Achalasia occurs with an incidence of approximately 1:100,000 with an equal gender distribution. It occurs at all ages with an increase in incidence observed after the seventh decade. Dysphagia is the predominant symptom and it is typically accompanied by regurgitation. Upper endoscopy is often the first test used to evaluate patients with suspected achalasia and may detect esophageal dilatation with retained saliva or food. A barium esophagram can be highly suggestive of the diagnosis of achalasia, particularly when there is the combination of esophageal dilatation with retained food and barium and a smooth, tapered constriction of the gastroesophageal junction. Quantitative assessment of the degree of esophageal emptying of barium over time may increase the diagnostic sensitivity of the esophagram for achalasia and serves as a valuable means by which to follow patients response to therapy.
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