[Achalasia--early diagnosis and treatment options]

Achalasia is a rare motility disorder of the distal esophagus, showing reduced or absent swallow induced relaxation of the lower esophageal sphincter region. The onset of the disease can be very slow and correct diagnosis might be delayed over years. Using exact medical history, upper GI endoscopy and barium swallow X-ray the achalasia can be suspected and can be confirmed by esophageal manometry. Other especially malignant diseases, which can imitate the clinical symptoms, have to be ruled out. Pneumatic balloon dilatation is therapy of first choice in achalasia. Especially in younger patients laparoscopic fundoplication with subsequent antireflux procedure should be offered early in the therapeutic algorithm when dilatation therapy fails. Medical therapy or intrasphincteric injection of botulinum toxin is only an alternative treatment for high risk patients, treatment failures or residual symptoms.