Dysphagia megalatriensis diagnosed by esophageal manometry in a patient with double compressive etiology. A diagnostic challenge

Díaz Molina, Raúl José; Perelló Juan, Antonia; Bosque López, Maria José; Garrido Durán, Carmen

doi:10.1016/j.gastre.2023.09.002

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A diagnostic challenge" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1303 "Ancho" => 1675 "Tamanyo" => 258374 ] ] "descripcion" => array:1 [ "es" => "Disfagia megalatriensis y compresión esofágica por osteofito cervical. 1a) MAR que objetiva hiperpresión medioesofágica pulsátil (flechas naranjas) y presurización compartimentalizada secundaria (flecha amarilla). 1b) ETT que muestra dilatación de aurícula izquierda. 1c) TEGD con fenómeno de doble compresión medioesofágica y afilamiento (flecha amarilla) por aurícula izquierda y osteofito cervical (puntas de flecha rojas). 1d) TAC torácico con contraste que muestra colapso esofágico por compresión extrínseca (puntas de flecha rojas). 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B) Adaptation of the flow chart proposed at the Ascona-III International Working Group meeting for the classification of categories of pharyngoesophageal dysfunction based on the study by Omari et al.<a class="elsevierStyleCrossRef" href="#bib0200">40</a> This diagram proposes to classify patients according to an initial pressurisation pattern. In pressurisation pattern type 1 (number 1) a clear biomechanical pattern of flow obstruction would appear. Patterns 2 or 3 are considered as UOS abnormalities/disorders when observing a combination of incomplete UOS relaxation (type 2), according to UOS IRP, or findings of altered distensibility (maximum UOS admittance) (type 3). To confirm UOS impairment in patients in whom there is no pressurisation pattern, both incomplete UOS relaxation and other distensibility impairments would be required (number 4). In patients where no UOS disorder is demonstrated (numbers 5–7), if pharyngeal propulsion is taken into account and is weak or absent, they would be classified as propulsion disorder (number 5). The remaining cases would be classified as "other disorders" if they have abnormal findings in one or more metrics (number 6), or no alterations if all variables are within normal ranges. HIBP: hypopharyngeal intrabolus pressure; LLN: lower limit of normal; PP: peak pressure; ULN: upper limit of normal; UOS: upper oesophageal sphincter; UOSRP: UOS relaxation pressure.<a class="elsevierStyleCrossRef" href="#bib0200">40</a>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Miguel Martínez-Guillén, Pere Clavé, Mónica Zavala, Silvia Carrión" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Miguel" "apellidos" => "Martínez-Guillén" ] 1 => array:2 [ "nombre" => "Pere" "apellidos" => "Clavé" ] 2 => array:2 [ "nombre" => "Mónica" "apellidos" => "Zavala" ] 3 => array:2 [ "nombre" => "Silvia" "apellidos" => "Carrión" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210570523004351" "doi" => "10.1016/j.gastrohep.2023.09.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210570523004351?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382424000646?idApp=UINPBA00004N" "url" => "/24443824/0000004700000003/v2_202405192000/S2444382424000646/v2_202405192000/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Dysphagia megalatriensis diagnosed by esophageal manometry in a patient with double compressive etiology. A diagnostic challenge" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "286" "paginaFinal" => "287" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Raúl José Díaz Molina, Antonia Perelló Juan, Maria José Bosque López, Carmen Garrido Durán" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Raúl José" "apellidos" => "Díaz Molina" "email" => array:1 [ 0 => "rauljosediazmolina@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Antonia" "apellidos" => "Perelló Juan" ] 2 => array:2 [ "nombre" => "Maria José" "apellidos" => "Bosque López" ] 3 => array:2 [ "nombre" => "Carmen" "apellidos" => "Garrido Durán" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Aparato Digestivo, Hospital Universitario Son Espases, Palma de Mallorca, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Diagnóstico de disfagia megalatriensis por manometría en paciente con doble fenómeno compresivo esofágico. Un reto diagnóstico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1303 "Ancho" => 1675 "Tamanyo" => 257795 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0150" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Dysphagia megalatriensis and esophageal compression by cervical osteophyte. a) HRM showing pulsatile mid-esophageal hyperpressure (orange arrows) and secondary compartmentalised pressurisation (yellow arrow). b) TTE showing left atrial dilation. c) Barium swallow with double mid-esophageal compression phenomenon and narrowing (yellow arrow) by left atrium and cervical osteophyte (red arrowheads). d) Chest CT with contrast showing esophageal collapse due to extrinsic compression (red arrowheads). L.A.: left atrium; C.O.: cervical osteophyte." ] ] ] "textoCompleto" => "This was a 77-year-old man with a history of bronchial asthma, osteoarthritis treated with paracetamol/tramadol 325/37.5mg, cerebrovascular disease of undetermined territory with no neurological sequelae, anticoagulated atrial fibrillation and valvular heart disease secondary to rheumatic mitral valve disease.The patient was referred to the gastrointestinal motility unit for investigation of mixed dysphagia for a number of months with no other accompanying symptoms. Gastroscopy showed no significant findings. High resolution esophageal manometry (HRM) was performed with 24-channel perfusion MMS® equipment. The lower esophageal sphincter (LOS) was found to be hypotensive (mean pressure 7mmHg) with complete relaxation (median IRP 5.7mmHg) and absent contractility, with a constant pulsatile mid-esophageal high pressure zone throughout the study, generating compartmentalised pressurisation in some swallows (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a) from the upper esophageal sphincter to the high pressure zone. The study was compatible with absent contractility and extrinsic compression of possible cardiogenic origin.