Vigorous achalasia with high-amplitude esophageal body contractions: a case report

A 25-year-old woman presented with dysphagia and chest pain in November 1999. Esophagography revealed esophageal stasis with spindle-shaped tapering at the cardia without dilatation of the lower esophagus. Manometry showed a hypertonic sphincter with incomplete relaxation on swallowing. Esophageal body contractions were simultaneous with an amplitude in excess of 200 mm Hg with tertiary contractions. These findings were not compatible with “classic” achalasia, but with vigorous achalasia. The patient underwent pneumatic dilatation with immediate relief of her symptoms. However, improvement in dysphagia and chest pain was temporary, necessitating four sessions of dilatation over three and a half years. The literature on this rare esophageal motility disorder is reviewed.