What are the key clinical features that suggest a diagnosis of achalasia in a patient presenting with dysphagia?

The key clinical features that suggest a diagnosis of achalasia in a patient presenting with dysphagia are primarily derived from the nature of the dysphagia itself and associated symptoms (Wilkinson and Halland, 2020). Achalasia is a primary esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter (LES) and absent esophageal peristalsis (Wilkinson and Halland, 2020). Patients typically experience progressive dysphagia to both solids and liquids (Wilkinson and Halland, 2020). This dysphagia is often long-standing, evolving over months to years (Wilkinson and Halland, 2020). Other common symptoms include regurgitation of undigested food, which can lead to nocturnal cough or aspiration (Wilkinson and Halland, 2020). Patients may also report chest pain and significant weight loss due to difficulty eating (Wilkinson and Halland, 2020). While heartburn or pyrosis can occur, it is often due to food stasis rather than acid reflux (Wilkinson and Halland, 2020).