An 80 year old woman had had difficulty in swallowing solids for a few months. The food tended to get stuck in the retrosternal area. Eating food slowly and having a glass of water helped. She also had occasional spasmodic retrosternal pain, usually after eating, but denied having symptoms of gastro-oesophageal reflux. Endoscopy showed normal oesophageal mucosa with increased oesophageal contractions. Barium swallow in the prone position showed marked tertiary contractions within the oesophagus with no effective peristalsis. In the erect position the barium passed slowly into the stomach. The appearances are those of a corkscrew oesophagus due to oesophageal dysmotility.

V Goel, specialist registrar in gastroenterology, T R Yapp, consultant gastroenterologist, R Clements, consultant radiologist, Royal Gwent Hospital, Newport NP20 2UB