Usefulness of the Comprehensive Evaluation of the Sequential Approach from the Abdomen to the Neck for Esophageal Achalasia: A Case Report

Abstract

Esophageal achalasia, a rare functional disease, causes esophageal dyspepsia and abnormal esophageal dilatation due to inadequate relaxation of the lower esophageal sphincter resulting from the degeneration or loss of Auerbach’s plexus and is considered a risk factor for esophageal squamous cell carcinoma. Here, we report the case of a Japanese woman in her 20s who visited our hospital approximately 1 year ago with complaints of chest tightness and pericardial discomfort while lying down at night, which gradually worsened over the past year. Abdominal ultrasonography revealed an esophagogastric junction between the left lobe of the liver and the abdominal aorta on the longitudinal scan of the orbitofemoral region, with a clear wall structure and absence of a dilated image, although slight wall thickening was observed. The lower thoracic esophagus was dilated to a maximum size of 35 mm and narrowed smoothly toward the esophagogastric junction with retention of contents. Cervical ultrasonography showed that the cervical esophagus was dilated to a maximum size of 34 mm. Subsequent esophageal fluoroscopy revealed a funnel-shaped stricture at the esophagogastric junction, leading to a diagnosis of grade III sigmoid esophageal achalasia. Further, a pregnancy test conducted at the same time was positive, and the patient underwent endoscopic balloon dilatation after delivery, which improved achalasia. Although esophagography is necessary for the diagnosis and follow-up of esophageal achalasia, a sequential approach consisting of ultrasonography from the abdomen to the neck may be useful in cases where radiation exposure should be avoided, particularly during pregnancy.