When should I consider referring a patient with achalasia to a specialist for further management?

You should consider referring a patient to a gastroenterologist or upper gastrointestinal surgeon for specialist investigations and management if they present with gastro-oesophageal symptoms that are refractory to treatment, persistent, or unexplained ⁴. Specialist investigations, such as oesophageal manometry and barium swallow, are undertaken in these settings to help exclude oesophageal motility disorders like achalasia ⁴.