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: Sandeep Lakhtakia, Amitabh Monga, Rajesh Gupta, Rakesh Kalpala, Nitesh Pratap, Eric Wee, Saravanan Arjunan, D Nageshwar Reddy
• Journal: Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology (Indian J Gastroenterol) Vol. 30 Issue 6 Pg. 277-9 (Dec 2011) ISSN: 0975-0711 [Electronic] India
• PMID: 22180005 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anti-Dyskinesia Agents
• Botulinum Toxins

Topics

• Anti-Dyskinesia Agents (administration & dosage)
• Botulinum Toxins (administration & dosage)
• Cardia (physiopathology)
• Celiac Plexus (drug effects, physiopathology)
• Endosonography (methods)
• Esophageal Achalasia (complications, physiopathology, therapy)
• Esophageal Sphincter, Lower (drug effects, physiopathology)
• Esophageal and Gastric Varices (etiology, physiopathology)
• Female
• Humans
• Hypertension, Portal (etiology, physiopathology)
• Liver Cirrhosis (complications, physiopathology)
• Middle Aged
• Nerve Block (methods)
• Treatment Outcome