Achalasia

Diagnosis

Typically, physicians diagnose achalasia by taking a careful medical history and performing a physical examination. In addition to a physical exam, the doctor may recommend various tests to diagnose achalasia such as:

Barium X-ray

For this test, patients drink a barium solution. The barium coats the inside of the esophagus, causing it to show up better on X-rays. The physician can then see changes in the shape of the esophagus and can assess the muscular activity. In achalasia, the X-ray shows a dilated (enlarged or widened) esophagus, with a characteristic tapered narrowing of the lower end that resembles a bird's beak. In addition, the barium stays in the esophagus longer than normal before passing into the stomach.

Endoscopy

A thin, flexible, lighted instrument (endoscope) which contains a camera is passed down the throat so the physician can view the inside of the esophagus. Endoscopy is important because it can rule out esophageal cancer, another serious disease that can obstruct the passage of food and dilate the esophagus.

Esophageal Manometry

In this test, a thin tube is inserted into the esophagus and connected to a pressure recorder. Muscle contractions of the esophagus are measured when the patient swallows. In a patient with achalasia, no wave of pressure due to muscular contraction is seen in the lower half of the esophagus after a swallow, and the pressure within the contracted sphincter does not relax with the swallow. An advantage of manometry is that it can diagnose achalasia in its early stages.