Pseudo-achalasia in chronic idiopathic pseudo-obstruction

We report the case of a 31 years old woman with a clinical diagnosis of achalasia. Since 1981 pneumatic dilatations of the lower esophageal sphincter were performed with improvement of the dysphagia. Because the dysphagia symptoms appeared in shorter periods of time, a myotomy of the lower esophageal sphincter and a fundoplication were performed in September 1991. Because of the functional and mechanic motility disorder of the esophagus, the fundoplication was disintegrated in May 1993. Two weeks later the patient developed an acute abdomen on account of adhesions. In August 1993 the predominant symptoms were non-cardiac chest pain, constipation and abdominal pain. Antro-duodenal manometry showed the typical motility pattern of chronic intestinal pseudoobstruction. We demonstrate a chronic intestinal pseudo-obstruction with predominating es' esophageal symptoms because of the rarity of this disease and the difficulties in finding the correct diagnosis.