Which manometric finding is typical of achalasia?

• A. LES non-relaxation with aperistalsis
• B. LES hyperrelaxation
• C. Normal LES with strong peristalsis
• D. Exaggerated esophageal contractions with rapid emptying

Answer: (A)

Achalasia disrupts the coordinated movement of the esophagus by causing the lower esophageal sphincter to fail to open and by eliminating organized peristaltic waves in the esophageal body. On manometry this appears as the LES not relaxing adequately when swallowing, with an elevated resting tone, combined with little to no peristaltic activity in the esophagus—i.e., non-relaxation of the LES with aperistalsis. This exact pattern distinguishes achalasia from other motility disorders.

The other patterns don’t fit: LES hyperrelaxation would incorrectly suggest an overly relaxed sphincter with easier bolus transit; normal LES with strong peristalsis would indicate normal motility; exaggerated esophageal contractions with rapid emptying describe a hypercontractile or vigorous motility disorder, not achalasia.