Dysphagia associated with an elevated amylase level - 23/08/11
Doi : 10.1016/j.gie.2009.06.019
| Commentary During the fourth week of gestation, the primitive foregut develops an anterior diverticulum, which becomes the respiratory tract, and a posterior division that develops into the upper GI tract. By definition, simple cysts involve duplication of the epithelium, whereas true duplications have a double lining of submucosa and muscle without duplication of the epithelium. The epithelial lining may be squamous, columnar, cuboid, pseudostratified, or ciliated and may contain tissue ectopia. The most important types of intraduplication ectopic tissue are gastric and pancreatic, because of the occurrence of peptic ulcer with the former and pancreatitis with elevated amylase levels with the latter. Amylase also is secreted by salivary epithelium, but I was not able to find a report of an ectopic salivary gland in an esophageal duplication. Most esophageal duplication cysts become symptomatic in early childhood. In adults, they usually are asymptomatic or cause mild dysphagia or respiratory difficulty from compression—or even cardiac arrhythmias when located in the lower esophagus; they can be complicated by intracystic hemorrhage, rupture, infection, and even malignant transformation. If I were to author an allegory here, what a wonderful story it could be: the duplication feels inadequate and not needed but cannot express itself because it fails to communicate with the lumen; the ectopic salivary gland is angry for being displaced and feels isolated and apart from his peers; the host is displeased because she just doesn’t feel well. Thankfully, authors, playwrights, and sometimes even doctors can bring about happy endings from potentially tumultuous beginnings. Lawrence J. Brandt, MD Associate Editor for Focal Points |
© 2009
Pubblicato da Elsevier Masson SAS.
Vol 70 - N° 5
P. 1023-1025 - novembre 2009 Ritorno al numero
Articolo precedente
- Self-assembled hydro-jet system for submucosal elevation before endoscopic resection of nonpolypoid colorectal lesions (with video)
- Livio Cipolletta, Gianluca Rotondano, Maria A. Bianco, Maria Lucia Garofano, Costantino Meucci, Antonio Prisco, Fabio Cipolletta, Roberto Piscopo
- Multiple cyanoacrylate (Histoacryl) emboli after injection therapy of cardia varices
- Helmut Neumann, Hubert Scheidbach, Klaus Mönkemüller, Maciej Pech, Peter Malfertheiner
Benvenuto su EM|consulte, il riferimento dei professionisti della salute.
L'accesso al testo integrale di questo articolo richiede un abbonamento.
Già abbonato a @@106933@@ rivista ?