Successful therapeutic combination of an antispasmodic and progressive pneumatic dilation in a patient with esophageal motor disorder: Importance of differentiation of classic and vigorous achalasia.
A 61-year-old Japanese woman who had been diagnosed as having classic achalasia was admitted to our hospital in April 199X because of dysphagia and chest pain of over 30 years' duration. Radiologic and manometric examinations resulted in a re-diagnosis of vigorous achalasia. Initial therapy with a pneumatic dilator relieved her dysphagia, but was ineffective for the chest pain. However, additional administration of an antispasmodic agent eliminated her esophageal symptoms completely. Although the concept of vigorous achalasia has been widely accepted in Western countries, to date only three cases of vigorous achalasia have been reported in Japan. When encountering a patient with dysphagia, not only should a diagnosis of achalasia be made, but also differentiation of its subtypes, classic or vigorous achalasia, should be done.