Mégaœsophage: un cas historique

Abstract

Achalasia, also known as cardiospasm or megaoesophagus is a rare disorder of unknown origin. It is a primary motor disorder of the esophagus characterized by the absence of the esophageal peristalsis and by an incomplete or an absent relaxation of the lower oesophageal sphincter. Common symptoms include dysphagia, regurgitations and retrosternal pain. At an advanced level, fibroscopy can show a dilation of the lower esophagus and a shrinkage that can be easily passed through with a lifting at the level of the cardia. Oesogastroduodenal transit shows esophageal dilation and allows to estimate esophageal evacuation speed. Esophageal manometry is the gold standard diagnostic tool because it can show the absence of esophageal body peristalsis, the elevation of lower esophageal sphincter pressure and the absence of complete relaxation of the lower esophageal sphincter during swallowing. The different therapeutic strategies aim to reduce lower oesophageal sphincter pressure. We report the case of a patient with immense extension of the oesophagus with typical achalasia appearance. The patient aged 33 years had capricious low dysphagia evolving since childhood associated with regurgitations and retrosternal pain within a context of a 10kg weight loss. Clinical examination was unremarkable. Oesophagogastroduodenoscopy (OGD) was performed showing very dilated atonic oesophagus with food stasis and very tight cardia easily passed through with a lifting. EGD-transit showed immense dilation of the oesophagus without oesogastric junction abnormality suggesting achalasia. Surgical treatment was recommended.