Tertiary esophageal contractions (scleroderma)
History of scleroderma. Investigated for dysphagia. Tertiary contractions observed on endoscopy.
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Normal transit of contrast though the larynx and esophagus.
Marked tertiary contractions demonstrated in the mid- and lower esophagus. No significant hold-up in contrast transit demonstrated.
No pharyngeal pouch, stricture or mucosal abnormality.
Mild gastro-esophageal reflux demonstrated. No hiatus hernia.
Normal transit of contrast from stomach to small bowel. The visualized proximal small bowel is grossly normal.
Tertiary contractions in mid and lower esophagus representing dysmotility
Predominant finding of dysmotility with mid/lower esophagus tertiary contractions and mild reflux. The relatively normal upper esophagus suggests sparing of striated muscle, with smooth muscle involvement.
Further manometry study revealed complete relaxation of the lower esophageal sphincter but infrequent and weak peristaltic contractions, consistent with esophageal involvement of scleroderma.