Case report: Management of achalasia with esophageal candidiasis and bradycardia at tertiary hospital


Background: Achalasia is rare case with a primary disorder in absence of esophageal peristalsis and relaxation disorders of the lower esophageal sphincter (LES). The etiology remains unclear but several factors is suspected. One of the complications is esophageal candidiasis. This case report is to report one case of achalasia with esophageal candidiasis and bradycardia.
Case report: A male patient 48 years old is referred to tertiary hospital with a diagnosis of esophageal dysphagia suspected of esophageal cancer. Patients were presented with difficulty in swallowing solid food, which kept getting more severe and causing him difficulty in drinking water. The patient experienced weight loss by approximately 17 kg in the past 1 year. After several examinations, the patient's diagnosis is achalasia accompanied by esophageal candidiasis with prerenal acute kidney injury (AKI), hypernatremia, hypokalemia, and hyperchloride ec. dehydration and suspected HIV.
Discussion: the patient was treated with mercury bougienage in 3 stages; the first stage of bougienage with the size of 5.3 mm (16 French) on October 23; the second stage with the size of 6 mm (18 French) and 6.6 mm (20 French) on November 4; and the third stage with the size of 7.4 mm (22 French) and 8 mm (24 French) on November 8. The three bougienage procedures above were successfully carried out, with a gap time of 1 week in between each stage. The patient was scheduled for mercury bougienage and therapy evaluation was also conducted after bougienage using TNE, as well as being monitored and backed up by cardiologist.
Conclusion: After 4 months of treatment, the patient shows no symptoms of achalasia and there was an increase in body weight.


  • Choi, J. H., Lee, C. G., Lim, Y. J., Kang, H. W., Lim, C. Y., & Choi, J.-S. (2013). Prevalence and risk factors of esophageal candidiasis in healthy individuals: a single center experience in Korea. Yonsei Medical Journal, 54(1), 160–165.
  • Eckardt, A. J., & Eckardt, V. F. (2009). Current clinical approach to achalasia. World Journal of Gastroenterology: WJG, 15(32), 3969.
  • Hirano, I., Tatum, R. P., Shi, G., Sang, Q., Joehl, R. J., & Kahrilas, P. J. (2001). Manometric heterogeneity in patients with idiopathic achalasia. Gastroenterology, 120(4), 789–798.
  • Kalantari, M., Hollywood, A., Lim, R., & Hashemi, M. (2020). Mapping the experiences of people with achalasia from initial symptoms to long‐term management. Health Expectations.
  • Krill, J. T., Naik, R. D., & Vaezi, M. F. (2016). Clinical management of achalasia: current state of the art. Clinical and Experimental Gastroenterology, 9, 71.
  • Kumar, P., Mohan, S., Verma, A., & Baijal, S. S. (2007). Candida esophagitis in achalasia cardia: Case report and review of literature. Saudi Journal of Gastroenterology, 13(2), 88.
  • Ling, T., Guo, H., & Zou, X. (2014). Effect of peroral endoscopic myotomy in achalasia patients with failure of prior pneumatic dilation: A prospective case–control study. Journal of Gastroenterology and Hepatology, 29(8), 1609–1613.
  • Markar, S. R., Wiggins, T., MacKenzie, H., Faiz, O., Zaninotto, G., & Hanna, G. B. (2019). Incidence and risk factors for esophageal cancer following achalasia treatment: national population-based case-control study. Diseases of the Esophagus, 32(5), doy106.
  • Munifah, A. P., Perdana, R. F., Juniati, S. H., Yusuf, M., & Dewi, E. R. (2020). The Profile of Laryngopharyngeal Reflux Patients at Dr. Soetomo Teaching Hospital, Surabaya Indonesia. Indian Journal of Forensic Medicine & Toxicology, 14(4), 4160–4166.
  • Park, W., & Vaezi, M. F. (2005). Etiology and pathogenesis of achalasia: the current understanding. American Journal of Gastroenterology, 100(6), 1404–1414.
  • Perdana, R. F. (2020). Transnasal Esophagoscopy Examination in Outpatient Unit, Department of Otorhinolaryngology Head and Neck Surgery, Dr. Soetomo Hospital, Surabaya. Folia Medica Indonesiana, 56(1), 75–81.
  • Sadowski, D. C., Ackah, F., Jiang, B., & Svenson, L. W. (2010). Achalasia: incidence, prevalence and survival. A population‐based study. Neurogastroenterology & Motility, 22(9), e256–e261.
  • Samo, S., & Qayed, E. (2019). Esophagogastric junction outflow obstruction: Where are we now in diagnosis and management? World Journal of Gastroenterology, 25(4), 411.
  • Stavropoulos, S. N., Friedel, D., Modayil, R., & Parkman, H. P. (2016). Diagnosis and management of esophageal achalasia. Bmj, 354, i2785.
  • Tuason, J., & Inoue, H. (2017). Current status of achalasia management: a review on diagnosis and treatment. Journal of Gastroenterology, 52(4), 401–406.
  • Vaezi, M. F., Pandolfino, J. E., Yadlapati, R. H., Greer, K. B., & Kavitt, R. T. (2020). ACG Clinical Guidelines: diagnosis and management of achalasia. Official Journal of the American College of Gastroenterology| ACG, 115(9), 1393–1411.
  • Vazquez, J. A. (2010). Optimal management of oropharyngeal and esophageal candidiasis in patients living with HIV infection. Hiv/Aids (Auckland, NZ), 2, 89.
  • Walzer, N., & Hirano, I. (2008). Achalasia. Gastroenterology Clinics of North America, 37(4), 807–825.
  • Wang, L., Li, Y.-M., & Li, L. (2009). Meta-analysis of randomized and controlled treatment trials for achalasia. Digestive Diseases and Sciences, 54(11), 2303–2311.
  • Zikos, T. A., Triadafilopoulos, G., & Clarke, J. O. (2020). Esophagogastric Junction Outflow Obstruction: Current Approach to Diagnosis and Management. Current Gastroenterology Reports, 22(2), 9.


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