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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2015; 25(03): 288-295
DOI: 10.4103/0971-3026.161465
Abdominal Radiology

Primary versus secondary achalasia: New signs on barium esophagogram

Pankaj Gupta
Department of Radiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
,
Uma Debi
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
,
Saroj Kant Sinha
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
,
Kaushal Kishor Prasad
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
› Author Affiliations
Financial support and sponsorship Nil.
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Abstract

Aim: To investigate new signs on barium swallow that can differentiate primary from secondary achalasia. Materials and Methods: Records of 30 patients with primary achalasia and 17 patients with secondary achalasia were reviewed. Clinical, endoscopic, and manometric data was recorded. Barium esophagograms were evaluated for peristalsis and morphology of distal esophageal segment (length, symmetry, nodularity, shouldering, filling defects, and "tram-track sign"). Results: Mean age at presentation was 39 years in primary achalasia and 49 years in secondary achalasia. The mean duration of symptoms was 3.5 years in primary achalasia and 3 months in secondary achalasia. False-negative endoscopic results were noted in the first instance in five patients. In the secondary achalasia group, five patients had distal esophageal segment morphology indistinguishable from that of primary achalasia. None of the patients with primary achalasia and 35% patients with secondary achalasia had a length of the distal segment approaching combined height of two vertebral bodies. None of the patients with secondary achalasia and 34% patients with primary achalasia had maximum caliber of esophagus approaching combined height of two vertebral bodies. Tertiary contractions were noted in 90% patients with primary achalasia and 24% patients with secondary achalasia. Tram-track sign was found in 55% patients with primary achalasia. Filling defects in the distal esophageal segment were noted in 94% patients with secondary achalasia. Conclusion: Length of distal esophageal segment, tertiary contractions, tram-track sign, and filling defects in distal esophageal segment are useful esophagographic features distinguishing primary from secondary achalasia.

Keywords

Achalasia - barium swallow - pseudoachalasia - secondary achalasia


Publication History

Article published online:
30 July 2021

© 2015. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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