Achalasia Achalasia is a motor disorder of the esophagus characterized by complete loss of peristalsis. Approximately 2 people per 200,000 per year will be diagnosed with this illness. The symptoms are somewhat similar to GERD, thus patients may be treated for reflux before the diagnosis of achalasia is made. Most patients will experience weight loss, and some may present with complications such as inhalation of debris from their esophagus. The diagnosis of achalasia may be suspected by barium xray or by endoscopy .
Upper endoscopy is performed to exclude cancer as a cause of blockage.
The primary diagnosis, however, is based on the lack of peristalsis documented on manometry. Manometry may also show a failure of the LES to relax with swallowing. Medications which lower LES pressure include nitroglycerin, Isordil, Verapamil and others. Small dilators may be used to help with difficulty swallowing but last only months. Currently, the mainstays of treatment are surgery or dilatation with large dilators although some physicians choose to relax the LES using injection of botulism toxin.