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How is it treated?

Treatment for achalasia includes oral medications, dilation or stretching of the lower oesophageal sphincter, surgery to cut the sphincter (myotomy), and injection of muscle-relaxing medicines (botulinum toxin) into the sphincter.
All of these treatments reduce the pressure within the lower oesophageal sphincter and allow easier passage of food from the oesophagus into the stomach.

Oral medications. Drugs such as nitrates and calcium channel blockers can be used to relax the lower oesophageal sphincter. Only about 10% of patients benefit from drugs so it is usually reserved for elderly patients who are not suitable for dilation or surgery or as a temporary measure while other treatments are considered.

Dilation. The patient swallows a tube with a balloon on the end. The balloon is positioned at the lower oesophageal sphincter and then blown up suddenly, stretching the sphincter. The success rate is 70-80%. Dilation is fast, inexpensive compared with surgery, and requires only a short hospital stay. Up to half of patients require more than one dilation.

Dilations that are unsuccessful may be repeated but the rate of success decreases with each additional dilation.

The main complication of forceful dilation is rupture of the oesophagus, which occurs in 5% of cases. Some of these perforations may heal without surgery but others will need surgery. Surgery to treat achalasia (myotomy) can be done at the same time.
Surgery (Heller Myotomy, Oesophagomyotomy). The muscle fibres of the lower oesophageal sphincter are cut surgically. This can be done using a large abdominal incision or laparoscopically through small punctures in the abdomen (keyhole surgery).

Acid reflux is a side effect after this procedure for 10-15% of patients. In order to prevent this, the oesophagomyotomy may be modified so that it doesn’t completely cut the sphincter or it may be combined with anti-reflux surgery (fundoplication).

Because of excellent results, (successful in 80-95% of patients), a short hospital stay (24-48 hours), and fast recovery time, laparoscopic heller myotomy combined with partial fundoplication is considered the treatment of choice for achalasia.
Botulinum toxin
This is the newest treatment for achalasia. Botulinum toxin is injected into the lower sphincter. It is fast, safe, and requires no hospitalisation. However, the effects on the sphincter often last only for months, and additional injections with botulinum toxin may be necessary. Injection is a good option for elderly patients or those who are high risk for surgery.

Are there any complications?

Complications of achalasia include weight loss and aspiration pneumonia. Oesophagitis (inflammation of the oesophagus) and oesophageal ulcerations can also occur.