[Dysphagia] celiac disease

[eripley at yahoo.com (Irene Campbell-Taylor)]

With respect to VFSS for this lady, I have been trying for years to discover where the practice of mixing food with barium started. Not only does it bear no relationship to real food, but, one would think that in a situation in which aspiration may very well occur, there would be more concern about inhalation of food than of barium alone, the latter being an innocuous event.
  Gastrografin must NEVER be used if there is a possibility of aspiration as it often proves to be lethal or, at the very least, extremely hazardous.
  All of the work that has been done over decades with respect to VFSS and the dynamics of swallowing has used barium and water only. In this case, VFSS may be mandatort re the following, using barium/water alone:
  Esophageal contractions and oropharyngeal and esophageal transits in patients with iron deficiency anemia
  Adriana Leonarda Martins Miranda, M.D. 
  Roberto Oliveira Dantas, M.D.
  Objective: Patients with iron deficiency may have reduced power of the pharyngeal muscle for bolus propulsion into the esophagus. We hypothesized that esophageal muscle is similarly impaired.
  Methods: We studied the oropharyngeal and esophageal transits and esophageal motility of 12 patients (11 women) aged 31?50 yr (median 36 yr) with iron deficiency anemia (serum iron less than 40 ?g/dl) and 17 normal volunteers (16 women) aged 26?52 yr (median 37 yr) with serum iron greater than 60 ?g/dl. The esophageal motility was studied by the manometric method, with continuous perfusion and 10 swallows of a 2-ml bolus of water alternated with 10 swallows of a 7-ml bolus; and the oropharyngeal and esophageal transits were studied by scintigraphy, with swallows of a 10-ml bolus for the study of oropharyngeal transit and of a 10-ml bolus for the study of esophageal transit. Motility and transit were studied in the supine position.
  Results: The amplitude, duration and area under the curve of contractions were lower in patients than in volunteers. There were no differences in peristaltic contraction velocity, lower esophageal sphincter pressure, and lower esophageal sphincter relaxation duration. There was no difference in oropharyngeal transit. In the esophagus the transit was slower in patients than in volunteers. The time needed by the scintigraphic activity to reach a peak in the proximal esophagus was longer in patients than in volunteers.
  Conclusions: Iron deficiency may decrease esophageal contractions and impair esophageal transit.
   
  (The association of postcricoid dysphagia, upper esophageal webs, and iron deficiency anemia is known as the Plummer-Vinson syndrome (PVS) in the United States and the Paterson-Brown Kelly syndrome in the United Kingdom. The term sideropenic dysphagia has also been used, since the syndrome can occur with iron deficiency (sideropenia), but it is not associated with anemia.)
   
  Atypical celiac disease with IgA deficiency presenting as Plummer?Vinson syndrome: a case report 
          Journal
    Esophagus
       
     
      ISSN
    1612-9059 (Print) 1612-9067 (Online)
      Issue
    Volume 3, Number 1 / April, 2006
      Category
    CASE REPORT
       
     
      Pages
    23-25
       
     
       
     
   
  


  Celiac disease presenting as the Paterson-Brown Kelly (Plummer-Vinson) syndrome American Journal of Gastroenterology 94 (2), 527?529.
  W. Dickey, M.D.
  B. McConnell, M.D
  We describe two patients with Paterson-Brown Kelly (Plummer-Vinson) syndrome whose iron deficiency anemia was due to celiac disease. They presented with dysphagia 13 and 9 yr, respectively, before celiac disease was diagnosed. Neither had gastrointestinal symptoms suggestive of malabsorption. Celiac disease is a recognized cause of chronic iron deficiency and should be considered as an etiological factor for sideropenic dysphagia.


Dr I Campbell-Taylor
Clinical Neuroscientist
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