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 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
Declarações
GYW is on the medical advisory boards of the following: Gilead Sciences, Bristol-Myers Squibb, AbbVie, and Intercept.
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Referências
Principais artigos
Zaninotto G, Bennett C, Boeckxstaens G, et al. The 2018 ISDE achalasia guidelines. Dis Esophagus. 2018 Sep 1;31(9).Texto completo Resumo
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.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Differentials
- Esophageal carcinoma
- Reflux esophagitis
- Connective tissue disorders (e.g., systemic sclerosis)
Mais DifferentialsGuidelines
- Adverse events associated with EGD and EGD-related techniques
- Diagnosis and management of achalasia
Mais Guidelines
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