title: Appearance of a double bubble in achalasia cardia: a case report.
abstract: BACKGROUND
  Achalasia cardia is characterized by failure of the lower esophageal sphincter to relax in response to swallowing and by an absence of peristalsis in the esophageal body. Absence of a gastric air bubble is a well known radiological finding. Pneumatic balloon dilatation results in reappearance of the gastric bubble.
  
  
  METHODS
  We report the case of a 43-year-old Indian man with achalasia cardia whose chest X-ray at the time of presentation showed an air bubble in the gastric region causing a diagnostic quandary. Successful dilatation of the lower esophageal sphincter resulted in the appearance of another air bubble in the gastric region. Proper analysis showed that the first bubble was actually a colonic air bubble of the splenic flexure and the appearance of the second bubble was the anticipated gastric air bubble.
  
  
  CONCLUSIONS
  In patients presenting with achalasia cardia, a colonic air bubble may be seen in the gastric region causing diagnostic difficulty. In these patients, a gastric air bubble may appear after pneumatic dilatation. At the end of the procedure, there will be two air bubbles ("double bubble"): a colonic and a gastric air bubble. To our knowledge, this finding has not been reported in the literature thus far.
authors.affiliation: Global Neuroscience Initiative Foundation, Los Angeles, CA, USA. slakhan@gnif.org
authors.forename: Shaheen E
authors.initials: SE
authors.lastname: Lakhan
authors.forename: S Jeevan
authors.initials: SJ
authors.lastname: Kumar
authors.forename: P Ratnakar
authors.initials: PR
authors.lastname: Kini