Current Diagnosis of Achalasia: Beyond Standard High-Resolution Manometry

Achalasia is a rare esophageal motility disorder characterized by incomplete relaxation of the lower esophageal sphincter and absence of normal peristalsis. A precise diagnosis is crucial to successful treatment, and over the past few years significant advances have been made in how achalasia is diagnosed. Although high resolution manometry (HRM) is generally considered the gold standard diagnostic modality, manometric findings can be inconclusive and in some cases patients may not tolerate the procedure. Therefore, the addition of provocative maneuvers during HRM, and the use of timed barium esophagram and the functional lumen imaging probe (FLIP) are all important tools that have improved our ability to accurately diagnose achalasia. In this review, we go over the current approach to the diagnosis of achalasia.