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Gastroenterology and Hepatology Achalasia Diagnosis Achalasia often presents with dysphagia fbr solids and liquids and regurgitation of undi- gested food. Testing Diagnostic evaluation should be perfbnned in the following orcler: o barium esophagography; sl.rows "bird's beak" narrowing of the GE junction . upper endoscopy to rule <tut adenocarcinoma (pseudoach:rlasia) at the GE junction . esophageal manometry confirnts diagnosis by documenting absence of peristalsis and incomplete relaxatior.r of tl.re [.ES with swallows DON'T BE TRICKED . If the patient has a history of travel to South America, suspect Chagas disease as the cause ofachalasia. Treatment Laparoscopic myotomy of the LES is the first line therapy fbr:rcl.ralasia. Gastroesophageal Reflux Disease Barium Esophagogram: Ihe "bird's beak" find. ing reflects narrowing of the distal esophagus and is characteristic of achalasia. Diagnosis Characteristic findings of GERD are heartburn andior regurgitxtion. Extraesophageal symptoms may include chest pain, cough, holrseness, and wheezing. h.r a patient without alarm leatures (anemia. dysphagia, von.riting, weight loss), symptom relief with a PPI is both diagnostic and therapeutic. Testing STUDY TABLE: GERD Diagnostic Studies tndication Test GERD symptoms refractory to empiric therapy Upper endoscopy; if normal, then choose ambulatory esophageal pH monitoring With PPIS or impedance pH testing while taking a PPI for symptom-reflux correlation Dysphagia, odynophagia, and weight loss Upper endoscopy to rule out cancer Treatment PPIs are first line therapy tbr GERD and GERD \^'ith extraesopl.rageal manifestations (asthr.r.ra, laryngitis. cough) 83