After removing the food and liquid from the esophagus, the characteristic “pop” is felt as the endoscope is passed through the tight lower esophageal sphincter into the stomach. Endoscopic diagnostic criteria _ Early: − Endoscopy may show no abnormalities − Increased, “springy” resistance to instrument passage − Failure of the cardia to open during prolonged observation − Persistent rosette appearance − Retroflexed view: cardia tightly closed around the endoscope _ Late: − Food residues and fluid in the esophagus − Esophagus dilated, lax, elongated, tortuous − Uncoordinated, nonpropulsive, or absent contractions − Diverticulumlike pouch above the LES − Increased resistance to cardial intubation − Mucosal changes due to food retention: padlike thickening of the mucosa, erythema, petechiae, grayish−yellow deposits, rarely erosions, very rarely ulcerations
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