Challenges in Diagnosis and Treatment of Achalasia Cardia in Uganda: a Case Report of an Adolescent Female Presenting with Dysphagia.(Article)
Achalasia cardia is an esophageal motility disorder resulting from failure of lower esophageal sphincter relaxation.1-3 The exact pathogenesis of achalasia cardia is unclear; however, some evidence suggests neuronal degeneration, autoimmunity, or infectious etiology.1-3 This disorder is relatively rare with an incidence rate of approximately 1/100,000 people per year which increases with age, and it mainly affects adults aged 25-60 years2; with the minority of cases seen among children and adolescents.2,3 Achalasia cardia presents with a wide range of symptoms including dysphagia, heartburn, and postprandial vomiting among others.1-4 In adolescents and young adults, it is commonly misdiagnosed as Gastroesophageal reflux disease or Anorexia nervosa leading to delays in diagnosis.3,4 Treatment options include pharmacologic therapy and surgery, which may be laparoscopic or open surgery.5 Esophageal perforation is a recognized but very rare complication of surgery for achalasia cardia6; therefore, informed consent should be obtained prior to surgery. Early identification of this complication is vital to reduce the associated morbidity and mortality. In this report, we present a challenging case of an adolescent female brought to our surgical service at St. Francis Hospital Nsambya, Uganda and we discuss the clinical presentation, diagnostic workup, and treatment complications encountered during her care.
Authoured by: Brian Bbosa
Academic units: Mother Kevin Post Graduate Medical School