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Achalasia — RACP Adult Medicine MCQ

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ModerateGastroenterologyAchalasiaRACP Adult Medicine

A 52-year-old man presents with dysphagia to solids and liquids, regurgitation of undigested food, and weight loss. Barium swallow shows a dilated oesophagus with a smooth tapering 'bird beak' appearance at the gastro-oesophageal junction. Manometry shows absent peristalsis and failure of LOS relaxation. What is the most likely diagnosis?

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Correct answer: B — Achalasia

Dysphagia to both solids and liquids with regurgitation, bird-beak appearance on barium swallow, and manometric findings of absent peristalsis with failure of LOS relaxation is diagnostic of achalasia. Treatment options include pneumatic dilatation, peroral endoscopic myotomy (POEM), or laparoscopic Heller myotomy. Malignancy (pseudoachalasia) should be excluded.

Reference: GESA – 2024 – Oesophageal Motility Disorders