Decreased tone of lower esophageal sphincter
Introduction
Introduction Lower esophageal sphincter tension is one of the symptoms of scleroderma esophagus, sclerodermal esophagus refers to scleroderma, also known as progressive systemic sclerosis, involving the dysplasia of the esophageal muscle layer.
Cause
Cause
(1) Causes of the disease
Scleroderma is a connective tissue disease affecting multiple organs of fibrous tissue and small blood vessels that cause esophageal smooth muscle spasm and smooth muscle atrophy and submucosal collagen deposition and fibrosis when involved in the esophagus.
(two) pathogenesis
1. Immunology: This disease is often associated with autoimmune diseases such as LE dermatomyositis and rheumatoid arthritis. There are various autoantibodies in the serum. Although the role of these autoantibodies in the pathogenesis is still unclear, it has been found and the type of disease. Related.
2. Collagen synthesis abnormality theory: It has been clarified that the skin tightening and firmness of scleroderma skin is due to the fact that the newly synthesized collagen replaces most or all of the dermis and/or subcutaneous fat to make the skin close to the underlying tissue.
3. Vascular theory: Raynaud's phenomenon is often the early manifestation of PSS. The location of telangiectasia seen in PSS is usually the predilection of Raynaud's phenomenon. That is, the face of the tongue and the upper chest in 95% of patients with scleroderma have Raynaud's phenomenon. Of these, 75% of them have the first symptom of Raynaud's phenomenon. These patients often have visceral damage and the prognosis and final outcome of scleroderma depend largely on the extent and severity of vascular damage.
Examine
an examination
Related inspection
Esophagography esophageal barium meal perspective
Symptoms and signs:
Esophageal involvement, difficulty swallowing, heartburn, more accompanied by vomiting, feeling of fullness behind the sternum or upper abdomen. As the lower esophageal sphincter is closed, esophageal clearance is reduced, like achalasia, and scleroderma produces slow progressive fluid and solid foods that are difficult to swallow. The heartburn symptoms are very significant due to severe gastroesophageal reflux. In patients with scleroderma complicated with typical esophageal involvement, air-filled esophageal images can be seen on the chest radiograph. The lower esophageal sphincter can not be closed. The barium meal examination further indicates that the normal esophagus is lost. It can be seen that the flaccid esophagus and the lower esophageal sphincter are open, or even lack of primary peristalsis. And may also provide evidence of esophagitis or stenosis. Esophageal manometry was performed to examine the esophageal body and the lower esophageal sphincter. Progressive involvement can be seen in the reduction of esophageal contraction length. Partial peristalsis of the smooth muscle of the esophageal body and decreased tension of the lower esophageal sphincter are typical in patients with scleroderma esophageal involvement, so that this is defined as a "scleroderma esophagus" radionuclide transfer test to detect esophageal movement and scleroderma esophagus Pressure measurement also has a good correlation:
1. First of all, to diagnose scleroderma;
2. Esophageal emptying delays the difficulty of swallowing or reflux symptoms;
3. Esophageal manometry shows a three-low phenomenon;
4.24h esophageal pH monitoring confirmed pathological reflux;
5. Endoscopy confirmed esophagitis and excluded other esophageal diseases.
Check the test:
Esophageal manometric examination of the esophagus and the lower esophageal sphincter showed abnormal progression of the affected esophageal contraction length. Esophageal smooth muscle partial peristalsis and decreased esophageal sphincter tension were typical in patients with scleroderma esophageal involvement.
1. Patients with scleroderma and typical esophageal involvement can be seen on the chest radiograph with air-filled esophagus. The lower esophageal sphincter can not be closed.
2. Barium meal examination further indicates that the normal esophageal movement loss of the visible flaccid esophagus and esophageal sphincter is open or even completely lack of primary peristalsis and may also provide evidence of esophagitis or stenosis.
3. Radionuclide transfer test to detect esophageal movement and scleroderma esophageal manometry also have a good correlation.
Diagnosis
Differential diagnosis
1. Esophageal tuberculosis: Patients with esophageal tuberculosis generally have pioneering symptoms of tuberculosis in other organs, especially tuberculosis. The symptoms of the esophagus are often confused or concealed by other organ symptoms, so that they cannot be discovered in time. According to the pathological process of tuberculosis, the early stage of infiltration may have symptoms such as fatigue, hypothermia and erythrocyte sedimentation rate, but there are also symptoms that are not obvious. Following swallowing discomfort and progressive dysphagia, often accompanied by persistent throat and retrosternal pain, swollen ulceration when swallowing, mostly characterized by pain when 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. Some patients can have no clinical symptoms. Common symptoms are swallowing pain, difficulty swallowing, upper abdominal discomfort, post-sternal pain, and burning sensation. The severe sternum is a knife-like colic, which can radiate to the back, resembling angina. Candida esophagitis can cause severe bleeding, but it is not common. Untreated patients may have epithelial shedding and even disseminated. Candidiasis esophageal perforation can cause mediastinal inflammation of the esophageal tracheal fistula and esophageal stricture, patients with persistent high fever of neutropenia should be checked for the presence of skin, liver, spleen and lung and other disseminated acute candidiasis.
3. Viral esophagitis: HSV infection of the esophagus often has nasal and herpes. The main symptom is swallowing pain. The pain is often exacerbated when swallowing food. After swallowing, the food is slow in the esophagus. A few patients have difficulty in swallowing. Slightly infected people can be asymptomatic.
