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Investigations

Authoring team

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:

  1. 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.
  2. 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.
  3. 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)

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