Controversies exist regarding optimal initial management of achalasia. This survey will help identify practice patterns of achalasia management among surgeons and gastroenterologists.

Assume for purposes of this survey that the patient is a 40 yo male with a 12 month history of symptoms compatible with achalasia. There is no evidence that he has Chagas' disease. The diagnosis has been confirmed with endoscopy, contrast esophagram, and manometry. His esophagus has slight dilatation but no tortuosity. He does not have symptoms of vigorous achalasia. His symptoms are present daily as evidenced by regurgitation after every meal. He has lost 6 kg in the past months.