A Patient With Dysphagia Associated With Opioid Medication

CC This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons. org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Figure 1. Esophageal manometry at first visit showed increased mean distal esophageal amplitude of 213.0 mmHg with intact peristalsis. Figure 2. Follow-up esophageal manometry showed decreased mean distal esophageal amplitude of 161.6 mmHg. A 40-year-old male visited Asan Medical Center complaining of dysphagia, which he had experienced for about six months. His medical history indicated that he had suffered from pulmonary tuberculosis with destructive lung, and took various medications to control his chronic cough. He denied any symptom of heartburn or acid regurgitation. Upper endoscopy findings were normal. The barium esophagogram showed no definite abnor-malies. However, esophageal manometry revealed nutcracker esophagus with a mean distal esophageal amplitude of 213.0 mmHg (resting lower esophageal sphincter pressure was 22.9 mmHg). He was taking many medications as needed, including codeine 20 mg, to control his frequent cough (more than 10 times/day). He also complained of chronic constipation after taking too many codeine tablets. At his second visit, he was in