下贲门肌切开术和扩张术。患者在2年后因扩张后食管穿孔死亡。将测压结果与之前的两例类似病例进行了比较，强调食管中淀粉样蛋白的无规则排列会产生不同的、不可预见的和非典型的运动模式。作者在文献中仅发现两例类风湿关节炎继发食管淀粉样变性模拟贲门失弛缓症的病例。
