[Distal esophageal spasm as a rare cause of progressive physical decline with malnutrition, sarcopenia, and frailty].

MEDICAL HISTORY: A 93-year-old sarcopenic female patient was admitted to the geriatric ward for further treatment and diagnostic evaluation following a fall and a sacral fracture that had been treated conservatively. Clinically, she primarily presented with loss of appetite accompanied by nausea and recurrent vomiting. A diagnosis of a traction diverticulum had already been made during a previous hospital stay. Subsequently, the patient experienced progressive weight loss with weakness, culminating in a fall and the resulting sacral fracture.

EXAMINATION FINDINGS: The clinical-neurological examination revealed no abnormalities other than advanced frailty (according to the Frailty Scale: "7," classified as "markedly frail" 1).

DIAGNOSIS AND COURSE OF TREATMENT: A swallow study raised a strong suspicion of a distal esophageal motility disorder in the form of esophageal sphincter spasm. Due to the patient's multimorbidity and preference, it was agreed to proceed with conservative treatment using botulinum toxin injections. This led to an improvement in symptoms within a short period of time.

SUMMARY: Dysphagia can lead to severe weight loss with associated sarcopenia and frailty. This can result in further complications such as falls and fractures, as in our case. Targeted diagnosis and treatment are therefore essential to break this vicious cycle.