Achalasia is a rare disorder of the esophagus in which the lower esophageal sphincter fails to relax and the muscular contractions that normally push food down the esophageal body are absent. The report's authors note that high-resolution manometry, the test that most reliably confirms the diagnosis by measuring pressures inside the esophagus, is rarely available at primary medical institutions, which contributes to missed and delayed diagnoses. The overlap in symptoms with reflux disease is a central obstacle.

In this case, the man's response to proton pump inhibitors was transient, yet repeated esophagogastroduodenoscopy continued to point toward reflux disease rather than a motility disorder. The diagnostic turning point came from a combination of the patient's long clinical history, chest computed tomography, endoscopy, and an upper gastrointestinal barium swallow, which revealed the pathognomonic bird-beak deformity. This characteristic tapering of the esophagus at the lower sphincter, resembling a bird's beak on X-ray imaging, is a classic sign of achalasia when manometry is unavailable.

With these findings combined, the clinical team established the diagnosis that had eluded them for more than two decades. The surgery was performed without intraoperative complications, and the patient's dysphagia resolved rapidly afterward. Over six months of postoperative follow-up, no symptom relapse was recorded.

The authors draw several clinical lessons from the case. Clinicians tend to confuse achalasia with gastroesophageal reflux disease, and short-term symptomatic improvement induced by proton pump inhibitors may mask the underlying disease and contribute to diagnostic delay. When high-resolution manometry cannot be performed, they conclude that a definitive diagnosis can still be reached through a typical medical history, barium radiography, and endoscopic evaluation.

On the treatment side, the report suggests that POEM delivered a satisfying safety profile and prominent short-term efficacy for a patient with long-standing achalasia. Because this is a single-patient case report, the findings describe one individual's experience rather than a measured effect across a population, and the six-month follow-up captures only short-term outcomes. The authors state that all claims in the article are solely their own and do not necessarily represent those of their affiliated organizations or the publisher.

A diagnosis delayed by decades is not merely an administrative error: in this patient it coincided with severe symptom burden, marked weight loss, and rapid clinical deterioration before corrective surgery finally restored his ability to eat.

Subject of Research: Long-term misdiagnosis of achalasia as gastroesophageal reflux disease and successful treatment with peroral endoscopic myotomy

Article Title: Twenty-six years of misdiagnosis as gastroesophageal reflux disease in a patient with achalasia presenting with chronic dysphagia: a case report

Article References: Dai, Y., Liu, Y., & Ye, J. (2026). Twenty-six years of misdiagnosis as gastroesophageal reflux disease in a patient with achalasia presenting with chronic dysphagia: a case report. Frontiers in Medicine, 13, Article 1994033. https://doi.org/10.3389/fmed.2026.1994033

Image Credits: AI Generated

DOI: 10.3389/fmed.2026.1994033

Keywords: achalasia, dysphagia, misdiagnosis, gastroesophageal reflux disease, peroral endoscopic myotomy, esophageal motility, barium swallow, Eckardt score, case report, endoscopy, proton pump inhibitors, Twenty-six