What is Increasing difficulty in swallowing both for solids and liquids in a woman with bird&;s beak appearance in X-ray seen in and explain in detail?
.ACHALASIA CARDIA is the failure of relaxation of oesophagogastric junction due to disorganised oesophageal peristalsis.aetiological factors include stress, vitamin b1 deficiency, Chagas&;s disease.it is a precancerous lesion chance to transform into squamous cell carcinoma.common in females of 20-40 yrs, presents with progressive dysphagia, more to liquids than solids, regurgitation and recurrent pneumonia, heaburn, and lung abscess.a barium swallow is diagnostic and shows pencil like smooth narrowing of the lower oesophagus (bird beak appearance) and dilatation of proximal oesophagus (cucumber oesophagus).chest x-ray shows patches of pneumonia, manometry reveals unrelaxed lower oesophagal sphincter.differential diagnosis includes *carcinoma oesophagus *scleroderma *stricture oesophagus.treatment includes *modified heller&;s operation *POEM(peroral endoscopic myotomy *forcible dilatation Ref: SRB&;s manual of surgery,5th ed, pg no 798