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1. Barium swallow: The esophagus appears dilated and is often fluid-filled. The barium may take a long time to empty into the stomach, even if the patient is upright. There is a "bird-beak" narrowing distally, which represents the tight LES.

2. OGD: generally the 2nd test ordered. It is done to exclude a tumor at the esophagogastric junction ("pseudoachalasia").

3. Esophageal manometry: last test to confirm the diagnosis, shows the absence of normal peristalsis & with a non-relaxing LES.

4. The use of high resolution manometry with impedance has revealed 3 distinct subtypes of achalasia: traditional aperistalsis, esophageal compression, or generalized spasm.


1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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