Achalasia cardia with esophageal varix managed with endoscopic ultrasound-guided botulinum toxin injection.

Abstract
Achalasia cardia is a motility disorder of the esophagus characterized by failure of relaxation of the lower esophageal sphincter. Nitrates and calcium channel blockers, pneumatic dilatation, botulinum toxin injection and surgical myotomy have been described in literature as possible management options. We present a patient who presented with achalasia and was co-incidentally diagnosed to have cryptogenic cirrhosis with portal hypertension and had esophageal varices. This clinical combination precluded the use of pneumatic dilatation and surgical myotomy.We injected botulinum toxin into the lower esophageal sphincter using a celiac plexus neurolysis needle under endoscopic ultrasound guidance; the clinical response was good.
Description
Keywords
Achalasia, Endoscopic ultrasound, Esophageal varices
Citation
Lakhtakia Sandeep, Monga Amitabh, Gupta Rajesh, Kalpala Rakesh, Pratap Nitesh, Wee Eric, Arjunan Saravanan, Reddy D Nageshwar. Achalasia cardia with esophageal varix managed with endoscopic ultrasound-guided botulinum toxin injection. Indian Journal of Gastroenterology. 2011 Nov-Dec; 30(6): 277-279.