From: JAR Smith

In a 29 year old man what is the likely diangosis?
In a 59 year old what would be the differential diagnosis?
What treatment would you recommend?

In a 29 year old man this is likely to be achalasia. In a 59 year old differential diagnosis would include a peptic stricture or an oesophageal carcinoma. In the young male patient, the treatment would be either balloon dilatation or a surgical myotomy. The latter can now be done laparoscopically. There is ongoing controversy as to whether an anti-reflux procedure should be performed.