Summary
Definition
History and exam
Key diagnostic factors
- disfagia
Other diagnostic factors
- postura para auxiliar na deglutição
- pressão/dor retroesternal
- regurgitação
- perda de peso gradual
- pirose
- alimentação lenta
- tosse/sufocamento na posição de decúbito
- infecções torácicas recorrentes
- sensação de nó na garganta (globus)
- soluços
Risk factors
- vírus do herpes e sarampo
- doença autoimune
- antígenos leucocitários humanos (HLA) classe II
- pais consanguíneos
- síndrome de Allgrove (triplo A)
Diagnostic investigations
1st investigations to order
- endoscopia digestiva alta
- esofagografia baritada
- manometria esofágica de alta resolução
Investigations to consider
- radiografia torácica
- estudos do esvaziamento esofágico por radionucleotídeos
- esofagograma com bário cronometrado
- tomografia computadorizada (TC) do tórax
- planimetria por impedância
Treatment algorithm
pacientes que aguardam tratamento definitivo
bom candidato cirúrgico
não candidato à cirurgia
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 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.
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
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
- Carcinoma esofágico
- Esofagite de refluxo
- Doenças do tecido conjuntivo (por exemplo, esclerose sistêmica)
More DifferentialsGuidelines
- Adverse events associated with EGD and EGD-related techniques
- American Society for Gastrointestinal Endoscopy guideline on informed consent for GI endoscopic procedures
More Guidelines
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer