Achalasia presenting as stridor

Abstract

### Learning Point for Clinicians Achalasia is the failure of the relaxation of the lower oesophageal sphincter leading to oesophageal dilatation. Stridor is a rare and unusual symptom of achalasia due to tracheal compression by the dilated oesophagus. Early identification and management with urgent decompression should be undertaken to avoid life-threatening airway obstruction. A 93-year-old woman presented to the emergency department with acute-onset dyspnoea and stridor following a bout of coughing, which had started just after finishing her evening meal. Her past medical history included dementia, stroke, asthma, hypertension and peptic ulcer disease. On examination, the patient had stridor but was able to complete sentences. Observations showed oxygen saturations of 95% on air, pulse rate of 100 beats per minute, blood pressure of 136/96 mmHg, respiratory rate of 20 breaths per minute and temperature of 36.4°C. …