Achalasia

Achalasia turns swallowing into a two-part failure: the esophageal body cannot propel the bolus forward, and the lower esophageal sphincter (LES) does not open when the bolus arrives. Contents therefore collect above the gastroesophageal junction rather than passing normally into the stomach. Dysphagia to both solids and liquids, bland regurgitation of retained food, nocturnal cough, and gradual weight loss make this pattern visible at the bedside. For an RPN, the priorities are linked: identify aspiration and nutritional risk, recognize when symptoms could represent a food bolus or pseudoachalasia, and support definitive treatment rather than treating the problem as routine reflux. High-resolution manometry confirms the motility disorder; endoscopy helps exclude a mechanical mimic. The sections that follow connect these findings to treatment choice, medication safety, monitoring, and escalation.