Achalasia other diagnostic studies
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Other Diagnostic Studies
- Manometry, the key test for establishing the diagnosis. A probe measures the pressure waves in different parts of the esophagus and stomach during the act of swallowing. A thin tube is inserted through the nose, and the patient is instructed to swallow several times.
- Elevated resting LES pressure, usually > 45 mmHg.
- Incomplete relaxation of the LES.
- Aperistalsis – contractions may be absent, diffuse and not coordinated, and / or ‘vigorous’ (> 60 mmHg).
- Most patients should get and EGD – primarily in order to rule out malignancy (esophageal and gastric).
- Findings include a dilated esophagus with residual pill / food fragments, normal mucosa and occasionally candidiasis (due to the prolonged stasis).
- Factors associated with an increased risk of malignancy include symptoms less than 6 months, presentation after 60 years old, excessive weight loss and difficult passage of the endoscope through the gastroesophageal junction.
- As malignancies can be intramural and not visible with the scope, repeat EGDs with biopsy are recommended when there is a ‘high’ suspicion of malignancy.
- Cholecystokinin (CCK) stimulation test: CCK causes mild contraction of the LES and a more pronounced release of inhibitory neurotransmitters in the wall of the esophagus. In normal people, LES tone will decrease due to the predominant effect of the inhibitory neurotransmitters. In patients with achalasia, however, the stimulatory effect on the LES is unopposed, and LES pressure increases.