What treatments are available for achalasia?
There are several successful treatments available for achalasia. Unfortunately, there is no useful oral drug therapy available. If left untreated, the symptoms of achalasia will progress over time.
Two types of treatment are performed under sedation using endoscopic guidance. One, known as pneumatic dilation, involves placing a balloon in the swallowing passage at the level of the valve between the esophagus and stomach.
This balloon is forcefully expanded, tearing the muscles of the valve so that the valve no longer obstructs passage of food from the esophagus into the stomach. This has a 75% chance of relieving symptoms for a period of years, but has a 3% risk of rupturing the esophagus. If esophageal rupture occurs, then emergency surgery is necessary to repair the rupture and then treat the achalasia surgically.
The other type of treatment that is performed under endoscopic guidance is botulinum toxin, or Botox, injection. This toxin paralyzes the muscles of the valve between the esophagus and stomach, permitting food to pass from the esophagus into the stomach. Over 60% of people who have this therapy get substantial relief of symptoms for at least one year.
Surgery is recommended for many patients with achalasia. The operation is designed to cut the muscles of the valve between the esophagus and stomach, permitting food to pass from the esophagus into the stomach.
The operation has been performed since early in the 20th century with good results. For much of this time was done through an open incision in the abdomen or through an incision in the left side of the chest between the ribs.
These types of incisions often required hospitalization of up to a week for adequate recovery. Since the early 1990s the operation has been done using telescopic techniques that permit patients to go home much earlier, often the day after surgery. Almost 95% of patients who have surgery for achalasia experience relief of symptoms for many years after the operation.
It should be understood that, since physicians don’t know the underlying cause for achalasia, it’s not possible to restore the function of the esophagus completely to normal. Most patients will have some residual symptoms after successful therapy but should be able to carry on a nearly normal lifestyle.