The findings are suggestive for hypoadrenocorticism (Addison disease) with secondary megaesophagus, microhepatica and hypovolemia which causes the microcardia. The gas filled gastrointestinal tract is also compatible with Addison disease that can lead to unspecific gastrointestinal symptoms.
Myasthenia gravis, idiopathic megaesophagus systemic lupus erythematosus, polymyositis, heavy metal (lead) or thallium toxicity, glycogen storage disease, neurotoxin-induced cholinesterase inhibition, dysautonomia, CNS disorders including neoplasia, and possibly hypothyroidism. There was no evidence of an esophageal stricture, foreign body, neoplasia, or extraesophageal compression. Lab work with special interest on sodium/potassium levels, Acetylcholine antibody test, T4 levels, also consider mestinon challenge.
– If these are inconclusive neuromuscular and liver biopsy may be considered.