Symptoms and diagnosis of achalasia

Pathologically, achalasia is characterised by degeneration of the ganglia of the nerves innervating the oesophagus; the cause is unknown but may relate to viral infection or autoimmunity. The cardinal features of achalasia are lack of relaxation of the lower oesophageal sphincter and aperistalsis of the oesophageal body, causing dysphagia, regurgitation, and chest discomfort or painRieder, 2020.

Diagnosis requires investigation as the symptoms are nonspecific. The approach to diagnosis depends on the symptom pattern and risk factors for other conditions that may cause similar symptoms. Oesophageal manometry is the most sensitive investigation, demonstrating the lack of sphincter relaxation and aperistalsis. It also allows for subclassification of the type of achalasia, which may influence managementRieder, 2020. Upper gastrointestinal endoscopy or a barium swallow may be used to exclude other causes (eg obstructing lesions, eosinophilic oesophagitis).