Updated Best Practices for Achalasia Diagnosis and Therapy

Experts offer up-to-date recommendations, particularly on use of per oral endoscopic myotomy for achalasia.

In a clinical update, three top opinion leaders provide evolving insights on best practices in the diagnosis and management of achalasia, building on existing national guidelines (NEJM JW Gastroenterol Dec 2013 and Am J Gastroenterol 2013; 108:1238).

Key points are as follows:

There are three manometric types of achalasia, although a fourth pattern, esophagogastric junction (EGJ) outflow obstruction, may or may not represent achalasia.
Integrated relaxation pressure (IRP) elevation is a hallmark of achalasia but may be normal, particularly in type I.
Late in disease progression, both the lower esophageal sphincter pressure (LESP) and IRP can be extremely low; if so, diagnosis is established by luminal imaging probe and stasis on barium esophagr…

Reviewing Author

David A. Johnson, MD

Disclosures

Consultant/Advisory boardMedscape/WebMD; Pfizer; CRH Medical Corporation; Aries

EquityCRH Medical Corporation

Editorial boardsMedscape Gastroenterology

Leadership positions in professional societiesAmerican College of Gastroenterology Research Institute Board of Directors