Achalasia during Pregnancy Treated with Botulinum Toxin A Injection at the Lower Esophageal Sphincter

Achalasia is a rare motor disorder of the esophageal smooth muscle that occurs in 1 in 100,000 individuals. The disorder occurs at the level of the lower esophageal sphincter which does not relax normally with swallowing [1]. This leads to progressive dysphagia, chest pain and regurgitation of undigested foods and liquids. The underlying abnormality is loss of intramural neurons and is usually idiopathic. In rare cases, achalasia can be associated with gastric carcinoma infiltration of the esophagus, Chagas’ disease, lymphoma, and neurodegenerative disorders [1]. Achalasia occurs in both males and females and at all ages and therefore, can be an uncommon cause of emesis and poor weight gain during pregnancy. While nausea and vomiting are common conditions of pregnancy, achalasia and other rare gastrointestinal disorders should be considered when vomiting and symptoms during pregnancy are persistent, not associated with the first trimester of pregnancy, and associated with concerning symptoms such as dysphagia, regurgitation of undigested food, and weight loss in particular [2]. Our case describes a severe case of achalasia during the third trimester of pregnancy that was able to be treated non-surgically with endoscopic injection of botulinum toxin A into the submucosal region of the lower esophagus without maternal or infant complications and provides additional evidence for a treatment option in the pregnant patient with achalasia that can be managed in the outpatient setting. CASE PRESENTATION