# Achalasia (Referral) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: StatPearls: Achalasia (NCBI Bookshelf NBK519515) - Verified date: 2026-08 ## Verified against - StatPearls: Achalasia (NCBI Bookshelf NBK519515) ## Treatment metadata - No drug therapy in primary care (Referral) ## Complete treatment card ```text ACHALASIA (REFERRAL) Sources: StatPearls: Achalasia (NCBI Bookshelf NBK519515) Review status: REVIEWED against the source listed above (2026-08) 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 Source StatPearls "Achalasia" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL) [1st line] Adult Refer to gastroenterology for high-resolution manometry, upper GI endoscopy, and definitive management (pneumatic dilation or surgical myotomy) - Surgical or specialist management Peds Refer to pediatric gastroenterology Source StatPearls: Achalasia (NCBI Bookshelf NBK519515) Why PPI therapy and empirical medications are ineffective; definitive mechanical intervention is required. Caution 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. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)