Clinical-Pathological Conference Series from the Medical University of Graz
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Wien Klin Wochenschr https://doi.org/10.1007/s00508-020-01694-x
Clinical-Pathological Conference Series from the Medical University of Graz Case No 171: A 37-year-old engineer with bolus hold-up (esophageal food impaction) Elisabeth Fabian · Hans Peter Gröchenig · Philipp K. Bauer · Andreas J. Eherer · Markus Gugatschka · Lukas Binder · Cord Langner · Peter Fickert · Guenter J. Krejs © The Author(s) 2020
Keywords Dysphagia · Eosinophilic esophagitis · Budesonide · Proton pump inhibitors
Presentation of case Dr. L. Binder: The patient is a technical engineer working for a large international company. Except for recurrent episodes of dysphagia over the last 3 years, his history is unremarkable. He reports that “ingested food gets stuck behind his chest bone about once a month”. Originally from Brno, Czech Republic, he has been living in France for the past several years where he has been treated for dysphagia by otorhinolaryngologists who prescribed prokinetics, E. Fabian, MD, PhD, MSc, BSc Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria H. P. Gröchenig, MD Department of Internal Medicine, Hospital Brothers of St. John of God, Sankt Veit an der Glan, Austria P. K. Bauer, MD Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria A. J. Eherer, MD · L. Binder, MD · P. Fickert, MD · G. J. Krejs, MD, AGAF, MWGO () Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria [email protected] M. Gugatschka, MD Division of Phoniatrics, Department of Otorhinolaryngology, Medical University of Graz, Graz, Austria C. Langner, MD Department of Pathology, Medical University of Graz, Graz, Austria
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a proton pump inhibitor (PPI) and neuroleptics; however, these medications did not improve his dysphagia. Finishing a meal would take him about twice as long as his wife. After moving to Graz, Austria 3 months ago, he again experienced a bolus hold-up (a piece of meat got stuck in his esophagus). Used to being treated by otorhinolaryngologists, the patient came to the emergency room of the Department for Otorhinolaryngology of this institution where the bolus was removed with the patient under general anesthesia using a rigid esophagoscope. The investigation also showed a questionable stenosis of the proximal esophagus with marked vulnerability of the mucosa. The patient was told that surgery might become necessary if esophageal injury or perforation has occurred, and he was admitted for observation. The physical examination was otherwise unremarkable and all routine laboratory parameters were within normal limits. A diagnostic test was performed.
Differential diagnosis Dr. H.P. Gröchenig: The patient under discussion is a young man with a history of dysphagia and recurrent food impaction, which may be due to a stenosis of the esophagus with remarkably increased vulnerability
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