How is it Diagnosed?
Achalasia is a rare esophageal motility disorder characterized by impaired relaxation of
the lower esophageal sphincter (LES) and absence of peristalsis in the esophageal
body. Diagnosis typically follows a history of progressive dysphagia (for solids and
liquids), regurgitation, chest pain, and weight loss.
Initial evaluation often involves a barium swallow study, which reveals a classic “birdbeak” appearance at the LES with esophageal dilatation. This test is non-invasive and
helps identify anatomical abnormalities.
The gold standard for diagnosis is esophageal manometry, which measures esophageal
pressure. Findings include incomplete LES relaxation and absence of normal peristalsis.
High-resolution manometry can classify achalasia into three subtypes, which can
influence treatment decisions.
Upper GI endoscopy is done to rule out malignancy at the gastroesophageal junction
(pseudoachalasia) and to exclude mechanical obstructions or inflammation. While the
esophagus may appear dilated with retained food or saliva, the LES may not relax
appropriately during the procedure.
In certain cases, chest X-ray or CT scan may show a widened mediastinum or air-fluid
levels if the esophagus is significantly dilated. These are especially helpful in advanced
disease.