Achalasia or not Achalasia-Is it as simple as we think?

_{70 years old male presented with Difficulty in swallowing(Solid+, Liquid+) with Retrosternal pain without regurgitation, weight loss and any significant past history since 6 month.(Ekcardt score – 4)Upper GI scopy showed Normal study.36 channel solid state HRM showed Median IRP 16.9 mm Hg with premature peristalsis with compartmental pressurization in>50% swallows. Impression was given EGJ outflow obstruction with compartmentalized pressurization. HRCT thorax was normal. Trial of PPI given and repeat HRM was advised after 6 months. Took PPI for 2 months but Symptoms were persistent. HRM(36 channel water perfusion)preformed, On wet swallows, showed mean IRP of 10 wet swallows -10 mm Hg, LES pressure – 14.1 mm Hg, 40% swallows showed Ineffective peristalsis(DCI<450).On cookie swallow mean was IRP -9 mm Hg, 100% swallowed showed ineffective peristalsis(DCI<450).Rapid drink challenge(supine position) showed median IRP-14.9 mm Hg, LES pressure – 42 mm Hg, presence of Pan esophageal pressurization. Timed barium esophagogram showed Smooth narrowing at distal esophagus with 11 cm height of barium column at 2 minutes s/o outflow obstruction/achalasia. Achalasia Cardia type II(In evolution) diagnosis was made and managed with 35 mm pneumatic balloon dilatation[Ekcardt score – 0 (2 weeks post dilatation),symptom free].EGJ outflow obstruction can be found in normal individuals, persistent symptoms should be thoroughly investigated. Provocative tests can be helpful in a diagnosis of inconclusive manometric findings. Supportive tests like TBE/EndoFLIP should be performed in such cases. Pneumatic balloon dilatation should be used to manage dysphagia in doubtful cases of achalasia} [1].

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Artikel online veröffentlicht:
27. März 2025

• References

• 1 Yadlapati R, Kahrilas PJ, Fox MR, Bredenoord AJ, Prakash Gyawali C, Roman S, Babaei A, Mittal RK, Rommel N, Savarino E, Sifrim D, Smout A, Vaezi MF, Zerbib F, Akiyama J, Bhatia S, Bor S, Carlson DA, Chen JW, Cisternas D, Cock C, Coss-Adame E, de Bortoli N, Defilippi C, Fass R, Ghoshal UC, Gonlachanvit S, Hani A, Hebbard GS, Wook Jung K, Katz P, Katzka DA, Khan A, Kohn GP, Lazarescu A, Lengliner J, Mittal SK, Omari T, Park MI, Penagini R, Pohl D, Richter JE, Serra J, Sweis R, Tack J, Tatum RP, Tutuian R, Vela MF, Wong RK, Wu JC, Xiao Y, Pandolfino JE.. Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0©. Neurogastroenterol Motil 2021; 33 (1): e14058 Erratum in: Neurogastroenterol Motil. 2024 Feb;36(2):e14179