title: Achalasia cardia with esophageal varix managed with endoscopic ultrasound-guided botulinum toxin injection.
abstract: Achalasia cardia is a motility disorder of the esophagus characterized by failure of relaxation of the lower esophageal sphincter. Nitrates and calcium channel blockers, pneumatic dilatation, botulinum toxin injection and surgical myotomy have been described in literature as possible management options. We present a patient who presented with achalasia and was co-incidentally diagnosed to have cryptogenic cirrhosis with portal hypertension and had esophageal varices. This clinical combination precluded the use of pneumatic dilatation and surgical myotomy. We injected botulinum toxin into the lower esophageal sphincter using a celiac plexus neurolysis needle under endoscopic ultrasound guidance; the clinical response was good.
authors.affiliation: Asian Institute of Gastroenterology, Somajiguda, Hyderabad, India. sandeeplakhtakia@rediffmail.com
authors.forename: Sandeep
authors.initials: S
authors.lastname: Lakhtakia
authors.forename: Amitabh
authors.initials: A
authors.lastname: Monga
authors.forename: Rajesh
authors.initials: R
authors.lastname: Gupta
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kalpala
authors.forename: Nitesh
authors.initials: N
authors.lastname: Pratap
authors.forename: Eric
authors.initials: E
authors.lastname: Wee
authors.forename: Saravanan
authors.initials: S
authors.lastname: Arjunan
authors.forename: D Nageshwar
authors.initials: DN
authors.lastname: Reddy
mesh_terms: D018726:Anti-Dyskinesia Agents / Q000008:administration & dosage; D001905:Botulinum Toxins / Q000008:administration & dosage*; D002299:Cardia / Q000503:physiopathology; D002447:Celiac Plexus / Q000187:drug effects / Q000503:physiopathology; D019160:Endosonography / Q000379:methods*; D004931:Esophageal Achalasia / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D049630:Esophageal Sphincter, Lower / Q000187:drug effects / Q000503:physiopathology; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins