Achalasia Cardia

BIRD BEAK SIGN

HOLD UP OF CONTRAST

Achalasia Cardia essentially refers to a failure of organised esophageal peristalsis with impaired relaxation at the level of lower oesophageal sphincter (LOS) resulting in often marked dilatation of the oesophagus and food stasis.

A barium swallow is able to not only confirm that the oesophagus is dilated but is also able to assess for mucosal abnormalities. Findings include:

• failure of normal peristalsis to clear the oesophagus of barium when the patient is in the recumbent position, with no primary waves identified
• uncoordinated, non-propulsive, tertiary contractions
• oesophageal body dilatation, which is typically maximal in the distal esophagus
• pooling or stasis of barium in the oesophagus when the oesophagus has become atonic or non contractile (late feature in the disease)
• when barium column is high enough (patient standing) the hydrostatic pressure can overcome the LOS pressure allowing passage of oesophageal content
• incomplete LOS relaxation that is not coordinated with oesophageal contraction
• BIRD BEAK SIGN.