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

Abstract

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.

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