| An 82 year
old patient with past history of active smoking
(20 cigs/day). He reported 5 months of
progressive dysphagia initially only with solids
and for the last week also with liquids. This
was associated with repeated vomiting of foamy
and enteric contents. He also reported
weight loss of some 8 kg since the initial symptoms.
He did not report any other symptoms. The
physical examination revealed a cutaneous dehydration
with positive skin fold sign.
With the suspicion of oesophageal dysmotility
secondary to oesophageal adenocarcinoma, fibrogastroscopic
evidence of a dysmotile oesophagus was found,
but without presence of a tumour. The
barium swallow shows the presence of achalasia
with food retention in the oesophagus. Oesophageal
manometry reports a hypertonic lower oesophageal
sphincter (LES) with tertiary waves of low amplitude
in body of the oesophagus consistent with the
diagnosis of achalasia. Balloon dilatation
is subsequently carried out via gastroscopy with
success. The progress of the patient is
satisfactory with total remission of the current
symptoms.
Authors:
Álvaro Flamarique Pascual
MIR Servicio de Medicina Interna
Isabel Izquierdo García
MIR Servicio de Hematología
Hospital Clínico Universitario "Lozano
Blesa"
Zaragoza
Translation: Kelly
Watt |
