ACHALASIA IN A YOUNG PATIENT: CASE REPORT (Atrena Editora)

Abstract

Introduction: Achalasia (ACL) is the most common primary motor disorder of the esophagus. Common after the 5th decade of life, it affects both sexes equally. Only 10% are described as idiopathic, where the inhibitory innervation is the most compromised, thus resulting in greater cholinergic activity. The remainder is attributed to chagasic esophagopathy. Dysphagia and regurgitation make up the main symptomatology and, weight loss with consequent malnutrition, the complications. Diagnosis is made by endoscopy, contrast radiology and esophageal manometry (EMN). Thus, in the face of suspicion, it is necessary to review the literature for an accurate diagnosis and effective treatment. Objective: to report a case of ACL in a young patient. Method: review of medical records and literature. Results: D.A.S.S., female, 27 years old, was referred to the gastroenterology clinic with a complaint of dysphagia for 2 years. Associated, there was weight loss, regurgitation and emesis; occasional retrosternal pain and constipation. Having already made use of proton pump inhibitors and prokinetics without success, she was referred for upper digestive endoscopy (EDA) which observed food residues in the esophagus. Afterwards, an esophagogram (EFG) was performed, which defined megaesophagus. Subsequently submitted to MNE, she was diagnosed with lower esophageal sphincter (LES) with normal basal pressure, without complete relaxation, in addition to esophageal body with simultaneous waves. She was referred to the digestive surgery outpatient clinic. Discussion: ACL is not frequent in young people. Diagnosis is delayed by up to 5 years. The first exam must be the EDA. The EFG demonstrates “bird's beak”, and the MNE, aperistaltic or simultaneous waves in addition to absent or incomplete relaxation of the LES. The definitive treatment is surgical. Conclusion: When in elderly people with Chagas' esophagopathy, the diagnosis of ACL is common. However, when it affects young people, there is a need for a study to exclude confounding factors, perform the correct choice and interpretation of exams, so that the diagnosis and treatment are effective.