Snapshot A 45-year-old man presents to his primary care physician complaining of difficulty swallowing solids and liquids for the past 5 months. He also reports unintentional weight loss of 20 lbs over the past 3 months. The patient denies any fever, diarrhea, or dyspnea but endorses chest pain that is worse following food ingestion. His past medical history is unremarkable except for an episode of dengue fever when he was traveling in South America 1 year ago. A barium study is subsequently ordered. Introduction Clinical definition login to view 1 more bullet Epidemiology Incidence of 1.6 cases per 100,000 individuals Demographics login to view 2 more bullets Risk factors login to view 2 more bullets Etiology The etiology of primary/idiopathic achalasia is unknown Secondary achalasia occurs due to diseases that cause esophageal motor abnormalities login to view 3 more bullets Pathogenesis login to view 5 more bullets Presentation Symptoms login to view 6 more bullets imaging Chest radiography login to view 1 more bullet Barium esophagram login to view 6 more bullets Upper endoscopy login to view 2 more bullets Esophageal manometry login to view 3 more bullets Studies Diagnostic testing login to view 6 more bullets Differential Gastroesophageal reflux disease (GERD) login to view 3 more bullets Pseudoachalasia due to malignancy login to view 2 more bullets DIAGNOSIS Diagnostic criteria login to view 2 more bullets Treatment First-line login to view 10 more bullets Second-line login to view 3 more bullets Other treatments login to view 2 more bullets Complications Increased risk of esophageal cancer Ulceration and bleeding