Wernicke's encephalopathy is a neurological disorder caused by thiamine (vitamin 
B1) deficiency characterized by vertigo, ataxia, and mental confusion. 
Wernicke's encephalopathy has a causative association with alcoholism but 
recently there has been an increased prevalence also in other clinical 
conditions. In literature potentially fatal Wernicke's encephalopathy onset in 
an advanced achalasia has been previously reported only once. We describe for 
the first time an improvement of achalasic symptoms in a young patient affected 
by end-stage achalasia and anorexia nervosa (coming from ineffective Heller-Dor 
myotomy) after vitamin B1 supplementation. This case report suggest a potential 
positive impact of B1 supplementation on end-stage achalasic patients and 
requires systematic studies to confirm this observation.