Skip to Content

Achalasia - Diagnosis

Achalasia Diagnosis

Videoesophagram: This study shows the anatomy and the function of the esophagus and the gastroesophageal junction. In patients with achalasia, the esophagus is dilated, the lower esophageal sphincter does not open, and the gastroesophageal junction is tight and is seen as a narrow point.

A picture of a patient with a dilated esophagus on Barium esophagram is shown in the image below.

  • Esophageal motility study:This study is the most important study to diagnose achalasia. In patients with achalasia all the esophageal contractions are of low amplitude (pressure) and are simultaneous (happen at the same time), therefore, there is no peristalsis (coordinated function to push the food toward the stomach) in the esophageal body. The lower esophageal sphincter (the valve between the esophagus and the stomach) does not open.

The image below illustrates an esophageal motility study (high-resolution manometry) in two swallows in a patient with achalasia. Each color corresponds to a certain pressure in the esophagus.

Manometry in a Patient with Achalasia

Bravo Capsule
  • In patients with vigorous achalasia, in contrast to patients with achalasia, all the esophageal contractions are of high amplitude (pressure); but similar to patients with achalasia, all the contractions are simultaneous (happen at the same time). Therefore, there is no peristalsis (coordinated function to push food toward the stomach) in the esophageal body. The lower esophageal sphincter (the valve between the esophagus and the stomach) does not open.

The image below shows esophageal contractions on an esophageal motility study (high-resolution manometry) in a patient with vigorous achalasia. Each color corresponds to a certain pressure in the esophagus.

Manometry in a Patient with Vigorous Achalasia

Bravo Capsule

The image below is a simple schematic presentation of esophageal contractions on an esophageal motility study (high-resolution manometry) in a patient with vigorous achalasia.

Manometry in a Patient with Vigorous Achalasia

Bravo Capsule
  • Upper endoscopy: In patients with achalasia, upper endoscopy shows a dilated esophagus with a narrow gastroesophageal junction. It is mandatory to perform an upper endoscopy to confirm that the narrowing of the gastroesophageal junction is not caused by other diseases such as stricture or cancer.

  • Computed tomography (CT) scan: A CT scan uses X-rays to make detailed pictures of structures inside the body. This study is not routinely done for diagnosis of achalasia but many patients present with dilated esophagus, which is visible on a CT scan of the chest as shown in the images below.