Achalasia: It ’s Not All About the Lower Esophageal Sphincter

Question: A 66-year-old man with cirrhosis secondary to hepatitis C (complicated with development of esophageal varices) and achalasia (diagnosed in 1980s, failed Botox injections, pneumatic dilatation, calcium channel blockers, and now status post  percutaneous endoscopic gastrostomy tube placement for feedings) presented as a referral for evaluation and management of achalasia. He was deemed to be a very high-risk surgical myotomy candidate owing to cirrhosis and signs of portal hypotension (platelets of 55,000 and International Normalized Ratio of 1.4).
Source: Gastroenterology - Category: Gastroenterology Authors: Tags: Electronic Clinical Challenges and Images in GI Source Type: research