[Generalized weakness in pre-existing achalasia]

Several endoscopic dilatations of the distal esophagus had been performed on this 77 year old woman with achalasia and secondary epiphrenic diverticulum. At present, swallowing was not essentially hampered and the body weight was stable. She was admitted for general weakness and a fall. The investigations revealed a traumatic pelvic fracture, as well as microcytic hypochromic anemia and marked hypoproteinemia. Endoscopy of the upper gastrointestinal tract showed an extreme inflammatory reaction of the mucosa. It was postulated that bacterial overgrowth had spread from the esophageal diverticulum to the upper intestinal tract and induced infectious anemia and protein-loosing enteropathy. Anemia and hypoproteinemia responded well to a treatment with cotrimotazole but relapsed after discontinuation of the antibiotics.