Intrasphincteric Botulinum Toxin Injections to Treat Achalasia Diagnosed in Pregnancy A Case Report

BACKGROUND: Achalasia is an esophageal smooth muscle disorder characterized by failure of the lower esophageal sphincter to relax with swallowing. CASE: A 17-year-old primigravid woman with an intrauterine pregnancy at 31+3 weeks reported an unintentional 22.5 kg weight loss in 2 years. Her body mass index was 15.9. Her symptoms included nausea, regurgitation, and worsening dysphagia. MRI suggested achalasia. She was started on total parenteral nutrition until she developed bacteremia. An esophagogastroduodenoscopy with Duotube placement and botulinum toxin A injections were performed. Tube feeds were initiated and continued until the Duotube became obstructed. The patient delivered at 37 + 4 weeks with mild preeclampsia. A postpartum barium swallow test indicated achalasia. CONCLUSION: A history of dysphagia to solids and/or liquids with weight loss should raise clinical suspicions for achalasia.