Dawaa Reference

Clinical reference

Achalasia (Referral)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources1 source

StatPearls: Achalasia (NCBI Bookshelf NBK519515)

Verified against1 document
  • StatPearls: Achalasia (NCBI Bookshelf NBK519515)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (6)

  • Heartburn is common and often gets mistaken for and treated as reflux disease first [heartburn]
  • Persistent reflux symptoms despite proton pump inhibitor therapy should prompt suspicion for this diagnosis [heartburn]
  • Difficulty swallowing solids comes first, but most patients eventually struggle with liquids too [difficulty swallowing]
  • Over half of patients report chest pain that rarely improves even after treatment restores esophageal emptying [chest pain]
  • Later in the disease, regurgitation with risk of aspiration, night cough, heartburn, and fast weight loss can develop [cough · heartburn · regurgitation · weight loss]
  • Hiccups and trouble belching are less common complaints [belching · hiccups]

Signs — what you find (2)

  • Severe dilation of the esophagus in the neck can cause a bullfrog-neck look with airway obstruction and stridor [stridor]
  • Physical exam is usually unremarkable, though the patient may appear wasted from weight loss [weight loss]

Tests (7)

  • Barium swallow is the first test of choice, classically showing a tapered lower esophagus with dilation above and no peristalsis
  • Upper endoscopy is done in every suspected case to exclude a tumor mimicking achalasia
  • Marked resistance passing the scope through the gastroesophageal junction, especially in an older patient with rapid weight loss, raises concern for a malignant mimic
  • Esophageal manometry is the gold-standard, most sensitive test, showing incomplete LES relaxation, absent peristalsis, and high LES pressure
  • An integrated relaxation pressure above 15 mm Hg on high-resolution manometry counts as elevated
  • FLIP measures the lower sphincter's cross-sectional area, minimum diameter, balloon pressure, and distensibility
  • Prolonged esophageal pH monitoring rules out reflux and checks for reflux caused by treatment

If not this — what else fits (6)

  • Gastric outlet obstruction should be distinguished, since it causes more vomiting than swallowing trouble
  • Diffuse esophageal spasm and esophagogastric junction outflow obstruction are motility mimics
  • Scleroderma and esophageal adenocarcinoma are structural or systemic mimics
  • Reflux disease, a peptic stricture, and a Schatzki ring can all cause similar swallowing symptoms
  • An epiphrenic diverticulum or a hiatal or paraesophageal hernia are structural alternatives
  • An infiltrating malignancy causing pseudoachalasia is an important mimic to exclude

SourceStatPearls "Achalasia" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (REFERRAL)

1st line
Adult dose and duration

Refer to gastroenterology for high-resolution manometry, upper GI endoscopy, and definitive management (pneumatic dilation or surgical myotomy) - Surgical or specialist management

Paediatric dose

Refer to pediatric gastroenterology

Dose source

StatPearls: Achalasia (NCBI Bookshelf NBK519515)

Why

PPI therapy and empirical medications are ineffective; definitive mechanical intervention is required.

Cautions
  • Distinguish from GERD; PPI therapy will not resolve dysphagia in true achalasia.
  • Suspect if patient has progressive dysphagia to both solids and liquids with regurgitation of undigested food.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.