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Gastroenterology›Condition·Updated Jun 27, 2026·v1

Achalasia

Achalasia is a chronic esophageal motility disorder characterized by failure of the LES to relax and absent peristalsis. Diagnosis relies on HRM with Chicago Classification v4.0 subtyping (I, II, III), which guides treatment selection. First-line definitive therapies, graded pneumatic dilation, laparoscopic Heller myotomy with fundoplication, and peroral endoscopic myotomy, have comparable efficacy (~80% at 2 years) but differ in complication profiles (POEM carries higher GERD risk). Eckardt score >3 defines treatment eligibility and ≤3 defines success. Post-procedural GERD surveillance (PPI, endoscopy at 1 year) is mandatory. Long-standing disease carries a 10- to 50-fold increased risk of esophageal squamous cell carcinoma, warranting consideration of surveillance endoscopy after 10-15 years. Chronic opioid use is a modifiable risk factor that must be identified. Pseudoachalasia (malignancy) must be excluded in at-risk populations.

High Evidence277 references·13,293 words·54 min read·v1
achalasiaesophageal motility disorderdysphagiahigh-resolution manometryChicago Classificationpneumatic dilationPOEMHeller myotomyEckardt scoreesophageal squamous cell carcinoma

Quick Reference

RxDrug of choiceBotulinum toxin (BTX) 100 U intrasphincteric injection, reserved as a temporizing measure for frail patients or as a bridge to definitive therapy; not for surgical candidates.
AltAlternativesNo effective oral pharmacotherapy exists. Opioid cessation may reverse opioid-induced esophageal dysfunction. Inhaled nitrates and calcium channel blockers (nifedipine 10-20 mg PO SL) have marginal efficacy and are not recommended for routine use.
⊘AvoidNon-dihydropyridine calcium channel blockers (diltiazem, verapamil) in patients with concomitant heart failure; long-term PPI therapy without proven GERD; BTX in patients who are candidates for POEM/Heller myotomy (causes fibrosis).
DxTest of choiceHigh-resolution manometry (HRM) with Chicago Classification v4.0, gold standard for diagnosis and subtyping. Timed barium esophagogram (TBE) is best for objective assessment of esophageal emptying and monitoring treatment response.
ScKey scoreEckardt score (dysphagia 0-3, regurgitation 0-3, chest pain 0-3, weight loss 0-3; sum 0-12), >3 indicates need for therapy; ≤3 defines clinical success.
→When to referRefer to a high-volume esophageal center (≥20 POEM/year) for any myotomy, especially in Type III or sigmoid esophagus. Refer to an esophagologist for refractory cases, management of post-procedural GERD, or surveillance for esophageal squamous cell carcinoma.
Diagnose achalasia with HRM + Chicago Classification v4.0. Choose therapy based on subtype: POEM for Type III, PD for elderly/frail, PD or POEM/LHM for Types I/II. All myotomy patients require PPI and endoscopic GERD surveillance. Untreated disease confers a 10- to 50-fold increased risk of esophageal squamous cell carcinoma.
Achalasia is a chronic esophageal motility disorder defined by failure of the lower esophageal sphincter (LES) to relax, absent peristalsis, and impaired esophageal emptying. Incidence is 1-1.6 per 100,000, prevalence 10-15 per 100,000. The cornerstone of diagnosis is high-resolution manometry (HRM) with the Chicago Classification (v4.0) identifying three subtypes (I, II, III) that predict treatment response. First-line definitive therapies include graded pneumatic dilation (PD), laparoscopic Heller myotomy (LHM) with fundoplication, and peroral endoscopic myotomy (POEM). The choice depends on subtype, age, and patient preference. Untreated achalasia carries a 2- to 16-fold increased risk of esophageal squamous cell carcinoma. This page provides a comprehensive, evidence-based reference for diagnosis, management, and long-term surveillance.

Overview and Recommendations

Background

  • •Achalasia is a rare esophageal motility disorder with three interdependent hallmarks: failure of LES relaxation, absent peristalsis, and impaired esophageal emptying, leading to progressive food stasis, esophageal dilation, and malnutrition. The term derives from Greek "chalasis" (loosening) with the prefix "a-" (without).
  • •Incidence is 1-1.6 per 100,000 person-years globally, but rising to 2.8 per 100,000 in high-resolution manometry (HRM) era series; prevalence is 10-15 per 100,000 with a slight male predominance (1.2-1.5:1) and peak onset between ages 40-60 years. A US claims analysis found incidence increasing from 0.9 (2001) to 1.8 (2018) per 100,000 among adults under 65.
  • •The condition is caused by progressive, immune-mediated destruction of inhibitory neurons in the esophageal myenteric plexus, specifically those releasing nitric oxide (NO) and vasoactive intestinal polypeptide (VIP). This selective neuronal loss leaves unopposed cholinergic tone, producing a hypertensive, non-relaxing LES and aperistalsis. An environmental trigger (likely viral infection, e.g., HSV-1, VZV) is implicated in genetically susceptible individuals (HLA class II associations).
  • •Three HRM-based Chicago Classification v4.0 subtypes define prognosis: Type I (classic), 100% failed peristalsis, no pressurization; Type II (panesophageal pressurization), best treatment response; Type III (spastic), requires longer myotomy and responds poorly to pneumatic dilation. EGJ outflow obstruction (EGJOO) is a separate category requiring exclusion of pseudoachalasia.
  • •Untreated achalasia carries a 2- to 16-fold increased risk of esophageal squamous cell carcinoma (not adenocarcinoma) due to chronic stasis and inflammation; annual incidence of SCC is approximately 0.64%. All-cause mortality is increased (HR 1.5) compared to the general population in large cohort studies.
  • •Chronic opioid use (>90 days) is the strongest modifiable risk factor (OR 5.8 for type III achalasia). Other mimics to exclude: Chagas disease, eosinophilic esophagitis, sarcoidosis, and pseudoachalasia (malignancy, most commonly gastric cardia adenocarcinoma).

Evaluation

  • •Suspect achalasia in any patient with dysphagia to both solids and liquids (present from onset), especially when accompanied by regurgitation of undigested food and saliva (often nocturnal, causing coughing/choking), non-cardiac chest pain (especially in type III), and weight loss. Heartburn that is refractory to high-dose PPI is a common misleader.
  • •Ask about symptom duration (typically >2 years before diagnosis), adaptive behaviors (eating slowly, drinking large volumes with meals), nocturnal regurgitation with aspiration symptoms, and prior treatments for GERD or dysphagia. Document weight loss (present in 35-50%; more common in type II).
  • •Examine for signs of malnutrition (temporal wasting, muscle atrophy), suprasternal fullness or gurgling (indicating a dilated, tortuous esophagus), halitosis from fermentation of retained food, and pulmonary findings (crackles, especially right lower lobe) suggesting recurrent aspiration pneumonia.
  • •Order upper endoscopy (EGD) as the first test, but be aware that a normal endoscopy does NOT rule out achalasia. Use the CARS scoring system (Content, Anatomy, Resistance, Stasis): score ≥2 predicts achalasia with 84% sensitivity. Key red flags: retained saliva/food, tight/puckered LES, resistance to scope passage, dilated/sigmoid esophagus. Absence of reflux changes is itself suspicious.
  • •Perform high-resolution manometry (HRM) with at least 10 supine and 5 upright swallows. Diagnostic threshold: integrated relaxation pressure (IRP) >15 mmHg supine. Preserved peristalsis with elevated IRP suggests EGJ outflow obstruction, requires exclusion of mechanical causes (stricture, fundoplication, malignancy) before labelling as primary disorder.
  • •Classify using Chicago Classification v4.0: Type I (100% failed swallows, no pressurization), Type II (≥20% swallows with panesophageal pressurization >30 mmHg), Type III (≥20% swallows with spastic contractions; distal latency <4.5 s). Subtype assignment is critical because it predicts treatment response.
  • •Obtain a timed barium esophagogram (TBE), patient drinks 200 mL dilute barium with radiographs at 1, 2, and 5 minutes. A barium column height >2 cm at 1 minute has 100% sensitivity and 83% specificity for achalasia. A barium tablet challenge (13 mm) showing retention >60 seconds further confirms obstruction. TBE also serves as an objective outcome measure post-treatment.
  • •Use functional lumen imaging probe (FLIP) panometry during the index EGD if available, an EGJ-distensibility index (DI) <2.0 mm²/mmHg is 95% specific for achalasia, and abnormal FLIP patterns can expedite diagnosis without awaiting HRM (positive predictive value 91%).
  • •Exclude pseudoachalasia in any patient >55 years with symptom duration <6 months, weight loss >10 kg, or a suspicious EGD. Perform EGD with retroflexed view of the gastric cardia and careful biopsy. If clinical suspicion persists despite normal EGD, obtain endoscopic ultrasound (EUS) and CT chest/abdomen to evaluate for submucosal tumors or extrinsic compression (most commonly gastric cardia adenocarcinoma).
  • •Consider Chagas serology (T. cruzi antibodies) in patients from endemic regions (Central/South America). Order CBC, albumin, and nutritional labs for baseline status. Serum anti-neuronal antibodies are research tools only and not recommended in routine practice.
  • •Calculate the Eckardt score (dysphagia, regurgitation, chest pain, weight loss, each scored 0-3; total 0-12). A score >3 indicates need for therapy and is the standard threshold for initiating treatment.

Management

  • •Select definitive therapy based on manometric subtype, age, and patient preference, all three first-line options (PD, LHM with fundoplication, POEM) have comparable long-term success (~80% at 2 years).
  • •For Type I or II achalasia: offer pneumatic dilation (PD) using a graded protocol, start with a 30 mm Rigiflex balloon under fluoroscopy; if inadequate response, repeat with 35 mm at 2-4 weeks; if still needed, 40 mm. Inflate to 8-12 psi for 15-60 seconds until the balloon waist disappears. Success: ~66% after one dilation; ~80-90% after up to three dilations. Alternatively, proceed directly to POEM or LHM.
  • •For Type III achalasia (spastic): POEM is preferred as first-line therapy because the myotomy can be extended proximally along the spastic segment, achieving success rates of ~80-85% at long-term follow-up. PD has a failure rate >70% in this subtype.
  • •For laparoscopic Heller myotomy (LHM): perform a 6-8 cm esophageal myotomy extending 2-3 cm onto the gastric cardia, always combined with a partial fundoplication (Dor or Toupet) to reduce postoperative GERD (from ~30% to ~10%). Success rates ~80-90% at 2 years. Mean hospital stay: 1-2 days.
  • •For peroral endoscopic myotomy (POEM): create a submucosal tunnel (12-14 cm total) and perform a myotomy of the circular muscle fibers, short myotomy (8 cm) is non-inferior to long myotomy (13 cm) at 24 months (Eckardt ≤3: 89.9% vs. 87.1%) and reduces post-procedure GERD. Single-dose prophylactic antibiotic (cefazolin 1-2 g IV) is sufficient.
  • •For elderly/frail patients (ASA ≥III or age >70): PD is first-line due to lower procedural risk; success rates approach 78% at 2 years with graded protocol. Botulinum toxin (BTX) injection (0.5 mL aliquots of 100 U divided into 4 quadrants at the LES) can be used as a temporizing measure, provides symptom relief in 78% at 1 year but efficacy wanes to 40% at 2 years. BTX should NOT be used in surgical candidates due to fibrosis.
  • •What NOT to do: Do NOT use standard balloons for dilation, only dedicated achalasia balloons (30-35-40 mm). Do NOT perform BTX as definitive therapy in surgical candidates. Do NOT omit fundoplication during LHM. Do NOT use a single 30 mm PD as definitive therapy, graded protocol is required.
  • •Post-procedural GERD management: All patients after any myotomy (especially POEM) should receive empiric PPI therapy (e.g., omeprazole 20 mg or pantoprazole 40 mg once daily) for at least 8 weeks. Escalate to twice-daily PPI if symptoms persist. Perform endoscopy at 1 year post-myotomy to assess for erosive esophagitis, followed by surveillance every 3 years if GERD is present.
  • •Monitoring for treatment failure: Assess Eckardt score at each follow-up (target ≤3). If score >3, obtain timed barium esophagogram, a barium column >5 cm at 5 minutes strongly predicts relapse (HR 3.1). Also consider HRM with rapid drink challenge (200 mL water), maximal pressurization >20 mmHg predicts incomplete emptying with 86% sensitivity.
  • •Managing treatment failure after first-line therapy: After failed PD, proceed to POEM or LHM (success ~80% at 5 years). After failed LHM, POEM is superior to repeat PD at 1 year (85% vs. 48%; level 1b). After failed POEM, repeat POEM (Re-POEM) is effective in ~80% of cases.
  • •Esophageal perforation: Most feared acute complication of PD (rate ~1.9% per procedure). Suspect if patient has severe chest pain, subcutaneous emphysema, or fever after dilation. Immediate water-soluble contrast esophagram. In stable patients without mediastinal soliage, conservative management with IV antibiotics, nasogastric suction, and endoscopic stent placement is successful in ~75% of cases.
  • •Cancer surveillance: Consider screening endoscopy with Lugol chromoendoscopy every 3 years starting 10-15 years after diagnosis, especially in patients with long-standing disease, sigmoid esophagus, or retained food (ESGE conditional recommendation). Lifetime risk of SCC is ~1-3%.
  • •Nutritional support: For patients with severe malnutrition or complete esophageal obstruction precluding oral intake, place a nasogastric tube under endoscopic guidance if possible. If not feasible, proceed with urgent POEM or PD for acute decompression. NPO status must be maintained until esophagus is cleared.
  • •Referral criteria: Refer to a high-volume esophageal center (≥20 POEM cases/year) for any myotomy procedure, especially in Type III or sigmoid esophagus. Refer to a gastroenterologist with expertise in motility disorders for HRM interpretation. Consider referral to an esophagologist for management of refractory cases and surveillance.

