A 42-year-old man with long-standing achalasia presented with recurrent dysphagia over 2 years. This is in the context of a laparoscopic Heller’s myotomy and partial fundoplication 12 years prior for dysphagia symptoms which provided relief for some time. Dysphagia occurred with all oral intake and was most pronounced with bread and meat. His Eckardt score was 4. He scored 3 for dysphagia, 1 for regurgitation, 0 for retrosternal pain and 0 for loss of weight. Despite this, he had minimal functional impairment and worked full time. Gastroscopy showed a moderately dilated oesophagus with stasis-related mucosal change and candidiasis, and there was no resistance to passage of the gastroscope through the gastro-oesophageal junction (GOJ). Videomanometry, a combination of fluoroscopy and manometry, was performed (figures 1 and 2).
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