How is achalasia diagnosed?
The diagnosis of achalasia usually is made by an x-ray study called a video-esophagram in which video x-rays of the esophagus are taken after barium is swallowed. The barium fills the esophagus, and the emptying of the barium into the stomach can be observed. In achalasia, the video-esophagram shows that the esophagus is dilated (enlarged or widened), with a characteristic tapered narrowing of the lower end sometimes likened to a “bird¦s beak.” In addition, the barium stays in the esophagus longer than normal before passing into the stomach. Another test, esophageal manometry, can demonstrate specifically the abnormalities of muscle function that are characteristic of achalasia, that is, the failure of the muscle to contract with swallowing and the failure of the lower sphincter to relax. For manometry, a thin tube that measures the pressure generated by the contracting esophageal muscle is passed through the nose and into the esophagus. In a patient with achalasia, no wave of pressure
The diagnosis of achalasia often is suspected on the basis of the history. Patients usually describe a progressive (worsening) of dysphagia for solid and liquid food over a period of many months to years. They may note regurgitation of food, chest pain, or loss of weight. Rarely, the first symptom is aspiration pneumonia. Because patients typically learn to compensate for their dysphagia by taking smaller bites, chewing well, and eating slowly, the diagnosis of achalasia often is delayed by months or even years. The delay in diagnosis of achalasia is unfortunate because it is believed that early treatment–before marked dilation of the esophagus occurs-can prevent esophageal dilation and its complications. The dysphagia in achalasia also is different from the dysphagia of esophageal stricture (narrowing of the esophagus due to scarring) and esophageal cancer. In achalasia, dysphagia occurs with both solid and liquid food, whereas in esophageal stricture and cancer, the dysphagia typica
