Achalasia

Case contributed by A.Prof Frank Gaillard

Presentation

Grave difficulties swallowing both food and liquids.

Patient Data

Age: 20 years
Gender: Female
Barium

Dilated esophagus with smooth distal tapering giving the parrot beak appearance. 

Case Discussion

Achalasia is a oesophageal motility disorder due to failure of relaxation of the lower oesophageal sphincter. This occurs due to an abnormality within the Auerbach's plexus - be it primary or secondary.

Baruim swallow demonstrates:

  1. Beaked tapering of the oesophagus at the gastro-oesophgeal junction
  2. A grossly dilated oesophagus
  3. Tertiary contractions
  4. Air-fluid level on the control/plain film

Key Points:

  1. Achalasia is associated with an increased risk of oesophageal malignancy
  2. Beware of pseudoachalasia due to destruction of the plexus by tumour such as linitis plastica
  3. The radiologist has a role in treatment by ballon dilatation

Image courtesy of Dr Ian Bickle

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Case information

rID: 7948
Case created: 24th Dec 2009
Last edited: 27th Sep 2015
Inclusion in quiz mode: Included

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