Achalasia is an irreversible condition characterised by a failure of oesophageal peristalsis combined with oesophago-gastric outflow obstruction. While return of peristalsis has been reported in some patients after treatment, the condition is more likely to have a progressive course than to go into remission. In patients presenting with symptoms following prior treatment, several questions must be asked. Was the initial diagnosis correct? Was the treatment adequate or incomplete? Are the symptoms new or persistent since treatment? Are the symptoms part of the primary achalasia condition, are they a result of complications or are they due to the development of secondary disease characteristics? Clinicians have various tools available for evaluation and therapy. As well as endoscopy, re-do High Resolution manometry (HRM) is the gold standard however its performance seems less reliable when used in patients with a dilated oesophagus. Impedance planimetry can be used, however its application into clinical practice has been patchy, despite being available for over a decade. Barium swallow evaluation is frequently used but is probably second line due to its subjective nature and lesser ability to determine oesophago-gastric anatomy when compared with functional CT scanning. Therapy can include anything from Pneumatic Dilation, redo myotomy, or more complex therapies. Conclusion. It is possible to offer patient specific therapy based on the characteristics of the problem identified. Patients presenting with a symptom burden following successful therapy however are likely to have some persisting symptoms after retreatment.