Discussion from this past #TracingTuesday:
As many have noted, this tracing showed inadequate LES relaxation & no normal esophageal body peristalsis - the definition for #achalasia. There’s evidence of esophageal shortening in some swallows, causing pseudo-relaxation. (1/4)
As many have noted, this tracing showed inadequate LES relaxation & no normal esophageal body peristalsis - the definition for #achalasia. There’s evidence of esophageal shortening in some swallows, causing pseudo-relaxation. (1/4)
This study does not clearly fall into any of 3 achalasia subtypes: no failed swallow, no PEP >30 mmHg, no spastic contractions (DL >4.5). Note the difference b/t true PEP (non-contractile, uniform pressurization) and this case, which has a clear distal contraction fragment. (2/4)
Although DL is normal throughout, if the former CFV metric is applied, the contraction front velocity is certainly high, suggesting simultaneous contractions. This highlights the limitation of using DL alone & importance of visual interpretation of peristaltic pattern. (3/4)
Overall, this tracing represents evolving #achalasia that may later develop into any one of the subtypes. Timed barium swallow later obtained showed significant retention at 5 minutes. EndoFLIP may also be useful. Management options include pneumatic dilation or myotomy. (4/4)
