As it should be done in every patient presenting with chronic dysphagia, the first examination to be done in patients with achalasia is barium esophageal film (esophageal passage graphy).
Delay in the passage of barium to the stomach in barium X-ray, enlargement of the esophagus, air-liquid level in the esophagus, the appearance of falling snow caused by swallowed barium in the liquid accumulated in the esophagus, loss of peristaltic activity in the esophagus, narrowing in the form of a bird’s beak at the lower end of the esophagus (Bird beak deformity) and disappearance in the stomach air pocket are radiological findings that can be seen in patients with achalasia.
In advanced cases, the over-enlarged esophagus becomes wide and curved, resembling an enlarged stocking (sigmoid esophagus). In some patients, enlargement of the esophagus shadow and air-fluid level can be seen on chest X-ray.
Endoscopy is a useful method in the differential diagnosis of other diseases (pseudoachalasia – false achalasia) that may cause achalasia-like symptoms such as malignancy and peptic stricture.
In patients over 40 years of age and/or with short-term symptoms of the disease, who have lost a lot of weight in a short time, in patients with a family history of esophageal or stomach cancer, in patients who consume large amounts of cigarettes and alcohol, in patients with gastroesophageal reflux disease for a long time, and suspicious findings on barium X-ray Upper gastrointestinal system endoscopy must be performed in patients with diabetes mellitus (See. Gastroscopy).
The absence of enlargement and peristalsis in the esophagus, difficulty in passing from the junction of the stomach and esophagus, and the presence of food residues in the esophagus are endoscopic findings that may help in the diagnosis of achalasia. Endosonography and computed tomography are other examination methods that can be used in differential diagnosis when necessary.