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Esophageal achalasia with severe malnutrition and liver enzyme elevation

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Abstract

A 70-year-old woman presented dysphagia and postprandial vomiting, and weight loss of about 15 kg in one year. She was markedly emaciated with a body mass index of 12.4 kg/m2 and had difficulty in movement. Esophagogastroduodenoscopy and computed tomography revealed stenosis of the esophagogastric junction (EGJ) with no malignant findings. Additionally, based on the findings of the esophagogram and high-resolution manometry, the patient was diagnosed with esophageal achalasia. The patient also had an elevation in liver enzymes but was ruled out alcoholic, drug-induced, viral, or other hepatitis. It was considered that malnutrition caused by esophageal achalasia led to a rise in liver enzymes. After the onset of nutritional therapy, the liver enzyme elevation deteriorated, electrolyte abnormalities and hypoglycemic attacks occurred frequently. She had developed the refeeding syndrome, thus feeding was reduced, but the condition deteriorated further and the liver enzymes reached a peak. These findings were assumed to be due to persistent malnutrition, and normalized with gradually increased nutrition. After improving the general condition, per-oral endoscopic myotomy (POEM) was performed. After POEM, her dysphagia disappeared and nutritional state completely improved. Careful nutritional therapy improved her general condition, and POEM improved gastrointestinal symptoms and prevented the recurrence of malnutrition.

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Acknowledgements

The authors would like to express their deep appreciation to all the endoscopy medical staff and ward staff at Fukushima Medical University Hospital for their assistance with the endoscopic procedures and the care of this patient. Moreover, we would also like to thank Enago (http://www.enago.jp) for proofreading the manuscript.

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Authors and Affiliations

  1. Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan

    Yutaro Takeda, Minami Hashimoto, Manabu Hayashi, Jun Nakamura, Mika Takasumi, Tsunetaka Kato, Ryoichiro Kobashi, Rei Suzuki, Mitsuru Sugimoto, Yuki Sato, Hiroki Irie, Yoshinori Okubo, Mai Murakami, Tadayuki Takagi & Hiromasa Ohira

  2. Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan

    Takuto Hikichi, Minami Hashimoto, Jun Nakamura, Tsunetaka Kato, Ryoichiro Kobashi, Yoshinori Okubo & Masao Kobayakawa

  3. Medical Research Center, Fukushima Medical University, Fukushima, Japan

    Masao Kobayakawa

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  1. Yutaro Takeda
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  2. Takuto Hikichi
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  3. Minami Hashimoto
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  10. Mitsuru Sugimoto
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  11. Yuki Sato
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  15. Tadayuki Takagi
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  16. Masao Kobayakawa
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  17. Hiromasa Ohira
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Contributions

The conception and design of this report were carried out by YT, TH, MH and MH. Endoscopic procedures were performed by YT, MH, JN. Patient management was conducted by YT, MH, MH, JN, MT, TK, RK, RS, MS, YS, HI, YO, MM, and TT. The first draft of the manuscript was written by YT, TH, MH, and MH. MK and HO advised on the manuscript. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Takuto Hikichi.

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Conflict of interest

Yutaro Takeda, Takuto Hikichi, Minami Hashimoto, Manabu Hayashi, Jun Nakamura, Mika Takasumi, Tsunetaka Kato, Ryoichiro Kobashi, Rei Suzuki, Mitsuru Sugimoto, Yuki Sato, Hiroki Irie, Yoshinori Okubo, Mai Murakami, Tadayuki Takagi, Masao Kobayakawa, and Hiromasa Ohira declare that they have no conflict of interest.

Human Rights

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed Consent

Informed consent was obtained from this patient for being included in the paper.

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Takeda, Y., Hikichi, T., Hashimoto, M. et al. Esophageal achalasia with severe malnutrition and liver enzyme elevation. Clin J Gastroenterol 15, 345–350 (2022). https://doi.org/10.1007/s12328-021-01576-3

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  • DOI: https://doi.org/10.1007/s12328-021-01576-3

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