Case of the Day

A 35-year-old woman visits the clinic with complaint of difficulty swallowing liquids and solids. There is also a mild chest pain on swallowing foods. She sometimes wakes up in the morning with coughing and brings up undigested food on the pillow. Her symptoms began about 3 months ago and have slowly progressed over time. She denies painful swallowing, heartburn, cough, asthma, or nausea and vomiting. She has lost approximately 6 lb in the past 3 months. A special swallow study called a barium swallow is performed. What does this lady likely have and why should you care?

This lady like has what is known in the medical field as ACHALASIA. Achalasia is described as a inability or difficulty to swallow due to tightening of the lower esophagus as demonstrated in the barium swallow study above. Risk factors for for the development of achalasia include smoking.

Here is also a classic example of the “bird’s beak” narrowing or tapering common in many radiographic studies that involve a sudden narrowing of a tube.



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