We report a patients who developed a Barrett,s esophageal ulcer 10 years after esophagomyotomy for achalasia. A-59-year-old female was admitted to the hospital with dysphagia for 2 months. In 1982, she had undergone a modified Heller
esophagomyotomy for
achalsia. After esophagogram, esophageal manometry, 24hr esophageal pH monitoring, esophagoscophy achalasia and Barrett,s esophageal ulcer was diagnosed. So, she had been treated with omeprazole and sucralfate and has been followed up in a
asymtomatic
state currently.
In Barrett,s esophagus, there is a metaplasia of the normal stratified squamous mucosa to columnar epithelium, caused by the reflux of acid. It appears in approximately 10% of patients with chronic gastroesophageal reflux and is associated with
increased probability of adenocarcinoma of the esophagus. Among the predisposing factors of gastroesophageal reflux, there is treatment of esophageal achalsia by forceful dilatation or by the esophagomyotomy. The results ralaxation of lower
esophageal
sphinter, combined with deficient propulsive esophageal peristalsis predisposed to gastroesophageal reflux.
Actually an increased incidence of gastroesophageal reflux, esophagitis and stricture are well-known complications after esophagomyotomy. But in spite of higher risk of gastroesophageal reflux after esophagomyotomy the development of Barrett,s
mucosa
has been rarely reported and only recently recognized.
Diagnosis of Barrett,s esophagus in such patients is difficult and the cumulative effects of achalasia and Barrett,s esophagus predispose these patients to higher risk of developing esophageal carcinoma. So, high index of awareness and regular
endoscopic surveillance are required.
|