Korean J Gastroenterol.  2024 Jan;83(1):23-27. 10.4166/kjg.2023.112.

A Case of Type II Achalasia Occurring in a Nonagenarian Diagnosed with Acute Food Impaction

• Koh SH
• Park MI
• Jung WH
• Jung K
• Kim SE
• Moon W
• Park SJ

• KMID: 2552239
• DOI: http://doi.org/10.4166/kjg.2023.112

Abstract

Achalasia is an esophageal motility disorder characterized by loss of esophageal peristalsis and impaired relaxation of the lower esophageal sphincter. Patients with achalasia often complain of persistent symptoms for several years before diagnosis. On the other hand, achalasia diagnosed as a sudden esophageal food impaction is uncommon, and no report has been issued on the diagnosis and successful treatment of achalasia in a 95-year-old patient. We report a case of achalasia diagnosed by high-resolution esophageal manometry and timed barium esophagography after food material removal by endoscopy in a 95-year-old woman who visited the hospital due to sudden esophageal food impaction and was successfully treated by endoscopic balloon dilatation.

Figure

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  Fig. 1 Chest contrast CT image showing diffuse esophageal dilatation with food impaction.

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  Fig. 2 Endoscopic findings. (A) Initial endoscopy revealed diffuse esophageal dilatation with food impaction. (B) Food material was removed using a basket and forceps. (C) A dilated esophageal lumen without food material was observed by follow-up endoscopy.

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  Fig. 3 High resolution manometry showed esophagogastric junction outflow obstruction. The median integrated relaxation pressure (IRP) was 34.4 mmHg. All swallows resulted in failed peristalsis, and 50 percent of swallows revealed panesophageal pressurization.

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  Fig. 4 Timed barium esophagogram showing tertiary esophageal contraction, minimal contrast stasis, but no definite bird-beak appearance. (A–C) Barium heights after 1, 2, and 5 minutes were 35, 34, and 0 mm, respectively.

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  Fig. 5 Endoscopic pneumatic balloon dilatation. A 30 mm balloon catheter was placed under fluoroscopic guidance on the esophagogastric junction along a guidewire. The balloon was inflated to 15 PSI (pounds per square inch) for 1 minute, to 18 PSI for 2 minutes, and then removed.

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  Fig. 6 Esophagograms obtained before and after balloon dilatation. Follow-up esophagogram obtained after balloon dilatation showing improved contrast media passage.

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