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GI snapshot: arrhythmia, dysphagia and weight loss in a 71-year-old man
  1. Martina De Siena1,
  2. Loredana Gualtieri2,
  3. Simone Varca1,
  4. Maria Valeria Matteo1,
  5. Valerio Pontecorvi1,
  6. Vincenzo Bove1,
  7. Cristiano Spada1,
  8. Ivo Boškoski1
  1. 1Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
  2. 2Department of Surgical Sciences, Università degli Studi di Roma La Sapienza, Rome, Italy
  1. Correspondence to Dr Martina De Siena, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy; martinadesiena{at}

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Case presentation

A 71-year-old man presented with a 2-months history of arrhythmia of undetermined cause, dysphagia, vomiting and 10 kg weight loss. The patient’s history was unremarkable except for multinodular goitre and hypertension. Laboratory exams did not demonstrate significant alterations, white cell count was 7.8×109/L (ref range: 4.0–10.0), haemoglobin 16.2 g/L (ref range: 12.0–15.0), platelet 281×109/L (ref range: 150–450), C reactive protein <0.05 mg/L (ref range: <5). Tumour markers were within normal range. An echocardiogram (figure 1) and gastroscopy (figure 2) were performed.

Figure 1

Echocardiogram view: ab-extrinsic atrial compression by a hyperechogenic mass.

Figure 2

Endoscopic appearance at the retroflexion manoeuvre. The figure shows type III or ‘mixed’ paraoesophageal hernia characterised by both the gastro-oesophageal junction and the fundus herniating through the hiatus. The fundus lies above the gastro-oesophageal junction.


What is the clinical problem?


A …

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  • X @ivoboskoski

  • Contributors MDS conceived of the presented idea. LG and SV drafted the manuscript. MVM and VP extrapolated and adapt the figures. VB and IB discussed the results and commented on the manuscript. MDS and CS revised and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests CS is consultant for Medtronic, Pentax, Olympus, Norgine, Alfasigma, Anx Robotics. IB is consultant for Apollo endosurgery. Boston Scientific, Cook Medical, Pentax medical, EndoTools, Microtech, ERBE Elektromedizin. Research grant: Apollo Endosurgery, Erbe, EndoTools.

  • Provenance and peer review Not commissioned; externally peer reviewed.