OJGas  Vol.2 No.4 , November 2012
Barrett’s esophagus following treatment of achalasia with botulinum toxin
ABSTRACT
Achalasia is an uncommon primary motor disorder of the esophagus with an annual incidence of 0.8/100,000. Very few cases of coexistent Barrett’s esophagus (BE) and achalasia in patients without prior surgical myotomy or pneumatic dilation have been reported. We report the case of a 65 year old female who was diagnosed with achalasia in June 2002. Endoscopy at that time revealed biopsy-confirmed normal esophageal mucosa. The patient subsequently underwent two trials of botox injection with progressively worsening dysphagia. A repeat endoscopy two years later showed a short segment of salmon-colored mucosa in the distal esophagus which was biopsy-confirmed Barrett’s epithelium with no dysplasia. The patient eventually underwent laparoscopic Heller myotomy and Toupet fundoplication. Postoperatively, she recovered well and with significant alleviation of her dysphagia. This study reviews reported cases of coexistent achalasia and BE, and discusses possible etiologies of concurrent BE and achalasia, and implications for treatment.

Cite this paper
Wells, C. , Carpenter, S. , Huguet, K. , Krochmal, D. , Fleischer, D. and Harold, K. (2012) Barrett’s esophagus following treatment of achalasia with botulinum toxin. Open Journal of Gastroenterology, 2, 168-171. doi: 10.4236/ojgas.2012.24032.
References
[1]   Spiess, A.E. and Kahrilas, P.J. (1998) Treating achalasia: From whalebone to laparoscope. The Journal of the American Medical Association, 280, 638-642. doi:10.1001/jama.280.7.638

[2]   Reynolds, J.C. and Parkman, H.P. (1989) Achalasia. Gas-troenterology Clinics of North America, 18, 223-255.

[3]   Goldblum, J.R., Whyte, R.I., Orringer, M.B., et al. (1994) Achalasia. A morphologic study of 42 resected specimens. The American Journal of Surgical Pathology, 18, 327- 337. doi:10.1097/00000478-199404000-00001

[4]   Singaram, C., Koch, J., Gaumnitz, E.A., et al. (1996) Nature of neuronal loss in human achalasia. Gastroenterology, 110, A259.

[5]   Spechler, S.J. (2002) Clinical practice. Barrett's Esophagus. The New England Journal of Medicine, 346, 836- 842. doi:10.1056/NEJMcp012118

[6]   Goldblum, J.R. (2003) Barrett’s esophagus and Barrett’s-related dysplasia. Modern Pathology, 16, 316-324. doi:10.1097/01.MP.0000062996.66432.12

[7]   Sprung, D.J. and Gibb, S.P. (1985) Barrett’s esophagus in a patient with achalasia. American Journal of Gastroen-terology, 80, 330-333.

[8]   Lee, F.I. and Bellary, S.V. (1991) Barrett’s esophagus and achalasia: A case report. Journal of Clinical Gastro-enterology, 13, 559-561. doi:10.1097/00004836-199110000-00017

[9]   Spechler, S.J., Souza, R.F., Rosenberg, S.J., et al. (1995) Heartburn in patients with achalasia. Gut, 37, 305-308. doi:10.1136/gut.37.3.305

[10]   Locke, M., Bank, S., Gross, C., et al. (1997) Long segment Barrett’s esophagus in a young patient with achalasia. American Journal of Gastroenterology, 92, 1596.

[11]   Ter, R.B., Govil, Y.K., Leite, L., et al. (1999) Adenos-quamous carcinoma in Barrett’s esophagus presenting as pseudoachalasia. American Journal of Gastroenterology, 94, 268-270. doi:10.1111/j.1572-0241.1999.00813.x

[12]   Tanigawa, H., Kida, Y., Kuwao, S., et al. (2002) Hepatoid adenocarcinoma in Barrett’s esophagus associated with achalasia: First case report. PATH International, 52, 141-146. doi:10.1046/j.1440-1827.2002.01328.x

[13]   Guo, J.-P., Gilman, P.B., Thomas, R.M., et al. (2002) Barrett’s esophagus and achalasia: A report of two cases and review of the literature. Journal of Clinical Gastro-enterology, 34, 439-443. doi:10.1097/00004836-200204000-00011

[14]   Ormsby, A.H., Kilgore, S.P., Goldblum, J.R., et al. (2000) The location and frequency of intestinal metaplasia at the esophagogastric junction in 223 consecutive autopsies: Implications for patient treatment and preventive strategies in Barrett’s esophagus. Modern Pathology, 13, 614- 620. doi:10.1038/modpathol.3880106

[15]   Rex, D.K., Cummings, O.W., Shaw, M., et al. (2003) Screening for Barrett’s esophagus in colonoscopy patients with and without heartburn. Gastroenterology, 125, 1670-1677. doi:10.1053/j.gastro.2003.09.030

[16]   Howard, P.J., Maher, L., Pryde, A., et al. (1992) Five year prospective study of the incidence, clinical features, and diagnosis of achalasia in Edinburgh. Gut, 33, 1011-1015. doi:10.1136/gut.33.8.1011

[17]   Smart, H.L., Foster, P.N., Evans, D.F., et al. (1987) Twenty- four-hour acidity in achalasia before and after pneumatic dilation. Gut, 28, 883-887. doi:10.1136/gut.28.7.883

[18]   Fitzgerald, R.C., Omary, M.B. and Triadafilopoulos, G. (1996) Dynamic effects of acid on Barrett’s esophagus. An ex vivo proliferation and differentiation model. The Journal of Clinical Investigation, 98, 2120-2128. doi:10.1172/JCI119018

[19]   Katz, P.O., Richter, J.E., Cowan, R., et al. (1986) Apparent complete lower esophageal relaxation in achalasia. Gastroenterology, 90, 978-983.

[20]   Shoenut, J.P., Micflikier, A.B., Yaffe, C.S., et al. (1995) Reflux in untreated achalasia patients. Journal of Clinical Gastroenterology, 20, 6-11. doi:10.1097/00004836-199501000-00004

[21]   Richards, W.O., Torquati, A., Holzman, M.D., et al. (2004) Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: A prospective randomized double-blind clinical trial. Annals of Surgery, 240, 405-415. doi:10.1097/01.sla.0000136940.32255.51

[22]   Harold, K.L., Matthews, B.D., Kercher, K.W., et al. (2003) Surgical treatment of achalasia in the 21st century. Southern Medical Journal, 96, 1-5.

 
 
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