Distal oesophageal spasm in a patient with multiple system atrophy: A case report

Q3 Neuroscience

eNeurologicalSci Pub Date : 2024-04-13 DOI:10.1016/j.ensci.2024.100500

Yoya Ono , Kenjiro Kunieda , Jun Takada , Takayoshi Shimohata

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Abstract

A 74-year-old man developed orthostatic syncope, a feeling of food stuck in his chest, and postprandial vomiting 3 years before presentation. Examination revealed severe orthostatic hypotension and cerebellar ataxia, and he was diagnosed with multiple system atrophy (MSA) with predominant cerebellar ataxia. Videofluoroscopic examination of swallowing showed lower oesophageal stricture and barium stagnation within the oesophagus. Oesophagogastroduodenoscopy revealed hypercontraction of the lower oesophagus, and high-resolution oesophageal manometry showed premature contractions of the lower oesophagus and decreased oesophageal peristalsis. The median integrated relaxation pressure in the lower oesophageal sphincter was normal, and achalasia was therefore excluded. Based on the Chicago classification version 4.0, his oesophageal dysmotility was classified as distal oesophageal spasm (DES). The stuck feeling in his chest and vomiting improved following endoscopic balloon dilation. This case suggests that DES can cause oesophageal food stagnation and postprandial vomiting in patients with MSA.

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一名多系统萎缩患者的远端食道痉挛：病例报告

一名74岁的男子在就诊前3年出现了正压性晕厥、食物卡在胸口的感觉以及餐后呕吐。检查发现他患有严重的正张性低血压和小脑共济失调，并被诊断为以小脑共济失调为主的多系统萎缩（MSA）。吞咽的视频荧光镜检查显示食道下端狭窄，食道内有钡滞留。食管胃十二指肠镜检查显示食管下端过度收缩，高分辨率食管测压显示食管下端过早收缩，食管蠕动减弱。下食道括约肌综合松弛压力中值正常，因此排除了贲门失弛缓症。根据芝加哥 4.0 版分类法，他的食道运动障碍被归类为远端食道痉挛（DES）。内镜下球囊扩张术后，他的胸闷和呕吐症状有所改善。本病例表明，DES 可导致 MSA 患者食道食物滞留和餐后呕吐。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

eNeurologicalSci Neuroscience-Neurology

CiteScore

3.50

自引率

0.00%

发文量

审稿时长

62 days

期刊介绍： eNeurologicalSci provides a medium for the prompt publication of original articles in neurology and neuroscience from around the world. eNS places special emphasis on articles that: 1) provide guidance to clinicians around the world (Best Practices, Global Neurology); 2) report cutting-edge science related to neurology (Basic and Translational Sciences); 3) educate readers about relevant and practical clinical outcomes in neurology (Outcomes Research); and 4) summarize or editorialize the current state of the literature (Reviews, Commentaries, and Editorials). eNS accepts most types of manuscripts for consideration including original research papers, short communications, reviews, book reviews, letters to the Editor, opinions and editorials. Topics considered will be from neurology-related fields that are of interest to practicing physicians around the world. Examples include neuromuscular diseases, demyelination, atrophies, dementia, neoplasms, infections, epilepsies, disturbances of consciousness, stroke and cerebral circulation, growth and development, plasticity and intermediary metabolism. The fields covered may include neuroanatomy, neurochemistry, neuroendocrinology, neuroepidemiology, neurogenetics, neuroimmunology, neuroophthalmology, neuropathology, neuropharmacology, neurophysiology, neuropsychology, neuroradiology, neurosurgery, neurooncology, neurotoxicology, restorative neurology, and tropical neurology.