in bowel habits. While doing endoscopy there is some difficulty passing through the LES, but no
other abnormality is noted. What is the single most useful inv?
a. CXR
b. MRI
c. Esophageal biopsy
d. Esophageal manometry
e. Abdominal XR
answer: D
Achalasia
Inflammatory degeneration of Auerbach’s plexus
increase in LES pressure,
incomplete relaxation of LES with swallowing, aperistalsis
- CXR: no air in stomach, dilated esophagus
- Barium studies: esophagus terminates in narrowing at LES ("bird’s beak")
- Endoscopy: rule out malignancy
- Manometry: definitive diagnosis
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