Achalasia cannot be diagnosed on the basis of history alone. Symptoms are often slowly progressive, during which time many patients may adapt to significant symptoms by slowly altering their diet or eating habits. A minority of patients present with heartburn, regurgitation, or slow eating compared with other family members, rather than dysphagia.[22]

Barium swallow or endoscopy can appear normal in patients with early disease. Therefore, many patients with achalasia may be symptomatic for months or years before the correct diagnosis is made.[22][23]

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