Achalasia can be tricky, and it is absolutely fair game for the Surgery Shelf. In this episode of Surgery Shelf Prep!, Chris and Mars break down the classic presentation of progressive dysphagia to both solids and liquids, regurgitation of undigested food, chest pain, and weight loss. They walk through the key pathophysiology of failed lower esophageal sphincter relaxation and loss of distal esophageal peristalsis, then connect it to the classic bird-beak finding on barium swallow and the gold-standard diagnosis with esophageal manometry.

The episode also covers the high-yield management pathway, including pneumatic dilation, Heller myotomy, POEM, and when to use botulinum toxin or medical therapy in poor surgical candidates. Chris and Mars also highlight the must-know differentials, including pseudoachalasia from malignancy, diffuse esophageal spasm, Zenker diverticulum, eosinophilic esophagitis, and scleroderma.

If you want a focused, shelf-ready review of one of the esophagus’s favorite board topics, this episode is a great one to lock in.