Sonographic findings in esophageal achalasia

There are only three reports using conventional sonography to detect the gastroesophageal junction through the left lobe liver window in patients with achalasia, and the results were inconsistent. This study further characterizes the sonographic features of achalasia and compares them to characteristics of subjects with gastroesophageal malignancies.

Conventional sonography was performed in 21 patients with achalasia (mean age 49.0 years, 11 male and 10 female, group A); 15 patients with malignancies at the gastroesophageal junction (n=10) and cardiac of the stomach (n=5) (mean age 55.3 years, 11 male and 4 female, group B); and 30 subjects with functional dyspepsia (mean age: 38.3 years, 15 male and 15 female, control group C).

The median esophageal wall thicknesses were 5.1+/-2.3 mm (group A), 19.5+/-7.8 mm (group B), and 3.3+/-1.2 mm (group C). However, there was overlap in the esophageal wall thickness in groups A and C. Sonographic features in group A were regular hypoechoic thickening of the wall at the gastroesophageal junction; in group B, we found irregular hypoechoic thickening of the wall. Control subjects had a regular hypoechoic gastroesophageal wall. Dilated lumens of the distal esophagus were seen in all achalasia patients.

Although conventional sonography is not a diagnostic tool for achalasia, it provides interesting sonographic information. It cannot reveal each layer of the wall of the lumen as endoscopic ultrasound does, but it may tentatively differentiate achalasia from malignancies and assists clinicians when endoscopic ultrasound is not available.