| Hi GI people,
I have an unusual esophageal case - any
ideas or have you seen a similar thing?
1.4 year old female Boxer presented for
regurgitation of 9 mos duration. (Signs
seemed to occur at about the time of an OHE). Dog is thin,
hungry and with regurgitation of almost all food. Does better
with liquids.
Routine chest films normal with no
esophageal dilation.
Contrast study shows sluggish
motility in cervical esophagus then a 10 cm area of narrowing
starting at the thoracic inlet, followed by normal esophagus with
sluggish motility (both primary and secondary contractions). The
narrowed area would however on occasion open somewhat maybe 1-2 cm.
On endoscopy the proximal esophagus
opens well with air, the narrowed area does not open but it is easy
to pass the endoscope through, and the distal esophagus appears
normal. The narrowed area looked like normal uninsufflated
esophagus with linear rugal folds.
I placed a 3 cm diameter balloon in
the area and it was easy to dilate with no resistance.
Repeat endoscopy following the
balloon was similar as the first one.
My impression is this dog has a
neuromuscular disorder possibly segmental with failure of relaxation
in this area. I plan on doing manometry on the esophagus
(haven't had an indication to do this in many years so need to try
to get the cob webs off the instruments). Our radiologist of
many years experience hasn't seen anything similar.
A last tidbit was a litter mate had
a reported esophageal problem and was euthanized at a young
age. It reminds me of a nutcracker esophagus reported in
people treated with Ca channel blockers with some success (however
that is smooth muscle). Any ideas or thoughts on diagnostics,
treatment?
Thanks for any advice,
David Twedt
Colorado State University
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