Diagnosis and Management of Achalasia - ACG Guidelines



Who to suspect?

 • Patients presenting with progressive dysphagia to solids and liquids, heart burn, chest pain, regurgitation, and weight loss or nutritional deficiencies.

 • Patients diagnosed with GERD who are unresponsiveto acid-suppressive therapy.

What test to order?

 • Endoscopy to look for foam or puckering of the EGJ

 • Barium esophagogram to look for retained barium or the classic "bird beaking"

 • High resolution esophageal manometry (HRM)

Chicago classification for achalasia subtypes

 • Achalasia I -  aperistalsis+ panesophageal pressurization < 30 mm Hg

 • Achalasia II -  aperistalsis+ panesophageal pressurization > 30 mm Hg

 • Achalasia Ill - spastic contractions

Definitive Treatment:

 • Pneumatic Dilation (PD)

 • Laparoscopic Heller Myotomy (LHM)

 • POEM

Symptomatic Treatment:

 • Botulinum toxin

 • Pharmacologic: Calcium channel blockers, Nitrates, Anticholinergics, Beta-adrenergic agonists, Theophylline, Sildenafil



By Dr. Cindy Ye @EmoryGastroHep



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