ESOPHAGEAL AMYLOIDOSIS SECONDARY TO RHEUM ATOID-ARTHRITIS SIMULATING ACHALASIA

The involvement of the esophagus in amyloidosis secondary to rheumatoi d arthritis is rare. The case of a female patient with rheumatoid arth ritis and secondary esophageal amyloidosis (type AA) with a radiologic and endoscopic clinical picture compatible with achalasia is presente d. In the manometry carried out after two cardiomyotomies, abundant no n propulsant tertiary waves were seen, as were two primary waves, intr aesophageal pressure higher than that of the gastric fundus and lower hypertensive esophageal sphincter which was completely relaxed on one occasion, resulting in a manometric pattern which was different to tha t of the other two cases published with the same disease. Endoscopic c ardiomyotomies and dilatations were performed. The patient died after 2 years due to post dilatation esophageal perforation. The manometric findings are compared with those of the two previous similar cases wit h emphasis being made in that the anarchic arrangement of the amyloid in the esophagus produces different unforeseen and uncharacteristic mo tility patterns. The authors only found in the literature two cases of esophageal amyloidosis secondary to rheumatoid arthritis simulating a chalasia.