Diffuse Systemic Sclerosis and CREST Syndrome With Refractory Dysphagia

19 Jul 2022 12:00 14:00
Kuala-Lumpur
Justin Yeong Yeh Lee  Host

Take this format and just change the id of the video

Patient Profile & Clinical History

  • Patient: 60-year-old female

  • Medical History: Diffuse systemic sclerosis and CREST syndrome.

  • Clinical Presentation: Refractory dysphagia.

  • Surgical Consideration: Surgery is being considered.

Diagnostic Evaluation

Upper Endoscopy

  • 2017: Erosive esophagitis and hiatal hernia.

  • 2022: Similar findings at endoscopy.

High-Resolution Manometry

  • 2017: Hypotensive LES sphincter with aperistaltic esophagus.

  • 2022: Similar findings at manometry.

Current Medical Therapy

  • Esomeprazole: 40 mg BID.

  • Itopride: 50 mg TID.

  • Current Status: Recent worsening of symptoms despite medical therapy.

Surgical Consideration

Fundoplication is considered for this patient.

Discussion Points

  1. Etiology of symptoms: Are symptoms attributed to GERD or dysmotility associated with CREST?

  2. Medical therapy: Is there any role for medical therapy to slow down progression or to treat refractory symptoms?

  3. Indications for surgery: What are the indications for surgery?

Panel for Discussion

Yeong Yeh Lee, Kota Bharu | Naveen Ramasami, Kota Bharu | Gew Lai Teck, Kuala Lumpur | Reynu Rajan, Kuala Lumpur | Yinglian Xiao, Guangzhou | Hiroshi Mashimo, Boston