Diagnostic evaluation in patients with suspected achalasia

LES: lower esophageal sphincter; EUS: endoscopic ultrasound; FNA: fine needle aspiration; IRP: integrated relaxation pressure.
* Diagnostic manometric findings of achalasia are incomplete relaxation of the LES (IRP above the upper limit of normal) and aperistalsis in the distal two-thirds of the esophagus.
¶ Equivocal manometric findings include incomplete LES relaxation but some preserved peristalsis; some complete LES relaxation with aperistalsis.
Δ Additional evaluation should be based on patient symptoms.