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Update on the Diagnosis and Treatment of Achalasia

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Abstract

Achalasia is a rare disease of the esophagus with impaired relaxation of the lower esophageal sphincter and aperistalsis. The etiology is unknown but speculations include a viral or autoimmune etiology. All specialists dealing with swallowing and esophageal diseases should recognize the classic symptoms of dysphagia for solids/liquids, regurgitation, and choking, especially at night. High-resolution manometry is critical for the diagnosis with endoscopy and barium esophagram having a supportive role. The disease cannot be cured but most can return to near normal swallowing and a regular diet with appropriate therapy. Treatment includes smooth muscle relaxants, botulinum toxin injections to the lower sphincter, pneumatic dilation, Heller myotomy, and peroral endoscopic myotomy. One treatment does not fit all and a tailored approach through a multidiscipline team will give the best long-term outcomes.

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Authors and Affiliations

  1. Division of Gastroenterology, James A. Haley VA Hospital, Tampa, FL, USA

    Wojciech Blonski

  2. Division of Gastroenterology and Nutrition, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd, MDC 72, Tampa, FL, 33612, USA

    Wojciech Blonski, Samuel Slone & Joel E. Richter

  3. Joy McCann Culverhouse Center for Esophageal Diseases, Morsani College of Medicine, University of South Florida, Tampa, FL, USA

    Joel E. Richter

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  1. Wojciech Blonski
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Invited review. Subject headings equally divided up among 3 authors who did literature search and wrote their sections. Senior author (JR) put the entire manuscript together.

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Correspondence to Joel E. Richter.

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Blonski, W., Slone, S. & Richter, J.E. Update on the Diagnosis and Treatment of Achalasia. Dysphagia 38, 596–608 (2023). https://doi.org/10.1007/s00455-022-10435-3

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