Updates in the Work-Up and Management of Achalasia: A Contemporary Review

Abstract Purpose of Review This review article discusses the latest updates in the pathophysiology, classification, diagnostic work-up, and therapeutic strategies for achalasia, with an emphasis on individualized, evidence-based approaches and future directions in care. Recent Findings The advancement in and implementation of high resolution manometry in patients with dysphagia have revolutionized the diagnostic accuracy and classification of achalasia. Additionally, manometry plays a critical role in guiding treatment selection both in the pre-procedural evaluation and even intraoperatively. Peroral Endoscopic Myotomy has emerged as a minimally invasive endoscopic treatment modality that is both effective and safe when compared to traditional treatment modalities. Summary Achalasia is a rare esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter (LES) and absence of peristalsis. Achalasia symptoms include dysphagia to solids and liquids, weight loss, regurgitation, and chest pain. Recent advances especially in high resolution manometry have significantly improved our understanding of achalasia pathophysiology, the diagnostic accuracy and sub-classification. Current treatment options include pharmacological, endoscopic, and surgical modalities. Our review summarizes the diagnostic tools of achalasia in addition to the evidence supporting different treatment modalities. There is a need for a more tailored approach to individual patients with achalasia while accounting for their age, comorbidities, achalasia classification and prior used treatment modalities.