Epidemiology, Evaluation, and Classification of Achalasia and Other Esophageal Motility Disorders

Dysphagia is an increasingly encountered symptom in an enlarging elderly segment of the population. Achalasia is an incurable disorder characterized by lack of deglutitive relaxation of the esophagogastric junction and esophageal aperistalsis. The pathophysiology is likely multifactorial, with the end result of inhibitory neural degeneration in Auerbach’s plexus, collagen deposition, and muscular hypertrophy. Evaluation for esophageal dysmotility includes meticulous focused history. Clinical symptoms for achalasia may be quantified with the Eckardt scoring system. Diagnostic studies include barium swallow, upper endoscopy, pH study, computed tomography, and esophageal manometry. The Chicago classification should be used to sequentially stratify patients with esophageal dysmotility based on manometric findings.