Limited data are available on the prevalence of esophageal motility disorders
(OMD) with a suggested range of 4-12% in cases with dysphagia. The
proposed pathophysiology is either impairment of inhibitory innervation or
overactivity of excitatory innervation. The optimal treatment is not defined until
now. This case represented one of the secondary OMD in a 70 years year
diabetic patient with ischemic cardiomyopathy, who was complaining of recurrent daily intermittent dysphagia to solids and fluids, with a previous
vague history of esophageal dilatation without available documentation. After
endoscopy with multiple biopsies and barium imaging, the picture of the
corkscrew esophagus was revealed. The patient, who was already on
nitrates, failed to respond to twice-daily proton pump inhibitor for two months
with a prokinetic drug, calcium channel blocker, and the first session of
endoscopic esophageal dilatation. After the second session of dilatation, we
add sodium alginate with the substitution of nitrates with sildenafil, and the
patient reported a gradual improvement of dysphagia especially to fluids with
decreasing in daily attacks. We learn from this case that there is a different
patient-to-patient response, which necessitates the use of different treatment
modalities even just switching between nitric oxide scavengers for each
patient.
Keywords: Case Report; Dysphagia; esophageal Motility Disorders.