High-resolution esophageal manometry in a Mexican population: diagnostic outcome

Esophageal Dysmotility Disorder and Dysphagia as Initial Manifestations of Lupus

Systemic lupus erythematosus (SLE) is a chronic, multisystemic autoimmune disease that is diagnosed using specific clinical and biochemical inclusion criteria. Here, we report the case of a young adult who was initially diagnosed with dysphagia and later diagnosed with SLE. Other rheumatological and non-rheumatological conditions were ruled out, and serology revealed that SLE was the cause of the patient's symptoms. To the best of our knowledge, no previous case studies or prior research identify dysphagia as a presenting symptom of SLE. While esophageal dysmotility ranging from ineffective esophageal motility (IEM) to achalasia can manifest as a later clinical consequence of SLE, it is rarely the first symptom of the disease. After diagnosis, the patient was treated with hydroxychloroquine and prednisolone, which led to significant improvement.

Jackhammer Esophagus: Current Concepts and Dilemmas

Jackhammer esophagus (JE) is a recently recognized esophageal motility disorder that is characterized by hypercontractile peristalsis. More than 500 cases have been reported in the literature. Among patients referred for esophageal motility disorders, the prevalence of JE ranges from 0.42% to 9%, with most series describing a prevalence of 2% to 4%. Most cases are women (60.5%). The mean reported age of patients with JE is 65.2 years, and patients commonly have dysphagia (62.8%). Reflux symptoms occur in ∼40% of patients, and chest pain affects more than one-third of patients (36.4%). JE is a heterogenous disorder that is associated with several conditions, including obesity, opioid use, lung transplantation, eosinophilic infiltration of the esophagus, neoplasia, and systemic diseases. The cause and pathogenesis remain unknown, but several observations suggest that it is the result of multiple conditions that likely precipitate increased excitation and abnormal inhibition of neuromuscular function. The natural course of JE also is unknown, but progression to achalasia has been observed in a few patients. Treatment is challenging, in part because of the insufficient understanding of the disorder's underlying mechanisms. Various therapeutic modalities have been used, ranging from observation only to pharmacologic and endoscopic interventions (eg, botulinum toxin injection) to peroral endoscopic myotomy. Treatment efficacy remains largely anecdotal and insufficiently studied.