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A 53-year-old woman presented with dysphagia for 2 months. She denied any acid regurgitation or heartburn symptoms. Esophagogastroduodenoscopy revealed no abnormal findings. However, bird-beak appearance of the distal esophagus was noticed on the esophagography. For evaluation of esophageal motility disorders, she underwent esophageal high resolution manometry (HRM). On the HRM, the integrated relaxation pressure was elevated and accompanied by compartmentalized esophageal pressurization, while esophageal body peristalsis, distal contractile integral, and distal latency were normal (Figure A). According to the Chicago classification (CC),1 she was diagnosed with esophagogastric junction outflow obstruction (EGJOO).1 The patient’s dysphagia was tolerable without specific treatment. However, the dysphagia became aggravated 1 year later. She underwent esophagography and HRM again. On the HRM, panesophageal pressurization with failed lower esophageal sphincter relaxation was noticed (Figure B). According to the CC she was diagnosed as type 2 achalasia. After pneumatic balloon dilatation, her symptoms improved (Eckardt score, 1).

Esophagogastric Junction Outflow Obstruction Transformed to Type II Achalasia