58 year man with Achalasia cardia who underwent Trans thoracic Heller"s cardio myotomy in 1962, started c/o of regurgitation of liquids from nose and mouth mostly at night for over one year.Details of the procedure are not available.Requested to have Upper GI scopy,Manometry and 24hr PH.Not a diabetic or Hypertensive.No respiratory symptoms.
UGI, where is abstraction (chest or abdomen) why? (narrow segment vs hernia or other) and how long? If no hernia, small 1 cm segment could be dealt with endoscoic dilation. Large segment- reoperation.
Does he have Dysphagia? In any case I would start with UGI gastrografin or Barium. This would help to map out esophagus before EGD. if this is recurrent achalasia, he may have megaesophagus or even epiphrenic diverticulae at risk of perforation.
I would even entertain the possibility of Zenker's with that presentation. UGI study should be able to show it too.
A timed barium study with liquid and bread component plus repeat manometry with ph impedance monitoring