Cases reported "Esophagitis"

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1/60. Esophagitis dissecans superficialis associated with pemphigus vulgaris.

    The extension of bullous lesions in pemphigus to the esophagus is relatively uncommon, especially in patients who appear to be in clinical remission. Very rarely, pemphigus vulgaris may affect the entire esophagus, resulting in complete sloughing of the mucous membrane. A 20-year-old man with pemphigus vulgaris presented to the emergency room with acute onset of dysphagia, odynophagia, and hemoptysis. There were no cutaneous or oral findings of pemphigus on presentation, since he was being maintained on corticosteroids and azathioprine with excellent results. During initial evaluation in the emergency room, the patient was observed to vomit a cast of the mucosal lining of the esophagus. The morphologic description of such an esophageal cast is termed esophagitis dissecans superficialis. This is the third case of esophagitis dissecans superficialis in pemphigus vulgaris recorded in the medical literature.
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ranking = 1
keywords = dysphagia
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2/60. doxycycline-induced esophageal ulceration in the U.S. Military service.

    U.S. military forces are frequently deployed with little warning to regions of the world where chloroquine-resistant malaria is endemic. doxycycline is often used for malaria chemoprophylaxis in these environments. The use of doxycycline can be complicated by esophageal injury. Two cases of esophageal ulceration will be discussed, followed by a review of the literature. doxycycline causes esophageal injury through a combination of drug-specific factors, the circumstances of drug administration, and individual patient conditions. patients with dysphagia attributable to esophageal ulceration are managed by intravenous fluid support and control of gastric acid reflux until their symptoms resolve over 5 to 7 days. The risk of esophageal injury can be minimized by use of fresh capsules, drug administration in the upright position well before lying down to sleep, and drinking at least 100 ml of water after swallowing the medication.
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ranking = 1
keywords = dysphagia
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3/60. Esophageal candidoma in a patient with acquired immunodeficiency syndrome.

    Oral thrush and esophagitis caused by candida are common in patients infected with the human immunodeficiency virus. We present the case of a 33-year-old man with acquired immunodeficiency syndrome who developed dysphagia during a hospitalization for pneumonia. signs and symptoms were consistent with candida esophagitis. Despite therapy with fluconazole, the patient's symptoms persisted. At upper endoscopy, a 1-cm, polypoid esophageal mass at 30 cm from the incisors and several other nodular lesions were observed; white plaques were noted throughout the esophagus. biopsy specimens of the mass contained hyphal forms consistent with candida species. Therapy with amphotericin b improved the patient's symptoms, and resolution of the mass was confirmed by repeat upper endoscopy. We believe this is the first case in the medical literature of a candida mass (candidoma) causing dysphagia in a patient with acquired immunodeficiency syndrome. Candidoma should be considered in the differential diagnosis of dysphagia in patients with human immunodeficiency virus infection or immunosuppression due to other causes.
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ranking = 3
keywords = dysphagia
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4/60. The spectrum of pediatric eosinophilic esophagitis beyond infancy: a clinical series of 30 children.

    OBJECTIVES: eosinophilic esophagitis, previously confused with esophageal inflammation due to gastroesophageal reflux, has recently begun to be distinguished from it. We undertook this analysis of our large series of children with the condition to clarify its spectrum: its presenting symptoms; its relation to allergy, respiratory disease, and reflux; its endoscopic and histological findings; and its diagnosis and therapy. methods: We analyzed the details of our clinical series of 30 children with eosinophilic esophagitis, defining it as > or =5 eosinophils per high power field in the distal esophageal epithelium. Retrospective chart review was supplemented by prospective, blinded, duplicate quantitative evaluation of histology specimens, and by telephone contact with some families to clarify subsequent course. Presentation and analysis of the series as a whole is preceded by a case illustrating a typical presentation with dysphagia and recurrent esophageal food impactions. RESULTS: Presenting symptoms encompass vomiting, pain, and dysphagia (some with impactions or strictures). Allergy, particularly food allergy, is an associated finding in most patients, and many have concomitant asthma or other chronic respiratory disease. A subtle granularity with furrows or rings is newly identified as the endoscopic herald of histological eosinophilic esophagitis. Histological characteristics include peripapillary or juxtaluminal eosinophil clustering in certain cases. association with eosinophilic gastroenteritis occurs, but is not common. Differentiation from gastroesophageal reflux disease is approached by analyzing eosinophil density and response to therapeutic trials. Therapy encompasses dietary elimination and anti-inflammatory pharmacotherapy. CONCLUSION: awareness of the spectrum of eosinophilic esophagitis should promote optimal diagnosis and treatment of this elusive entity, both in children and in adults.
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ranking = 2
keywords = dysphagia
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5/60. Crohn's disease of the esophagus: Three cases and a literature review.

