Presentation
Dysphagia
Patient Data
Age: Adult
From the case:
Achalasia and tertiary waves
Frontal
This patient with achalasia demonstrates prominent tertiary waves and poor / absent relaxation of the lower esophageal sphincter.
Case Discussion
A barium swallow is able to confirm that:
- bird beak sign
- esophageal dilatation
- pooling or stasis of barium in the esophagus when the esophagus has become atonic or non-contractile (a late feature in the disease)
- incomplete lower esophageal sphincter relaxation that is not coordinated with esophageal contraction
- failure of normal peristalsis to clear the esophagus 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 lower esophageal sphincter pressure allowing passage of esophageal content
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