Background :
Achalasia is a rare disorder with characteristic features of impaired distal esophageal peristalsis and lower esophageal sphincter relaxation. Secondary achalasia after spinal cord injury has been more rarely reported in the literature. We report a case of achalasia after Cervical spinal cord injury.
Case description :
A 55-year-old man with spinal cord injury C6 American spinal injury association (ASIA) D admitted our hospital 9 months after the onset. He sustained C6 and C7 fracture due to fall down and had anterior and posterior fusion operation. After injury, he complained of swallowing difficulty and intermittent regurgitation of both solids and liquids. Despite of these symptoms, he was never tested for 9 months and received conservative medication care. For further evaluation, we first performed Video Fluoroscopic Swallowing Study and observed regurgitation of fluid and rice after swallowing. Esophagogastroduodenoscopy was performed to rule out gastric malignancy or any structural deformity, there was no abnormality. On Esophagography, however, diffuse esophageal spasm and distal esophagus obstruction was observed and manometry was recommended. Finally on esophageal manometry, Type III Achalasia (Elevated median integrated relaxation pressure (IRP, 73.6mmHg) of lower esophageal sphincter (LES) and esophago-gastric junction (EGJ) tone (79.9mmHg)) was diagnosed. For treatment, we prescribed sublingual calcium channel blocker before meal. After that, both intensity and frequency of food regurgitation were partly relieved. After 3-months, follow up manometry showed decreased IRP (32.8mmHg) of LES and EGJ tone (43.7mmHg) than former test.
Conclusion :
The possibility of esophageal motility disorders should be kept in mind for swallowing difficulty that occur after cervical spinal cord injury, and further examination should be considered.
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