Achalasia

Left: Retained content with an air-fluid level in the esophagus of an 87 year-old man with difficulty swallowing. Center: Appearance of the distal esophagus in an 83 year-old woman who with difficulty swallowing solids and liquids. Barium x-ray was suggestive of achalasia. Endoscopy revealed retained esophageal content with an air-fluid level in a dilated, tortuous esophagus, a high pressure zone at the esophagastric junction, and the absence of true stricture or neoplasm. Right: 84 year-old woman with achalasia. Endoscopy revealed retained content within the esophagus, with an air-fluid level. Symptoms responded well to injections of botulinum toxin.

Left: Retained content and air-fluid level in the dilated esophagus of a 54 year-old woman with several years of progressive dysphagia. Right: View of lower esophageal sphincter zone, which never relaxed more than a few millimeters.