The relative application of endoscopy and other diagnostic methods in achalasia

Clinical, radiologic, manometric, and endoscopic data were applied to distinguish achalasia in a group of 52 patients complaining of dysphagia or chest pain or both. Endoscopically, achalasia was characterized by a non-relaxing lower esophageal sphincter that would yield to gentle but firm forward thrust of the instrument. The finding of hiatal hernia or esophagitis was against a diagnosis of achalasia. Manometry was particularly helpful in achalasia patients with little or no esophageal dilation by radiography. Peroral endoscopy was found to add essential information leading to the correct diagnosis of patients with dysphagia or esophageal chest pain.