A case of achalasia diagnosed first on capsule endoscopy: find that hard to swallow?

Achalasia often manifests with dysphagia but can also, albeit less frequently, present more insidiously with unexplained weight loss. We describe the case of a 42-year-old female with Crohn's disease who presented with unexplained weight loss and upper abdominal discomfort. As part of her investigations, a video capsule endoscopy was performed, primarily to assess for small bowel mucosal lesions. This revealed a delay in oesophageal transit time of more than 45 min (normally 2-4 s) giving rise to the discovery of previously undiagnosed achalasia. This was later confirmed by manometry. After subsequent oesophageal dilatation, our patient's weight rose substantially and abdominal discomfort was completely resolved. To our knowledge, this is the first case report of achalasia diagnosed by video capsule endoscopy.