Achalasia: investigation and management

Br J Hosp Med (Lond). 2023 Jan 2;84(1):1-9. doi: 10.12968/hmed.2022.0437. Epub 2023 Jan 24.


Achalasia, characterised by the absence of peristalsis and failure of relaxation of the lower oesophageal sphincter, is an uncommon degenerative condition that results in dysphagia. If left untreated it can lead to aspiration, oesophageal perforation, oesophagitis and malnutrition. It has a range of immune, allergic, viral and genetic aetiological causes. Successful diagnosis relies on the use of oesophagogastroduodenoscopy, barium swallow and oesophageal manometry to characterise the severity of the disease and to rule out underlying malignancy. Although no treatment can reverse the degenerative process, therapeutic strategies including lifestyle modification, medication, endoscopic and operative intervention can help to reduce symptoms. This article reviews the latest methods used to investigate and manage achalasia.

Keywords: Achalasia; Barium swallow; Dysphagia; Eckardt score; Manometry; Oesphagogastroduodenoscopy.

Publication types

  • Review

MeSH terms

  • Deglutition Disorders* / diagnosis
  • Deglutition Disorders* / etiology
  • Deglutition Disorders* / therapy
  • Esophageal Achalasia* / diagnosis
  • Esophageal Achalasia* / therapy
  • Esophageal Sphincter, Lower / surgery
  • Esophagoscopy / methods
  • Humans
  • Manometry / adverse effects
  • Manometry / methods