Achalasia evolving from segmental aperistalsis.

A 17-year-old woman was evaluated for dysphagia. Radiologic study revealed a rigid segment 10 cm long in the midesophagus, which was found to be aperistaltic on manometric evaluation. The rest of the esophagus and the lower esophageal sphincter were manometrically normal. Four years later the patient was seen for evaluation of severe dysphagia and symptoms of esophageal overflow. Characteristic radiologic and manometric findings of classic achalasia were noted. The case is discussed as an atypical form of achalasia evolving from a segmental esophageal aperistalsis.