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Achalasia

Kathleen Barry, MD Reviewed 04/2024
 


BASICS

An esophageal smooth muscle motility disorder resulting in impaired swallowing (deglutition).​​​​​​ 

DESCRIPTION

  • Absence of esophageal peristalsis and impaired relaxation of the lower esophageal ...

DIAGNOSIS

HISTORY

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

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

  • Vomiting

  • Nocturnal coug...

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 e...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Obtain a post-treatment barium study to evaluate for resolution

  • Consider proton pump inhibitor in patients with reflux symptoms

  • Reassess for treatment failure or re...

REFERENCES

1
Wessels EM, Masclee GMC, Bredenoord AJ. An overview of the efficacy, safety, and predictors of achalasia treatments. Expert Rev Gastroenterol Hepatol. 2023;17(12):1241-1254. doi: 10.1080/1...

CODES

ICD10

  • Q39.5 Congenital dilatation of esophagus

  • K22.0 Achalasia of cardia

SNOMED

  • 48531003 Achalasia

  • 45798009 Congenital cardiospasm

  • 45564002 Achalasia of esophagus

  • 715192004 Idiopathic achalasia of esop...

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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