Ye Jiaqu, attending physician of the Hepatobiliary and Gastroenterology Department of Haoxingan Outpatient Center, pointed out that if the cause of dysphagia cannot be found during gastroscopy, it is most likely to be "esophageal achalasia".

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[Instant News/Comprehensive Report] Do you have difficulty swallowing?

There are many causes of dysphagia, and it is not easy to clarify, and it is even difficult to distinguish it from common gastrointestinal diseases such as gastroesophageal reflux.

Ye Jiachu, attending physician of the Department of Hepatobiliary and Gastroenterology at Haoxingan Outpatient Center and part-time attending physician of the Department of Internal Medicine of National Taiwan University Hospital, pointed out that if no obvious obstructive cause can be found during gastroscopy, it may be a relatively rare primary esophageal motility disorder. "Esophageal achalasia" is the most common cause.

The latest research has found that the chance of esophageal cancer in such patients increases, which may be related to the change of esophageal microflora!

Dr. Ye Jiaqu pointed out that the cause of esophageal achalasia is the weak peristalsis of the esophageal body and the abnormal relaxation of the lower esophageal sphincter, which leads to the gradual occurrence of dysphagia, weight loss, and even gradual enlargement and distortion of the esophagus. In the long run, the chance of esophageal cancer also increase.

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In addition, such patients are also affected by the long-term retention and fermentation of food in the esophagus and chronic inflammation of the mucosa, which in turn affects the composition of the patient's esophageal microflora.

However, in the past, there were few studies on the composition of the microflora of various esophageal diseases. Dr. Yeh focused on this topic when he was studying in the master's class of the Institute of Clinical Medicine, National Taiwan University School of Medicine. Under the in-depth study, complete the dissertation to obtain a master's degree.

Under the cooperation of National Taiwan University Hospital and Haoxingan Clinic, the microflora of esophagus was sampled and analyzed using esophageal cell brush, and the microflora characteristics of patients with esophageal achalasia and the microflora of esophagus before and after transoral endoscopic myotomy were analyzed. flora changes.

The results found that the composition of the esophageal microflora of the patients was significantly different from that of the healthy adult group, and the highest proportion was Lactobacillus, which can produce nitrosamine compounds in the acidic environment of the esophagus, which is carcinogenic. May increase the risk of esophageal cancer.

However, after the patient underwent endoscopic myotomy, the proportion of Lactobacillus in the esophagus decreased significantly, while the proportion of Neisseria increased. Long-term follow-up should not be ignored.

In short, patients with esophageal achalasia have their special microflora composition characteristics due to changes in the local environment of the esophagus, and may be associated with an increased risk of long-term esophageal cancer, but the causality still needs to be verified.

The results of this study are unique and have attracted the attention of academic circles at home and abroad. In April 2023, they were published in the "Journal of Gastroenterology and Hepatology", the official medical journal of the Asia Pacific Gastroenterology Association.

Dr. Ye Jiaqu reminded that patients with dysphagia should go to a medical institution for further examinations (such as gastroscopy, esophageal photography, esophageal pressure examination, etc.) to confirm the cause. Its stagnant esophageal environment avoids long-term complications.