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 #Achalasia #Diagnosis #Management #ACG #Guidelines #gastroenterology #Treatemtn
