Mild to moderate weight loss occurs; when weight loss is pronounced, particularly in older patients whose symptoms of dysphagia developed rapidly, pseudoachalasia secondary to a tumor of the gastroesophageal junction should be considered. Diagnosis of Achalasia Esophageal manometry Sometimes barium swallow Sometimes upper endoscopy (See also the American College of Gastroenterology's 2020 practice guidelines on the diagnosis and management of achalasia.)