chronic

Achalasia (Referral)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources1 source

StatPearls: Achalasia (NCBI Bookshelf NBK519515)

Verified against1 document

StatPearls: Achalasia (NCBI Bookshelf NBK519515)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (6)

Heartburn is common and often gets mistaken for and treated as reflux disease first [heartburn]
Persistent reflux symptoms despite proton pump inhibitor therapy should prompt suspicion for this diagnosis [heartburn]
Difficulty swallowing solids comes first, but most patients eventually struggle with liquids too [difficulty swallowing]
Over half of patients report chest pain that rarely improves even after treatment restores esophageal emptying [chest pain]
Later in the disease, regurgitation with risk of aspiration, night cough, heartburn, and fast weight loss can develop [cough · heartburn · regurgitation · weight loss]
Hiccups and trouble belching are less common complaints [belching · hiccups]

Signs — what you find (2)

Severe dilation of the esophagus in the neck can cause a bullfrog-neck look with airway obstruction and stridor [stridor]
Physical exam is usually unremarkable, though the patient may appear wasted from weight loss [weight loss]

Tests (7)

Barium swallow is the first test of choice, classically showing a tapered lower esophagus with dilation above and no peristalsis
Upper endoscopy is done in every suspected case to exclude a tumor mimicking achalasia
Marked resistance passing the scope through the gastroesophageal junction, especially in an older patient with rapid weight loss, raises concern for a malignant mimic
Esophageal manometry is the gold-standard, most sensitive test, showing incomplete LES relaxation, absent peristalsis, and high LES pressure
An integrated relaxation pressure above 15 mm Hg on high-resolution manometry counts as elevated
FLIP measures the lower sphincter's cross-sectional area, minimum diameter, balloon pressure, and distensibility
Prolonged esophageal pH monitoring rules out reflux and checks for reflux caused by treatment

If not this — what else fits (6)

Gastric outlet obstruction should be distinguished, since it causes more vomiting than swallowing trouble
Diffuse esophageal spasm and esophagogastric junction outflow obstruction are motility mimics
Scleroderma and esophageal adenocarcinoma are structural or systemic mimics
Reflux disease, a peptic stricture, and a Schatzki ring can all cause similar swallowing symptoms
An epiphrenic diverticulum or a hiatal or paraesophageal hernia are structural alternatives
An infiltrating malignancy causing pseudoachalasia is an important mimic to exclude

SourceStatPearls "Achalasia" - disease-level clinical article

Presentation findings are traced to the source above.

NO DRUG THERAPY IN PRIMARY CARE (REFERRAL)

1st line

Adult dose and duration

Refer to gastroenterology for high-resolution manometry, upper GI endoscopy, and definitive management (pneumatic dilation or surgical myotomy) - Surgical or specialist management

Paediatric dose

Refer to pediatric gastroenterology

Dose source

StatPearls: Achalasia (NCBI Bookshelf NBK519515)

Why

PPI therapy and empirical medications are ineffective; definitive mechanical intervention is required.

Cautions

Distinguish from GERD; PPI therapy will not resolve dysphagia in true achalasia.
Suspect if patient has progressive dysphagia to both solids and liquids with regurgitation of undigested food.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.