Review Question - QID 106326

This patient presents with the classic signs and symptoms of achalasia. Upper GI endoscopy to rule out malignancy is indicated prior to treatment in cases of suspected achalasia.

Achalasia is a disorder of esophageal motility in which esophageal peristalsis is absent and lower esophageal sphincter relaxation after swallowing is impaired. Patients report difficulty swallowing both solids and liquids, and barium swallow shows the classic "bird's beak" appearance. Besides dysphagia, patients frequently report heartburn, chest pain, weight loss, and regurgitation. Esophageal manometry and pH monitoring are also used in the diagnosis of this condition.

Layke and Lopez discuss the diagnosis and management of esophageal cancer. They note that risk factors include H. pylori infection, GERD, smoking, and heavy alcohol use. Common presenting symptoms are dysphagia, odynophagia, and weight loss.

Zendehdel et al. present a retrospective cohort study of 2,896 patients with achalasia. They note that male patients with a discharge diagnosis of achalasia are at increased risk for squamous cell carcinoma as well as adenocarcinoma of the esophagus.

Figure A shows the classic barium swallow findings seen in achalasia (the so-called "bird's beak" sign).

Incorrect Answers:
Answer 1: Calcium channel blocker administration may help decrease lower esophageal sphincter pressure and ease the symptoms of achalasia; however, malignancy must be ruled out first through endoscopy.
Answer 2: High-calorie nutritional supplementation is inappropriate in this case, as her weight loss is most likely caused by a GI condition such as achalasia or malignancy.
Answer 3: Botulinum toxin administration may help decrease lower esophageal sphincter pressure and ease the symptoms of achalasia; however, malignancy must be ruled out first through endoscopy.
Answer 4: Surgical myotomy is indicated for treatment of achalasia in many patients; however, malignancy must first be ruled out through endoscopy.