ACHALASIA: DIAGNOSIS, TREATMENT, AND CLINICAL CHALLENGES

Abstract

Achalasia is a rare and complex esophageal disorder characterized by the failure of the lower esophageal sphincter (LES) to relax properly and by the loss of peristaltic motility in the distal esophagus. This condition leads to a range of debilitating symptoms, including dysphagia (difficulty swallowing), regurgitation, and chest pain, which can significantly affect patients' quality of life. The diagnosis of achalasia is generally established through a combination of tests, with esophageal manometry being the gold standard method for assessing esophageal motility and LES function. Endoscopy is used to rule out other pathologies, and contrast radiography can reveal esophageal dilation and food retention. Treatment of achalasia aims to relieve symptoms and may include pharmacological, endoscopic, and surgical approaches. Pharmacological therapies, such as nitrates and calcium channel blockers, may reduce LES pressure, while endoscopic techniques, such as pneumatic dilation and endoscopic myotomy, have shown good results in terms of symptom relief. Surgery, such as Heller myotomy, remains an effective option, especially in more severe cases or when other approaches fail. New therapies, including botulinum toxin and radiofrequency, are being explored to offer less invasive alternatives.