Müjgan GÜRLER, Murat PEHLİVAN, Güray CAN, Meral AKDOĞAN KAYHAN

Nadir bir olgu: Jackhammer özofagus

Jackhammer özofagus, özofagus manometri incelemelerinin ortalama %4’ünde saptanan peristaltik hiperkontraktil motilite bozukluğudur. Tanısı çoğunlukla disfaji, bazen göğüs ağrısı veya gastroözofageal reflü şikayetleri ile başvuran hastalarda konur. Disfaji semptomu, alt özofageal sfinkterdeki güçlü kasılmalar, özofageal çıkış darlığı ve yüksek distal kontraktil integral ile ilişkilidir. Jackhammer özofagus tedavisi ile ilgili net bir konsensüs bulunmamaktadır. Asid maruziyetinin azaltılması semptom ve motor bozukluğunu azalttığı gösterilmiştir. Ağırlıklı semptomlar göğüs ağrısı ve disfaji için ise nöromodülatörler ile düz kas gevşeticileri verilebilir. Ağır refrakter olgularda özofageal Botulinum toksini enjeksiyonu ve POEM gibi endoskopik yöntemlerin yanında Heller myotomi gibi cerrahi seçenekler de düşünülebilir. Vakamızda Botulinum enjeksiyonu ve kalsiyum kanal blokeri ile klinik yanıt elde edilmiştir.

Anahtar Kelimeler:

Jackhammer özofagus, özofagus manometrisi, disfaji, botulinum toksini

A rare case: Jackhammer esophagus

Jackhammer esophagus is a peristaltic hypercontractile motility disorder detected on average of 4% of esophageal manometry examinations. The diagnosis is mostly performed in patients presenting with dysphagia, sometimes chest pain or gastroesophageal reflux. The symptom of dysphagia is associated with strong contractions in the lower esophageal sphincter, esophageal outlet stenosis, and high distal contractile integral. There is no clear consensus regarding Jackhammer esophageal therapy. Reducing acid exposure has been shown to reduce symptoms and motor impairment. If the main symptoms are chest pain and dysphagia, neuromodulators and smooth muscle relaxants can be given. In severe refractory cases, besides endoscopic methods such as esophageal Botulinum toxin injection and POEM, surgical options such as Heller myotomy can be considered. In our case, clinical response was obtained with Botulinum injection and calcium channel blocker.

Keywords:

Jackhammer esophagus, esophageal manometry, dysphagia, botulinum toxin,

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