Introduction The multiple names such as cardiospasm, achalasia, esophageal dystonia, or megaesophagus for this disease, known for some 300 years, indicate the confusion and controversy which has and does yet exist regarding the true underlying pathophysiology. Diagnosis The symptoms of mild, progressive dysphagia, substernal fullness and discomfort with varying mild pain often radiating into the back, and frequent regurgitation of old foul masticated food, especially when recumbent, are well known. Severe pain is not very common. Exacerbation and remission early in the course of the disease are noted. The adverse effects of emotional trauma and ingestion of cold liquids are usual. Moderate to marked weight loss is common. In the late stages of the disease a chest x-ray may reveal an enormously dilated esophagus encroaching upon the right lung. An air fluid level may be evident. Earlier stages are identified by barium swallow and ideally by cine-esophagram. Esophageal dilatation with