The choice of treatment method will depend on:
Your general condition
Your doctor's expertise with various techniques
Pneumatic (balloon) dilation. This is widely thought to be the best non-surgical treatment. Your doctor passes an endoscope into your stomach while you are sedated.
He or she then inflates a balloon at the esophageal sphincter. The muscle fibers are stretched. This relieves the pressure that blocks food from passing easily into the stomach.
Most patients experience relief from their symptoms for several years following dilation. The procedure may have to be repeated. Other treatments also may be needed.
The chief risk of balloon dilation is a tear in the esophagus, which occurs in a small number of patients. This requires emergency surgery.
Surgery (Heller myotomy). The esophageal sphincter can be opened with surgery, called myotomy. Newer surgical techniques have led to improved outcomes with shorter hospital stays and lower risks.
Myotomy can be done laparoscopically. This means telescopic equipment is inserted through small incisions in the abdomen. Most people have good to excellent results.
Botulinum toxin. Tiny amounts of botulinum toxin are injected directly into the esophageal sphincter. This paralyzes and then relaxes the sphincter, allowing food to pass readily into the stomach.
Botulinum (Botox) is expensive, however. And its effects are relatively short-lived.
Other medications. Drugs can be taken to reduce pressure at the esophageal sphincter. They include nifedipine (Adalat, Procardia) and nitrates (isosorbide or nitroglycerin). To be most effective, a tablet is dissolved under the tongue before meals.
Improvements with these medications are quite variable. They are seldom used as primary therapy today.