- Inability of LES to relax and loss of normal peristalsis 
- Chest pain
- Esophageal spasm can feel like tight, crushing retrosternal pain similar to ACS
- Ingested foreign body
- Esophageal carcinoma - dysphagia predominantly for solid foods during initial stages
- Reflux esophagitis - dysphagia results from inflammatory swelling or a fibrotic stricture
- Pseudoachalasia - underlying malignancy mimics achalasia
- Connective tissue disorders - e.g. systemic sclerosis
- Esophageal spasm - chest pain a predominant feature
- Upper GI
- Esophageal dilatation
- Birds beak sign
- Esophageal Manometry
- Trial of antispasmodic for esophageal spasm
- Surgical intervention
- Balloon dilatation
- Botulinum toxin injection 
- Consider gastrostomy for frail and older patients
- Patients need to eat upright at all times.
- Treatment may improve dysphagia, but there is no cure and swallowing never completely normalizes
- Krill JT, Naik RD, Vaezi MF. Clinical management of achalasia: current state of the art. Clin Exp Gastroenterol. 2016 Apr 4;9:71-82.
- Nassri A, Ramzan Z. Pharmacotherapy for the management of achalasia: Current status, challenges and future directions. World J Gastrointest Pharmacol Ther. 2015 Nov 6;6(4):145-55.