胸痛を伴った食道運動障害の2例

Esophageal Motility Disorder with Chest Pain：a Case Series

要旨●患者は食道運動障害を呈した40歳代，50歳代男性の2例．両症例ともに，つかえ感，胸痛を主訴に他院を受診し，難治性の胃食道逆流症や心因性の疾患と診断されていた．内服治療による症状の改善が得られなかったため，当院に紹介され受診となった．いずれの症例も，初回のEGDでは異常所見を指摘できなかったが，症状が増悪した際に行った2回目の検査（EGD，食道X線造影検査，高解像度食道内圧検査）で，食道体部に強い収縮を認め，胸痛の原因を特定できた．その後，経口内視鏡的筋層切開術（POEM）を行い，症状の改善が得られた．現在，術後7年目となるが，症状の再燃なく順調に経過している．

　We report two male patients in their 40s and 50s, respectively, presenting with esophageal motility disorders. Both cases first visited other hospitals with complaints of dysphagia and chest pain and were diagnosed with refractory gastroesophageal reflux disease or psychogenic disorders. Their symptoms did not improve with medication ; thus, they were referred to our hospital. The initial upper gastrointestinal endoscopy revealed no abnormalities in both cases.

　However, a second examination（upper endoscopy, esophagography, and high-resolution manometry）during the exacerbation of symptoms indicated that strong esophageal body contractions cause the symptoms. Subsequently, peroral endoscopic myotomy was performed, resulting in symptom improvement. Currently, both cases remain symptom-free with no recurrence 7 years postoperatively.