Board Review — High Yield

  • •Eckardt score, the validated clinical tool for assessing achalasia severity and treatment response; score >3 indicates need for therapy, ≤3 defines success.
  • •Chicago Classification v4.0, HRM-based system that subtypes achalasia into Type I (failed peristalsis, no pressurization), Type II (panesophageal pressurization, best prognosis), and Type III (spastic contractions; needs longer myotomy).
  • •Pseudoachalasia, malignancy-mimicking achalasia (most often gastric cardia adenocarcinoma); suspect in patients >55 years with symptom duration <6 months and weight loss >10 kg; requires EGD with retroflexed view and EUS/CT.
  • •Opioid-induced esophageal dysfunction (OIED), chronic opioid use (>90 days) produces a manometric pattern mimicking Type III achalasia; OR 5.8 for Type III; partially reversible with opioid cessation.
  • •Pneumatic dilation (PD), graded protocol (30→35→40 mm) with Rigiflex balloon; 1.9% perforation rate; success ~80-90% with up to 3 sessions; first-line for elderly/frail patients and Type II achalasia.
  • •POEM vs. LHM, POEM has higher post-procedure GERD (30-50% vs. 8-15% with fundoplication); short myotomy (8 cm) non-inferior to long (13 cm) for success, with less GERD.
  • •Esophageal squamous cell carcinoma (SCC), risk is increased 10- to 50-fold in long-standing achalasia; consider surveillance with Lugol chromoendoscopy every 3 years starting 10-15 years after diagnosis.
  • •Timed barium esophagogram (TBE), objective measure of esophageal emptying; barium column >5 cm at 5 minutes strongly predicts relapse (HR 3.1); tablet retention >60 seconds confirms obstruction.
  • •Chagas disease, T. cruzi infection causes achalasia in endemic regions (Central/South America); requires serology and cardiac evaluation before myotomy.
  • •Zhongshan POEM Score, predicts failure after POEM: Eckardt >6 (1 point), sigmoid esophagus (1 point), Type I/III (1 point); score 3 predicts 49% success at 5 years.

Deep Dive — Evidence Details

References

  1. [1]

    Kahrilas PJ, Katzka D, Richter JE. “Clinical Practice Update: The Use of Per-Oral Endoscopic Myotomy in Achalasia: Expert Review and Best Practice Advice From the AGA Institute.” Gastroenterology (2017). PMID: 28989059 ↗

    L5GUIDELINECited in: Definition, Classification & Nomenclature, Pathophysiology & Mechanism, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management, Prognosis & Natural History
  2. [2]

    Savarino E, di Pietro M, Bredenoord AJ et al.. “Use of the Functional Lumen Imaging Probe in Clinical Esophagology.” The American journal of gastroenterology (2020). PMID: 33156096 ↗

    L5GUIDELINECited in: Definition, Classification & Nomenclature, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management
  3. [3]

    Roman S, Huot L, Zerbib F et al.. “High-Resolution Manometry Improves the Diagnosis of Esophageal Motility Disorders in Patients With Dysphagia: A Randomized Multicenter Study.” The American journal of gastroenterology (2016). PMID: 26832656 ↗

    L1RCTCited in: Definition, Classification & Nomenclature, Acute Management, Long-term & Definitive Medical Management
  4. [4]

    Yadlapati R, Gyawali CP, Pandolfino JE. “AGA Clinical Practice Update on the Personalized Approach to the Evaluation and Management of GERD: Expert Review.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2022). PMID: 35123084 ↗

    L5GUIDELINECited in: Definition, Classification & Nomenclature, Pathophysiology & Mechanism
  5. [5]

    Carlson DA, Gyawali CP, Roman S et al.. “Esophageal Hypervigilance and Visceral Anxiety Are Contributors to Symptom Severity Among Patients Evaluated With High-Resolution Esophageal Manometry.” The American journal of gastroenterology (2020). PMID: 31990697 ↗

    L2TRIAL_NONRANDOMCited in: Definition, Classification & Nomenclature, Pathophysiology & Mechanism, Severity, Staging & Risk Stratification (GI Scores), Special Populations & Prevention
  6. [6]

    Gu L, Ouyang Z, Lv L et al.. “Safety and efficacy of peroral endoscopic myotomy with standard myotomy versus short myotomy for treatment-naïve patients with type II achalasia: a prospective randomized trial.” Gastrointestinal endoscopy (2020). PMID: 33058884 ↗

    L1RCTCited in: Definition, Classification & Nomenclature, Acute Management, Long-term & Definitive Medical Management
  7. [7]

    Misselwitz B, Hollenstein M, Bütikofer S et al.. “Prospective serial diagnostic study: the effects of position and provocative tests on the diagnosis of oesophageal motility disorders by high-resolution manometry.” Alimentary pharmacology & therapeutics (2020). PMID: 32056267 ↗

    L2RCTCited in: Definition, Classification & Nomenclature, Pathophysiology & Mechanism, Epidemiology, Etiology & Risk Factors, Special Populations & Prevention
  8. [8]

    Inoue H, Minami H, Kobayashi Y et al.. “Peroral endoscopic myotomy (POEM) for esophageal achalasia.” Endoscopy (2010). PMID: 20354937 ↗

    L4TRIAL_NONRANDOMCited in: Definition, Classification & Nomenclature, Endoscopic & Procedural Management
  9. [9]

    Forss A, Hansson MR, Holmberg D et al.. “All-cause and Cause-specific Mortality in Achalasia: A Nationwide Matched Cohort Study.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2025). PMID: 40220848 ↗

    L2COHORTCited in: Definition, Classification & Nomenclature, Epidemiology, Etiology & Risk Factors, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Prognosis & Natural History, Special Populations & Prevention
  10. [10]

    Shiwaku H, Sato H, Shimamura Y et al.. “Risk factors and long-term course of gastroesophageal reflux disease after peroral endoscopic myotomy: A large-scale multicenter cohort study in Japan.” Endoscopy (2022). PMID: 35172368 ↗

    L2COHORTCited in: Definition, Classification & Nomenclature, Pathophysiology & Mechanism, Epidemiology, Etiology & Risk Factors, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Prognosis & Natural History, Special Populations & Prevention
  11. [11]

    Carlson DA, Pandolfino JE, Yadlapati R et al.. “A Standardized Approach to Performing and Interpreting Functional Lumen Imaging Probe Panometry for Esophageal Motility Disorders: The Dallas Consensus.” Gastroenterology (2025). PMID: 39914779 ↗

    L5OTHERCited in: Definition, Classification & Nomenclature, Pathophysiology & Mechanism, Clinical Presentation, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs)
  12. [12]

    Fass OZ, Pandolfino JE, Schauer JM et al.. “Diagnostic Accuracy of Timed Barium Esophagram for Achalasia.” Gastroenterology (2025). PMID: 40020937 ↗

    L2OTHERCited in: Definition, Classification & Nomenclature, Pathophysiology & Mechanism, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Special Populations & Prevention
  13. [13]

    Kahrilas PJ, Boeckxstaens G. “The spectrum of achalasia: lessons from studies of pathophysiology and high-resolution manometry.” Gastroenterology (2013). PMID: 23973923 ↗

    L5REVIEW_NARRATIVECited in: Definition, Classification & Nomenclature, Pathophysiology & Mechanism
  14. [14]

    Pandolfino JE, Kwiatek MA, Nealis T et al.. “Achalasia: a new clinically relevant classification by high-resolution manometry.” Gastroenterology (2008). PMID: 18722376 ↗

    L2OTHERCited in: Definition, Classification & Nomenclature, Severity, Staging & Risk Stratification (GI Scores), Endoscopic & Procedural Management, Prognosis & Natural History, Special Populations & Prevention
  15. [15]

    Zizer E, Beilke S, Bäuerle T et al.. “Loss of Lsc/p115 protein leads to neuronal hypoplasia in the esophagus and an achalasia-like phenotype in mice.” Gastroenterology (2010). PMID: 20600037 ↗

    L5OTHERCited in: Definition, Classification & Nomenclature
  16. [16]

    Shteyer E, Edvardson S, Wynia-Smith SL et al.. “Truncating mutation in the nitric oxide synthase 1 gene is associated with infantile achalasia.” Gastroenterology (2014). PMID: 25479138 ↗

    L4OTHERCited in: Definition, Classification & Nomenclature
  17. [17]

    Bruley des Varannes S, Chevalier J, Pimont S et al.. “Serum from achalasia patients alters neurochemical coding in the myenteric plexus and nitric oxide mediated motor response in normal human fundus.” Gut (2005). PMID: 16105888 ↗

    L5OTHERCited in: Definition, Classification & Nomenclature, Pathophysiology & Mechanism, Complications, Special Populations & Prevention
  18. [18]

    Goudie E, Kou W, Pandolfino JE et al.. “Four-Dimensional Impedance Manometry in Esophageal Motility Disorders.” The American journal of gastroenterology (2024). PMID: 39422339 ↗

    L3OTHERCited in: Definition, Classification & Nomenclature, Pathophysiology & Mechanism, Special Populations & Prevention
  19. [19]

    Triggs JR, Kahrilas PJ. “Editorial: Assessing Esophageal Function in Achalasia: The Old and the New.” The American journal of gastroenterology (2018). PMID: 29467529 ↗

    L5OTHERCited in: Definition, Classification & Nomenclature, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Severity, Staging & Risk Stratification (GI Scores), Endoscopic & Procedural Management
  20. [20]

    Miller AT, Matar R, Abu Dayyeh BK et al.. “Postobesity Surgery Esophageal Dysfunction: A Combined Cross-Sectional Prevalence Study and Retrospective Analysis.” The American journal of gastroenterology (2020). PMID: 32558689 ↗

    L4OTHERCited in: Definition, Classification & Nomenclature, Clinical Presentation, Special Populations & Prevention
  21. [21]

    Blonski W, Kumar A, Feldman J et al.. “Timed Barium Swallow: Diagnostic Role and Predictive Value in Untreated Achalasia, Esophagogastric Junction Outflow Obstruction, and Non-Achalasia Dysphagia.” The American journal of gastroenterology (2017). PMID: 29257145 ↗

    L2OTHERCited in: Definition, Classification & Nomenclature, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs)
  22. [22]

    Hernandez JC, Ratuapli SK, Burdick GE et al.. “Interrater and intrarater agreement of the chicago classification of achalasia subtypes using high-resolution esophageal manometry.” The American journal of gastroenterology (2011). PMID: 22008895 ↗

    L4OTHERCited in: Definition, Classification & Nomenclature
  23. [23]

    Mari A, Calabrese F, Pasta A et al.. “Esophageal and Oropharyngeal Dysphagia: Clinical Recommendations From the United European Gastroenterology and European Society for Neurogastroenterology and Motility.” United European gastroenterology journal (2025). PMID: 40543044 ↗

    L5GUIDELINECited in: Definition, Classification & Nomenclature, Pathophysiology & Mechanism, Epidemiology, Etiology & Risk Factors
  24. [24]

    Barchi A, Gyawali CP, Pandolfino J et al.. “High-Resolution Manometry in Treated Achalasia: Scoping Review and Novel Nomenclature.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2025). PMID: 40885411 ↗

    L5REVIEW_NARRATIVECited in: Definition, Classification & Nomenclature, Pathophysiology & Mechanism
  25. [25]

    Kahrilas PJ, Bredenoord AJ, Carlson DA et al.. “Advances in Management of Esophageal Motility Disorders.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2018). PMID: 29702296 ↗

    L5REVIEW_NARRATIVECited in: Definition, Classification & Nomenclature, Pathophysiology & Mechanism, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management
  26. [26]

    Low EE, Yadlapati R, Liu L et al.. “Development and Validation of a National US Achalasia Cohort: The Veterans Affairs Achalasia Cohort (VA-AC).” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2022). PMID: 36075504 ↗

    L2OTHERCited in: Definition, Classification & Nomenclature, Pathophysiology & Mechanism, Epidemiology, Etiology & Risk Factors, Severity, Staging & Risk Stratification (GI Scores), Special Populations & Prevention
  27. [27]

    Reddy CA, Allen-Brady K, Uchida AM et al.. “Achalasia is Strongly Associated With Eosinophilic Esophagitis and Other Allergic Disorders.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2023). PMID: 37391057 ↗

    L3OTHERCited in: Definition, Classification & Nomenclature
  28. [28]

    Rengarajan A, Rogers BD, Wong Z et al.. “High-Resolution Manometry Thresholds and Motor Patterns Among Asymptomatic Individuals.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2020). PMID: 33144149 ↗

    L2OTHERCited in: Definition, Classification & Nomenclature, Pathophysiology & Mechanism, Epidemiology, Etiology & Risk Factors, Special Populations & Prevention
  29. [29]

    Carlson DA, Prescott JE, Baumann AJ et al.. “Validation of Clinically Relevant Thresholds of Esophagogastric Junction Obstruction Using FLIP Panometry.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2021). PMID: 34216821 ↗

    L3OTHERCited in: Definition, Classification & Nomenclature, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Severity, Staging & Risk Stratification (GI Scores)
  30. [30]

    Carlson DA, Li M, Fass O et al.. “A combined endoscopy and functional lumen imaging probe panometry approach can expedite diagnosis of esophageal motility disorders.” Gastrointestinal endoscopy (2025). PMID: 40210016 ↗

    L3OTHERCited in: Definition, Classification & Nomenclature, Pathophysiology & Mechanism, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Severity, Staging & Risk Stratification (GI Scores), Endoscopic & Procedural Management, Special Populations & Prevention
  31. [31]

