Pneumatic dilatation for achalasia after fundoplication.

Area of Science:

• Gastroenterology
• Esophageal Motility Disorders

Background:

• Achalasia is a primary esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter.
• Antireflux procedures are sometimes mistakenly performed for achalasia, misdiagnosed as gastroesophageal reflux disease (GERD).
• Such interventions without addressing the underlying achalasia can lead to worsened dysphagia.

Observation:

• This report details two cases of patients with achalasia who underwent antireflux procedures without myotomy.
• These patients experienced a worsening of their dysphagia post-procedure.
• The medical literature offers limited guidance on managing this specific iatrogenic complication.

Findings:

• Pneumatic dilatation was employed as a management strategy in both described cases.
• Symptomatic improvement in dysphagia was observed following pneumatic dilatation in these patients.
• Accurate diagnosis is crucial to avoid this complication.

Implications:

• Careful clinical assessment, including detailed history and barium esophagram, is essential for correct achalasia diagnosis.
• Esophageal motility studies are vital to differentiate achalasia from GERD and prevent misdiagnosis.
• Prompt and accurate diagnosis can avoid iatrogenic worsening of dysphagia in achalasia patients.