Achalasia

Krunal Patel, MD and Christopher A. Marshall, MD Reviewed 06/2017
 


BASICS

DESCRIPTION

  • Primary esophageal dysmotility

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

EPIDEMIOLOGY

INCIDENCE

  • 1/100,000 population/year (1)

  • Age o...

DIAGNOSIS

HISTORY

  • Dysphagia to solids and liquids, worsening gradually over a period of time (1)

  • Indolent course

  • Sitophobia (fear of eating) can lead to weight loss.

  • Regurgitation, most commonly at night ...

TREATMENT

GENERAL MEASURES

  • Oral/sublingual medications are not as effective as endoscopic and surgical therapies

  • Type II achalasia typically responds best to treatment.

  • Consider endoscopic treatment for ...

ONGOING CARE

FOLLOWUP RECOMMENDATIONS

  • Obtain a posttreatment barium study to evaluate for resolution.

  • Consider proton pump inhibitor in patients with reflux symptoms.

  • Reassess for treatment failure or re...

REFERENCES

Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol.  2013;108(8):1238–1249. [View Abstract on OvidInsights]
Stavropoul...

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...

PEARLS

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

  • High-resolution esophageal manometry allows for subclassification, which impacts treatment outcomes.

  • Perform EGD on all patients w...

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