• Rishi D. NaikEmail author
  • Dhyanesh A. Patel


Achalasia is a primary disorder of esophageal motility and is the most common motor neuron disorder of the esophagus. Classic presentation involves dysphagia to solids and liquids with regurgitation and chest pain. The gold standard test is using high-resolution manometry to evaluate the motility of the esophagus when an endoscopy has ruled out causes of pseudo-achalasia, such as a cancer at the gastroesophageal junction. Endoscopic appearance of the esophagus at the lower esophageal sphincter often shows a “puckered appearance” with retained food or saliva proximal to this narrowing. Barium esophagram may reveal distal tapering of the lower esophageal sphincter giving the classic “bird beak’s appearance.” Several therapeutic options for achalasia are available including both endoscopic and surgical options for those able to tolerate the risks of these procedures. Increased attention has been placed on management based on subtype of achalasia to direct a personalized approach. Limitations of the current state of achalasia include the lack of etiological risk factor and lack of curative approaches. The goals of therapy are to improve symptoms and prevent esophageal stasis. Future work guided at understanding fundamental causal factors of achalasia, which may provide insight to more durable therapies is needed.


Esophageal peristalsis EPT EGJOO Esophagogastroduodenoscopy Functional lumen imaging probe Botulinum toxin injection Pneumatic dilation POEM Laparoscopic Heller myotomy 


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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Section of Gastroenterology, Hepatology, and NutritionCenter for Swallowing and Esophageal Disorders, Digestive Disease Center, Vanderbilt University Medical CenterNashvilleUSA

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