Upper-airway Obstruction and Achalasia of the Esophagus

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Abstract
Achalasia is a generalized disorder of esophageal motility characterized by aperistalsis, incomplete [lower] esophageal sphincter (LES) relaxation and increased LES tension. Obstruction at the esophageal hiatus results in dilatation of the thoracic esophagus, which can cause cough and dyspnea by compression of the trachea and main-stem bronchi, and predisposes to regurgitation and pulmonary aspiration of stagnant esophageal contents. Because the upper esophageal sphincter at the level of the cricopharyngeus muscle can resist cephalad distending pressure of 100 cm H2O, while opening to pressures of 15-25 cm H2O from above, air swallowing and positive-pressure ventilation can cause progressive dilatation of the thoracic and cervical esophagus, which may compromise the airway. Severe upper-airway obstruction caused by a dilated esophagus in a patient with achalasia is presented in this case report.

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