Dysphagia Megalatriensis in an 87-Year-Old Woman
Bibliographic record
Abstract
Dysphagia megalatriensis is a rare cause of esophageal dysphagia caused by left atrial enlargement (LAE). LAE is often caused by chronic atrial fibrillation, chronic hypertension and left ventricular dysfunction, or mitral valvulopathy. Here, we report a case of an 87-year-old female presenting with a 4-week history of progressive dysphagia and odynophagia to solid foods and a 2-week history to liquids. The patient had intermittent nausea and vomiting for the past 6 months, accompanied by an unintentional weight loss of 40 lbs over the same time period. This had worsened since the onset of the chest pain and she now experienced daily vomiting. Her past medical history was significant for hypertension, coronary artery disease, atrial fibrillation (AF) requiring AV node ablation with pacemaker insertion, and COPD. Echocardiography revealed a severely enlarged left atrium with patent foramen ovale, mitral annular calcification, severe TR and an elevated pulmonary artery systolic pressure of 77 mmHg. This case highlights the importance of dysphagia megalatriensis as a pertinent differential to consider in patients with long-standing cardiac conditions presenting with dysphagia and the importance of utilizing the Canadian Association of Gastroenterology’s diagnostic approach to uninvestigated dysphagia to come to the appropriate diagnosis. Additionally, we discuss the merits of rate vs. rhythm control in patients with AF-induced LAE. While there is some data to suggest that rhythm control is associated with poor outcomes in patients with normal to mild LAE, there is limited information is available on patients with existing LAE who would likely benefit from rhythm control.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".