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Achalasia

Последний просмотренный: 13 Sep 2025
Last updated: 01 Oct 2025

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • dysphagia
Detalhes completos

Outros fatores diagnósticos

  • posturing to aid swallowing
  • retrosternal pressure/pain
  • regurgitation
  • gradual weight loss
  • heartburn
  • slow eating
  • coughing/choking while recumbent
  • recurrent chest infections
  • sensation of a lump in the throat (globus)
  • hiccups
Detalhes completos

Fatores de risco

  • herpes and measles viruses
  • autoimmune disease
  • HLA class II antigens
  • consanguineous parents
  • triple A (Allgrove) syndrome
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • upper gastrointestinal endoscopy
  • barium swallow
  • high-resolution esophageal manometry
Detalhes completos

Investigações a serem consideradas

  • chest x-ray
  • radionucleotide esophageal emptying studies
  • timed barium esophagogram
  • CT chest
  • impedance planimetry
Detalhes completos

Algoritmo de tratamento

Inicial

patients awaiting definitive treatment

AGUDA

good surgical candidate

poor surgical candidate

Colaboradores

Autores

Jamal Omar Hayat, MBBS, BSc, MRCP, MD (Res)

Consultant Gastroenterologist and Honorary Senior Lecturer

Department of Gastroenterology

St George's University Hospitals NHS Trust

London

UK

Declarações

JOH declares that he has no competing interests.

Kalliopi Alexandropoulou, MD, FRCP

Consultant Gastroenterologist

Royal Surrey County Hospital

Guildford

Surrey

UK

Disclosures

KA declares that sshe has no competing interests.

Acknowledgements

Dr Jamal Omar Hayat and Dr Kalliopi Alexandropoulou wish to gratefully acknowledge Dr Jin-Yong Kang, the previous contributor to this topic.

Disclosures

JYK declares that he has no competing interests.

Peer reviewers

Nigel Trudgill, MB ChB

Consultant Gastroenterologist

Sandwell General Hospital

West Bromwich

UK

Disclosures

NT declares that he has no competing interests.

John de Caestecker, BChir

Consultant in General Medicine

Leicester General Hospital

Leicester

UK

Disclosures

JdC declares that he has no competing interests.

David Hackam, MD, PhD

Assistant Professor of Surgery

Children's Hospital of Pittsburgh

Pittsburgh

PA

Disclosures

DH declares that he has no competing interests.

George Y. Wu, MD, PhD

Professor of Medicine

University of Connecticut Health Center

Farmington

CT

Disclosures

GYW is on the medical advisory boards of the following: Gilead Sciences, Bristol-Myers Squibb, AbbVie, and Intercept.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Zaninotto G, Bennett C, Boeckxstaens G, et al. The 2018 ISDE achalasia guidelines. Dis Esophagus. 2018 Sep 1;31(9).Full text  Abstract

Vaezi MF, Pandolfino JE, Yadlapati RH, et al. ACG clinical guidelines: diagnosis and management of achalasia. Am J Gastroenterol. 2020 Sep;115(9):1393-411.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Achalasia images
  • Differentials

    • Esophageal carcinoma
    • Reflux esophagitis
    • Connective tissue disorders (e.g., systemic sclerosis)
    More Differentials
  • Guidelines

    • Adverse events associated with EGD and EGD-related techniques
    • Diagnosis and management of achalasia​
    More Guidelines
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