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We report a case of achalasia presenting as acute stridor and respiratory distress in an 87-year-old woman. A mega-oesophagus was decompressed by aspiration through a naso-oesophageal tube, stiffened with paediatric endoscopic biopsy forceps before placement. Subsequent barium swallow showed mega-oesophagus secondary to achalasia causing tracheal compression at the level of the thoracic inlet. There have been 28 previous case reports of mega-oesophagus due to achalasia causing tracheal obstruction and the literature is reviewed. Recognition and urgent treatment of this very rare complication of achalasia by naso-oesophageal decompression may avoid fatality.

Original publication




Journal article


European journal of gastroenterology & hepatology

Publication Date





1125 - 1128


Gastroenterology Unit, Derriford Hospital, Plymouth, UK.


Humans, Esophageal Achalasia, Airway Obstruction, Respiratory Sounds, Barium Compounds, Radiography, Fatal Outcome, Aged, Aged, 80 and over, Female