40 year-old Man With Difficulty In Swallowing

Mr. J, a 40 years old Malay gentle man was referred from JB hospital for suspected Achalasia Cardia. He was previously well until 9 months ago, he started to experience constant difficulty in swallowing his food particularly solid food. This was also associated with increased burping and regurgitation of food particles after eating. There was  significant loss of weight as a result of poor feeding. Mr. J however, denied  history  of loss in appetite, pain while swallowing, vomiting of blood and passing out black colored stools. Past medical history and family history of malignancy were not significant.

Q1 What are the differential diagnosis do you have in mind?

 

Q2: What are the investigations to confirm your diagnosis?


Answers:

Q1: What are your differential diagnosis ?
1. Achalasia cardia
2. Oesophageal carcinoma
3. Diffuse esophageal spasm
4. Benign esophageal stricture due to past GERD


Q2: What are the investigations to confirm your diagnosis?
Several investigations were done with results as below:
1. Oesgophagoscopy showed dilated esophageal with narrowing of the lower esophagus; multiple biopsies were taken with negative histopathology result.
2. Barrow enema showed lower third esophageal dilatation with bird’s beak appearance seen.
3. Esophageal Manometry showed absence of peristalsis and high resting LES pressure (50 cm).

Plan 

Diagnosis of Achalasia Cardia was made and patient was scheduled for elective laparoscopy Hellen’s cardiomyotomy

Q3: Describe the barium swallow .

There is appearance of dilated esophageal with bird’s beak deformity. Contrast media was able to past through the lower esophageal junction to the stomach. This is a typical radiological picture of Achalasia cardia. Oesophageal manometry remains the gold standard for the diagnosis.