A 45-year-old man with dysphagia undergoes barium swallow. The study reveals a dilated oesophagus with retained food residue, absent peristalsis in the body, and a smoothly tapered, beak-like narrowing at the lower oesophageal sphincter that intermittently relaxes during the examination. Which diagnosis is MOST likely?

• A Diffuse oesophageal spasm
• B Scleroderma oesophagus
• C Achalasia cardia ✓
• D Chagas disease

Explanation

Achalasia cardia shows a dilated oesophagus with a smoothly tapered, beak-like narrowing at the lower oesophageal sphincter, absent peristalsis in the oesophageal body, and intermittent relaxation of the sphincter, producing the classic 'bird's beak' appearance. Chagas disease produces identical radiological findings (megaoesophagus) but is a distractor; however, achalasia is the primary diagnosis in standard Indian exam contexts unless endemic exposure is specified. Diffuse oesophageal spasm shows simultaneous contractions producing a corkscrew appearance. Scleroderma shows a patulous lower oesophageal sphincter with free reflux.

Reference: Gore and Levine's Textbook of Gastrointestinal Radiology, 4th ed.

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Written and medically reviewed by the StethoPrep medical team.