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Achalasia

Christopher Kim, MD and Jadranko Corak, MD Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Primary esophageal dysmotility

  • Absence of esophageal peristalsis and impaired relaxation of the lower esophageal sphincter (LES)

EPIDEMIOLOGY

Incidence

  • 1 to 2/100,000 population/year (1)

  • ...

DIAGNOSIS

HISTORY

  • Dysphagia to solids and liquids, gradually worsening over time (1,2)

  • Regurgitation (most commonly at night in the recumbent position) (1,2)

    • Can result in nocturnal cough and aspiration

  • N...

TREATMENT

GENERAL MEASURES

  • Primary goal of management is to prevent complications and preserve esophageal structure and function.

  • Oral/sublingual medications provide short-term treatment and are not as ...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Obtain a posttreatment barium study to evaluate for resolution.

  • Consider proton pump inhibitor in patients with reflux symptoms.

  • Reassess for treatment failure or r...

REFERENCES

1
Tuason J, Inoue H. Current status of achalasia management: a review on diagnosis and treatment. J Gastroenterol.  2017;52(4):401–406. {L-End} [View Abstract on OvidMedline]
2
Vaezi MF,...

CODES

ICD10

K22.0 Achalasia of cardia 

ICD9

530.0 Achalasia and cardiospasm 

SNOMED

  • 48531003 Achalasia

  • 266434009 Esophageal dysmotility

  • 45564002 Achalasia of esophagus

  • 715192004 Idiopathic achalasia of esopha...

CLINICAL PEARLS

  • Achalasia is a rare, idiopathic disorder of esophageal motility.

  • HREM allows for disease subclassification, which impacts treatment outcomes.

  • Perform EGD on all patients with achalasia t...

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