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Published online before print April 15, 2005, 10.1148/radiol.2353040732
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Achalasia with Complete Relaxation of Lower Esophageal Sphincter: Radiographic-Manometric Correlation1

Raghu Amaravadi, MD, Marc S. Levine, MD, Stephen E. Rubesin, MD, Igor Laufer, MD, Regina O. Redfern, BBA, RT and David A. Katzka, MD

1 From the Departments of Radiology (R.A., M.S.L., S.E.R., I.L., R.O.R.) and Medicine (D.A.K.), Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104. Received April 22, 2004; revision requested June 29; revision received July 30; accepted September 28. Address correspondence to M.S.L. (e-mail: marc.levine@uphs.upenn.edu).



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  		Figure 1. Esophagogram in 23-year-old man with 6-year history of dysphagia. Left posterior oblique view obtained with the patient upright shows typical findings of achalasia: dilated aperistaltic esophagus, beaklike narrowing (arrow) near gastroesophageal junction, and slow emptying of barium into the stomach. Manometry revealed complete LES relaxation during swallowing with a normotensive sphincter at rest. Despite the manometric findings, this patient’s dysphagia resolved after treatment for achalasia with Heller myotomy.

 


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  		Figure 2a. Images from biphasic esophagography performed in 45-year-old man with 6-month history of dysphagia. (a) Double-contrast left posterior oblique view obtained with the patient upright and (b) single-contrast right anterior oblique view obtained with the patient prone show typical findings of achalasia: dilated, aperistaltic esophagus; beaklike narrowing (arrow) near gastroesophageal junction; and slow emptying of barium into the stomach. Manometry revealed complete LES relaxation during swallowing with a normotensive sphincter at rest. Despite the manometric findings, this patient’s dysphagia resolved after treatment for achalasia with botulinum toxin injection and Heller myotomy.

 


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  		Figure 2b. Images from biphasic esophagography performed in 45-year-old man with 6-month history of dysphagia. (a) Double-contrast left posterior oblique view obtained with the patient upright and (b) single-contrast right anterior oblique view obtained with the patient prone show typical findings of achalasia: dilated, aperistaltic esophagus; beaklike narrowing (arrow) near gastroesophageal junction; and slow emptying of barium into the stomach. Manometry revealed complete LES relaxation during swallowing with a normotensive sphincter at rest. Despite the manometric findings, this patient’s dysphagia resolved after treatment for achalasia with botulinum toxin injection and Heller myotomy.

 




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