Difficult To Treat Recurrent Esophageal Dysphagia Due To Secondary Esophageal Motility Disorders: A 24 Weeks Follow Up Case Report

Limited data are available on the prevalence of esophageal motility disorders (OMD), with a suggested range of 4-12% in cases with dysphagia. The proposed pathophysiology is either impairment of inhibitory innervation or overactivity of excitatory innervation. The optimal treatment is not defined until now. This case represented one of the secondary OMD in a 70 years year diabetic patient with ischemic cardiomyopathy, who was complaining of recurrent daily intermittent dysphagia to solids and fluids, with a previous vague history of esophageal dilatation without available documentation. After endoscopy with multiple biopsies and barium imaging, the picture of the corkscrew esophagus was revealed. The patient, who was already on nitrates, failed to respond to twice-daily proton pump inhibitor for two months with a prokinetic drug, calcium channel blocker, and the first session of endoscopic esophageal dilatation. After the second dilatation session, we added sodium alginate to substitute nitrates with sildenafil. The patient reported a gradual improvement in dysphagia, especially fluids, decreasing daily attacks. We learned from this case that a different patient-to-patient response necessitates other treatment modalities, even switching between each patient's nitric oxide scavengers.