Primary achalasia diagnosed during pregnancy: rare cause of nausea and vomiting

BMJ Case Rep. 2024 Jun 24;17(6):e258792. doi: 10.1136/bcr-2023-258792.

Abstract

Nausea and vomiting during pregnancy are very common; however, when persistent symptoms lead to severe malnutrition, other conditions should be considered. We present a patient with severe postprandial nausea and vomiting resulting in 120 lb weight loss. She was treated for presumed hyperemesis gravidarum but diagnosed with achalasia type 1 upon further work-up. The pregnancy was further complicated by fetal growth restriction, shortened cervix and preterm premature rupture of membranes, and resulted in delivery at 26 weeks of gestation. Postpartum, she underwent a peroral endoscopic myotomy procedure and has returned to normal body mass index.The differential for nausea/vomiting is broad, and major medical conditions can manifest for the first time during pregnancy. Severe malnutrition adversely affects maternal and fetal health. Further work-up should be pursued when symptoms cannot otherwise be explained.

Keywords: Gastroenterology; Obstetrics and gynaecology; Oesophagus; Pregnancy.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Diagnosis, Differential
  • Esophageal Achalasia* / complications
  • Esophageal Achalasia* / diagnosis
  • Esophageal Achalasia* / surgery
  • Female
  • Humans
  • Hyperemesis Gravidarum / complications
  • Hyperemesis Gravidarum / diagnosis
  • Nausea* / etiology
  • Pregnancy
  • Pregnancy Complications* / diagnosis
  • Pregnancy Complications* / surgery
  • Vomiting* / etiology