Postoperative pregnancy in female achalasia patients: Report of three cases

BACKGROUND: The aggravation of symptoms in female patients with esophageal achalasia has been sporadically reported to be associated with pregnancy. However, the relationship between symptoms recurrence and postoperative pregnancy after radical surgery remains unclear. CASE PRESENTATION: There were 3 female achalasia patients who became pregnant after surgery between 1994 and 2018. Patient #1, #2 and #3 were 32, 27 and 25 years old, respectively. The main symptom was vomiting in #1, chest pain in #2, dysphagia in #3, the Eckardt score was 12, 9 and 7, respectively. The classification of achalasia was St grade Ⅱ in #1-2, St grade Ⅲ in #3. Laparoscopic Heller-Dor was underwent in all patients, there were no intraoperative and postoperative complications, and the symptoms improved in these patients. The Eckardt scores decreased to 2, 3 and 1, respectively. Each patient became pregnant 36, 24 and 46 months after surgery, and symptoms recurred during pregnancy in all patients. The Eckardt scores increased to 4, 5 and 4. These patients were followed without oral administration due to the risk of teratogenicity, and the pregnancies progressed smoothly. Healthy babies were delivered vaginally at 38–41 weeks. The symptoms in all patients were immediately improved after delivery, and there was no recurrence of symptoms thereafter. CONCLUSIONS: This case report showed that female patients who became pregnant after achalasia surgery had temporary symptom relapse during pregnancy. It was possible to continue pregnancy and deliver without treatment, and symptoms spontaneously improved immediately after delivery.