    Three cases of esophageal Crohn's disease (CD) are described, each with dysphagia and/or odynophagia caused by esophageal ulceration. All three patients had associated ileocolitis. One patient followed for a prolonged period responded to treatment with sulfasalazine and prednisone. A computer search back to 1967 produced 72 additional cases of esophageal CD. Among these 75 patients (total), who were, on average, 34 years old, esophageal disease was the presenting disease symptom in 41 patients (55%). The diagnosis was difficult in 13 patients, in whom no distal bowel disease was detected at the time of initial esophageal presentation. The most common presentation was dysphagia associated with aphthous or deeper ulcerations (52 patients). In 11 of these patients, oral aphthous ulcerations were also present. esophageal stenosis or fistulas to surrounding structures were present in 27 patients and led to surgery in 17 patients. Most of the unfavourable outcomes were in this group of 27 patients with esophageal complications, including five deaths. Fourteen additional patients required surgery for CD of other areas. Responses of uncomplicated ulcerative disease of the esophagus tended to be favourable if the medical regimen included prednisone. Clinical patterns of esophageal CD were divided into three categories: ulcerative, stenosing and asymptomatic (acute disease in children).
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ranking = 2
keywords = dysphagia
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6/60. Subglottic stenosis complicated by allergic esophagitis: case report.

    Allergic esophagitis is a known entity that had been described in patients with dysphagia. It has not been previously described in association with subglottic stenosis. We report the case of a 2-year-old girl with symptoms suggestive of allergic esophagitis who suffered from subglottic stenosis that recurred despite surgical measures. Her esophageal ph monitoring results were normal, and she did not respond to antireflux medications. She did respond dramatically to corticosteroid therapy with improvement of both her esophageal and laryngeal symptoms. Allergic esophagitis as a clinical entity is discussed.
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ranking = 1
keywords = dysphagia
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7/60. herpes simplex esophagitis in immunocompetent individuals.

    herpes simplex esophagitis commonly occurs in immune-compromised individuals. We report the condition in two immunocompetent individuals (one presenting with retrosternal pain and diarrhea and the other with dysphagia and fever) and in two patients with obstructive airway disease who had received corticosteroid therapy. The first two did not receive treatment, one was lost to follow up and the other is asymptomatic two years later. The latter two patients received acyclovir therapy.
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ranking = 1
keywords = dysphagia
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8/60. Esophageal intramural pseudodiverticulosis (diffuse type).

    A rare case of esophageal intramural pseudodiverticulosis (EIPD) in a 65-year-old woman with intermittent dysphagia is reported. An upper gastrointestinal series revealed multiple pseudodiverticula, which had tiny flask-shaped outpouchings with a narrow neck extending outward from the upper to the lower thoracic esophageal wall. In particular, the occurrence of the pseudodiverticula was coincident with a narrowed segment of inflamed esophagus. The length of the esophagus involved was approximately 15 cm. Endoscopic findings included mild stricture and chronic inflammation of the mucosa. biopsy specimens showed active chronic esophagitis with bacterial and candida superinfection, but no evidence of neoplasm. Cellular local immune reactions, as a consequence of chronic inflammation, and possibly abnormal motor activity in the narrowed esophagus, may explain the etiological agent or may be possible secondary factors that caused the EIPD.
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ranking = 1
keywords = dysphagia
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9/60. Tuberculous involvement of the oesophagus with oesophagobroncheal fistula.

    Tuberculous involvement of the oesophagus is a rare disease. Even if it is suspected, diagnosis is often difficult though dysphagia and chest pain are the most common symptoms without any other specific signs of tuberculosis. The diagnosis is based on oesophagography, oesophagoscopy, bronchoscopy, and computed tomographic scan. Suspected tuberculosis can be confirmed with histology, smear, and culture. The two most common differential diagnoses are Crohn's disease and carcinoma. The case is reported of a female patient with tuberculous involvement of the oesophagus, who developed an oesophagobroncheal fistula during steroid treatment started for suspicion of Crohn's disease. The patient was immunocompromised due to treatment with azathioprine that she was receiving for multiple sclerosis. The fistula was successfully treated by antituberculous chemotherapy alone.
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ranking = 1
keywords = dysphagia
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10/60. Dysphagia in Crohn's disease: a diagnostic challenge.

    Dysphagia is a rare manifestation in a patient with Crohn's disease. We report on the case of a patient with long-standing Crohn's disease who developed progressive dysphagia over 3 years. endoscopy showed minimal distal oesophagitis with non-specific histological findings. Further investigation with cinematography, barium swallow and manometry established an achalasia-like motility disorder. Biopsies obtained from the oesophagus were non-specific. Balloon dilatation was performed. Initial success was followed by recurrent dysphagia. At repeat endoscopy, an oesophageal fistula was detected. An attempt at conservative medical management failed and oesophagectomy was successfully performed. pathology results of the resected specimen confirmed the suspected diagnosis of oesophageal Crohn's disease. Even if achalasia is suspected in a Crohn's patient, it should be taken into consideration that the motility disorder could be the result of a transmural inflammation with or without fibrosis caused by Crohn's disease.
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ranking = 2
keywords = dysphagia
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