Achalasia is one of the most studied esophageal motility disorders. However, the 
pathophysiology and reasons that patients develop achalasia are still unclear. 
Patients often present with dysphagia to solids and liquids, regurgitation, and 
varying degrees of weight loss. There is significant latency prior to diagnosis, 
which can have nutritional implications. The diagnosis is suspected based on 
clinical history and confirmed by esophageal high-resolution manometry testing. 
Esophagogastroduodenoscopy is necessary to rule out potential malignancy that 
can mimic achalasia. Recent data presented in abstract form suggest that 
patients with type II achalasia may be most likely, and patients with type III 
achalasia may be least likely, to report weight loss compared to patients with 
type I achalasia. Although achalasia cannot be permanently cured, palliation of 
symptoms is possible in over 90% of patients with the treatment modalities 
currently available (pneumatic dilation, Heller myotomy, or peroral endoscopic 
myotomy). This article reviews the clinical presentation, diagnosis, and 
management options in patients with achalasia, as well as potential insights 
into histopathologic differences and nutritional implications of the subtypes of 
achalasia.