This is a classic case of achalasia. The signs seen on a barium swallow study include:
- tapering narrowing of the lower oesophagus - known as the bird beak sign (see image below)
- slow passage of barium through the lower oesophageal sphincter which is abnormally tight
- food residue seen within lower oesophagus
- tertiary contractions
- there is a risk of malignancy so the mucosa needs to be carefully evaluated
- lung parenchyma changes secondary to chronic aspiration
Achalasia may be primary (idiopathic) or secondary to Chagas disease. Pseudoachalasia is the name given to a malignant stricture.
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