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Achalasia — RACP Adult Medicine MCQ

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ModerateGastroenterologyAchalasiaRACP Adult Medicine

A 40-year-old man presents with intermittent dysphagia for both solids AND liquids equally, chest pain, and regurgitation. Barium swallow shows a bird-beak appearance at the gastro-oesophageal junction. Oesophageal manometry shows absent peristalsis and incomplete LOS relaxation with an integrated relaxation pressure of 18 mmHg. OGD shows no mucosal abnormality but retention of food debris. What is the most likely type of dysphagia?

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Correct answer: E — Motility disorder (achalasia)

Dysphagia for solids AND liquids equally (suggesting motility rather than mechanical cause), bird-beak on barium swallow, absent peristalsis, and incomplete LOS relaxation on HRM (IRP >15 mmHg) is achalasia. Chicago Classification v4.0 categorises into types I-III. Treatment: pneumatic dilatation, laparoscopic Heller myotomy, or peroral endoscopic myotomy (POEM). Type II has the best treatment response.

Reference: GESA – 2024 – Achalasia; Chicago Classification v4.0