J Korean Soc Laryngol Phoniatr Logoped.  2017 Jun;28(1):43-47. 10.0000/jkslpl.2017.28.1.43.

A Case of Esophageal Achalasia Misconceived as Laryngopharyngeal Reflux Disease

• Noh SH
• Lee YW
• Park JS
• Lee SH

• KMID: 2388203
• DOI: http://doi.org/10.0000/jkslpl.2017.28.1.43

Abstract

Laryngopharyngeal reflux disease (LPRD) is common in laryngologic practice. In Korea, up to 1 out of every 5 patients who visit otorhinolaryngology clinic is supposed to have LPRD with symptoms and physical findings. Major symptoms of LPRD include hoarseness, cough, reflux symptom and mild dysphagia. Even though LPRD is common, its diagnosis may be difficult, because its symptoms are nonspecific and the laryngeal findings are not always associated with symptom severity. In Recent study, 66.4% of Patient who has LPRD also associated with esophageal motility disorders. Esophageal achalasia is a disease of unknown etiology characterized by an absence of peristalsis in the body of esophagus and nonrelaxing hypertension of the lower esophageal sphincter. Common cause is loss of ganglion cells in Auerbachs plexus. The classic triad of symptoms in achalasia includes dysphagia, regurgitation and weight loss. LPRD and esophageal achalasia have similar symptoms but have different treatment of choice. The Differentiation diagnosis of theses disease is important and should be established by history, radiologic examination and endoscopic examination. We recently assessed a 59-year-old female patient who complained of an epigastric pain, dysphagia and chronic cough. LPRD was initially diagnosed on Laryngoscopic examination and Reflux Symptom Index, but patient was not relieved of any symptoms after treatment of Proton Pump Inhibitor for 3 months. After high resolution manometry, esophageal achalasia was finally diagnosed. We report this case regarding the diagnosis and treatment with review of literatures because we have to think about esophageal motility disorders as a differential diagnosis in laryngology.

Keyword

Esophageal achalasia; Laryngopharyngeal reflux disease; High resolution manometry; Esophagus; Diagnosis

MeSH Terms

Cough
Deglutition Disorders
Diagnosis
Diagnosis, Differential
Esophageal Achalasia*
Esophageal Motility Disorders
Esophageal Sphincter, Lower
Esophagus
Female
Ganglion Cysts
Hoarseness
Humans
Hypertension
Korea
Laryngopharyngeal Reflux*
Manometry
Middle Aged
Myenteric Plexus
Otolaryngology
Peristalsis
Proton Pumps
Weight Loss
Proton Pumps