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Achalasia in pregnancy
  1. Zafirah Akmal Azahar,
  2. Mohd Fadliyazid Ab Rahim,
  3. Nasriah Ahmad and
  4. Roziana Ramli
  1. Ministry of Health Malaysia, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia
  1. Correspondence to Dr Roziana Ramli; drroziana{at}


Achalasia is characterised by incomplete relaxation of the lower oesophageal sphincter and aberrant oesophageal peristaltic activity resulting in impaired oesophageal emptying. This rare condition in pregnancy is unique as both the disease and its treatment are associated with fetomaternal risks and complications. A woman in her early 30s, gravida 3 para 2 at 35 weeks’ pregnancy with suspected oesophageal achalasia, presented with shortness of breath, cough and fever following frequent bouts of vomiting and fluid regurgitation. She was diagnosed with aspiration pneumonia complicated by severe metabolic acidosis, malnutrition syndrome and fetal growth restriction. Following stabilisation of the acute clinical problems, delivery was expedited via caesarean section. Postpartum endoscopy confirmed the diagnosis of achalasia as per initial suspicion. Definitive surgery was performed several months later after optimisation of the patient’s nutritional status. This case illustrates the life-threatening complications of achalasia in pregnancy.

  • Gastrointestinal surgery
  • Obstetrics and gynaecology

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  • Contributors All authors were involved in the clinical management of the patient. The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content—ZAA, MFAR, NA and RR. The following authors gave final approval of the manuscript—ZAA, MFAR, NA and RR.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.