    Nabi Z, Reddy DN, Ramchandani M. “Adverse events during and after per-oral endoscopic myotomy: prevention, diagnosis, and management.” Gastrointestinal endoscopy (2017). PMID: 28987545 ↗

    L5REVIEW_NARRATIVECited in: Definition, Classification & Nomenclature, Epidemiology, Etiology & Risk Factors, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management, Complications
  32. [32]

    Bapaye A, Yewale R, Shah J et al.. “Long-term (3-year) composite gastroesophageal reflux outcomes of peroral endoscopic myotomy with or without concomitant endoscopic fundoplication in matched cohorts of achalasia.” Gastrointestinal endoscopy (2025). PMID: 40288696 ↗

    L3OTHERCited in: Definition, Classification & Nomenclature, Special Populations & Prevention
  33. [33]

    Haseeb M, Khan Z, Kamal MU et al.. “Short-term outcomes after peroral endoscopic myotomy, Heller myotomy, and pneumatic dilation in patients with achalasia: a nationwide analysis.” Gastrointestinal endoscopy (2023). PMID: 36639060 ↗

    L2OTHERCited in: Definition, Classification & Nomenclature, Complications
  34. [34]

    Chen YI, Inoue H, Ujiki M et al.. “An international multicenter study evaluating the clinical efficacy and safety of per-oral endoscopic myotomy in octogenarians.” Gastrointestinal endoscopy (2017). PMID: 28235595 ↗

    L4OTHERCited in: Definition, Classification & Nomenclature
  35. [35]

    Carlson DA, Gyawali CP, Kahrilas PJ et al.. “Esophageal motility classification can be established at the time of endoscopy: a study evaluating real-time functional luminal imaging probe panometry.” Gastrointestinal endoscopy (2019). PMID: 31279625 ↗

    L2OTHERCited in: Definition, Classification & Nomenclature
  36. [36]

    Meining A, Spaun G, Fernández-Esparrach G et al.. “NOTES in Europe: summary of the working group reports of the 2012 EURO-NOTES meeting.” Endoscopy (2013). PMID: 23446668 ↗

    L5REVIEW_NARRATIVECited in: Definition, Classification & Nomenclature, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs)
  37. [37]

    Bapaye A, Dashatwar P, Dharamsi S et al.. “Single-session endoscopic fundoplication after peroral endoscopic myotomy (POEM+F) for prevention of post gastroesophageal reflux - 1-year follow-up study.” Endoscopy (2021). PMID: 33291157 ↗

    L4OTHERCited in: Definition, Classification & Nomenclature
  38. [38]

    Neville JJ, den Uijl I, Irvine W et al.. “Development of a core outcome set for paediatric achalasia: a joint ERNICA, ESPGHAN and EUPSA study protocol.” BMJ paediatrics open (2025). PMID: 39947877 ↗

    L4TRIAL_NONRANDOMCited in: Definition, Classification & Nomenclature
  39. [39]

    Vespa E, Barchi A, Mandarino FV et al.. “Standard length of peroral endoscopic myotomy (POEM) for achalasia: a systematic review and meta-analysis.” Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus (2024). PMID: 39214522 ↗

    L1SR_OBSCited in: Definition, Classification & Nomenclature
  40. [40]

    Iqbal U, Yodice M, Ahmed Z et al.. “Safety and efficacy of EsoFLIP dilation in patients with esophageal dysmotility: a systematic review.” Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus (2024). PMID: 38659256 ↗

    L1SR_OBSCited in: Definition, Classification & Nomenclature, Complications
  41. [41]

    Lee K, Hong SP, Yoo IK et al.. “Global trends in incidence and prevalence of achalasia, 1925-2021: A systematic review and meta-analysis.” United European gastroenterology journal (2024). PMID: 38430514 ↗

    L1SR_OBSCited in: Definition, Classification & Nomenclature
  42. [42]

    DeVault KR. “Review article: the role of acid suppression in patients with non-erosive reflux disease or functional heartburn.” Alimentary pharmacology & therapeutics (2006). PMID: 16483268 ↗

    L5REVIEW_NARRATIVECited in: Definition, Classification & Nomenclature, Pathophysiology & Mechanism, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Prognosis & Natural History
  43. [43]

    Midya S, Ghosh D, Mahmalat MW. “Fundoplication in laparoscopic Heller's cardiomyotomy for achalasia.” The Cochrane database of systematic reviews (2022). PMID: 36478353 ↗

    L1SR_OBSCited in: Definition, Classification & Nomenclature, Special Populations & Prevention
  44. [44]

    Neville JJ, Westwood E, Ladell A et al.. “Management and outcomes of paediatric achalasia: multicentre retrospective study in the UK.” BJS open (2025). PMID: 41557457 ↗

    L4COHORTCited in: Definition, Classification & Nomenclature, Special Populations & Prevention
  45. [45]

    Perananthan V, Mohammed MF, Beran A et al.. “Reassessing the Risk of Esophageal Cancer in Achalasia Post-Therapy: Findings From a Large United States Multi-Centre Retrospective Propensity-Matched Cohort Study.” Neurogastroenterology and motility (2025). PMID: 40887794 ↗

    L3COHORTCited in: Definition, Classification & Nomenclature, Endoscopic & Procedural Management, Special Populations & Prevention
  46. [46]

    Nguyen AD, Carlson DA, Patel A et al.. “AGA Clinical Practice Update on Incorporating Functional Lumen Imaging Probe Into Esophageal Clinical Practice: Expert Review.” Gastroenterology (2025). PMID: 40679455 ↗

    L5GUIDELINECited in: Pathophysiology & Mechanism, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs)
  47. [47]

    Trudgill NJ, Sifrim D, Sweis R et al.. “British Society of Gastroenterology guidelines for oesophageal manometry and oesophageal reflux monitoring.” Gut (2019). PMID: 31366456 ↗

    L1GUIDELINECited in: Pathophysiology & Mechanism
  48. [48]

    Vaezi MF, Pandolfino JE, Yadlapati RH et al.. “ACG Clinical Guidelines: Diagnosis and Management of Achalasia.” The American journal of gastroenterology (2020). PMID: 32773454 ↗

    L1GUIDELINECited in: Pathophysiology & Mechanism
  49. [49]

    Moonen A, Annese V, Belmans A et al.. “Long-term results of the European achalasia trial: a multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy.” Gut (2015). PMID: 26614104 ↗

    L1RCTCited in: Pathophysiology & Mechanism, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Acute Management, Long-term & Definitive Medical Management, Endoscopic & Procedural Management
  50. [50]

    Reddy CA, McGowan E, Yadlapati R et al.. “AGA Clinical Practice Update on Esophageal Dysfunction Due to Disordered Immunity and Infection: Expert Review.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2024). PMID: 39436337 ↗

    L5GUIDELINECited in: Pathophysiology & Mechanism, Long-term & Definitive Medical Management, Endoscopic & Procedural Management, Prognosis & Natural History
  51. [51]

    Weusten BLAM, Barret M, Bredenoord AJ et al.. “Endoscopic management of gastrointestinal motility disorders - part 1: European Society of Gastrointestinal Endoscopy (ESGE) Guideline.” Endoscopy (2020). PMID: 32375192 ↗

    L1GUIDELINECited in: Pathophysiology & Mechanism, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management
  52. [52]

    Niu C, Zhang J, Bapaye J et al.. “Systematic Review With Meta-Analysis: Chronic Opioid Use Is Associated With Esophageal Dysmotility in Symptomatic Patients.” The American journal of gastroenterology (2023). PMID: 37463432 ↗

    L1SR_OBSCited in: Pathophysiology & Mechanism, Epidemiology, Etiology & Risk Factors
  53. [53]

    Oude Nijhuis RAB, Prins LI, Mostafavi N et al.. “Factors Associated With Achalasia Treatment Outcomes: Systematic Review and Meta-Analysis.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2019). PMID: 31622735 ↗

    L1SR_OBSCited in: Pathophysiology & Mechanism, Epidemiology, Etiology & Risk Factors, Endoscopic & Procedural Management, Prognosis & Natural History, Special Populations & Prevention
  54. [54]

    Jacobs CC, Al-Haddad M, Stainko S et al.. “Prevalence and impact of opioid use in patients undergoing peroral endoscopic myotomy.” Gastrointestinal endoscopy (2022). PMID: 36509112 ↗

    L2TRIAL_NONRANDOMCited in: Pathophysiology & Mechanism, Epidemiology, Etiology & Risk Factors, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management, Prognosis & Natural History
  55. [55]

    Robalino Gonzaga E, Chandan S, Abbasi A et al.. “Clinical impact of routine esophagram after peroral endoscopic myotomy: a systematic review and meta-analysis.” Gastrointestinal endoscopy (2025). PMID: 41076026 ↗

    L1SR_OBSCited in: Pathophysiology & Mechanism, Epidemiology, Etiology & Risk Factors, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management
  56. [56]

    Akintoye E, Kumar N, Obaitan I et al.. “Peroral endoscopic myotomy: a meta-analysis.” Endoscopy (2016). PMID: 27617421 ↗

    L1SR_OBSCited in: Pathophysiology & Mechanism, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Severity, Staging & Risk Stratification (GI Scores), Endoscopic & Procedural Management
  57. [57]

    Puli SR, Wagh MS, Forcione D et al.. “Learning curve for esophageal peroral endoscopic myotomy: a systematic review and meta-analysis.” Endoscopy (2022). PMID: 36049775 ↗

    L1SR_OBSCited in: Pathophysiology & Mechanism, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management, Prognosis & Natural History
  58. [58]

    Rodríguez de Santiago E, Tate DJ, Santos-Antunes J et al.. “Curriculum for training in peroral endoscopic myotomy (POEM) in Europe (Part I): European Society of Gastrointestinal Endoscopy (ESGE) Position Statement.” Endoscopy (2025). PMID: 40203869 ↗

    L1SR_OBSCited in: Pathophysiology & Mechanism, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management
  59. [59]

    Kimoto Y, Inoue H, Shimamura Y et al.. “Hood-attached versus conventional triangular tip-jet knife in peroral endoscopic myotomy: a propensity score matching cohort study.” Gastrointestinal endoscopy (2023). PMID: 38065514 ↗

    L2COHORTCited in: Pathophysiology & Mechanism, Acute Management, Special Populations & Prevention
  60. [60]

    Bredenoord AJ, Jafari J, Kadri S et al.. “Case report: achalasia-like dysmotility secondary to oesophageal involvement of sarcoidosis.” Gut (2010). PMID: 21051451 ↗

    L4CASE_REPORTCited in: Pathophysiology & Mechanism
  61. [61]

    Sidhu M, Tate DJ, Bourke MJ. “Transmucosal diverticular myotomy for the treatment of oesophageal diverticula associated with spastic motility disorders.” Gut (2020). PMID: 32217637 ↗

    L4CASE_REPORTCited in: Pathophysiology & Mechanism, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management, Prognosis & Natural History
  62. [62]

    Patel DA, Yadlapati R, Vaezi MF. “Esophageal Motility Disorders: Current Approach to Diagnostics and Therapeutics.” Gastroenterology (2022). PMID: 35227779 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology & Mechanism, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs)
  63. [63]

    Khashab MA, Benias PC, Swanstrom LL. “Endoscopic Myotomy for Foregut Motility Disorders.” Gastroenterology (2018). PMID: 29454796 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology & Mechanism, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management
  64. [64]

    Patel DA, Goss J, Hayat M et al.. “Opioid Exposure Differentially Impacts Esophageal Body Contraction Over the Lower Esophageal Sphincter.” Gastroenterology (2022). PMID: 35537552 ↗

    L3OTHERCited in: Pathophysiology & Mechanism, Epidemiology, Etiology & Risk Factors
  65. [65]

    Pandolfino JE, Roman S, Carlson D et al.. “Distal esophageal spasm in high-resolution esophageal pressure topography: defining clinical phenotypes.” Gastroenterology (2011). PMID: 21679709 ↗

    L3OTHERCited in: Pathophysiology & Mechanism
  66. [66]

    Park S, Zifan A, Kumar D et al.. “Genesis of Esophageal Pressurization and Bolus Flow Patterns in Patients With Achalasia Esophagus.” Gastroenterology (2018). PMID: 29733830 ↗

    L3OTHERCited in: Pathophysiology & Mechanism, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs)
  67. [67]

    Richter JE, Boeckxstaens GE. “Management of achalasia: surgery or pneumatic dilation.” Gut (2011). PMID: 21303915 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology & Mechanism, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management
  68. [68]

    Ponds FA, Oors JM, Smout AJPM et al.. “Reflux symptoms and oesophageal acidification in treated achalasia patients are often not reflux related.” Gut (2020). PMID: 32439713 ↗

    L3OTHERCited in: Pathophysiology & Mechanism, Special Populations & Prevention
  69. [69]

    Boeckxstaens GE. “Novel mechanism for impaired nitrergic relaxation in achalasia.” Gut (2006). PMID: 16474101 ↗

    L5OTHERCited in: Pathophysiology & Mechanism
  70. [70]

    Spechler SJ, Konda V, Souza R. “Can Eosinophilic Esophagitis Cause Achalasia and Other Esophageal Motility Disorders?” The American journal of gastroenterology (2018). PMID: 30315308 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology & Mechanism
  71. [71]

    Pomenti SF, Flashner SP, Del Portillo A et al.. “Clinical and Biological Perspectives on Noncanonical Esophageal Squamous Cell Carcinoma in Rare Subtypes.” The American journal of gastroenterology (2024). PMID: 39166765 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology & Mechanism, Clinical Presentation, Complications
  72. [72]

    Holloway RH. “Esophageal ultrasonography: A new view on esophageal motility.” The American journal of gastroenterology (2007). PMID: 17266692 ↗

