Misinterpretation of High-Resolution Manometry Leading to Inappropriate Treatment of Achalasia: A Diagnostic Challenge.

Achalasia is a motility disorder of the esophagogastric junction outflow, characterized by impaired lower esophageal sphincter (LES) relaxation and loss of normal peristalsis of the esophageal smooth muscle. The common clinical manifestations of achalasia include dysphagia of both solids and liquids, regurgitation of undigested food and saliva, and chest pain. It shares symptoms with gastroesophageal reflux disease (GERD), such as a retrosternal burning sensation and dysphagia, which can delay the diagnosis. Several modalities are useful in establishing the diagnosis of achalasia, including high-resolution manometry (HRM), barium esophagram (BE), and upper endoscopy. Despite potential issues with HRM, it remains the gold standard for diagnosing achalasia, underscoring the importance of proper technique and interpretation. Improper probe placement can lead to inaccurate diagnoses. Here, we present the case of a patient with achalasia who was misdiagnosed with GERD and underwent an inappropriate Toupet fundoplication, who eventually required peroral endoscopic myotomy (POEM) as a salvage treatment to relieve their symptoms.