Rare case of upper gastrointestinal bleeding in achalasia

Abstract

Achalasia is a prototypic esophageal motility disorder with complications including aspiration-pneumonia, esophagitis, esophageal-tracheal fistula, spontaneous rupture of the esophagus, and squamous cell carcinoma. However, achalasia is rarely associated with esophageal stones and ulcer formation that lead to upper gastrointestinal bleeding. Here, we report the case of a 61-year-old woman who was admitted to our department after vomiting blood for six hours. Physical examination revealed that the patient had severe anemia and mild palpitation in the upper abdomen. CT revealed lower esophageal dilatation and esophageal wall thickening, and an emergency upper endoscopy showed that the esophagus was substantially expanded by a dark round stone, with multiple ulcers on the esophageal wall and a slit in the cardiac mucosa with a large clot attached. The patient’s history included ingestion of 1 kg hawthorn three days prior. The acute upper gastrointestinal bleeding was caused by Mallory-Weiss syndrome associated with achalasia and an esophageal stone. For patients with achalasia, preventing excessive ingestion of tannins is crucial to avoid complications such as bleeding and rupture.

Keywords: Achalasia; Esophageal stone; Mallory-Weiss syndrome; Upper gastrointestinal bleeding

Core tip: Achalasia is the prototypic esophageal motility disorder that leaves patients at risk for various complications. This is a rare report of long-term achalasia associated with esophageal stone and ulcer formation leading to upper gastrointestinal bleeding caused by Mallory-Weiss syndrome. This paper highlights the importance of avoiding excess tannin ingestion for patients with achalasia to prevent the development of complications such as bleeding and rupture.