Achalasia other imaging findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]

Overview

Esophagogastroduodenoscopy is complementary to manometry in diagnosing achalasia. It is indicated primarily to rule out any mechanical obstruction or pseudoachalasia (neoplastic iniltration).

Esophagogastroduodenoscopy

  • Most patients should get an EGD – primarily in order to rule out any mechanical obstruction and malignancy (esophageal and gastric).
    • Findings include a dilated esophagus with residual 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.
  • In cases diagnosed with GERD, endoscopic findings of dilated esophagus, retained food in esophagus can help diagnose achalasia correctly.
  • In cases undergoing endoscopy for dysphagia, esophageal biopsies are recommended to rule out eosinophilic esophagitis. However if the endoscopic picture is very clear for achalasia, biopsy is not recommended.[1]

References

  1. Vaezi MF, Pandolfino JE, Vela MF (2013). "ACG clinical guideline: diagnosis and management of achalasia". Am J Gastroenterol. 108 (8): 1238–49, quiz 1250. doi:10.1038/ajg.2013.196. PMID 23877351.



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