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Diagnostic dilemmas in dysphagia aortica
J M Wilkinson1, H A Euinton, L F Smith
1Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, UK.
Summary
Dysphagia aortica, a swallowing difficulty caused by aortic compression, was diagnosed in 5 patients using esophageal manometry. Video bolus swallow proved crucial for confirming diagnosis when other tests were normal.
Area of Science:
- Gastroenterology
- Diagnostic Imaging
- Esophageal Motility Disorders
Background:
- Dysphagia aortica is characterized by swallowing difficulty due to aortic compression.
- High-pressure barriers (HPB) on manometry can suggest this condition.
- Accurate diagnosis often requires advanced imaging and functional tests.
Purpose of the Study:
- To present cases of dysphagia aortica diagnosed via manometry.
- To evaluate the utility of various diagnostic modalities.
- To explore the role of video solid bolus swallow in confirming the diagnosis.
Main Methods:
- Five patients with dysphagia symptoms underwent esophageal manometry, endoscopy, radiography, CT, barium swallow, and video solid bolus swallow.
- Oesophageal manometry and 24-hour ambulatory pH monitoring were performed.
- Contrast-enhanced CT and barium swallow were utilized for imaging.
Main Results:
- Manometry revealed a high-pressure barrier (HPB) in all patients, with median basal pressure rise of 45 mmHg.
- Video solid bolus swallow identified aortic arch obstruction in 2 cases.
- Standard barium swallow and CT scans were normal in all patients.
Conclusions:
- Dysphagia aortica frequently coexists with esophageal motility disorders and gastroesophageal reflux disease (GORD).
- Video solid bolus swallow effectively determined the clinical significance of manometric HPB in 4 out of 5 patients.
- This technique is recommended for diagnosing dysphagia aortica when manometry suggests HPB and barium swallow is normal.