Health A-Z

Medical Content Created by the Faculty of the
Harvard Medical School

Achalasia

Treatment

The choice of treatment method will depend on your general condition, your doctor's expertise with various techniques, personal choice and prior treatments. Choices include:

• Pneumatic (balloon) dilation — This is widely thought to be the best non-surgical treatment. In balloon dilation your doctor passes an endoscope, a flexible telescope, into your stomach while you are sedated, and then inflates a balloon at the level of the esophageal sphincter. The muscle fibers will be stretched, relieving the pressure that blocks food from passing easily into the stomach. Between 51% and 93% of people experience relief from their symptoms for several years following dilation. The procedure may have to be repeated, or other treatments also may be needed. The chief risk of balloon dilation is a tear in the esophagus, which occurs in 2% to 3% of patients and requires emergency surgery.

• Surgery (Heller myotomy) — The esophageal sphincter can be opened with surgery, called myotomy. In the past, surgery was done only when balloon dilation was not successful. However, newer surgical techniques have led to improved outcomes with shorter hospital stays and lower risks, so the procedure is being used more often. The procedure can be done laparoscopically, which means telescopic equipment is inserted through small incisions in the abdomen. Most people have good to excellent results. Even with older forms of myotomy, benefits have been observed five years following surgery.

• Botulinum toxin — Tiny amounts of botulinum toxin are injected directly into the esophageal sphincter to paralyze and then relax the sphincter, allowing food to pass readily into the stomach. Botulinum (Botox) is expensive, however, and its effects are relatively short-lived. Only 32% of people receiving botulinum toxin do well 12 months later compared to 70% of those who have pneumatic dilation.

• Other medications — Drugs can be taken to reduce pressure at the esophageal sphincter. They include nifedipine (Adalat, Procardia) and nitrates (isosorbide or nitroglycerin, both sold under several brand names). To be most effective, a tablet is dissolved under the tongue before meals. Improvements with these medications are quite variable and they are seldom used as primary therapy today.