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The advent of high-resolution esophageal manometry and endoscopic myotomy has led to renewed interest in achalasia. This rare disease is the best characterized esophageal motor disorder, although its pathophysiology is still poorly understood. These motor abnormalities are the consequence of esophageal smooth muscle dysfunction, related to impaired nervous control of esophageal motor function. Failure of the lower esophageal sphincter to relax and the absence of normal esophageal contraction are responsible for the development of dysphagia. The Eckardt score is a symptom score that is easy to use in clinical practice to assess the severity of symptoms of dysphagia, regurgitation, pain, and weight loss. Esophageal manometry is the gold standard for diagnosing achalasia, following an upper GI endoscopy. Currently, there is no treatment to correct the pathophysiological alterations responsible for achalasia. Treatment at the moment aims to reduce the functional obstruction at the lower esophageal sphincter and to improve esophageal clearance. Peroral endoscopic myotomy (“POEM”) has gained considerable momentum over the past decade. It has gradually become the first-line therapy. Due to the increased risk of chronic acid reflux, maintaining long-term endoscopic monitoring seems preferable.