Summary
Definition
History and exam
Key diagnostic factors
- dysphagia
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
Risk factors
- herpes and measles viruses
- autoimmune disease
- HLA class II antigens
- consanguineous parents
- triple A (Allgrove) syndrome
Diagnostic tests
1st tests to order
- upper gastrointestinal endoscopy
- barium swallow
- high-resolution esophageal manometry
Tests to consider
- chest x-ray
- radionucleotide esophageal emptying studies
- timed barium esophagogram
- CT chest
- impedance planimetry
Treatment algorithm
patients awaiting definitive treatment
good surgical candidate
poor surgical candidate
Contributors
Authors
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
Disclosures
JOH is on the advisory board for Falk.
Jin-Yong Kang, MD, PhD, FRCP, FRCPEd, FRACP
Retired Consultant Gastroenterologist
London
UK
Disclosures
JYK declares that he holds shares in AstraZeneca.
Kalliopi Alexandropoulou, MD, FRCP
Consultant Gastroenterologist
Royal Surrey County Hospital
Guildford
Surrey
UK
Disclosures
KA declares that sshe 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.
References
Key articles
Eckardt VF. Clinical presentations and complications of achalasia. Gastrointest Endosc Clin N Am. 2001 Apr;11(2):281-92. Abstract
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.
Differentials
- Esophageal carcinoma
- Reflux esophagitis
- Connective tissue disorders (e.g., systemic sclerosis)
More DifferentialsGuidelines
- American Society for Gastrointestinal Endoscopy guideline on informed consent for GI endoscopic procedures
- Adverse events associated with EGD and EGD-related techniques
More Guidelines
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