    L5OTHERCited in: Pathophysiology & Mechanism, Epidemiology, Etiology & Risk Factors, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs)
  73. [73]

    Carlson DA, Kahrilas PJ, Lin Z et al.. “Evaluation of Esophageal Motility Utilizing the Functional Lumen Imaging Probe.” The American journal of gastroenterology (2016). PMID: 27725650 ↗

    L3OTHERCited in: Pathophysiology & Mechanism, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs)
  74. [74]

    Kahrilas PJ. “Esophageal motor disorders in terms of high-resolution esophageal pressure topography: what has changed?” The American journal of gastroenterology (2010). PMID: 20179690 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology & Mechanism, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management
  75. [75]

    Snyder DL, Crowell MD, Horsley-Silva J et al.. “Opioid-Induced Esophageal Dysfunction: Differential Effects of Type and Dose.” The American journal of gastroenterology (2019). PMID: 31403963 ↗

    L3OTHERCited in: Pathophysiology & Mechanism, Special Populations & Prevention
  76. [76]

    Levine MS, Rubesin SE, Laufer I. “Barium esophagography: a study for all seasons.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2008). PMID: 18083069 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology & Mechanism, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs)
  77. [77]

    Ramchandani M, Nabi Z, Inavolu P et al.. “Recent Advancements and Future Perspectives of Per Oral Endoscopic Myotomy.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2024). PMID: 38759824 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology & Mechanism, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management
  78. [78]

    Camilleri M, Lembo A, Katzka DA. “Opioids in Gastroenterology: Treating Adverse Effects and Creating Therapeutic Benefits.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2017). PMID: 28529168 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology & Mechanism
  79. [79]

    Boeckxstaens GE, Zaninotto G, Richter JE. “Achalasia.” Lancet (London, England) (2013). PMID: 23871090 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology & Mechanism, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management
  80. [80]

    Ihara E, Ogino H, Esaki M et al.. “Efficacy and safety of acotiamide in esophagogastric junction outflow obstruction: a placebo-controlled phase II trial.” Esophagus : official journal of the Japan Esophageal Society (2026). PMID: 41692899 ↗

    L1RCTCited in: Pathophysiology & Mechanism, Acute Management, Long-term & Definitive Medical Management, Prognosis & Natural History, Special Populations & Prevention
  81. [81]

    Ellison A, Peller M, Nguyen AD et al.. “An endoscopic scoring system for achalasia: the CARS score.” Gastrointestinal endoscopy (2024). PMID: 38431105 ↗

    L4OTHERCited in: Pathophysiology & Mechanism, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management, Special Populations & Prevention
  82. [82]

    Hasan A, Low EE, Fehmi SA et al.. “Evolution and evidence-based adaptations in techniques for peroral endoscopic myotomy for achalasia.” Gastrointestinal endoscopy (2022). PMID: 35278427 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology & Mechanism, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management, Prognosis & Natural History
  83. [83]

    Kadiyala J, Canakis A, Lee DU et al.. “Comparing clinical success and procedural difficulty between treatment-naïve and treatment-refractory patients with esophageal motility disorders during peroral endoscopic myotomy.” Gastrointestinal endoscopy (2023). PMID: 36739994 ↗

    L2OTHERCited in: Pathophysiology & Mechanism, Prognosis & Natural History
  84. [84]

    Fayyaz F, Roshanshad R, Jagannath P et al.. “Peroral endoscopic myotomy as an emergent treatment in hospitalized patients with esophageal motility disorders.” Gastrointestinal endoscopy (2025). PMID: 40254099 ↗

    L4OTHERCited in: Pathophysiology & Mechanism, Complications, Prognosis & Natural History, Special Populations & Prevention
  85. [85]

    Shrigiriwar A, Mony S, Fayyaz F et al.. “Clinical outcomes of peroral endoscopic myotomy with and without septotomy for management of epiphrenic diverticula: an international multicenter experience (with video).” Gastrointestinal endoscopy (2024). PMID: 38795736 ↗

    L2OTHERCited in: Pathophysiology & Mechanism
  86. [86]

    Canakis A, Lee DU, Grossman JL et al.. “Anesthesia choice and its potential impact on endoluminal functional lumen imaging probe measurements in esophageal motility disorders.” Gastrointestinal endoscopy (2023). PMID: 38052328 ↗

    L2OTHERCited in: Pathophysiology & Mechanism, Special Populations & Prevention
  87. [87]

    Zhang LY, Bejjani M, Ghandour B et al.. “Through-the-scope suture closure of peroral endoscopic myotomy mucosal incision sites.” Endoscopy (2022). PMID: 35926541 ↗

    L4OTHERCited in: Pathophysiology & Mechanism, Endoscopic & Procedural Management, Prognosis & Natural History
  88. [88]

    Zhang XC, Li QL, Xu MD et al.. “Major perioperative adverse events of peroral endoscopic myotomy: a systematic 5-year analysis.” Endoscopy (2016). PMID: 27448052 ↗

    L4OTHERCited in: Pathophysiology & Mechanism, Epidemiology, Etiology & Risk Factors, Complications, Special Populations & Prevention
  89. [89]

    Perananthan V, Gupta S, Whitfield A et al.. “When less is more: lower esophageal sphincter-preserving peroral endoscopic myotomy is effective for non-achalasia esophageal motility disorders.” Endoscopy (2024). PMID: 38183976 ↗

    L4OTHERCited in: Pathophysiology & Mechanism, Special Populations & Prevention
  90. [90]

    Nabi Z, Ramchandani M, Kotla R et al.. “Gastroesophageal reflux disease after peroral endoscopic myotomy is unpredictable, but responsive to proton pump inhibitor therapy: a large, single-center study.” Endoscopy (2020). PMID: 32208499 ↗

    L2OTHERCited in: Pathophysiology & Mechanism
  91. [91]

    Baig MU, Gouda Z, Polavarappu AD et al.. “Use of impedance planimetry (325 catheter with 8-cm balloon) improves per-oral endoscopic myotomy outcomes in achalasia patients: a systematic review and a meta-analysis.” Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus (2026). PMID: 42296262 ↗

    L1SR_OBSCited in: Pathophysiology & Mechanism, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management, Prognosis & Natural History
  92. [92]

    Ma O, Brar K, McCluskey S et al.. “Long-term outcomes after per-oral endoscopic myotomy versus laparoscopic Heller myotomy in the treatment of achalasia: a systematic review and meta-analysis.” Surgical endoscopy (2025). PMID: 40624423 ↗

    L1SR_OBSCited in: Pathophysiology & Mechanism, Epidemiology, Etiology & Risk Factors, Prognosis & Natural History
  93. [93]

    Kraichely RE, Arora AS, Murray JA. “Opiate-induced oesophageal dysmotility.” Alimentary pharmacology & therapeutics (2009). PMID: 20003176 ↗

    L4OTHERCited in: Pathophysiology & Mechanism
  94. [94]

    Moosavi S, Woo M, Jacob DA et al.. “Anticholinergic, anti-depressant and other medication use is associated with clinically relevant oesophageal manometric abnormalities.” Alimentary pharmacology & therapeutics (2020). PMID: 32383253 ↗

    L2OTHERCited in: Pathophysiology & Mechanism, Special Populations & Prevention
  95. [95]

    Pandolfino JE, Carlson DA, McGarva J et al.. “Validation of the Achalasia Patient-Reported Outcomes Questionnaire.” Alimentary pharmacology & therapeutics (2022). PMID: 36127750 ↗

    L4OTHERCited in: Pathophysiology & Mechanism, Severity, Staging & Risk Stratification (GI Scores)
  96. [96]

    Di Nardo G, Blandizzi C, Volta U et al.. “Review article: molecular, pathological and therapeutic features of human enteric neuropathies.” Alimentary pharmacology & therapeutics (2008). PMID: 18410560 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology & Mechanism, Prognosis & Natural History
  97. [97]

    Lake JM, Wong RK. “Review article: the management of achalasia - a comparison of different treatment modalities.” Alimentary pharmacology & therapeutics (2006). PMID: 16948803 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology & Mechanism, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Long-term & Definitive Medical Management, Endoscopic & Procedural Management, Prognosis & Natural History
  98. [98]

    Sawada A, Zhang M, Ustaoglu A et al.. “Superficial oesophageal mucosal innervation may contribute to severity of symptoms in oesophageal motility disorders.” Alimentary pharmacology & therapeutics (2023). PMID: 37845817 ↗

    L2OTHERCited in: Pathophysiology & Mechanism
  99. [99]

    Taft TH, Triggs JR, Carlson DA et al.. “Validation of the oesophageal hypervigilance and anxiety scale for chronic oesophageal disease.” Alimentary pharmacology & therapeutics (2018). PMID: 29528128 ↗

    L4OTHERCited in: Pathophysiology & Mechanism, Severity, Staging & Risk Stratification (GI Scores), Prognosis & Natural History, Special Populations & Prevention
  100. [100]

    Bravi I, Nicita MT, Duca P et al.. “A pneumatic dilation strategy in achalasia: prospective outcome and effects on oesophageal motor function in the long term.” Alimentary pharmacology & therapeutics (2009). PMID: 20003094 ↗

    L4OTHERCited in: Pathophysiology & Mechanism, Long-term & Definitive Medical Management, Endoscopic & Procedural Management, Complications, Special Populations & Prevention
  101. [101]

    Leyden JE, Moss AC, MacMathuna P. “Endoscopic pneumatic dilation versus botulinum toxin injection in the management of primary achalasia.” The Cochrane database of systematic reviews (2014). PMID: 25485740 ↗

    L1SR_OBSCited in: Pathophysiology & Mechanism, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Long-term & Definitive Medical Management, Endoscopic & Procedural Management, Complications, Prognosis & Natural History
  102. [102]

    Leyden JE, Moss AC, MacMathuna P. “Endoscopic pneumatic dilation versus botulinum toxin injection in the management of primary achalasia.” The Cochrane database of systematic reviews (2006). PMID: 17054234 ↗

    L1SR_OBSCited in: Pathophysiology & Mechanism, Long-term & Definitive Medical Management, Endoscopic & Procedural Management, Complications, Prognosis & Natural History
  103. [103]

    Ali ABAA, Bukasa LL, Moh'd T et al.. “Dysphagia is associated with major esophageal motility disorders in the UAE: a retrospective cohort study from a tertiary care center in Abu Dhabi.” BMC gastroenterology (2026). PMID: 41709145 ↗

    L3COHORTCited in: Pathophysiology & Mechanism, Special Populations & Prevention
  104. [104]

    Lin L, Braudigom M, Debreceni T et al.. “Esophageal hypervigilance and symptom-specific anxiety as key determinants of symptom severity: a prospective study with manometry and pH metrics.” European journal of gastroenterology & hepatology (2025). PMID: 41342317 ↗

    L2COHORTCited in: Pathophysiology & Mechanism, Special Populations & Prevention
  105. [105]

    Letafatkar N, Habibi A, Mohammadyari F et al.. “Comprehensive evaluation of current strategies in achalasia treatment: Insights from an umbrella review.” Medicine (2025). PMID: 41366919 ↗

    L2SR_OBSCited in: Pathophysiology & Mechanism, Endoscopic & Procedural Management
  106. [106]

    Alvarado Soto GJ, Maldonado M, Armentrout A et al.. “Caudal esophageal achalasia in a Quarter Horse colt.” Journal of veterinary internal medicine (2026). PMID: 41904681 ↗

    L4CASE_REPORTCited in: Pathophysiology & Mechanism
  107. [107]

    Saleh CMG, Familiari P, Bastiaansen BAJ et al.. “The Efficacy of Peroral Endoscopic Myotomy vs Pneumatic Dilation as Treatment for Patients With Achalasia Suffering From Persistent or Recurrent Symptoms After Laparoscopic Heller Myotomy: A Randomized Clinical Trial.” Gastroenterology (2023). PMID: 36907524 ↗

    L1RCTCited in: Epidemiology, Etiology & Risk Factors, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Acute Management, Long-term & Definitive Medical Management, Endoscopic & Procedural Management, Prognosis & Natural History
  108. [108]

    Kuipers T, Ponds FA, Fockens P et al.. “Focal Distal Esophageal Dilation (Blown-Out Myotomy) After Achalasia Treatment: Prevalence and Associated Symptoms.” The American journal of gastroenterology (2024). PMID: 38619115 ↗

    L2RCTCited in: Epidemiology, Etiology & Risk Factors, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Acute Management, Long-term & Definitive Medical Management, Endoscopic & Procedural Management, Special Populations & Prevention
  109. [109]

    Nabi Z, Chandran V, Basha J et al.. “Conventional versus oblique fiber-sparing endoscopic myotomy for achalasia cardia: a randomized controlled trial (with videos).” Gastrointestinal endoscopy (2023). PMID: 37598863 ↗

    L1RCTCited in: Epidemiology, Etiology & Risk Factors, Acute Management, Long-term & Definitive Medical Management, Prognosis & Natural History
  110. [110]

    Low EE, Demb J, Shah SC et al.. “Risk of Esophageal Cancer in Achalasia: A Matched Cohort Study Using the Nationwide Veterans Affairs Achalasia Cohort.” The American journal of gastroenterology (2023). PMID: 37975607 ↗

    L3COHORTCited in: Epidemiology, Etiology & Risk Factors
  111. [111]

    Zendehdel K, Nyrén O, Edberg A et al.. “Risk of esophageal adenocarcinoma in achalasia patients, a retrospective cohort study in Sweden.” The American journal of gastroenterology (2011). PMID: 21212754 ↗

    L3COHORTCited in: Epidemiology, Etiology & Risk Factors, Severity, Staging & Risk Stratification (GI Scores)
  112. [112]

