Recognizing idiopathic esophageal dilation

For the general public, idiopathic enlargement of the esophagus is a little known disease; meanwhile, with modern research methods, these cases are no longer as rare as previously thought.

Esophageal Dilation and Other Clinical Factors Associated with Pulmonary Function Decline in Patients with Systemic Sclerosis

Objective To identify clinical factors, including esophageal dilation on chest high-resolution computed tomography (HRCT), that are associated with pulmonary function decline in patients with systemic sclerosis (SSc). Methods Patients fulfilled 2013 SSc criteria and had ≥1 HRCT and ≥2 pulmonary function tests (PFTs). According to published methods, widest esophageal diameter (WED) and radiographic interstitial lung disease (ILD) were assessed, and WED was dichotomized as dilated (≥19mm) vs. not dilated (<19mm). Clinically meaningful PFT decline was defined as %-predicted change in forced vital capacity (FVC) ≥5 and/or diffusion capacity for carbon monoxide (DLCO) ≥15. Linear mixed effect models were used to model PFT change over time. Results 138 SSc patients met study criteria: 100 (72%) had radiographic ILD; 49 (35%) demonstrated FVC decline (median follow-up 2.9y). Patients with Scl-70 autoantibodies had 5- year %-predicted FVC decline (-6.3; 95% CI -9.9, -2.8), while patients without Scl-70 autoantibodies demonstrated 5-year FVC stability (+1.78; 95% CI -0.6, 4.15). Esophageal diameter did not distinguish between those with vs. without FVC decline. Patients with esophageal dilation had statistically significant 5-year %-predicted DLCO decline (-5.6; 95% CI - 10.0, -1.2), but this decline was unlikely clinically significant. Similar results were observed in sub-analysis of patients with radiographic ILD. Conclusion In patients with SSc, Scl-70 positivity is a risk factor for %-predicted FVC decline at five years. Esophageal dilation on HRCT was associated with a minimal, non-clinically significant decline in DLCO and no change in FVC during 5-year follow-up. These results have prognostic implications for SSc-ILD patients with esophageal dilation.

Double caustic, esophagic and pyloric stenosis post-ingestion of soda: Rare case

The ingestion of caustic soda is frequently a source of complications. Esophageal stenosis remains among them the most frequent complication and by far the most formidable. Pyloric stenosis remains rare following ingestion of soda. We report through this clinical case, a cicatricial pyloric stenosis after ingestion of caustic soda associated with a stenosis of the esophagus having caused vomiting with the onset of severe malnutrition. The diagnosis was confirmed by the oeso-gastro-duodenal transit (OGDT) and the child underwent under general anesthesia an enlargement pyloroplasty according to Mikulicz initially and an esophageal dilation secondly to the candle of SAVARY. The postoperative follow-up was favorable with an improvement of the signs and a progressive postoperative weight gain after a follow-up of 06 months. The evolution was favorable after the monthly dilation sessions with a good resumption of transit.