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>The patient's most recent imaging tests were reviewed, with a plain chest X-ray showing an increased cardiothoracic index and his latest transthoracic echocardiography (TTE) showing normal overall systolic function and a double mitral valve lesion with severe dilation of both left chambers, particularly the atrium (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>b). The case was classified as probable dysphagia secondary to atrial compression. Barium swallow was requested, confirming narrowing of the oesophagus in the middle segment with retrograde dilation, contrast retention and tertiary peristalsis due to compression by the left atrium and previously unknown dorsal osteophyte at D8-D9 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>c). The study was completed with chest computed tomography (CT) with intravenous contrast with identical results (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>d).Our patient consulted having had the sole symptom of mixed dysphagia for months. With the suspected diagnosis from the result of the HRM, the patient's recent imaging tests were reviewed and the study was extended with barium swallow and CT scan, confirming the finding of this rare condition, dysphagia megalatriensis. To our knowledge, it has only been reported on six occasions and on none of these occasions was esophageal manometry performed.<a class="elsevierStyleCrossRefs" href="#bib0005">1–6</a> Additionally in our case, a dorsal osteophyte was identified which was also exerting compression. In conclusion, we propose this manometry finding as objective evidence of extrinsic esophageal involvement of cardiogenic origin, which should particularly be taken into account in patients with structural heart disease, with this being important as it could help in the difficult diagnosis of dysphagia megalatriensis. Once the diagnosis had been made, we referred the patient to Cardiology as the adjustment of organ-specific treatment would improve cardiac function and thereby reduce the esophageal compression phenomenon.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1303 "Ancho" => 1675 "Tamanyo" => 257795 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0150" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Dysphagia megalatriensis and esophageal compression by cervical osteophyte. a) HRM showing pulsatile mid-esophageal hyperpressure (orange arrows) and secondary compartmentalised pressurisation (yellow arrow). b) TTE showing left atrial dilation. c) Barium swallow with double mid-esophageal compression phenomenon and narrowing (yellow arrow) by left atrium and cervical osteophyte (red arrowheads). d) Chest CT with contrast showing esophageal collapse due to extrinsic compression (red arrowheads). L.A.: left atrium; C.O.: cervical osteophyte." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case report of a patient with heart failure with preserved ejection fraction presented as dysphagia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Leonidou" 1 => "M. Ioannou" 2 => "P. Mavrommatis" 3 => "A. Mouzarou" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ehf2.14415" "Revista" => array:6 [ "tituloSerie" => "ESC Heart Fail" "fecha" => "2023 May 30" "volumen" => "10" "paginaInicial" => "2707" "paginaFinal" => "2710" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/37254634" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dysphagia Megalatriensis: An Uncommon Cause of Dysphagia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.A. Abdallah" 1 => "M. Ellithi" 2 => "E.A. Larson" 3 => "J.A. Murray" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "S D Med" "fecha" => "2021 Mar" "volumen" => "74" "paginaInicial" => "106" "paginaFinal" => "107" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34232587" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiogenic Dysphagia by Dysphagia Megalatriensis and Aortica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H.A. Zia" 1 => "M.F. Madhoun" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cgh.2018.10.049" "Revista" => array:5 [ "tituloSerie" => "Clin Gastroenterol Hepatol" "fecha" => "2020 Feb" "volumen" => "18" "paginaInicial" => "e21" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30404038" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dysphagia megalatriensis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.T. Le Roux" 1 => "M.A. Williams" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/thx.24.5.603" "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "1969 Sep" "volumen" => "24" "paginaInicial" => "603" "paginaFinal" => "606" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4242328" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiogenic Dysphagia: Dysphagia Megalatriensis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "V. Khurana" 1 => "S.K. Thakur" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjms.2017.10.002" "Revista" => array:5 [ "tituloSerie" => "Am J Med Sci" "fecha" => "2018 Mar" "volumen" => "355" "paginaInicial" => "e9" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29549936" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An Unusual Cause of Dysphagia in an Elderly Woman: Dysphagia Megalatriensis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Y.C. Hsu" 1 => "S.S. Wu" 2 => "H.H. Yen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjms.2019.02.018" "Revista" => array:6 [ "tituloSerie" => "Am J Med Sci" "fecha" => "2019 Jul" "volumen" => "358" "paginaInicial" => "e1" "paginaFinal" => "e2" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30981414" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/24443824/0000004700000003/v2_202405192000/S2444382424000634/v2_202405192000/en/main.assets" "Apartado" => array:4 [ "identificador" => "48445" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24443824/0000004700000003/v2_202405192000/S2444382424000634/v2_202405192000/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382424000634?idApp=UINPBA00004N"]

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Gastroenterology and Hepatology is the first journal to cover the latest advances in pathology of the gastrointestinal tract, liver, pancreas, and bile ducts, making it an indispensable tool for gastroenterologists, hepatologists, internists and general practitioners. In addition to the rigorously selected, systematically peer-reviewed manuscripts published in the research sections (Original Articles, Scientific Letters, Editorials, and Letters to the Editor), the journal also contains other important sections, such as Review Articles and Clinical Decision-Making Support, which offer in-depth reviews and updates on issues relating to the specialty.

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Impact factor 2023

2.2

Citescore

CiteScore measures average citations received per document published.

Citescore 2023

1.5

SJR

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.

SJR 2023

0.263

SNIP

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.

SNIP 2023

0.306

View more metrics

Journal Information

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Vol. 47. Issue 3.

Pages 286-287 (March 2024)

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