Achalasia is a major esophageal motor disorder featured by the altered relaxation of the esophagogastric junction in the absence of effective peristaltic activity. As a consequence of the esophageal outflow obstruction, achalasia patients present with clinical symptoms of dysphagia, chest pain, weight loss, and regurgitation of indigested food. Other less specific symptoms can also present including heartburn, chronic cough, and aspiration pneumonia. The delay in diagnosis, particularly when the presenting symptoms mimic those of gastroesophageal reflux disease, may be as long as several years. The widespread use of high-resolution manometry has permitted earlier detection and uncovered achalasia phenotypes which can have prognostic and therapeutic implications. Other tools have also emerged to help define achalasia severity and which can be used as objective measures of response to therapy including the timed barium esophagogram and the functional lumen imaging probe. Such diagnostic innovations, along with the increased awareness by clinicians and patients due to the availability of alternative therapeutic approaches (laparoscopic and robotic Heller myotomy, and peroral endoscopic myotomy) have radically changed the natural history of the disorder. Herein, we report the most recent advances in the diagnosis, classification, and management of esophageal achalasia and underline the still-grey areas that needs to be addressed by future research to reach the goal of personalizing treatment.

中文翻译：

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现代贲门失弛缓症：诊断、分类和治疗。

贲门失弛缓症是一种主要的食管运动障碍，其特征是在缺乏有效蠕动活动的情况下食管胃连接处的松弛改变。由于食管流出道阻塞，贲门失弛缓症患者会出现吞咽困难、胸痛、体重减轻和未消化食物反流等临床症状。其他不太具体的症状也可能出现，包括胃灼热、慢性咳嗽和吸入性肺炎。诊断的延迟，特别是当出现的症状与胃食管反流病相似时，可能会长达数年。高分辨率测压法的广泛使用使得早期检测和发现贲门失弛缓症表型成为可能，这可能具有预后和治疗意义。还出现了其他工具来帮助确定贲门失弛缓症的严重程度，并可用作治疗反应的客观指标，包括定时食管钡餐造影和功能性管腔成像探头。这种诊断创新，以及由于替代治疗方法（腹腔镜和机器人海勒肌切开术以及经口内窥镜肌切开术）的出现而引起的临床医生和患者意识的提高，从根本上改变了这种疾病的自然史。在此，我们报告了食管贲门失弛缓症的诊断、分类和治疗方面的最新进展，并强调了未来研究需要解决的灰色领域，以实现个性化治疗的目标。