achalasia A slackening, Failure to relax; referring especially to
visceral openings such as the pylorus, cardia, or any other
On a plain chest film the oesophagus appears dilated and
extends into the right side of the chest cavity, often seen as
opaque when filled with food.
CXR - widening of mediastinum, air / fluid level and absence of
gastric fundus gas bubble
Barium Swallow - dilatation & residue, small tertiary contractions
and 'rat tail' of distal oesophagus
An obstruction which develops in the terminal oesophagus just
proximal to the card oesophageal junction, the upper oesophagus
becoming dilated and filled with retained food; sometimes originates
from a loss of motor innervation by fibres originating in the dorsal
nucleus of the vagus nerve.
Aetiology is unknown but a neurotropic virus may be important.
- Commonest in patients between 40 - 70 years
- Male : female ratio is approximately equal
- Symptoms include dysphagia, weight loss, regurgitation, chest
- 5% of patients develop squamous carcinoma
Conservative treatment may include endoscopic dilitation,
if unsuccessful general surgery may be indicated.
|Image 1 CXR
Image 2 Barium Swallow