    Zagari RM, Marasco G, Tassi V et al.. “Risk of Squamous Cell Carcinoma and Adenocarcinoma of the Esophagus in Patients With Achalasia: A Long-Term Prospective Cohort Study in Italy.” The American journal of gastroenterology (2021). PMID: 33009050 ↗

    L2COHORTCited in: Epidemiology, Etiology & Risk Factors
  113. [113]

    Leeuwenburgh I, Scholten P, Alderliesten J et al.. “Long-term esophageal cancer risk in patients with primary achalasia: a prospective study.” The American journal of gastroenterology (2010). PMID: 20588263 ↗

    L2COHORTCited in: Epidemiology, Etiology & Risk Factors, Clinical Presentation, Severity, Staging & Risk Stratification (GI Scores)
  114. [114]

    Novais PA, Lemme EM. “24-h pH monitoring patterns and clinical response after achalasia treatment with pneumatic dilation or laparoscopic Heller myotomy.” Alimentary pharmacology & therapeutics (2010). PMID: 20955445 ↗

    L1RCTCited in: Epidemiology, Etiology & Risk Factors, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Acute Management, Long-term & Definitive Medical Management, Endoscopic & Procedural Management, Prognosis & Natural History, Special Populations & Prevention
  115. [115]

    Huang Z, Cui Y, Li Y et al.. “Peroral endoscopic myotomy for patients with achalasia with previous Heller myotomy: a systematic review and meta-analysis.” Gastrointestinal endoscopy (2020). PMID: 32522483 ↗

    L2SR_OBSCited in: Epidemiology, Etiology & Risk Factors, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management, Prognosis & Natural History
  116. [116]

    Repici A, Fuccio L, Maselli R et al.. “GERD after per-oral endoscopic myotomy as compared with Heller's myotomy with fundoplication: a systematic review with meta-analysis.” Gastrointestinal endoscopy (2017). PMID: 29102729 ↗

    L2SR_OBSCited in: Epidemiology, Etiology & Risk Factors
  117. [117]

    Singh AP, Singla N, Budhwani E et al.. “Defining "true acid reflux" after peroral endoscopic myotomy for achalasia: a prospective cohort study.” Gastrointestinal endoscopy (2023). PMID: 37598862 ↗

    L2COHORTCited in: Epidemiology, Etiology & Risk Factors, Special Populations & Prevention
  118. [118]

    Brewer Gutierrez OI, Chang KJ, Benias PC et al.. “Is transoral incisionless fundoplication (TIF) an answer to post-peroral endoscopic myotomy gastroesophageal reflux? A multicenter retrospective study.” Endoscopy (2021). PMID: 34049409 ↗

    L3COHORTCited in: Epidemiology, Etiology & Risk Factors
  119. [119]

    Gaddam S, Reddy CA, Munigala S et al.. “The learning curve for interpretation of oesophageal high-resolution manometry: a prospective interventional cohort study.” Alimentary pharmacology & therapeutics (2016). PMID: 27859421 ↗

    L2COHORTCited in: Epidemiology, Etiology & Risk Factors
  120. [120]

    Harvey PR, Thomas T, Chandan JS et al.. “Incidence, morbidity and mortality of patients with achalasia in England: findings from a study of nationwide hospital and primary care data.” Gut (2018). PMID: 29925629 ↗

    L3OTHERCited in: Epidemiology, Etiology & Risk Factors, Prognosis & Natural History, Special Populations & Prevention
  121. [121]

    Wouters MM, Lambrechts D, Becker J et al.. “Genetic variation in the lymphotoxin-α (LTA)/tumour necrosis factor-α (TNFα) locus as a risk factor for idiopathic achalasia.” Gut (2013). PMID: 24259423 ↗

    L3OTHERCited in: Epidemiology, Etiology & Risk Factors
  122. [122]

    Alderliesten J, Conchillo JM, Leeuwenburgh I et al.. “Predictors for outcome of failure of balloon dilatation in patients with achalasia.” Gut (2010). PMID: 21068135 ↗

    L2OTHERCited in: Epidemiology, Etiology & Risk Factors, Clinical Presentation, Prognosis & Natural History, Special Populations & Prevention
  123. [123]

    Wong RK. “Achalasia: should we or should we not follow the bag?” The American journal of gastroenterology (2006). PMID: 16635217 ↗

    L5OTHERCited in: Epidemiology, Etiology & Risk Factors
  124. [124]

    Patel P, Rogers BD, Rengarajan A et al.. “Identification of Achalasia Within Absent Contractility Phenotypes on High-Resolution Manometry: Prevalence, Predictive Factors, and Treatment Outcome.” The American journal of gastroenterology (2024). PMID: 38299616 ↗

    L3OTHERCited in: Epidemiology, Etiology & Risk Factors, Clinical Presentation, Prognosis & Natural History, Special Populations & Prevention
  125. [125]

    Gaber CE, Eluri S, Cotton CC et al.. “Epidemiologic and Economic Burden of Achalasia in the United States.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2021). PMID: 33652152 ↗

    L3OTHERCited in: Epidemiology, Etiology & Risk Factors, Special Populations & Prevention
  126. [126]

    Roman S, Kahrilas PJ, Boris L et al.. “High-resolution manometry studies are frequently imperfect but usually still interpretable.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2011). PMID: 21854736 ↗

    L4REVIEW_NARRATIVECited in: Epidemiology, Etiology & Risk Factors
  127. [127]

    Samo S, Carlson DA, Gregory DL et al.. “Incidence and Prevalence of Achalasia in Central Chicago, 2004-2014, Since the Widespread Use of High-Resolution Manometry.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2016). PMID: 27581064 ↗

    L2OTHERCited in: Epidemiology, Etiology & Risk Factors, Special Populations & Prevention
  128. [128]

    Carlson DA, Shehata C, Gonsalves N et al.. “Esophageal Dysmotility Is Associated With Disease Severity in Eosinophilic Esophagitis.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2021). PMID: 34768010 ↗

    L4OTHERCited in: Epidemiology, Etiology & Risk Factors, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Severity, Staging & Risk Stratification (GI Scores), Special Populations & Prevention
  129. [129]

    Ghisa M, Laserra G, Marabotto E et al.. “Achalasia and Obstructive Motor Disorders Are Not Uncommon in Patients With Eosinophilic Esophagitis.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2020). PMID: 32763482 ↗

    L4OTHERCited in: Epidemiology, Etiology & Risk Factors, Clinical Presentation, Endoscopic & Procedural Management
  130. [130]

    Ma LY, Guo KY, Liu ZQ et al.. “Repeat peroral endoscopic myotomy: technical difficulty and risk factors.” Gastrointestinal endoscopy (2024). PMID: 39557206 ↗

    L2OTHERCited in: Epidemiology, Etiology & Risk Factors, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management, Special Populations & Prevention
  131. [131]

    Liu XY, Cheng J, Chen WF et al.. “A risk-scoring system to predict clinical failure for patients with achalasia after peroral endoscopic myotomy.” Gastrointestinal endoscopy (2019). PMID: 31421076 ↗

    L2OTHERCited in: Epidemiology, Etiology & Risk Factors, Severity, Staging & Risk Stratification (GI Scores)
  132. [132]

    Zhang ZC, Xu JQ, Pan HT et al.. “Peroral endoscopic myotomy for symptomatic blown-out myotomy following previous myotomy for achalasia.” Endoscopy (2025). PMID: 40154504 ↗

    L2OTHERCited in: Epidemiology, Etiology & Risk Factors, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management, Prognosis & Natural History, Special Populations & Prevention
  133. [133]

    Inoue H, Ueno A, Shimamura Y et al.. “Peroral endoscopic myotomy and fundoplication: a novel NOTES procedure.” Endoscopy (2019). PMID: 30654395 ↗

    L4OTHERCited in: Epidemiology, Etiology & Risk Factors, Endoscopic & Procedural Management
  134. [134]

    Khashab MA, Messallam AA, Saxena P et al.. “Jet injection of dyed saline facilitates efficient peroral endoscopic myotomy.” Endoscopy (2013). PMID: 24338241 ↗

    L4OTHERCited in: Epidemiology, Etiology & Risk Factors, Long-term & Definitive Medical Management
  135. [135]

    Moran RA, Brewer Gutierrez OI, Rahden B et al.. “Impedance planimetry values for predicting clinical response following peroral endoscopic myotomy.” Endoscopy (2020). PMID: 33147642 ↗

    L2OTHERCited in: Epidemiology, Etiology & Risk Factors
  136. [136]

    Ichkhanian Y, Assis D, Familiari P et al.. “Management of patients after failed peroral endoscopic myotomy: a multicenter study.” Endoscopy (2021). PMID: 33197943 ↗

    L2OTHERCited in: Epidemiology, Etiology & Risk Factors
  137. [137]

    Liu ZQ, Li QL, Chen WF et al.. “The effect of prior treatment on clinical outcomes in patients with achalasia undergoing peroral endoscopic myotomy.” Endoscopy (2018). PMID: 30261536 ↗

    L2OTHERCited in: Epidemiology, Etiology & Risk Factors, Severity, Staging & Risk Stratification (GI Scores)
  138. [138]

    Dai Y, Ma Y, Li X et al.. “The efficacy of peroral endoscopic myotomy (POEM) for type III achalasia: a systematic review and meta-analysis.” Surgical endoscopy (2026). PMID: 42135495 ↗

    L1SR_OBSCited in: Epidemiology, Etiology & Risk Factors, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management, Prognosis & Natural History
  139. [139]

    Amdetsion GY, Pan CW, Tebeje HG et al.. “Diagnostic Performance and Reproducibility of the CARS Endoscopic Score in Achalasia: A Systematic Review and Meta-Analysis.” Neurogastroenterology and motility (2026). PMID: 41553234 ↗

    L1SR_OBSCited in: Epidemiology, Etiology & Risk Factors, Clinical Presentation, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs)
  140. [140]

    Abosheisha M, Nasr E, Kandeel M et al.. “Durability and reflux outcomes of peroral endoscopic myotomy compared to laparoscopic heller myotomy in achalasia: a meta-analysis of long-term studies.” Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus (2025). PMID: 41348606 ↗

    L1SR_OBSCited in: Epidemiology, Etiology & Risk Factors, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management, Prognosis & Natural History
  141. [141]

    Wu Y, Grieme A, Garza M et al.. “Impact of myotomy length on per-oral endoscopic myotomy (POEM) outcomes for achalasia: a meta-analysis of randomized trials.” Surgical endoscopy (2025). PMID: 40897875 ↗

    L1SR_OBSCited in: Epidemiology, Etiology & Risk Factors, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management, Prognosis & Natural History
  142. [142]

    Neville JJ, Schaffer S, Eaton S et al.. “Outcome reporting in studies of paediatric achalasia: A systematic review.” Journal of pediatric gastroenterology and nutrition (2025). PMID: 40544378 ↗

    L2SR_OBSCited in: Epidemiology, Etiology & Risk Factors
  143. [143]

    Puri R, Giri S, Panigrahi SC et al.. “Efficacy and safety of per-oral endoscopic myotomy in non-achalasia esophageal motility disorders: a systematic review and meta-analysis.” Esophagus : official journal of the Japan Esophageal Society (2024). PMID: 39141223 ↗

    L1SR_OBSCited in: Epidemiology, Etiology & Risk Factors
  144. [144]

    Ponds FA, van Raath MI, Mohamed SMM et al.. “Diagnostic features of malignancy-associated pseudoachalasia.” Alimentary pharmacology & therapeutics (2017). PMID: 28382674 ↗

    L2OTHERCited in: Epidemiology, Etiology & Risk Factors, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Complications
  145. [145]

    Sawas T, Ravi K, Geno DM et al.. “The course of achalasia one to four decades after initial treatment.” Alimentary pharmacology & therapeutics (2016). PMID: 27925255 ↗

    L2OTHERCited in: Epidemiology, Etiology & Risk Factors, Endoscopic & Procedural Management, Prognosis & Natural History
  146. [146]

    Leeuwenburgh I, Van Dekken H, Scholten P et al.. “Oesophagitis is common in patients with achalasia after pneumatic dilatation.” Alimentary pharmacology & therapeutics (2006). PMID: 16611281 ↗

    L2OTHERCited in: Epidemiology, Etiology & Risk Factors, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Special Populations & Prevention
  147. [147]

    Frankhuisen R, van Herwaarden MA, Heijkoop R et al.. “Persisting symptoms and decreased health-related quality-of-life in a cross-sectional study of treated achalasia patients.” Alimentary pharmacology & therapeutics (2007). PMID: 17767474 ↗

    L4OTHERCited in: Epidemiology, Etiology & Risk Factors, Long-term & Definitive Medical Management, Prognosis & Natural History
  148. [148]

    Pandolfino JE, Fass R, Chan WW et al.. “Patient-Reported Outcome Measures in Benign Esophageal Disorders.” The American journal of gastroenterology (2025). PMID: 40192144 ↗

    L5REVIEW_NARRATIVECited in: Clinical Presentation, Severity, Staging & Risk Stratification (GI Scores)
  149. [149]

    Facco M, Brun P, Baesso I et al.. “T cells in the myenteric plexus of achalasia patients show a skewed TCR repertoire and react to HSV-1 antigens.” The American journal of gastroenterology (2008). PMID: 18557707 ↗

    L3OTHERCited in: Clinical Presentation
  150. [150]

    Kessing BF, Bredenoord AJ, Smout AJ. “Erroneous diagnosis of gastroesophageal reflux disease in achalasia.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2011). PMID: 21683804 ↗

    L5REVIEW_NARRATIVECited in: Clinical Presentation, Diagnosis & Workup (Endoscopy, Imaging & Severity Labs)
  151. [151]

