Rapid Review: Achalasia

Reviewed February 2024

Achalasia

• Sx: dysphagia to solids and liquids
  • Chronic Chagas disease may present similarly
• PE: absent peristalsis in the lower esophagus
• Barium swallow shows bird-beak appearance
• Diagnosis is confirmed with esophageal manometry: increased LES pressure

---

Sample question:

A 60-year-old man comes to the clinic with reports of difficulty swallowing, heartburn, chest pain, and mild weight loss. He has difficulty swallowing solids and liquids and often regurgitates undigested food. He has no significant past medical history and takes no medications. He reports no travel-related infection. Esophageal manometry reveals aperistalsis in the distal two-thirds of the esophagus and incomplete lower esophageal sphincter relaxation. Which of the following is the most likely diagnosis?