Partial peristalsis of esophageal body smooth muscle
Introduction
Introduction Partial peristalsis of esophageal smooth muscle and decreased esophageal sphincter tension are typical in patients with scleroderma esophageal involvement. Partial peristalsis of esophageal smooth muscle is one of the clinical manifestations of scleroderma esophagus. Sclerodermal esophagus refers to scleroderma, also known as progressive systemic sclerosis (PSS) involving the dysplasia of the esophageal muscle layer. Esophageal involvement manifests difficulty in swallowing, heartburn, vomiting, and a feeling of fullness behind the sternum or upper abdomen.
Cause
Cause
(1) Causes of the disease
Scleroderma is a connective tissue disease that affects fibrous tissue and small blood vessels of multiple organs. When the esophagus is involved, it causes esophageal smooth muscle spasm, ischemia, and smooth muscle atrophy and submucosal collagen deposition and fibrosis.
(two) pathogenesis
1. Immunology: This disease often involves autoimmune diseases such as LE, dermatomyositis, rheumatoid arthritis, and various autoantibodies in serum. Although the role of these autoantibodies in the pathogenesis is still unclear, it has been found. Related to the type of disease.
2. Abnormal synthesis of collagen: It is now clear that the tightness and firmness of scleroderma skin is due to the replacement of most or all of the dermis and/or subcutaneous fat by newly synthesized collagen, which makes the skin close to its underlying tissue.
3. Vascular theory of Raynaud: often early manifestations of PSS, the site of telangiectasia seen in PSS is usually the predilection of Raynaud's phenomenon, namely the face, tongue, lips, hands and upper chest. In scleroderma, 95% of patients have Raynaud's phenomenon, 75% of which are caused by Raynaud's phenomenon. These patients often have visceral damage, and the prognosis and final outcome of scleroderma depend largely on the extent of vascular damage. And seriousness.
Examine
an examination
Related inspection
Esophagography esophageal barium meal perspective
1. First of all, to diagnose scleroderma.
2. Esophageal emptying delays the difficulty of swallowing or reflux symptoms.
3. Esophageal manometry showed a three-low phenomenon.
4.24h esophageal pH monitoring confirmed pathological reflux.
5. Endoscopy confirmed esophagitis, and other esophageal diseases were excluded.
Diagnosis
Differential diagnosis
1. Esophageal tuberculosis: Esophageal tuberculosis patients generally have pioneering symptoms of tuberculosis in other organs, especially tuberculosis. The symptoms of the esophagus itself are often confused or concealed by other organ symptoms so that they cannot be detected in time. According to the pathological process of tuberculosis, the early stage of infiltration may have symptoms such as fatigue, hypothermia, and increased erythrocyte sedimentation rate, but there are also symptoms with inconspicuous swallowing discomfort and progressive dysphagia often accompanied by persistent throat and retrosternal pain. Increased when swallowing. Ulcer-type lesions are often characterized by pain during swallowing. Food spillage into the trachea should take into account the formation of tracheoesophageal fistula. Dysphagia suggests that lesion fibrosis causes scarring.
2. Fungal esophagitis: The clinical symptoms of fungal esophagitis are mostly atypical, and some patients may have no clinical symptoms. Common symptoms are swallowing pain, difficulty swallowing, upper abdominal discomfort, post-sternal pain, and burning sensation. Severe sternum is a knife-like colic, which can radiate to the back like angina. Candida esophagitis can cause severe bleeding but is not common. Untreated patients may have epithelial shedding, perforation, or even disseminated candidiasis. Perforation of the esophagus can cause mediastinal inflammation, esophageal fistula, and esophageal stricture. Patients with persistent high fever neutropenia should be examined for the presence of disseminated acute candidiasis such as skin, liver, spleen and lung.
3. Viral esophagitis: HSV infection of the esophagus often has nasal and herpes simplex symptoms of swallowing pain. Pain often worsens when the patient swallows food. The food is swallowed in the esophagus after swallowing. A small number of patients have dysphagia as the main symptom, and mild infection can be asymptomatic.
