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Oesophageal achalasia diagnosed in pregnancy in a woman managed as severe hyperemesis refractory to medical management

Achalasia is a rare oesophageal motility disorder due to the failure of the lower oesophageal sphincter (LOS) to relax (El Kafsi et al. 2016). The symptoms include dysphagia to solids and liquids, heartburn and chest pain. It is a disease of unknown aetiology and is a relatively uncommon condition. In a secondary care setting, the incidence is 1.99 per 100,000 (Harvey et al. 2019). The symptoms of hyperemesis gravidarum (HG): nausea and vomiting, which are common in pregnancy, can lead to a delay in diagnosis of achalasia. The disorder is associated with increased maternal and foetal morbidity and mortality, due to severe malnutrition which is generally linked with preterm delivery and small-for-gestational-age infants (King 2003). Achalasia can be managed medically or surgically depending on the severity. There is a lack of evidence on the perinatal management of achalasia due to its rarity in pregnancy (Khudyak et al. 2006).