A 64-year-old manpresented to the gastroenterology clinic with regurgitation and  dysphagia  which  occurred  with  every  meal, accompanied with postprandial chest pain. For 5 years, he had had difficulty in swallowing both solids and liquids with the symptomworsened during this two months before presentation. Meanwhile, a weight loss of 10 kg was notable in the previous year. Gastroscopy was notable for a detained mass in the esophagus (Figure A) and a tight gastroesophageal junction. Furthermore, a barium esophagram showed esophagram with typical bird-beak appearance of distal esophagus (Figure B). High-resolution esophageal manometry revealed an elevated integrated relaxation pressure of the lower esophageal sphincter and absence of peristalsis, which were consistent with type I (classic) achalasia. The diagnosis of esophageal achalasia was made. Achalasia is considered to be a primary motor disorder of the esophagus,which is characterized by loss of esophageal peristalsis and insufficient lower esophageal sphincter relaxation [1, 2]. This leads to patients’ complaints of regurgitation and dysphagia to liquids and solids, often along with chest pain and weight loss [3, 4]. Appropriate diagnostic and therapeutic strategies should be prompted when endoscopic finds retained saliva with puckered gastroesophageal junction or barium swallow shows dilated esophagus with birds beaking in a symptomatic patient [5, 6]. The patient opted for treatment with peroral endoscopic myotomy (POEM). At follow-up 1year after treatment, he had no dysphagia and regurgitation.

Acknowledgements

Funding: This work was supported by National Natural Science Foundation of China (31600134).

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects  of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Written informed consent was obtained from the patient for publication of this “Image”.