Dysphagia in an elderly patient suffering from long-lasting rheumatoid arthritis

idiopathic esophageal achalasia (IEA) is a rare motor disorder whose initial manifestation is dysphagia,sometimes versus liquids. IEA can be an uncommon manifestation of some rheumatic inflammatory diseasessuch as Sjogren syndrome, systemic lupus erythematosus, sclerodermia, rheumatoid arthritis. IEA is considereda precancerous condition and the possibility that it represents a risk factor for development of esophagealcarcinoma (EC) has been more and more descripted. These same rheumatic diseases - when long-standingand/or aggressive - can give an esophageal amyloidosis (EA) with AA amyloid deposits . EA is very rarelydescripted as unique manifestation of systemic amyloidosis during these diseases. IEA has a typicalmanometric pattern whereas in EA the anarchic arrangement of amyloid can produce unforeseen anduncharacteristc motility patterns different from the idiopathic one. Both IEA and EA are very rare conditions.For IEA, it has been extimated an annual incidence of 2/100,000 and a prevalence rate of 10/100,000 with apeak incidence between 30 and 60 years of age. The prevalence and incidence of EA are uncertain. The surgicalexperiences in esophageal pseudoachalasia are aneddhotic. We describe the clinical case of an elderly womansuffering from long-lasting rheumatoid arthritis in which an EA overlapped an IEA, causing the sharpworsening of dysphagia and poor prognosis despite surgical approaches. According to our knowledge, thisoverlap has been never descripted.

Keywords:

esophageal achalasia , dysphagia , rheumatoid arthritis , amyloidotic psuedoachalasia , elderly patient