Achalasia ultrasound

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

Overview

Achalasia should be differentiated from mechanical obstruction or neoplastic infiltration of lower esophageal sphincter which can present with similar symptoms such as dysphagia, regurgitation and weight loss. Endoscopic ultrasound is required in cases where malignancy is suspected.[1]

Endoscopic Ultrasound

Endoscopic ultrasound (EUS) is indicated in cases of achalasia like picture with strong suspicion of malignancy. Presence of following risk factors raises suspicion for malignancy:

  • Elderly patients
  • Short duration of dysphagia history
  • Significant weight loss
  • Unusually increased resistance to passage of endoscope through gastroesophageal junction

Unusual thickening of gastroesophageal junction, mass lesions or neoplastic infiltration revealed on EUS suggests diagnosis of pseudoachalasia instead of achalasia.[2]

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.
  2. Boeckxstaens GE, Zaninotto G, Richter JE (2013). "Achalasia". Lancet. doi:10.1016/S0140-6736(13)60651-0. PMID 23871090.

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