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Case 181

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Female patient, 47 years old, from Belo Horizonte. Two years ago began with intense retrosternal pain on swallowing. Last year progressed with dysphagia, heartburn, regurgitation and involuntary 50kg weight loss. Sedentary, obese class III without other comorbidities. An esophagogram with barium sulfate was done.

Based on clinical and radiological findings, which is the most likely diagnosis?

a) Esophageal achalasia

25%

b) Esophageal carcinoma

25%

c) Zenker’s diverticulum

25%

d) Peptic stenosis

25%
   

Image Analysis

Image 1: esophagogram with barium sulfate showing dilation of the thoracic esophagus due narrowing of the gastroesophageal junction (highlighted in red).

Highlights

- Achalasia is the most common disorder of esophageal motility.

- The pathophysiology is due to no relaxation of the lower esophageal sphincter and aperistalsis.

- The main symptoms are dysphagia for solids and liquids and regurgitation.

- Diagnostic tests are a contrasted esophagogram with barium and esophageal manometry.

- The definitive treatment is surgical myotomy of lower esophageal sphincter.

Bibliographic references

- Sabinston, DC, Townsend CM. Sabiston Tratado de Cirurgia: a base biológica da prática cirúrgica moderna. 18. ed. Rio de Janeiro: Elsevier, 2010.

- Fass R. Overview of dysphagia in adults. UpToDate, 2014. [accessed in september, 2014]. Available at: http://www.uptodate.com/contents/overview-of-dysphagia-in-adults.

- Spechler SJ. Clinical manifestations and diagnosis of achalasia. UpToDate, 2014. [accessed in september 2014]. Available at: http://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-achalasia.

- D¨Ippolito, G, Caldana RP. Gastrointestinal. Rio de Janeiro: Elsevier, 2011.

Authors

Thais Salles Araujo, 6th year medical student at UFMG School of Medicine. E-mail: thaissalles9[at]gmail.com

Isabela Alves Campos Lacerda, 5th year medical student at UFMG School of Medicine. E-mail: isabela.aclacerda[at]gmail.com 

Isis Miranda Diniz, 5th year medical student at UFMG School of Medicine. E-mail: isisvieirabio[at]yahoo.com.br

Giane Moreira Praça, 5th year medical student at UFMG School of Medicine. E-mail: giane_moreira2[at]hotmail.com

Supervisors

Marco Antônio Gonçalves Rodrigues, surgeon of the digestive system and professor of the Surgery Department of UFMG Medical School. E-mail: magro.mg[at]terra.com.br

José Nelson Mendes Vieira, Radiologist, Professor of the Department of Anatomy and Imaging at UFMG School of Medicine.

E-mail: zenelson.vieira[at]gmail.com

Reviewers

Lucas Vieira Rodrigues, Bárbara Queiroz e Bragaglia, André Ribeiro Guimarães, Hercules Hermes Riani Martins Silva, Marina Bernardes Leão and professor Viviane Santuari  Parisotto.

Translated by

Ana Júlia Furbino Dias Bicalho, 6th year medical student at UFMG School of Medicine. Email: anajuliabicalho[at]gmail.com

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