    Clayton SB, Patel R, Richter JE. “Functional and Anatomic Esophagogastic Junction Outflow Obstruction: Manometry, Timed Barium Esophagram Findings, and Treatment Outcomes.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2016). PMID: 26792374 ↗

    L3OTHERCited in: Clinical Presentation
  152. [152]

    Hulselmans M, Vanuytsel T, Degreef T et al.. “Long-term outcome of pneumatic dilation in the treatment of achalasia.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2009). PMID: 19782766 ↗

    L2OTHERCited in: Clinical Presentation, Endoscopic & Procedural Management
  153. [153]

    Schizas D, Theochari NA, Katsaros I et al.. “Pseudoachalasia: a systematic review of the literature.” Esophagus : official journal of the Japan Esophageal Society (2020). PMID: 31989338 ↗

    L1SR_OBSCited in: Clinical Presentation
  154. [154]

    Mohajeri S, Ansari G, Isaac DM et al.. “Pediatric cricopharyngeal achalasia: A systematic review.” International journal of pediatric otorhinolaryngology (2024). PMID: 39353299 ↗

    L4SR_OBSCited in: Clinical Presentation
  155. [155]

    Katsumata R, Manabe N, Sakae H et al.. “Clinical characteristics and manometric findings of esophageal achalasia-a systematic review regarding differences among three subtypes.” Journal of smooth muscle research = Nihon Heikatsukin Gakkai kikanshi (2023). PMID: 36948611 ↗

    L1SR_OBSCited in: Clinical Presentation
  156. [156]

    Cehic M, Mitrovic K, Vukovic R et al.. “Very early and severe presentation of Triple A syndrome - case report and review of the literature.” Frontiers in endocrinology (2024). PMID: 39387047 ↗

    L4CASE_REPORTCited in: Clinical Presentation
  157. [157]

    Holmes I, Ko MS, Kouanda A et al.. “Epiphrenic diverticula: An added source of complexity in achalasia management.” Neurogastroenterology and motility (2019). PMID: 31777144 ↗

    L5CASE_REPORTCited in: Clinical Presentation
  158. [158]

    Jacob RB, Fairlie T, Talley NJ et al.. “Disorders of Gut-Brain Interaction (DGBI) Symptoms and Response to Peroral Endoscopic Myotomy in Patients With Achalasia.” Neurogastroenterology and motility (2025). PMID: 41399176 ↗

    L2OTHERCited in: Clinical Presentation
  159. [159]

    Musa SA, Abdullah MA, Hassan SS et al.. “Insights into genetic and clinical profiles of triple A syndrome in Sudanese children.” Frontiers in endocrinology (2025). PMID: 40917361 ↗

    L4OTHERCited in: Clinical Presentation
  160. [160]

    Yang D, Bechara R, Dunst CM et al.. “AGA Clinical Practice Update on Advances in Per-Oral Endoscopic Myotomy (POEM) and Remaining Questions-What We Have Learned in the Past Decade: Expert Review.” Gastroenterology (2024). PMID: 39425737 ↗

    L5GUIDELINECited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management, Prognosis & Natural History
  161. [161]

    Sami SS, Haboubi HN, Ang Y et al.. “UK guidelines on oesophageal dilatation in clinical practice.” Gut (2018). PMID: 29478034 ↗

    L1GUIDELINECited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs)
  162. [162]

    Vaezi MF, Pandolfino JE, Vela MF. “ACG clinical guideline: diagnosis and management of achalasia.” The American journal of gastroenterology (2013). PMID: 23877351 ↗

    L1GUIDELINECited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs)
  163. [163]

    Sharma P, Kozarek R. “Role of esophageal stents in benign and malignant diseases.” The American journal of gastroenterology (2009). PMID: 20029413 ↗

    L1GUIDELINECited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Severity, Staging & Risk Stratification (GI Scores), Complications, Prognosis & Natural History
  164. [164]

    Rohof WO, Salvador R, Annese V et al.. “Outcomes of treatment for achalasia depend on manometric subtype.” Gastroenterology (2012). PMID: 23277105 ↗

    L1RCTCited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Severity, Staging & Risk Stratification (GI Scores), Acute Management, Long-term & Definitive Medical Management, Endoscopic & Procedural Management, Prognosis & Natural History, Special Populations & Prevention
  165. [165]

    Boeckxstaens G, Elsen S, Belmans A et al.. “10-year follow-up results of the European Achalasia Trial: a multicentre randomised controlled trial comparing pneumatic dilation with laparoscopic Heller myotomy.” Gut (2024). PMID: 38050085 ↗

    L1RCTCited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Acute Management, Long-term & Definitive Medical Management, Endoscopic & Procedural Management, Prognosis & Natural History
  166. [166]

    Familiari P, Borrelli de Andreis F, Landi R et al.. “Long versus short peroral endoscopic myotomy for the treatment of achalasia: results of a non-inferiority randomised controlled trial.” Gut (2023). PMID: 37072180 ↗

    L1RCTCited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Acute Management, Long-term & Definitive Medical Management, Endoscopic & Procedural Management, Prognosis & Natural History
  167. [167]

    Werner YB, Hakanson B, Martinek J et al.. “Endoscopic or Surgical Myotomy in Patients with Idiopathic Achalasia.” The New England journal of medicine (2019). PMID: 31800987 ↗

    L1RCTCited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Acute Management, Long-term & Definitive Medical Management, Endoscopic & Procedural Management
  168. [168]

    Boeckxstaens GE, Annese V, des Varannes SB et al.. “Pneumatic dilation versus laparoscopic Heller's myotomy for idiopathic achalasia.” The New England journal of medicine (2011). PMID: 21561346 ↗

    L1RCTCited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Acute Management, Long-term & Definitive Medical Management, Endoscopic & Procedural Management, Complications, Prognosis & Natural History
  169. [169]

    Ates F, Yuksel ES, Higginbotham T et al.. “Mucosal impedance discriminates GERD from non-GERD conditions.” Gastroenterology (2014). PMID: 25448923 ↗

    L2TRIAL_NONRANDOMCited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs)
  170. [170]

    Rohof WO, Hirsch DP, Kessing BF et al.. “Efficacy of treatment for patients with achalasia depends on the distensibility of the esophagogastric junction.” Gastroenterology (2012). PMID: 22562023 ↗

    L2TRIAL_NONRANDOMCited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Prognosis & Natural History
  171. [171]

    Khashab MA, Vela MF, Thosani N et al.. “ASGE guideline on the management of achalasia.” Gastrointestinal endoscopy (2019). PMID: 31839408 ↗

    L1GUIDELINECited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Long-term & Definitive Medical Management, Endoscopic & Procedural Management
  172. [172]

    Wessels EM, Masclee GMC, Bastiaansen BAJ et al.. “Long-Term Outcomes of Peroral Endoscopic Myotomy vs Pneumatic Dilation After Prior Laparoscopic Heller Myotomy for Achalasia.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2026). PMID: 41932531 ↗

    L1RCTCited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Acute Management, Long-term & Definitive Medical Management, Endoscopic & Procedural Management, Prognosis & Natural History
  173. [173]

    Lynch KL, Pandolfino JE, Howden CW et al.. “Major complications of pneumatic dilation and Heller myotomy for achalasia: single-center experience and systematic review of the literature.” The American journal of gastroenterology (2012). PMID: 23032978 ↗

    L2SR_OBSCited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management, Complications, Special Populations & Prevention
  174. [174]

    Suresh Kumar VC, Singh S, Moond V et al.. “Comparison of the safety, efficacy, and rates of gastroesophageal reflux disease between full-thickness versus modified peroral endoscopic myotomy for achalasia: a systematic review and meta-analysis.” Gastrointestinal endoscopy (2025). PMID: 40701351 ↗

    L1SR_OBSCited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management, Prognosis & Natural History
  175. [175]

    Vespa E, Pellegatta G, Chandrasekar VT et al.. “Long-term outcomes of peroral endoscopic myotomy for achalasia: a systematic review and meta-analysis.” Endoscopy (2022). PMID: 35798336 ↗

    L1SR_OBSCited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management, Prognosis & Natural History
  176. [176]

    Mohan BP, Ofosu A, Chandan S et al.. “Anterior versus posterior approach in peroral endoscopic myotomy (POEM): a systematic review and meta-analysis.” Endoscopy (2020). PMID: 31958861 ↗

    L1SR_OBSCited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management, Prognosis & Natural History
  177. [177]

    Abe H, Tanaka S, Sato H et al.. “Risk scoring system for the preprocedural prediction of the clinical failure of peroral endoscopic myotomy: a multicenter case-control study.” Endoscopy (2022). PMID: 35705149 ↗

    L3CASE_CONTROLCited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Prognosis & Natural History
  178. [178]

    Werner YB, Costamagna G, Swanström LL et al.. “Clinical response to peroral endoscopic myotomy in patients with idiopathic achalasia at a minimum follow-up of 2 years.” Gut (2015). PMID: 25934759 ↗

    L4OTHERCited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management, Complications, Prognosis & Natural History, Special Populations & Prevention
  179. [179]

    Shah ED, Yadlapati R, Chan WW. “Optimizing the Management Algorithm for Esophageal Dysphagia After Index Endoscopy: Cost-Effectiveness and Cost-Minimization Analysis.” The American journal of gastroenterology (2023). PMID: 37883488 ↗

    L2OTHERCited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs)
  180. [180]

    Carlson DA, Schauer JM, Kou W et al.. “Functional Lumen Imaging Probe Panometry Helps Identify Clinically Relevant Esophagogastric Junction Outflow Obstruction per Chicago Classification v4.0.” The American journal of gastroenterology (2022). PMID: 36002925 ↗

    L2OTHERCited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management
  181. [181]

    Hirano I, Pandolfino JE, Boeckxstaens GE. “Functional Lumen Imaging Probe for the Management of Esophageal Disorders: Expert Review From the Clinical Practice Updates Committee of the AGA Institute.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2017). PMID: 28212976 ↗

    L5REVIEW_NARRATIVECited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs)
  182. [182]

    Kaklamanos E, Kristinsdottir K, Wittbrodt M et al.. “From Pixels to Peristalsis: Comparing Achalasia Diagnosis With Artificial Intelligence With Expert Endoscopists.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2025). PMID: 41067594 ↗

    L3OTHERCited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Special Populations & Prevention
  183. [183]

    Triggs JR, Carlson DA, Beveridge C et al.. “Upright Integrated Relaxation Pressure Facilitates Characterization of Esophagogastric Junction Outflow Obstruction.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2019). PMID: 30708108 ↗

    L3OTHERCited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs)
  184. [184]

    Liu Z, Zhang X, Zhang W et al.. “Comprehensive Evaluation of the Learning Curve for Peroral Endoscopic Myotomy.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2017). PMID: 29208537 ↗

    L4OTHERCited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Severity, Staging & Risk Stratification (GI Scores), Endoscopic & Procedural Management, Prognosis & Natural History, Special Populations & Prevention
  185. [185]

    Bechara R, Onimaru M, Ikeda H et al.. “Per-oral endoscopic myotomy, 1000 cases later: pearls, pitfalls, and practical considerations.” Gastrointestinal endoscopy (2016). PMID: 27020899 ↗

    L5REVIEW_NARRATIVECited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management, Complications
  186. [186]

    Geeratragool T, Boonumnuay P, Maneerattanaporn M et al.. “Long-term outcomes of pneumatic balloon dilation versus peroral endoscopic myotomy in type I and II achalasia patients: a propensity score-matched analysis.” Gastrointestinal endoscopy (2024). PMID: 39477022 ↗

    L2OTHERCited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management, Complications, Prognosis & Natural History, Special Populations & Prevention
  187. [187]

    Rajab I, Abu Suilik H, Awashra A et al.. “Evaluating Myotomy Length in POEM for Achalasia: A Grade-Assessed Meta-Analysis of Randomized Controlled Trials.” Journal of clinical gastroenterology (2026). PMID: 40892045 ↗

    L1SR_MA_RCTCited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management, Prognosis & Natural History
  188. [188]

    Săftoiu A, Hassan C, Areia M et al.. “Role of gastrointestinal endoscopy in the screening of digestive tract cancers in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement.” Endoscopy (2020). PMID: 32052404 ↗

    L1OTHERCited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Prognosis & Natural History, Special Populations & Prevention
  189. [189]

    Chiu PW, Inoue H, Rösch T. “From POEM to POET: Applications and perspectives for submucosal tunnel endoscopy.” Endoscopy (2016). PMID: 27855465 ↗

    L5REVIEW_NARRATIVECited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management
  190. [190]

    Enestvedt BK, Williams JL, Sonnenberg A. “Epidemiology and practice patterns of achalasia in a large multi-centre database.” Alimentary pharmacology & therapeutics (2011). PMID: 21480936 ↗

    L2OTHERCited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management, Special Populations & Prevention
  191. [191]

    Nasr I, Attaluri A, Coss-Adame E et al.. “Diagnostic utility of the oesophageal balloon distension test in the evaluation of oesophageal chest pain.” Alimentary pharmacology & therapeutics (2012). PMID: 22524415 ↗

    L3OTHERCited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Severity, Staging & Risk Stratification (GI Scores)
  192. [192]

    Nabi Z, Dhar J, Samanta J et al.. “Short versus standard esophageal myotomy during peroral endoscopic myotomy for achalasia: A systematic review and meta-analysis of randomized controlled trials.” Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology (2025). PMID: 41359117 ↗

    L1SR_MA_RCTCited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management
  193. [193]

    Shiratori Y, Sharma N, Kodilinye SM et al.. “Impact of hiatal hernia on periprocedural outcomes following peroral endoscopic myotomy: a nationwide retrospective study.” Surgical endoscopy (2025). PMID: 40676296 ↗

    L2COHORTCited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management, Special Populations & Prevention
  194. [194]

