Achalasia occurring years after acute poliomyelitis

Area of Science:

• Gastroenterology
• Neurology
• Infectious Diseases

Background:

• Idiopathic achalasia is a rare esophageal motility disorder.
• The etiology of achalasia remains largely unknown, with several hypotheses proposed.
• Chagas' disease is a known infectious cause of achalasia.

Observation:

• A 19-year-old female presented with a 4-month history of dysphagia.
• Diagnostic evaluations confirmed idiopathic achalasia.
• The patient had a history of acute poliomyelitis at age three, resulting in leg muscle atrophy.

Findings:

• Clinical, epidemiologic, and serologic tests excluded Chagas' disease.
• The patient's history of poliomyelitis suggests a potential neurological link.
• Poliomyelitis may have caused damage to the dorsal motor nucleus of the vagus nerve, leading to lower esophageal sphincter dysfunction.

Implications:

• This case supports the infective hypothesis for achalasia.
• Poliomyelitis is a potential, previously unrecognized, cause of achalasia.
• Further investigation into viral etiologies of esophageal motility disorders is warranted.