Post-myotomy achalasia complicated by squamous cell carcinoma of the esophagus: A case report

Abstract

Achalasia is a primary motility disorder of the esophagus characterized by aperistalsis in the distal two thirds of the body and abnormal lower esophageal relaxation with swallows. Esophageal cancer has been reported in patients with achalasia and esophageal squamous cell carcinoma commoner than adenocarcinoma. Patients with achalasia estimatedly have a 33 times higher likelihood of developing esophageal cancer than general population. The disease manifests more than two decades after onset of achasia symptoms. Proposed mechanisms adduced to the malignant transformation in achalasia include food stasis, bacterial overgrowth, chronic inflammation, mucosal irritation leading to dysplastic changes and malignant transformation. Esophageal myotomy has not been shown to lower this risk, therefore lifelong medical surveillance mostly endoscopically is of paramount importance in patients with achalasia

Key words: achalasia, esophageal cancer, dysphagia