ABSTRACT
A 29-year-old man was admitted because of melena for 5 days. Two years ago, he underwent allogenic bone marrow transplantation for chronic myeloid leukemia and received immunosuppressive agents. Esophagogastroduodenoscopy showed a picture - multiple scattered deep ulcers and friable pseudomembranes - of highly suggestive of a herpes simplex esophagitis and biopsy revealed multinucleated giant cells and pathognomonic intranuclear inclusion bodies. Esophageal lesions and melena improved after acyclovir therapy.
Subject(s)
Adult , Humans , Acyclovir , Biopsy , Bone Marrow Transplantation , Endoscopy, Digestive System , Esophagitis , Esophagus , Giant Cells , Herpes Simplex , Immunosuppressive Agents , Intranuclear Inclusion Bodies , Leukemia, Myelogenous, Chronic, BCR-ABL Positive , Melena , UlcerABSTRACT
Diffuse esophageal spasm (DES) is a motility disorder of the esophagus characterized by symptoms of retrosternal chest pain and intermittent dysphagia. The diagnosis of DES has relied on criteria obtained from a standard esophageal manometry (more than one simultaneous contraction in a series of 10 wet swallows with the rest being peristaltic). Because symptoms and/or typical manometric findings are not always documented during the standard manometry, 24 hour manometry may be more useful in such cases. We recently assessed a 29-year-old male patient who complained of chest pain and dysphagia. He showed nonspecific findings on the laboratory based manometry, but DES was diagnosed by his typical manometric findings on the 24 hour manometry. Therefore, a 24 hour manometry should always be performed when the patient's history suggests the presence of DES and the laboratory based manometry failed to detect the symptomatic contractions of DES. Following we report this case with a review of the literature.
Subject(s)
Adult , Humans , Male , Chest Pain , Deglutition Disorders , Diagnosis , Esophageal Spasm, Diffuse , Esophagus , Manometry , SwallowsABSTRACT
BACKGROUND/AIMS: Generally, it is recommended for patients with gastroesophageal reflux disease to sleep with the head of the bed elevated; however, many patients in Korea do not have heartburn symptoms during the night. METHODS: We investigated the pattern of acid reflux in patients who were diagnosed as having definite pathological acid reflux on 24-hour pH monitoring. RESULTS: One hundred patients were categorized into 3 groups; upright refluxer (68%), supine refluxer (2%), or combined refluxer (30%). Acid reflux was rare in supine positions but instead, usually occurred in upright positions. Acid reflux was found to occur most commonly after meals. The reflux symptoms occurred during pH monitoring with the average frequency of 5.5 times (total of 254 times) in 46 patients. The acid related symptoms were more common in the upright period and postprandially than the supine period. The presence of an esophagitis, an esophageal motility disorder, or the LES pressure did not make a significant difference between upright refluxer and supine refluxer. CONCLUSIONS: Gastroesophageal reflux was found to be rare in supine positions but usually occurred in upright positions. Gastroesophageal reflux occurred most commonly after meals, and was frequently associated with reflux symptoms.