Gastro-oesophageal fistula in an achalasia patient following myotomy as an unusual cause of heartburn.

We report a case of delayed presentation of a gastro-oesophageal fistula following a Heller myotomy and anterior fundoplication for achalasia in a 28-year-old man. After a period of symptom resolution following initial operation, dysphagia and severe heartburn commenced temporarily, related to non-steroidal anti-inflammatory drug (NSAID) use. Endoscopy demonstrated a secondary opening in the lower oesophagus and a barium swallow showed an oesophageal fistula to the stomach. Currently, reasonable symptom control has been obtained on double dose pantoprazole. Barium study best demonstrated the abnormality. NSAIDs should possibly be avoided in cases of severe dysmotility of the oesophagus.