Severe acute cholangitis after endoscopic sphincterotomy induced by barium examination:A case report

Endoscopic sphincterotomy (EST) is considered as a possible etiological factor for severe cholangitis. We herein report a case of severe cholangitis after endo-scopic sphincterotomy induced by barium examination. An adult male patient presented with epigastric pain was diagnosed as having choledocholithiasis by ultra-sonography. EST was performed and the stone was completely cleaned. Barium examination was done 3 d after EST and severe cholangitis appeared 4 h later. The patient was recovered after treated with tienam for 4 d. Barium examination may induce severe cholangitis in patients after EST, although rare, barium examination should be chosen cautiously. Cautions should be also used when EST is performed in patients younger than 50 years to avoid the damage to the sphincter of Oddi.

Esophageal motility in patients with sliding hiatal hernia with reflux esophagitis

Background Patients with sliding hiatus hernia （HH） and reflux esophagitis （RE） usually suffer from esophageal dysmotility. The aim of the present study was to investigate the role of acid reflux and duodenal gastroesophageal reflux （DGER）, esophageal manometry, and esophageal dysmotility by applying the barium meal examination. Methods RE with HH was initially diagnosed using the reflux disease questionnaire, and was further confirmed by a barium meal examination and an endoscopy. The radiographic technique was used to test for spasms, strictures, and the coarseness of the mucosa, also was to study the types of reflux and clearance. Then, the esophageal manometry, the esophageal 24-hour pH, and the bilirubin monitoring were observed. Results Fifty-five patients were diagnosed as HH combined with RE and divided into two groups according to the severity of their esophagitis： group HH1 （grades A and B） and group HH2 （grades C and D）. The barium meal examination revealed that the mucosa was either granular or nodular in all cases. The dump reflux and delayed clearance were more significant in patients in the HH2 group than those in the HH1 group （P 〈0.05）. The percentages of total, supine, and upright acid exposure time were greater in patients with HH than those in the control group （P 〈0.01）, but the differences between the HH1 and the HH2 groups were not significant. Lower esophageal sphictor pressure （LESP） was lower in the HH group than in the control group （P 〈0.05）. Three DGER parameters： the percentage of time with absorbance greater than 0.14, the number of bile reflux episodes, the number of bile refluxes lasting longer than 5 minutes were （28.43±23.34）, （40.57±31.30）, and （15.15±8.72）, respectively in the HH2 group; these statistics were significantly higher than those for the HH1 （P 〈0.05）. The frequency and amplitude of peristalsis were all lower in HH patients than in the control （P 〈0.05）. Of all the patients, 54.3% （30 of 55） with acid reflux and DGER simultaneously in the HH group exhibited refluxes of barium from the stomach to the esophagus in the recumbent position, and 29.4% （5 in 17） with delayed clearance in the HH group were correlated with esophageal body peristalses. The result was that the frequency and amplitude of peristalsis were less and the duration of esophageal peristalsis was longer than those of control group. Conclusions Esophageal dysmotility may play an important role in the severity of RE combined with HH. Esophageal motility results on a barium examination may coincide with esophageal manometry, 24-hour pH, and bilirubin monitoring in the RE and HH, but the radiologic method was the simplest to apply.