A 32-year-old woman reports progressive dysphagia to both solids and liquids with occasional regurgitation of undigested food. Barium swallow shows a dilated esophagus tapering to a bird beak appearance. High resolution esophageal manometry is done. Which pattern establishes the diagnosis?

• A Hypertensive peristalsis with normal lower esophageal sphincter relaxation
• B Absent contractile activity with complete lower esophageal sphincter relaxation
• C Normal peristalsis with repetitive premature contractions distally
• D Absent peristalsis with impaired lower esophageal sphincter relaxation ✓

Explanation

Achalasia is defined manometrically by absent esophageal peristalsis together with incomplete lower esophageal sphincter relaxation, often with elevated integrated relaxation pressure. Option A describes jackhammer esophagus, which presents with chest pain and preserves LES relaxation. Option C resembles distal esophageal spasm, which retains some peristalsis. Option B describes absent contractility, which lacks the impaired LES relaxation that defines achalasia.

Reference: Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.