Idiopathic Achalasia Primarily Diagnosed as Bulimia Nervosa: the Importance of the Nutrologyst

Idiopathic achalasia is a primary esophageal motor disorder characterized by esophageal aperistalsis and abnormal lower esophageal sphincter relaxation in response to deglutition. Bulimia nervosa is an eating disorder, which amongst other symptoms presents with self-induced vomiting after repetitive episodes of binge eating in order to prevent weight gain. The present study reports the case of a female patient initially diagnosed with bulimia nervosa, after ruling out an etiology of organic cause through lab tests and endoscopy. The patient was referred to a nutrologyst for treating the eating disorder, and after nutritional evaluation, she received nutritional supplementation due to severe dysphagia, regurgitation and weight loss. As diagnostic criteria of bulimia nervosa were not met, a further investigation was conducted, which eventually confirmed idiopathic achalasia through two specific tests: digital esophagogastroduodenal seriography, and esophageal manometry. Chagas disease, the major cause of idiopathic achalasia in Brazil, was ruled out by specific lab test. In view of the severity of the disease, the patient underwent urgent cardiomyotomy and fundoplication. Later, balloon dilators were also used in two occasions. After sixteen months of medical and nutrology follow-up, the patient now is in good nutritional status and was able to go back to her daily activities and healthy lifestyle.