Increasing difficulty in swallowing both for solids and liquids in a woman with bird's beak appearance in X-ray seen in

ACHALASIA CARDIA is the failure of relaxation of oesophagogastric junction due to disorganised oesophageal peristalsis. aetiological factors include stress, vitamin b1 deficiency, Chagas's disease.it is a precancerous lesion chance to transform into squamous cell carcinoma.common in females of 20-40 yrs, presents with progressive dysphagia, more to liquids than solids, regurgitation and recurrent pneumonia, heartburn, and lung abscess. a barium swallow is diagnostic and shows pencil like smooth narrowing of the lower oesophagus (bird beak appearance) and dilatation of proximal oesophagus (cucumber oesophagus). chest x-ray shows patches of pneumonia, manometry reveals unrelaxed lower oesophagal sphincter. differential diagnosis includes *carcinoma oesophagus   *scleroderma  *stricture oesophagus. treatment includes *modified heller's operation *POEM(peroral endoscopic myotomy *forcible dilatation