Increasing difficulty in swallowing both for solids & liquids in a woman with bird's beak appearance in X-ray seen in:
Ans. A (Achalasia cardia) Achalasia affects patients of all ages and both sexes. Dysphagia, chest pain, and regurgitation are the main symptoms. Dysphagia occurs early with both liquids and solids and is worsened by emotional stress and hurried eatingDiagnosis# A chest x-ray shows absence of the gastric air bubble and sometimes a tubular mediastinal mass beside the aorta. An air-fluid level in the mediastinum in the upright position represents retained food in the esophagus. Barium swallow shows esophageal dilation, and in advanced cases the esophagus may become sigmoid.# On fluoroscopy with barium swallow, normal peristalsis is lost in the lower two-thirds of the esophagus.# The terminal part of the esophagus shows a persistent beak like narrowing representing the nonrelaxing LES Esophageal dysphagia | | |Solids and Liquids(Suggests motility disorder)Solids only(Suggests mechanical obstruction)|| | | | |ProgressiveInterittent(Non progressive)Progressiveinterittent(Nonprogressive)|||||||||| | | | Heartburn Pulmonarysymptoms Chest pain Weight loss Pulmonarysymptoms | | |' | | Progressive systemic sclerosis Achalasia Diffuseesophageal spasm Cancer Peptic stricture Lower esophageal ring
Achalasia cardia
Carcinoma
Reflux esophagitis
Barrett's esophagus
Diagnostic Evaluation of the Esophagus