It is well established that there is an increased risk of esophageal malignancy associated with achalasia, with esophageal squamous cell carcinoma being the most common histologic subtype thought to be secondary to the detrimental effects of food and saliva stasis resulting from poor esophageal emptying. Esophageal adenocarcinoma has also been found in this population with majority of these cases occurring after achalasia treatment, presumably as a result of iatrogenic reflux. Nevertheless, the benefits of cancer screening in this population remains an area of controversy. We reviewed the literature examining the pathogenesis of malignancy among patients with achalasia and the current data examining the potential strategies for long-term surveillance in this patient population.

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The differential diagnosis of dysphagia is broad. A thorough history and physical examination are of paramount importance in determining the etiology of the patient’s dysphagia and guiding their subsequent management. This article discusses our approach to the evaluation of a patient presenting with dysphagia.