Achalasie in der Schwangerschaft

A 29-year-old gravida 2, para 1 developed an exacerbation of esophageal achalasia at 27 weeks' gestation. Achalasia was first diagnosed 8 months before conception and had been treated with intrasphincteric injection of botulinum toxin. During pregnancy the patient developed progressive dysphagia and retrosternal pain and lost 4 kg weight in 3 weeks. She was treated with endoscopic pneumatic dilatation of the lower esophageal sphincter (at a pressure of up to 200 mm Hg over 6 min., compared with 250 mm Hg over 15 min. in nonpregnant patients). There were no adverse events and the patient was free of complaints. At 38 weeks' gestation she was delivered of a healthy, 3240-g infant. Symptoms recurred 14 weeks after delivery and she underwent renewed dilatation (up to 330mmHg over 15 min.). Four months later she is free of symptoms.