Acute airway obstruction in a patient with achalasia.

Megaesophagus resulting from achalasia is a rare but serious cause of acute airway obstruction. We treated achalasia in a 52-year-old woman with acute respiratory distress and stridor. Chest X-ray and endoscopy showed a marked dilatation of the cervical esophagus with a large amount of undigested food. Emergency suction of the food through a nasogastric tube led to decompression of the esophagus and the immediate relief of respiratory symptoms. These findings suggest a dysfunction of the upper esophageal sphincter as a possible mechanism. As this exceptional complication of achalasia is fatal, a wider appreciation is required.