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Case Reports
. 2023 Mar 13;15(3):e36071.
doi: 10.7759/cureus.36071. eCollection 2023 Mar.

Burn Pits: A Possible Trigger for Achalasia

Paul M Travers  1 , Dawn L Francis  2
Affiliations
Case Reports

Burn Pits: A Possible Trigger for Achalasia

Paul M Travers et al. Cureus. .

Abstract

A 45-year-old female veteran of the United States Air Force (USAF), who was exposed to burn pits on multiple occasions while deployed in the Middle East, presented for a second opinion regarding ongoing chest pain and regurgitation after a Heller myotomy for achalasia. An esophageal X-ray showed no meaningful peristalsis, a slight diverticulum in the distal esophagus, and easy passage of liquids through the lower esophageal sphincter (LES). Esophageal manometry findings were consistent with type 3 achalasia. Based on these and endoscopic evaluation, the prior surgical intervention appeared to be successful for lower esophageal sphincter disruption, so symptoms were managed medically with a proton pump inhibitor, trazodone, and a long-acting nitrate resulting in 70% improvement. We present this case because the patient developed achalasia with a notable history of exposure to open-air burn pits during her military service. While we acknowledge that causality cannot be proven, our case is the first we are aware of that shows a temporal association between burn pit exposure and achalasia. In August of 2022, the United States Congress passed the Promise to Address Comprehensive Toxics (PACT) Act, which expanded the healthcare benefits of veterans exposed to burn pits, making identification of associated conditions a relevant and important endeavor.

Keywords: achalasia; esophageal dysmotility; esophageal manometry; gastroenterology; military; regurgitation.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Barium Esophagram
Single-contrast barium esophagography showing (A) no meaningful esophageal peristalsis consistent with a diagnosis of achalasia and (B) a slight diverticulum in the distal esophagus, which did not inhibit passage of liquids through the Heller myotomy/fundoplication
Figure 2
Figure 2. Esophageal Manometry
High-resolution esophageal manometry showing no meaningful peristalsis, consistent with a diagnosis of achalasia
Figure 3
Figure 3. Esophagogastroduodenoscopy
Esophagogastroduodenoscopy showing (A) evidence of Heller myotomy with Dor fundoplication wrap appearing below the gastroesophageal junction and (B) mild dilation of the lower third of the esophagus
See this image and copyright information in PMC

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