    Scaffidi MA, Forbes N, Huynh L et al.. “Surgical and endoscopic interventions in the management of idiopathic achalasia.” The Cochrane database of systematic reviews (2025). PMID: 40747760 ↗

    L5OTHERCited in: Diagnosis & Workup (Endoscopy, Imaging & Severity Labs), Endoscopic & Procedural Management
  195. [195]

    Verlaan T, Rohof WO, Bredenoord AJ et al.. “Effect of peroral endoscopic myotomy on esophagogastric junction physiology in patients with achalasia.” Gastrointestinal endoscopy (2013). PMID: 23453184 ↗

    L1TRIAL_NONRANDOMCited in: Severity, Staging & Risk Stratification (GI Scores)
  196. [196]

    Kumbhari V, Behary J, Szczesniak M et al.. “Efficacy and safety of pneumatic dilatation for achalasia in the treatment of post-myotomy symptom relapse.” The American journal of gastroenterology (2013). PMID: 23458850 ↗

    L4OTHERCited in: Severity, Staging & Risk Stratification (GI Scores), Long-term & Definitive Medical Management, Prognosis & Natural History
  197. [197]

    Mearin F, García-González MA, Strunk M et al.. “Association between achalasia and nitric oxide synthase gene polymorphisms.” The American journal of gastroenterology (2006). PMID: 16848803 ↗

    L3OTHERCited in: Severity, Staging & Risk Stratification (GI Scores)
  198. [198]

    Bedell A, Taft TH, Keefer L et al.. “Development of the Northwestern Esophageal Quality of Life Scale: A Hybrid Measure for Use Across Esophageal Conditions.” The American journal of gastroenterology (2016). PMID: 26881974 ↗

    L4OTHERCited in: Severity, Staging & Risk Stratification (GI Scores)
  199. [199]

    Pandolfino JE, Ghosh SK, Rice J et al.. “Classifying esophageal motility by pressure topography characteristics: a study of 400 patients and 75 controls.” The American journal of gastroenterology (2007). PMID: 17900331 ↗

    L3OTHERCited in: Severity, Staging & Risk Stratification (GI Scores)
  200. [200]

    Zaninotto G, Bennett C, Boeckxstaens G et al.. “The 2018 ISDE achalasia guidelines.” Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus (2018). PMID: 30169645 ↗

    L1GUIDELINECited in: Severity, Staging & Risk Stratification (GI Scores)
  201. [201]

    Taft TH, Guadagnoli L, Carlson DA et al.. “Validation of the Short-Form Esophageal Hypervigilance and Anxiety Scale.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2021). PMID: 33348046 ↗

    L3OTHERCited in: Severity, Staging & Risk Stratification (GI Scores)
  202. [202]

    Vela MF, Richter JE, Khandwala F et al.. “The long-term efficacy of pneumatic dilatation and Heller myotomy for the treatment of achalasia.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2006). PMID: 16630776 ↗

    L2OTHERCited in: Severity, Staging & Risk Stratification (GI Scores)
  203. [203]

    Liu XY, Geng ZH, Chen WF et al.. “A prediction model and nomogram for technical difficulty of peroral endoscopic myotomy.” Surgical endoscopy (2022). PMID: 36477640 ↗

    L2RCTCited in: Severity, Staging & Risk Stratification (GI Scores), Acute Management, Long-term & Definitive Medical Management
  204. [204]

    Ponds FA, Fockens P, Lei A et al.. “Effect of Peroral Endoscopic Myotomy vs Pneumatic Dilation on Symptom Severity and Treatment Outcomes Among Treatment-Naive Patients With Achalasia: A Randomized Clinical Trial.” JAMA (2019). PMID: 31287522 ↗

    L1RCTCited in: Severity, Staging & Risk Stratification (GI Scores)
  205. [205]

    Marin I, Caballero N, Guarner-Argente C et al.. “Rapid drink challenge test for the clinical evaluation of patients with Achalasia.” Neurogastroenterology and motility (2018). PMID: 30101425 ↗

    L2TRIAL_NONRANDOMCited in: Severity, Staging & Risk Stratification (GI Scores)
  206. [206]

    Gupta P, Parshad R, Balakrishna P et al.. “Angle of His Accentuation Is a Viable Alternative to Dor Fundoplication as an Adjunct to Laparoscopic Heller Cardiomyotomy: Results of a Randomized Clinical Study.” Digestive diseases and sciences (2018). PMID: 29796913 ↗

    L1RCTCited in: Severity, Staging & Risk Stratification (GI Scores)
  207. [207]

    Andolfi C, Fisichella PM. “Meta-analysis of clinical outcome after treatment for achalasia based on manometric subtypes.” The British journal of surgery (2019). PMID: 30690706 ↗

    L1SR_OBSCited in: Severity, Staging & Risk Stratification (GI Scores)
  208. [208]

    Tustumi F, Bernardo WM, da Rocha JRM et al.. “Esophageal achalasia: a risk factor for carcinoma. A systematic review and meta-analysis.” Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus (2017). PMID: 28859394 ↗

    L1SR_OBSCited in: Severity, Staging & Risk Stratification (GI Scores)
  209. [209]

    Takahashi K, Sato H, Shimamura Y et al.. “Persistent body-weight change on achalasia and peroral endoscopic myotomy: a multicenter cohort study.” Journal of gastroenterology (2024). PMID: 39739029 ↗

    L2COHORTCited in: Severity, Staging & Risk Stratification (GI Scores)
  210. [210]

    Karyampudi A, Nabi Z, Ramchandani M et al.. “Gastroesophageal reflux after per-oral endoscopic myotomy is frequently asymptomatic, but leads to more severe esophagitis: A case-control study.” United European gastroenterology journal (2021). PMID: 32723068 ↗

    L3CASE_CONTROLCited in: Severity, Staging & Risk Stratification (GI Scores)
  211. [211]

    Chrystoja CC, Darling GE, Diamant NE et al.. “Achalasia-Specific Quality of Life After Pneumatic Dilation or Laparoscopic Heller Myotomy With Partial Fundoplication: A Multicenter, Randomized Clinical Trial.” The American journal of gastroenterology (2016). PMID: 27619832 ↗

    L1RCTCited in: Acute Management, Long-term & Definitive Medical Management, Endoscopic & Procedural Management, Prognosis & Natural History, Special Populations & Prevention
  212. [212]

    Vanuytsel T, Bisschops R, Farré R et al.. “Botulinum toxin reduces Dysphagia in patients with nonachalasia primary esophageal motility disorders.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2013). PMID: 23591282 ↗

    L1RCTCited in: Acute Management, Long-term & Definitive Medical Management, Prognosis & Natural History
  213. [213]

    Maselli R, Oliva A, Badalamenti M et al.. “Single-dose versus short-course prophylactic antibiotics for peroral endoscopic myotomy: a randomized controlled trial.” Gastrointestinal endoscopy (2021). PMID: 34119499 ↗

    L1RCTCited in: Acute Management, Long-term & Definitive Medical Management
  214. [214]

    Tan Y, Lv L, Wang X et al.. “Efficacy of anterior versus posterior per-oral endoscopic myotomy for treating achalasia: a randomized, prospective study.” Gastrointestinal endoscopy (2018). PMID: 29571969 ↗

    L1RCTCited in: Acute Management, Long-term & Definitive Medical Management
  215. [215]

    Campos JM, Evangelista LF, Ferraz AA et al.. “Treatment of ring slippage after gastric bypass: long-term results after endoscopic dilation with an achalasia balloon (with videos).” Gastrointestinal endoscopy (2010). PMID: 20493480 ↗

    L4RCTCited in: Acute Management, Long-term & Definitive Medical Management
  216. [216]

    Ichkhanian Y, Abimansour JP, Pioche M et al.. “Outcomes of anterior versus posterior peroral endoscopic myotomy 2 years post-procedure: prospective follow-up results from a randomized clinical trial.” Endoscopy (2020). PMID: 32572862 ↗

    L1RCTCited in: Acute Management, Long-term & Definitive Medical Management
  217. [217]

    Mikaeli J, Bishehsari F, Montazeri G et al.. “Injection of botulinum toxin before pneumatic dilatation in achalasia treatment: a randomized-controlled trial.” Alimentary pharmacology & therapeutics (2006). PMID: 16948810 ↗

    L1RCTCited in: Acute Management, Long-term & Definitive Medical Management, Prognosis & Natural History
  218. [218]

    Shukla J, Mandavdhare HS, Shah J et al.. “Transverse versus longitudinal mucosal incision during POEM for esophageal motility disorders: a randomized trial.” Surgical endoscopy (2024). PMID: 39009726 ↗

    L1RCTCited in: Acute Management, Long-term & Definitive Medical Management
  219. [219]

    Nabi Z, Bhaware B, Ramchandani M et al.. “Single-Versus Multiple-Dose Antimicrobial Prophylaxis in Peroral Endoscopic Myotomy: A Randomized Controlled Study (SMAPP Trial).” Dysphagia (2023). PMID: 37142733 ↗

    L1RCTCited in: Acute Management, Long-term & Definitive Medical Management
  220. [220]

    Khashab MA, Sanaei O, Rivory J et al.. “Peroral endoscopic myotomy: anterior versus posterior approach: a randomized single-blinded clinical trial.” Gastrointestinal endoscopy (2019). PMID: 31408652 ↗

    L1OTHERCited in: Acute Management, Long-term & Definitive Medical Management
  221. [221]

    Rohof WO, Lei A, Boeckxstaens GE. “Esophageal stasis on a timed barium esophagogram predicts recurrent symptoms in patients with long-standing achalasia.” The American journal of gastroenterology (2012). PMID: 23007004 ↗

    L2TRIAL_NONRANDOMCited in: Long-term & Definitive Medical Management, Prognosis & Natural History
  222. [222]

    Von Renteln D, Fuchs KH, Fockens P et al.. “Peroral endoscopic myotomy for the treatment of achalasia: an international prospective multicenter study.” Gastroenterology (2013). PMID: 23665071 ↗

    L2OTHERCited in: Long-term & Definitive Medical Management, Endoscopic & Procedural Management, Prognosis & Natural History
  223. [223]

    Zerbib F, Thétiot V, Richy F et al.. “Repeated pneumatic dilations as long-term maintenance therapy for esophageal achalasia.” The American journal of gastroenterology (2006). PMID: 16635216 ↗

    L4OTHERCited in: Long-term & Definitive Medical Management, Complications, Prognosis & Natural History
  224. [224]

    Chumpitazi BP, Fishman SJ, Nurko S. “Long-term clinical outcome after botulinum toxin injection in children with nonrelaxing internal anal sphincter.” The American journal of gastroenterology (2009). PMID: 19259081 ↗

    L4OTHERCited in: Long-term & Definitive Medical Management
  225. [225]

    Sanagapalli S, McGuire J, Leong RW et al.. “The Clinical Relevance of Manometric Esophagogastric Junction Outflow Obstruction Can Be Determined Using Rapid Drink Challenge and Solid Swallows.” The American journal of gastroenterology (2021). PMID: 33136563 ↗

    L3OTHERCited in: Long-term & Definitive Medical Management
  226. [226]

    Bonifácio P, de Moura DTH, Bernardo WM et al.. “Pneumatic dilation versus laparoscopic Heller's myotomy in the treatment of achalasia: systematic review and meta-analysis based on randomized controlled trials.” Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus (2019). PMID: 30380036 ↗

    L1SR_MA_RCTCited in: Long-term & Definitive Medical Management
  227. [227]

    Penagini R, de Bortoli N, Savarino E et al.. “Rapid Drink Challenge During High-resolution Manometry for Evaluation of Esophageal Emptying in Treated Achalasia.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2022). PMID: 35240328 ↗

    L2OTHERCited in: Long-term & Definitive Medical Management, Prognosis & Natural History
  228. [228]

    Kuipers T, Ponds FA, Fockens P et al.. “Peroral endoscopic myotomy versus pneumatic dilation in treatment-naive patients with achalasia: 5-year follow-up of a randomised controlled trial.” The lancet. Gastroenterology & hepatology (2022). PMID: 36206786 ↗

    L1RCTCited in: Long-term & Definitive Medical Management
  229. [229]

    Fukuda H, Sato H, Fujiyoshi Y et al.. “Risks of refractory chest pain after peroral endoscopic myotomy in achalasia-related esophageal motility disorders: short-term results from a multicenter study in Japan.” Gastrointestinal endoscopy (2022). PMID: 35568241 ↗

    L2OTHERCited in: Long-term & Definitive Medical Management
  230. [230]

    Elliott TR, Wu PI, Fuentealba S et al.. “Long-term outcome following pneumatic dilatation as initial therapy for idiopathic achalasia: an 18-year single-centre experience.” Alimentary pharmacology & therapeutics (2013). PMID: 23659347 ↗

    L2OTHERCited in: Long-term & Definitive Medical Management, Complications
  231. [231]

    Bassotti G, D'Onofrio V, Battaglia E et al.. “Treatment with botulinum toxin of octo-nonagerians with oesophageal achalasia: a two-year follow-up study.” Alimentary pharmacology & therapeutics (2006). PMID: 16696811 ↗

    L4OTHERCited in: Long-term & Definitive Medical Management, Special Populations & Prevention
  232. [232]

    Park CH, Jung DH, Kim DH et al.. “Comparative efficacy of per-oral endoscopic myotomy and Heller myotomy in patients with achalasia: a meta-analysis.” Gastrointestinal endoscopy (2019). PMID: 31443929 ↗

    L2SR_OBSCited in: Endoscopic & Procedural Management, Prognosis & Natural History
  233. [233]

    McGrath B, Calderon LF, Xie M et al.. “Delayed Tension Symptomatic Pneumoperitoneum After POEM Requiring Needle Decompression.” The American journal of gastroenterology (2021). PMID: 33136569 ↗

