General and Gastrointestinal Surgery

Treatment Options

Unfortunately, there are no medications available to treat achalasia that offer significant or sustained responses. The three ways achalasia is treated are by: 

Most patients require an endoscopy, an upper GI series and an esophageal motility test. These tests are needed to confirm the diagnosis, exclude other diseases that also may be present and to look for abnormalities that may alter the therapy chosen or favor one therapy over another.

No matter which therapy is chosen, the patients never eat exactly as they did before.  This is because the lower esophageal sphincter has sustained permanent damage.  Food may get stuck; however this will occur rarely. Patients will not be able to eat or drink lying down.  Nonetheless, they should be able to enjoy almost all meals without distress, regain lost weight, sleep normally and enjoy life again.

The best treatment method

Most authorities believe the best long-term results are obtained with surgery. This opinion is based on numerous studies comparing open esophageal myotomy to pneumatic dilatation. The recent introduction of the laparoscopic approach has placed even greater favor on the surgical procedure. Some doctors today believe a laparoscopic myotomy is the procedure of choice.

However, surgery is the most invasive of the three treatments. It seems only reasonable to try the botulinum toxin injections at least once. In some people the injections offer long-term relief and, in most, at least short-term relief. This period of time can be used to regain nutritional strength. Should injection fail patients will be in better overall condition for one of the other procedures.

Some authorities believe age is an important determinant of the therapy used, since pneumatic dilatation is not as successful in patients under 40 years of age compared to patients over 40. In fact, pneumatic dilatation is reported to be less than 70 percent effective in people under 40 years of age. Thus, surgery may be the best option for this group. 

It is important to consider that pneumatic dilatation is less invasive than surgery. Thus, at least one attempt at dilatation should be considered in most patients before surgery, unless patients have had previous surgery near the lower esophageal sphincter, have a large hiatal hernia, have a very tortuous esophagus, have significant inflammation of the distal esophagus or an outpouching of the distal esophagus known as an epiphrenic diverticulum. These patients are not good candidates for pneumatic distillation, as studies have shown a higher risk of perforation.