Achalasia

Last reviewed: 24 Apr 2022
Last updated: 01 Apr 2022

Summary

Definition

History and exam

Key diagnostic factors

  • dysphagia
More key diagnostic factors

Other diagnostic factors

  • 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
Other diagnostic factors

Risk factors

  • herpes and measles viruses
  • autoimmune disease
  • HLA class II antigens
  • consanguineous parents
  • triple A (Allgrove) syndrome
More risk factors

Diagnostic investigations

1st investigations to order

  • upper gastrointestinal endoscopy
  • barium swallow
  • high-resolution oesophageal manometry
More 1st investigations to order

Investigations to consider

  • chest x-ray
  • radionucleotide oesophageal emptying studies
  • timed barium oesophagogram
  • CT chest
More investigations to consider

Treatment algorithm

INITIAL

patients awaiting definitive treatment

ACUTE

good surgical candidate

poor surgical candidate

Contributors

Authors

Jin-Yong Kang, MD, PhD, FRCP, FRCPEd, FRACP
Jin-Yong Kang

Honorary Consultant Gastroenterologist

St George's Hospital

London

UK

Disclosures

JYK declares that he has no competing interests.

Kalliopi Alexandropoulou, MD, FRCP

Consultant Gastroenterologist

Royal Surrey County Hospital

Guildford

Surrey

UK

Disclosures

KA declares that he has no competing interests.

Acknowledgements

Dr Jin-Yong Kang would like to gratefully acknowledge Kalliopi Alexandropoulou, a previous contributor to this topic. KA declares that she 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.

  • Achalasia images
  • Differentials

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

    • American Society for Gastrointestinal Endoscopy guideline on informed consent for GI endoscopic procedures
    • Guidelines for oesophageal manometry and oesophageal reflux monitoring
    More Guidelines
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