Tests will be done to diagnose achalasia. These tests will also look for other conditions that could be causing the symptoms.
Esophagography (barium swallow). You will swallow a thick liquid (barium) that can be seen on an X-ray. The test can show whether the esophagus is enlarged or dilated. It will also show whether the barium is able to empty properly into the stomach.
The study is generally painless. Some people with achalasia experience discomfort, similar to what they feel when swallowing foods or liquids.
Endoscopy. Even if your medical history and barium swallow suggest achalasia, endoscopy usually is done. Endoscopy allows the doctor to see if some other problem might be causing the narrowed esophagus.
Endoscopy is an outpatient procedure. You will be sedated as the doctor passes a flexible tube down your esophagus. He or she will look at the lining of the esophagus and stomach. A piece of tissue (biopsy) may be taken to be examined under a microscope.
Balloon dilation, a treatment for achalasia, can be done during endoscopy.
Manometry. Manometry is a key test in diagnosing achalasia. A thin tube will be passed through your nose into your stomach. Pressure in your esophagus and at the sphincter will be recorded while you drink sips of water . The tube will be slowly withdrawn. The pattern of pressure measurements can indicate whether a person has achalasia.