PAEA Surgery End Of Rotation (EOR) Practice Exam

What is the diagnostic study of choice for achalasia?

1. Esophageal endoscopy

2. Manometry

3. Barium swallow

4. CT scan of the abdomen

The correct answer is: Manometry

The diagnostic study of choice for achalasia is manometry. This test directly measures the pressures and patterns of muscle contractions in the esophagus, specifically the lower esophageal sphincter (LES) and the body of the esophagus. In achalasia, manometry typically reveals a failure of the LES to relax appropriately with swallowing, along with abnormal peristaltic contractions in the esophageal body. This makes manometry a crucial tool for confirming the diagnosis of achalasia, distinguishing it from other esophageal disorders. While esophageal endoscopy can be useful in ruling out other conditions such as malignancy or strictures, it does not provide information about the function of the esophagus or the LES. A barium swallow can show dilation of the esophagus and delayed emptying, suggesting achalasia, but it is not as definitive as manometry. A CT scan of the abdomen is not routinely used in the diagnosis of achalasia and may not provide relevant information regarding the esophageal function. Thus, manometry remains the gold standard for diagnosing this condition, confirming the choice of this study as the most effective for its assessment.