Grave difficulties swallowing both food and liquids.
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Achalasia is an oesophageal motility disorder due to a failure of relaxation of the lower oesophageal sphincter. This occurs due to an abnormality within the Auerbach plexus - be it primary or secondary.
Barium swallow demonstrates:
- beaked tapering of the oesophagus at the gastro-oesophageal junction
- a grossly dilated oesophagus
- tertiary contractions
- air-fluid level on the control/plain film
- achalasia is associated with an increased risk of oesophageal malignancy
- beware of pseudoachalasia due to the destruction of the plexus by a tumour such as linitis plastica
- the radiologist has a role in treatment by balloon dilatation
Image courtesy of Dr Ian Bickle