Vigorous achalasia: Zebra amongst horses.

Jayaranjeetham Jayabalan,Aravintho Natarajan,Nithin Theckumparampil,Dilip S Phansalkar,George Kurian

doi:10.4102/sajr.v24i1.1953

Jayaranjeetham Jayabalan, Aravintho Natarajan + Show 3 more

Open Access

https://doi.org/10.4102/sajr.v24i1.1953

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Abstract

Vigorous achalasia is an oesophageal disorder with clinical and radiological characteristics of classic achalasia and diffuse oesophageal spasm. It is a rarely reported variant. A 60-year-old gentleman presented with complaints of difficulty in swallowing, regurgitation and chest pain for the past 10 years. His symptoms persisted despite the use of proton pump inhibitors. On endoscopy and barium swallow, the diagnosis of vigorous achalasia was confirmed. It is a rare variant of classic achalasia usually misdiagnosed as diffuse oesophageal spasm.

Highlights

Classic achalasia and diffuse oesophageal spasm (DES) both have different clinical, radiological and manometric features.[1]
Chest pain is more common in DES, whereas it is uncommon in classic achalasia
Regurgitation and retention are more common in classic achalasia, whereas they are uncommon in DES.[2]

Summary

Introduction

Classic achalasia and diffuse oesophageal spasm (DES) both have different clinical, radiological and manometric features.[1] Chest pain is more common in DES, whereas it is uncommon in classic achalasia. Regurgitation and retention are more common in classic achalasia, whereas they are uncommon in DES.[2] At barium swallow imaging, classic achalasia shows dilatation and DES demonstrates a corkscrew appearance. A 60-year-old male with no known comorbidities, presented with a 10-year history of difficulty in swallowing (liquids more than solids) and chest pain, which persisted despite the use of proton pump inhibitors. His physical examination and laboratory parameters were unremarkable. There was difficulty in passing the UGI scope beyond the site of the stenosis (Figure 4)

Discussion

Findings

Data availability statement