An Unusual Case of Dysphagia

Some patients may also have heartburn, weight loss, cough, or chest pain.3 A barium esophagogram showing persistent narrowing at the gastroesophageal junction, which produces a “bird's beak” or “rat's tail” appearance, is characteristic of esophageal achalasia. Treatment of esophageal achalasia includes medications such as nitrates, anticholinergics, and calcium channel blockers to reduce LES pressure. Summary Table Condition Characteristics Esophageal achalasia Progressive dysphagia; associated with respiratory symptoms and weight loss; barium esophagogram shows persistent narrowing at the gastroesophageal junction, and computed tomography often shows an air-fluid level above the narrowing; lower esophageal sphincter does not relax on manometry Esophageal carcinoma Progressive dysphagia, initially to solids only; associated with weight loss; mucosal irregularities on barium esophagography; endoscopic biopsy confirms the diagnosis Esophageal spasm Intermittent dysphagia and chest pain; “corkscrew” appearance on barium esophagography and manometry Peptic stricture Progressive dysphagia, initially to solids only; associated with heartburn; pH monitoring positive for acid reflux; smooth narrowing of the distal esophagus on barium esophagography Scleroderma Chronic progressive dysphagia to solids and liquids; heartburn and reflux; hypomotility in lower esophagus on manometry and barium esophagography; multiorgan involvement with a positive result on an antibody panel Address correspondence to Dahlia Hassan, MD, at kifaya@yahoo.com.