    L4CASE_REPORTCited in: Endoscopic & Procedural Management
  234. [234]

    Abi Nassif M, Kostandy EGN, Fei L et al.. “Safety and Efficacy of Pneumatic Balloon Dilation for Pediatric Achalasia-A Single-Center Experience.” The American journal of gastroenterology (2025). PMID: 41081567 ↗

    L4OTHERCited in: Endoscopic & Procedural Management, Prognosis & Natural History
  235. [235]

    Ponds FA, Moonen A, Smout AJPM et al.. “Screening for dysplasia with Lugol chromoendoscopy in longstanding idiopathic achalasia.” The American journal of gastroenterology (2018). PMID: 29748564 ↗

    L2OTHERCited in: Endoscopic & Procedural Management, Special Populations & Prevention
  236. [236]

    von Renteln D, Inoue H, Minami H et al.. “Peroral endoscopic myotomy for the treatment of achalasia: a prospective single center study.” The American journal of gastroenterology (2011). PMID: 22068665 ↗

    L4OTHERCited in: Endoscopic & Procedural Management
  237. [237]

    Jain AS, Carlson DA, Triggs J et al.. “Esophagogastric Junction Distensibility on Functional Lumen Imaging Probe Topography Predicts Treatment Response in Achalasia-Anatomy Matters!” The American journal of gastroenterology (2019). PMID: 30741739 ↗

    L2OTHERCited in: Endoscopic & Procedural Management
  238. [238]

    Ngamruengphong S, Inoue H, Ujiki MB et al.. “Efficacy and Safety of Peroral Endoscopic Myotomy for Treatment of Achalasia After Failed Heller Myotomy.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2017). PMID: 28189695 ↗

    L2OTHERCited in: Endoscopic & Procedural Management
  239. [239]

    Liu X, Yao L, Cheng J et al.. “Landscape of Adverse Events Related to Peroral Endoscopic Myotomy in 3135 Patients and a Risk-Scoring System to Predict Major Adverse Events.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2021). PMID: 33905769 ↗

    L2OTHERCited in: Endoscopic & Procedural Management, Prognosis & Natural History
  240. [240]

    Sanaka MR, Parikh MP, Thota PN et al.. “Peroral Endoscopic Myotomy Is Effective for Patients With Achalasia and Normal Lower-Esophageal Sphincter Relaxation Pressures.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2018). PMID: 30153516 ↗

    L2OTHERCited in: Endoscopic & Procedural Management
  241. [241]

    Dominitz JA, Dire CA, Billingsley KG et al.. “Complications and antireflux medication use after antireflux surgery.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2006). PMID: 16527692 ↗

    L2OTHERCited in: Endoscopic & Procedural Management
  242. [242]

    Wu QN, Xu XY, Zhang XC et al.. “Submucosal fibrosis in achalasia patients is a rare cause of aborted peroral endoscopic myotomy procedures.” Endoscopy (2017). PMID: 28658680 ↗

    L2OTHERCited in: Endoscopic & Procedural Management, Special Populations & Prevention
  243. [243]

    Katzka DA, Castell DO. “Review article: an analysis of the efficacy, perforation rates and methods used in pneumatic dilation for achalasia.” Alimentary pharmacology & therapeutics (2011). PMID: 21848630 ↗

    L5REVIEW_NARRATIVECited in: Endoscopic & Procedural Management, Complications, Prognosis & Natural History
  244. [244]

    Yaghoobi M, Mayrand S, Martel M et al.. “Laparoscopic Heller's myotomy versus pneumatic dilation in the treatment of idiopathic achalasia: a meta-analysis of randomized, controlled trials.” Gastrointestinal endoscopy (2013). PMID: 23684149 ↗

    L1SR_OBSCited in: Complications
  245. [245]

    Kappelle WF, Bogte A, Siersema PD. “Hydraulic dilation with a shape-measuring balloon in idiopathic achalasia: a feasibility study.” Endoscopy (2015). PMID: 26349065 ↗

    L4TRIAL_NONRANDOMCited in: Complications, Special Populations & Prevention
  246. [246]

    Harvey PR, Coupland B, Mytton J et al.. “Outcomes of pneumatic dilatation and Heller's myotomy for achalasia in England between 2005 and 2016.” Gut (2019). PMID: 30606814 ↗

    L2OTHERCited in: Complications, Prognosis & Natural History, Special Populations & Prevention
  247. [247]

    Wang YR, Dempsey DT, Friedenberg FK et al.. “Trends of Heller myotomy hospitalizations for achalasia in the United States, 1993-2005: effect of surgery volume on perioperative outcomes.” The American journal of gastroenterology (2008). PMID: 18684189 ↗

    L2OTHERCited in: Complications
  248. [248]

    Vanuytsel T, Lerut T, Coosemans W et al.. “Conservative management of esophageal perforations during pneumatic dilation for idiopathic esophageal achalasia.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2011). PMID: 22064041 ↗

    L2OTHERCited in: Complications
  249. [249]

    Li ZS, Sun ZX, Zou DW et al.. “Endoscopic management of foreign bodies in the upper-GI tract: experience with 1088 cases in China.” Gastrointestinal endoscopy (2006). PMID: 16996336 ↗

    L4OTHERCited in: Complications
  250. [250]

    Shah ED, Chang AC, Law R. “Valuing innovative endoscopic techniques: per-oral endoscopic myotomy for the management of achalasia.” Gastrointestinal endoscopy (2018). PMID: 29684386 ↗

    L2OTHERCited in: Complications
  251. [251]

    Tyberg A, Seewald S, Sharaiha RZ et al.. “A multicenter international registry of redo per-oral endoscopic myotomy (POEM) after failed POEM.” Gastrointestinal endoscopy (2016). PMID: 27756611 ↗

    L4OTHERCited in: Complications
  252. [252]

    Zori AG, Kirtane TS, Gupte AR et al.. “Utility of clinical suspicion and endoscopic re-examination for detection of esophagogastric perforation after pneumatic dilation for achalasia.” Endoscopy (2015). PMID: 26394248 ↗

    L4OTHERCited in: Complications
  253. [253]

    Pasricha PJ, Hawari R, Ahmed I et al.. “Submucosal endoscopic esophageal myotomy: a novel experimental approach for the treatment of achalasia.” Endoscopy (2007). PMID: 17703382 ↗

    L4OTHERCited in: Complications
  254. [254]

    Wang L, Liu ZQ, Zhang JY et al.. “Management of delayed bleeding of upper gastrointestinal endoscopic submucosal tunneling procedures: a retrospective single-center analysis and brief meta-analysis.” Journal of gastroenterology and hepatology (2023). PMID: 37816538 ↗

    L4SR_OBSCited in: Complications
  255. [255]

    Ciomperlik H, Dhanani NH, Mohr C et al.. “Systematic Review of Treatment of Patients with Achalasia: Heller Myotomy, Pneumatic Dilation, and Peroral Endoscopic Myotomy.” Journal of the American College of Surgeons (2022). PMID: 36382896 ↗

    L1SR_OBSCited in: Complications
  256. [256]

    Pontecorvo AA, Cornejo J, Alomari M et al.. “Outcomes of esophagectomy in patients with previous foregut surgery: a matched retrospective cohort study.” Surgical endoscopy (2025). PMID: 40328976 ↗

    L3COHORTCited in: Complications
  257. [257]

    Misra D, Banerjee A, Das K et al.. “Outcome of sequential dilatation in achalasia cardia patients: a prospective cohort study.” Esophagus : official journal of the Japan Esophageal Society (2022). PMID: 35066711 ↗

    L2COHORTCited in: Complications
  258. [258]

    Aiolfi A, Damiani R, Manara M et al.. “Robotic versus laparoscopic heller myotomy for esophageal achalasia: an updated systematic review and meta-analysis.” Langenbeck's archives of surgery (2025). PMID: 39961886 ↗

    L1SR_OBSCited in: Complications
  259. [259]

    Diab AF, Sujka JA, Nashit M et al.. “The Use of Knives With Versus Without Integrated Water-jet Function During Peroral Endoscopic Myotomy for Patients With Achalasia: A Meta-analysis.” Surgical laparoscopy, endoscopy & percutaneous techniques (2025). PMID: 39812005 ↗

    L1SR_OBSCited in: Complications
  260. [260]

    Conner A, Wills MV, Navarrete S et al.. “Modern treatment for achalasia: endoscopic and surgical therapies.” The British journal of surgery (2026). PMID: 42037164 ↗

    L5REVIEW_NARRATIVECited in: Complications
  261. [261]

    McCaul M, Borja J, Richards WO. “Outcomes of Robotic vs Laparoscopic Heller Myotomy.” Journal of the American College of Surgeons (2026). PMID: 41615705 ↗

    L3OTHERCited in: Complications
  262. [262]

    Carlson DA, Lin Z, Kahrilas PJ et al.. “The Functional Lumen Imaging Probe Detects Esophageal Contractility Not Observed With Manometry in Patients With Achalasia.” Gastroenterology (2015). PMID: 26278501 ↗

    L3OTHERCited in: Prognosis & Natural History, Special Populations & Prevention
  263. [263]

    Haito-Chavez Y, Inoue H, Beard KW et al.. “Comprehensive Analysis of Adverse Events Associated With Per Oral Endoscopic Myotomy in 1826 Patients: An International Multicenter Study.” The American journal of gastroenterology (2017). PMID: 28534521 ↗

    L3OTHERCited in: Prognosis & Natural History
  264. [264]

    Wu PI, Szczesniak MM, Craig PI et al.. “Novel Intra-Procedural Distensibility Measurement Accurately Predicts Immediate Outcome of Pneumatic Dilatation for Idiopathic Achalasia.” The American journal of gastroenterology (2017). PMID: 29206815 ↗

    L2OTHERCited in: Prognosis & Natural History
  265. [265]

    Hoversten P, Otaki F, Katzka DA. “Course of Esophageal Candidiasis and Outcomes of Patients at a Single Center.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2018). PMID: 29702297 ↗

    L4OTHERCited in: Prognosis & Natural History
  266. [266]

    Li QL, Yao LQ, Xu XY et al.. “Repeat peroral endoscopic myotomy: a salvage option for persistent/recurrent symptoms.” Endoscopy (2015). PMID: 26349067 ↗

    L4OTHERCited in: Prognosis & Natural History
  267. [267]

    Zhou PH, Li QL, Yao LQ et al.. “Peroral endoscopic remyotomy for failed Heller myotomy: a prospective single-center study.” Endoscopy (2013). PMID: 23389963 ↗

    L2TRIAL_NONRANDOMCited in: Special Populations & Prevention
  268. [268]

    Mittal RK, Kumar D, Kligerman SJ et al.. “Three-Dimensional Pressure Profile of the Lower Esophageal Sphincter and Crural Diaphragm in Patients with Achalasia Esophagus.” Gastroenterology (2020). PMID: 32437748 ↗

    L3OTHERCited in: Special Populations & Prevention
  269. [269]

    Samo S, Hamo F, Hamza A et al.. “Rapid Development of Achalasia After SARS-CoV-2 Infection: Polymerase Chain Reaction Analysis of Esophageal Muscle Tissue.” The American journal of gastroenterology (2024). PMID: 38265043 ↗

    L3OTHERCited in: Special Populations & Prevention
  270. [270]

    Dhamija R, Tan KM, Pittock SJ et al.. “Serologic profiles aiding the diagnosis of autoimmune gastrointestinal dysmotility.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (2008). PMID: 18599359 ↗

    L4OTHERCited in: Special Populations & Prevention
  271. [271]

    Ichkhanian Y, Brewer Gutierrez O, Roman S et al.. “Role of functional luminal imaging probe in the management of postmyotomy clinical failure.” Gastrointestinal endoscopy (2022). PMID: 35149045 ↗

    L4OTHERCited in: Special Populations & Prevention
  272. [272]

    Nabi Z, Ramchandani M, Chavan R et al.. “Peroral endoscopic myotomy in treatment-naïve achalasia patients versus prior treatment failure cases.” Endoscopy (2017). PMID: 29169196 ↗

    L3OTHERCited in: Special Populations & Prevention
  273. [273]

    Hernández Mondragón OV, González Martinez MA, Blancas Valencia JM et al.. “Long-term quality of life after peroral endoscopic myotomy remains compromised in patients with achalasia type III.” Endoscopy (2017). PMID: 28898921 ↗

    L4OTHERCited in: Special Populations & Prevention
  274. [274]

    Oh MJ, Choi YJ, Han K et al.. “Hormone replacement therapy and the risk of achalasia in postmenopausal women: A nationwide cohort study.” Medicine (2026). PMID: 41760046 ↗

    L2COHORTCited in: Special Populations & Prevention
  275. [275]

    Matto MA, Luketich JD, Levy RM et al.. “Minimally invasive surgical management of mid- to distal esophageal diverticula: a large single-center review.” Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract (2026). PMID: 41990992 ↗

    L4REVIEW_NARRATIVECited in: Special Populations & Prevention
  276. [276]

    Hao XW, Bi YW, Wang ZM et al.. “Simultaneous treatment of concomitant achalasia coexisting with epiphrenic diverticulum: The practice of submucosal tunneling technique.” World journal of gastroenterology (2026). PMID: 41810444 ↗

    L2OTHERCited in: Special Populations & Prevention
  277. [277]

    Wessels EM, Warringa N, Masclee GMC et al.. “The Role of Functional Lumen Imaging Probe (FLIP) in Addition to High-Resolution Manometry and Timed Barium Esophagram in Treated Achalasia Patients With Persistent or Recurrent Symptoms.” Neurogastroenterology and motility (2026). PMID: 41804673 ↗

    L2OTHERCited in: Special Populations & Prevention

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