Diagnosis and Management of Achalasia

Michael F. Vaezi, MD, PhD, MSc, FACG1, John E. Pandolfino, MD, MSCI2 and Marcelo F. Vela, MD, MSCR3

1Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA
2Department of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, USA
3Division of Gastroenterology and Hepatology, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, Texas, USA

Am J Gastroenterol 2013; 108:1238–1249; doi:10.1038/ajg.2013.196; published online 23 July 2013
Received 3 July 2012; Accepted 1 May 2013
Advance online publication 23 July 2013

Correspondence: Michael F. Vaezi, MD, PhD, MSc, Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, 1660 TVC, 1301–22nd Avenue South, Nashville, Tennessee 37232-5280, USA. E-mail: Michael.vaezi@vanderbilt.edu

Abstract

Achalasia is a primary motor disorder of the esophagus characterized by insufficient lower esophageal sphincter relaxation and loss of esophageal peristalsis. This results in patients’ complaints of dysphagia to solids and liquids, regurgitation, and occasional chest pain with or without weight loss. Endoscopic finding of retained saliva with puckered gastroesophageal junction or barium swallow showing dilated esophagus with birds beaking in a symptomatic patient should prompt appropriate diagnostic and therapeutic strategies. In this ACG guideline the authors present an evidence-based approach in patients with achalasia based on a comprehensive review of the pertinent evidence and examination of relevant published data.

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