Duplication of the pylorus found concomitantly with achalasia: congenital or peptic etiology?

Double Pylorus: Report of a Case With Endoscopic Follow-Up and Review of the Literature

Double pylorus is a rare endoscopic finding that has been reported in 0.001% to 0.4% of upper gastrointestinal endoscopies and can be either congenital or acquired. Acquired double pylorus is usually an uncommon complication of peptic ulcer that erodes and creates a fistula between the duodenal bulb and the prepyloric antrum. We describe a case of a 67-year-old man who experienced mild epigastric pain and dyspepsia over the last 6 months. The patient periodically took nonsteroidal anti-inflammatory drugs (NSAIDs) due to joint pain. Esophagogastroduodenoscopy revealed gastritis and a double pylorus. An accessory channel connected the lesser curvature of the prepyloric antrum to the duodenal bulb and the endoscope was able to be passed through both of the ducts. The Helicobacter pylori quick test proved positive. Two years later, a follow-up endoscopy showed that fistula fused with normal pylorus and there was a single large opening.

Achalasia: will genetic studies provide insights?

Despite increasing understanding of the pathophysiology of achalasia, the etiology of this esophageal motility disorder remains largely unknown. However, the occurrence of familial achalasia and its association with well-defined genetic syndromes suggest the involvement of genetic factors. Mutant mouse models display gastrointestinal disturbances that are similar to those observed in achalasia patients. The candidate gene approach has revealed some promising results; however, it has not established conclusive links to specific genes so far. The aim of this review was to summarize current knowledge of the genetics of achalasia. We also discuss the extent to which our understanding of achalasia is likely to be enhanced through future molecular genetic research.

Achalasia: will genetic studies provide insights?

Despite increasing understanding of the pathophysiology of achalasia, the etiology of this esophageal motility disorder remains largely unknown. However, the occurrence of familial achalasia and its association with well-defined genetic syndromes suggest the involvement of genetic factors. Mutant mouse models display gastrointestinal disturbances that are similar to those observed in achalasia patients. The candidate gene approach has revealed some promising results; however, it has not established conclusive links to specific genes so far. The aim of this review was to summarize current knowledge of the genetics of achalasia. We also discuss the extent to which our understanding of achalasia is likely to be enhanced through future molecular genetic research.

The clinical significance and natural history of the double pylorus

The double pylorus is a fistulous communication between the gastric antrum and duodenal bulb. In most instances, it is believed to be a complication of peptic ulcer disease. In prior reports, the longest follow-up has been only 5 years. We report four cases of double pylorus, three of which have been followed medically (one for 7 years), and a fourth which required surgery for recurrent pain after 10 years of medical treatment. In previously reported cases, only 20% have required surgery, usually for refractory symptoms, whereas 80% of patients have been managed medically and have been free of complications. In one of our cases, the mucosal bridge separating the pylorus from the fistula perforated, with coalescence of the two channels into one large gastroduodenal passage. There were no serious clinical symptoms or sequelae caused by this additional destruction of tissue. We conclude that the double pylorus is a destructive but relatively benign complication of peptic ulcer disease.

Multiple congenital anomalies associated with infantile achalasia

Achalasia is rare in the pediatric age group, particularly in the neonate and young infant. The symptoms are often nonspecific and may not even suggest a primary esophageal disorder. This is a report of two cases of achalasia seen in neonates, both of whom has other unusual and exceedingly uncommon congenital abnormalities.