High resolution manometry (HRM) is currently the gold standard for the diagnosis of
achalasia and other functional esophageal disorders. All patients accusing
dysphagia should be endoscopically evaluated prior to manometric investigations in order to rule out pseudoachalasia. The Chicago HRM classification has led to a subclassification of three manometric types of
achalasia that seem to have different results to treatment. None of the actual
achalasia treatment options are curative. Type II
achalasia patients respond best to all treatment options compared to those with types I and III. Pneumatic dilation (PD) or Heller miotomy (LHM) can be both chosen as initial
therapy in type I and II as they have good outcome , while type III
achalasia patients respond better to LHM as a first therapeutic option. Peroral endoscopic
myotomy (POEM) is a promising new technique but long-term follow-up studies for its safety and efficacy must be performed. This article reviews the current therapeutic options in
achalasia and other functional esophageal disorders, based on the differences in safety and efficacy between approaches, highlighting the impact of HRM to predict the outcome but also the role of the techinque in guiding antireflux surgery.