investigations
Last edited 02/2022 and last reviewed 09/2023
Investigations are as follows:
- barium swallow – characteristic appearance with proximal dilatation and distal smooth tapering (dilated oesophagus with bird beak appearance) (1)
- manometric tests – demonstrate motility disorder
- gastroesophageal sphincter that has a high resting tone and only partially relaxes
- tone does not fall to gastric fundal pressure
- gold standard (2)
- endoscopy – exclusion of pseudo achalasia (1) or carcinoma (3)
- oesophageal pH monitoring – to ruled out reflux disease (3)
- chest radiograph may reveal:
- widened mediastinum with possibly a fluid level behind the heart
- absence of gastric air bubble
Reference:
- Vaezi MF, Pandolfino JE, Yadlapati RH, Greer KB, Kavitt RT. ACG Clinical Guidelines: Diagnosis and Management of Achalasia. Am J Gastroenterol. 2020 Sep;115(9):1393-1411. doi: 10.14309/ajg.0000000000000731. PMID: 32773454.
- Schlottmann F, Patti MG. Esophageal achalasia: current diagnosis and treatment. Expert Rev Gastroenterol Hepatol. 2018 Jul;12(7):711-721. doi: 10.1080/17474124.2018.1481748. Epub 2018 Jun 8. PMID: 29804476.
- Momodu II, Wallen JM. Achalasia. [Updated 2021 Aug 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519515/ - article-17083.s4 (accessed 21 January 2022)