Achalasia cardia associated with esophageal varices: a therapeutic dilemma.
A 63-year-old male, chronic alcohol consumer, presented with progressively increasing dysphagia of 6 months duration. Upper gastrointestinal endoscopy revealed dilated esophagus with residue along with esophageal varices. Esophageal manometry revealed findings suggestive of classic achalasia cardia. Endoscopic ultrasound (EUS) examination revealed peri-esophageal collaterals as well as prominent perforators at lower end of esophagus. The co-existence of varices with achalasia is very rare and this case posed a difficult therapeutic dilemma as risk of bleeding from the varices limited the treatment options available. This case was successfully treated with EUS-guided botulinum toxin injection.
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research -PGIMER (Surinder Singh Rana, Deepak Kumar Bhasin, Chalapathi Rao, Kartar Singh), Chandigarh, India.
Surinder Singh
SS
Rana
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research -PGIMER (Surinder Singh Rana, Deepak Kumar Bhasin, Chalapathi Rao, Kartar Singh), Chandigarh, India.
Deepak Kumar
DK
Bhasin
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research -PGIMER (Surinder Singh Rana, Deepak Kumar Bhasin, Chalapathi Rao, Kartar Singh), Chandigarh, India.
Chalapathi
C
Rao
Sarwal Gastroenterology Centre (Rajiv Sarwal), Chandigarh, India.
Rajiv
R
Sarwal
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research -PGIMER (Surinder Singh Rana, Deepak Kumar Bhasin, Chalapathi Rao, Kartar Singh), Chandigarh, India.
Kartar
K
Singh
Achalasia cardia; cirrhosis; endoscopic ultrasound; varices