A 28-year-old man reports dysphagia to both solids and liquids with intermittent regurgitation of undigested food. Barium swallow shows a dilated esophagus tapering to a bird-beak deformity. High-resolution manometry shows impaired lower esophageal sphincter relaxation with absent peristalsis. What is the definitive diagnostic modality for this condition?

• A Barium swallow
• B Upper GI endoscopy with biopsy
• C 24-hour pH monitoring
• D Esophageal high-resolution manometry ✓

Explanation

Manometry is the gold standard for diagnosing achalasia because it demonstrates absent distal peristalsis with incomplete LES relaxation, findings that define the disease under the Chicago Classification. Barium swallow shows the bird-beak appearance but cannot exclude pseudoachalasia reliably, so endoscopy is mandatory to rule out an infiltrating cardia tumour. pH monitoring has no role in establishing the diagnosis.

Reference: Shackelford's Surgery of the Alimentary Tract, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.