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Achalasia and tertiary waves

Case contributed by Dr Frank Gaillard



Patient Data:

Age: Adult
Modality: X-ray

This patient with achalasia demonstrates prominent tertiary waves and poor / absent relaxation of the lower oesophageal sphincter.

Case Discussion:

A barium swallow is able to confirm that:

  • bird beak sign
  • oesophageal dilatation
  • pooling or stasis of barium in the oesophagus when the oesophagus has become atonic or non contractile (late feature in the disease)
  • incomplete LOS relaxation that is not coordinated with oesophageal contraction
  • failure of normal peristalsis to clear the oesophagus of barium when the patient is in the recumbent position, with no primary waves identified
  • uncoordinated, non-propulsive, tertiary contractions 
  • when barium column is high enough (patient standing) the hydrostatic pressure can overcome the LOS pressure allowing passage of oesophageal content

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