A Long-Lasting Dysphagia

Abstract

Question: A 74-year-elderly woman was presented to the clinic to be treated for dysphagia, which had persisted for more than 5 years. Previously, repetitive botulinum injections for suspected hypercontractile esophagus had been implemented in an external clinic without any success. The present esophagogastroduodenoscopy revealed an elongated esophagus with tertiary contractions and reflux stage A according to the Los Angeles classification. Eosinophilic esophagitis was excluded histologically, and laboratory results showed no relevant pathologies. Oral endosonography was unsuspicious. However, barium swallow demonstrated a left-sided deviation and impression of the lower esophagus (Figure A).What may be the reason for the left-sided deviation of the lower esophagus causing dysphagia in this woman?See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.