2016-08-17 20:35:50 UTC

The Case of a Man With Lupus and 10 Years of Dysphagia

Aug. 17, 2016

The patient had a diagnosis of systemic lupus erythematosus for approximately 30 years and was chronically on daily prednisone.

Question: A 64-year-old man with systemic lupus erythematosus was referred for evaluation of dysphagia and regurgitation. The patient reported a 10-year history of difficulty swallowing solid foods with associated burning substernal chest discomfort. He was not symptomatic with drinking but his symptoms progressed and he developed occasional regurgitation. He was treated empirically for GERD with esomeprazole 20 mg/d; however, he noted persistent symptoms. He did not report weight loss, neurologic deficits or prior stroke. His physical examination was unremarkable.

Of note, the patient had a diagnosis of systemic lupus erythematosus for approximately 30 years and was chronically on daily prednisone. A barium esophagram displayed three large (3.2-8.3 mm) diverticuli of the lower esophagus, impaired relaxation of the esophagogastric junction with reflux of barium into the mid esophagus and a 17-mm Zenker’s diverticulum (Figure A). An upper endoscopy confirmed these findings, excluded malignancy and revealed a benign-appearing intrinsic stricture at the gastroesophageal junction.High-resolution esophageal manometry demonstrated normal esophageal body peristalsis of low amplitude (40.1 mm Hg; reference, 43-152 mm Hg) with borderline incomplete relaxation of the lower esophageal sphincter (15.1 mm Hg; reference, <15 mm Hg).

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