胃食管静脉曲张患者伴有失弛缓症:尚有疑问的治疗方案

作     者：Pinillos H. Legnani P. Schiano T. 纪泛扑(译) 史敏(校) 

作者机构：不详 Division of Liver Diseases Mount Sinai Medical Center One Gustave Levy Place New York NY 10029 United States 

出 版 物：《世界核心医学期刊文摘（胃肠病学分册）》 (Core Journals in Gastroenterology)

年 卷 期：2006年第2卷第6期

页      面：6-6页

学科分类：1002[医学-临床医学] 1010[医学-医学技术（可授医学、理学学位）] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 100215[医学-康复医学与理疗学] 10[医学] 

主　　题：胃食管静脉曲张 最佳治疗方案 失弛缓症 经颈静脉肝内门体分流术 患者 进行性吞咽困难 胃底静脉曲张 肉毒杆菌毒素 西班牙妇女 影像学检查 

摘      要：The coexistence of achalasia and gastroesophageal varices has been reported sporadically in the English medical literature. We report the case of a 60-year-old Hispanic woman with cryptogenic cirrhosis who was referred for a liver transplant evaluation and subsequently developed progressive dysphagia to both solids and liquids as well as substernal chest pain and weight loss. Endoscopy revealed the presence of grade I esophageal varices and large fundic varices, as well as retained liquid and solid food in the distal esophagus. Radiographic and manometric studies were consistent with achalasia. After botulinum toxin (Botox) injections were no longer effective a transjugular intrahepatic portosystemic shunt was performed for portal decompression before proceeding with pneumatic dilation. Optimal treatment of these 2 conditions, when they occur simultaneously, is problematic. We discuss this patient’s management and our approach to this infrequent combination of diseases.