CASE REPORT   

Chirurgia 2020 April;33(2):111-3

DOI: 10.23736/S0394-9508.19.04982-9

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Natural history of achalasia captured

Andreas LARENTZAKIS, Tania TRIANTAFYLLOU ✉, Dimitrios THEODOROU

First Department of Propaedeutic Surgery, Hippocration General Hospital of Athens, Medical School, National and Kapodistrian University of Athens, Athens, Greece

Achalasia of the esophagus is a primary motility disorder involving the smooth muscle layer of the esophagus and the lower esophageal sphincter. Despite the use of novel diagnostic tools such as high-resolution manometry, the disease may remain misdiagnosed for several years. Even after diagnosis, if left untreated, the natural history of achalasia leads to deterioration of both clinical and radiologic image. A female patient complained of dysphagia and weight loss since the age of 20, but it was not until the age of 40 that she agreed to undergo the complete diagnostic workup, which disclosed achalasia of the esophagus. This case report is a presentation of the evolution of the disease after medical, endoscopic and, finally, surgical treatment several years after the initial diagnosis. Laparoscopic myotomy and fundoplication resulted in improvement of her clinical condition. Treatment options of achalasia consist of conservative, endoscopic, and surgical techniques. Laparoscopic myotomy achieves the optimal long-term outcome as it is considered to be up to 90% successful. Although peroral endoscopic myotomy seems to be a promising approach, the literature still lacks long-term results especially regarding postoperative reflux rates. All approaches are thought to be palliative aiming to reduce the severity of symptoms. In the present case we present the natural history of a case diagnosed with achalasia at a young age that gradually underwent all treatment options until the surgical approach improved her symptoms several years after initial diagnosis.

KEY WORDS: Esophageal achalasia; Gastrointestinal motility; Lower esophageal sphincter