Comparison of high-resolution manometry parameters among type II diabetes patients and normal volunteers

Abstract Aim Ulcerating CMV associated esophagitis in an immuncompetent patient has not been described before. This case report highlights diagnostic pitfalls in differentiating achalasia from pseudo achalasia. Background & Methods A 41-year-old man presented to the high resolution manometry lab with progressive retrosternal dysphagia and regurgitation. Endoscopy revealed a dilated esophagus with a passable stenosis of the esophagogastric junction. Between 27 to 39 cm a deep 3 x 12 cm ulcer reaching the lamina muscularis was detected. Biopsies were taken and processed to the institute for pathology and microbiology. A barium swallow revealed typical features of achalasia. A dilated hypomotile esophagus and a beak sign were seen. Histopathology described a deep ulcer with a mixed inflammatory infiltration without any signs for malignancy. The virology finally revealed a strong positivity for CMV in PCR. Therefor the diagnosis of CMV esophagitis was made. Reasons for an immunodeficiency (HIV, Trypanosoma pallidum etc.) could be excluded. After endoscopic placement of a probe, high resolution manometry was performed. It showed a disturbed EGJ relaxation, an enhanced residual pressure (IRP) and panesophageal pressurizations in almost every swallow. These are typical features of Type II Achalasia (Chicago Classification v 3.0). Results The patient received antiviral therapy (Ganciclovir) for 2 months. Only a moderate symptom relief was achieved. Endoscopic reevaluation showed a complete remission of the huge esophageal ulcer. There was no esophageal scar or other reason for EGJ obstruction. CMV was no longer detected. A second high resolution manometry confirmed again a Type II Achalasia. The patient underwent laparoscopic myotomy an 180° degree fundoplication. 6 months after the intervention the patient is well and has a complete remission of his symptoms. Conclusion Although ulcerating CMV esophagitis may be a cause of pseudoachalasia, in this case for the first time primary achalasia is described to be the reason for ulcerating CMV esophagitis.

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Diagnostic Role of NT Pro BNP in Diabetes Type 2 Patients Associated with Cardiovascular Disease Risk, A Study from Central India

Journal of Medicine ◽

10.3329/jom.v11i1.4266 ◽

1970 ◽

Vol 11 (1) ◽

pp. 33-38 ◽

Cited By ~ 1

Author(s):

Ashok Sahu ◽

Trapti Gupta ◽

Arvind Kavishwar ◽

Purnima Dey Sarkar ◽

RK Singh

Keyword(s):

Cardiovascular Disease ◽

Lipid Profile ◽

Vascular Disease ◽

Type Ii Diabetes ◽

Type Ii ◽

Patients With Diabetes ◽

Cardio Vascular Disease ◽

Cardio Vascular ◽

Diabetes Patients

Cardiovascular disease is the most frequent cause of death in patient with diabetes. It is difficult to evaluate cardiovascular status of patients with diabetes because of complex symptomatology. NTproBNP, a split peptide from pro BNP molecule is a novel biomarker, released from cardiac myocytes in response to myocardial stretch, cardio vascular disease, endothelial dysfunction and heart failure. We aimed to test that is elevated NTproBNP levels associated with increased risk of cardiovascular disease in diabetes patients in comparison to matched control. Demographic, anthropometric measure, NT pro BNP, lipid profile, blood glucose were estimated and compared among angiographically proven cardiovascular disease patients with diabetes and healthy controls. Univariate and multivariate analysis were carried out to compare individual factor using t-Test, ANOVA and the inter group comparisons were done by using Bon ferroni Post Hoc test. Patients with type 2 diabetes were shown to have higher NTproBNP values (n=50, 1481.021±813.405) than control subjects (n=50, 23.562±23.395) (p <0.05). NTproBNP levels were independently related to diabetes after adjustment for age, sex, family history, smoking, obesity, blood pressure and lipid profile. Our data suggests that the secretion of NT pro BNP is increased in type II diabetes patients, suggesting association of diabetes and NTproBNP in cardio vascular disease with higher prevalence. Thus NTproBNP may serve as a screening tool to diagnose patients with type II diabetes with cardiovascular disease having complex symptomatology. Keyword: NTproBNP, Cardiovascular disease, Diabetes DOI:10.3329/jom.v11i1.4266 J Medicine 2010: 11: 33-38

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