Achalasia

This women in her 20’s presented with grave difficulties swallowing both food and liquids.
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:
a. Achalasia is associated with an increased risk of oesophageal malignancy
b. Beware of pseudoachalasia due to destruction of the plexus by tumour such as linitis plastica
c. The radiologist has a role in treatment by ballon dilatation
Reference: Primer in Diagnostic Imaging, Weissleder et al, Mosby.
Credit: Dr Ian Bickle
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