Sonographic findings in achalasia

Area of Science:

• Gastroenterology
• Medical Imaging
• Diagnostic Sonography

Background:

• Achalasia is a rare esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter and absent peristalsis.
• Accurate diagnosis is crucial for effective management and to differentiate from other gastroesophageal junction pathologies.

Purpose of the Study:

• To delineate the sonographic features of achalasia using transabdominal sonography.
• To evaluate the utility of sonography in differentiating achalasia from carcinoma and peptic stricture of the gastroesophageal junction.

Main Methods:

• Transabdominal sonography was performed on 35 achalasia patients and compared with 41 healthy volunteers, 10 patients with gastroesophageal junction carcinoma, and 4 with peptic stricture.
• Key sonographic parameters assessed included distal esophageal dilatation, fluid retention, esophageal wall thickness, and morphology at the gastroesophageal junction.

Main Results:

• Sonography identified dilatation, fluid retention, and a bird's beak-like narrowing in 80% of fasting achalasia patients, increasing to 97% after water ingestion.
• Achalasia patients exhibited significantly thicker esophageal walls (mean 4.8 mm) with regular, symmetric thickening localized to the gastroesophageal junction compared to volunteers (mean 2.3 mm).
• Carcinoma showed irregular thickening (mean 17.0 mm), while peptic stricture presented with irregular thickening over a longer segment (mean 5.1 mm).

Conclusions:

• Transabdominal sonography effectively visualizes key sonographic markers of achalasia, including esophageal wall thickening, fluid retention, dilatation, and the bird's beak sign.
• Sonography offers a valuable, non-invasive method for differentiating achalasia from malignant and benign conditions at the gastroesophageal junction.