What is the initial diagnostic assessment for achalasia according to gastroenterology guidelines?

The initial diagnostic assessment for achalasia according to gastroenterology guidelines focuses on evaluating esophageal function and morphology. The preferred approach involves conducting a barium esophagram, which helps visualize the esophagus and any potential dilation or obstruction. This imaging technique allows for the assessment of the characteristic "bird-beak" appearance often seen in achalasia, where there is narrowing of the esophagus at the lower esophageal sphincter (LES) due to the inability of the sphincter to relax.

In addition to the barium esophagram, esophagogastroduodenoscopy (EGD) serves a crucial role in directly examining the esophageal lining and can confirm the diagnosis by enabling the clinician to see any structural abnormalities. Moreover, the EGD can help rule out other potential causes of dysphagia by allowing biopsies if necessary. Although the barium esophagram indicates structural abnormalities, an esophageal motility study is often performed to confirm the diagnosis and assess the specific motility pattern associated with achalasia.

Other options, such as endoscopic ultrasound, CT scan of the abdomen, or upper gastrointestinal series alone, do not provide the same level of detail in diagnosing achalasia and may be employed in different clinical