Diagnostic and Therapeutic Challenges in a Case of Achalasia Masquerading as Gastroesophageal Reflux Disease (GERD)

Achalasia is a rare swallowing disorder that occurs due to the deterioration of the inhibitory neurons that control the lower esophageal sphincter (LES). Achalasia shares many clinical characteristics and symptoms with gastroesophageal reflux disease (GERD), a common process involving reflux of stomach acid into the esophagus, causing difficulties in differentiating diagnoses for therapeutic management. We report the case of a 49-year-old male patient with a history of chronic GERD who presented with dysphagia. Despite proton pump inhibitor (PPI) therapy, the patient developed worsening dysphagia. Esophagogastroduodenoscopy (EGD) suggested a diagnosis of achalasia, later confirmed with barium esophagram and manometry. Due to worsening symptoms and concerns about surgical fitness, the patient underwent bridge Botox therapy. However, further deterioration necessitated surgical myotomy. This case highlights the importance of a full dysphagia evaluation, including barium esophagram and EGD. This case also highlights the treatment of achalasia, which may include Botox injections as bridge therapy and myotomy for complete resolution.