Achalasia

Treatment

Although achalasia has no cure, several treatments can provide good to excellent relief from symptoms for a number of years. The focus of treatment is relaxing or forcing open the lower esophagus valve (sphincter) between the esophagus and stomach.

• Oral medications to relax the esophageal sphincter are not commonly used because they often aren't effective and have adverse side effects, such as headache, low blood pressure and pedal edema (swollen feet).

Main treatment options are:

• Botulinum toxin. Botox is injected directly into the esophageal sphincter with the aid of an endoscope. The toxin weakens the sphincter muscle, which allows food to pass into the stomach. Botulinum toxin injections are effective for many people, but they must be repeated every few months. There is some evidence that the injections make performing surgery later more difficult. This treatment is usually reserved for elderly people or people who are poor risks for surgery.
• Balloon dilatation. A balloon is inserted into the esophageal sphincter via an endoscope and inflated to enlarge the opening. This procedure is successful 50 to 80 percent of the time and does not require hospitalization. When balloon dilatation is successful, its benefits are usually permanent. However, a small number of people may need repeat treatment if the esophageal sphincter contracts. There is a small risk (2 to 6 percent) of puncturing the esophagus during the procedure.

• Surgery. Surgery to cut the esophageal sphincter muscle (esophagomyotomy) is successful about 90 percent of the time. When esophagomyotomy is successful, the benefits are usually permanent. A small number of people may need repeat treatment if the esophageal sphincter contracts.

  At Mayo Clinic, this procedure is usually done with minimally invasive techniques (a Heller myotomy); instruments are inserted through several small incisions in the abdomen. This procedure usually requires one to two days in the hospital, compared to up to a week after conventional surgery through an incision into the chest or abdomen.

  In some cases, minimally invasive esophagomyotomies can be done via robotic surgery.

  When performed by experienced surgeons at Mayo Clinic, the Heller myotomy is as safe as conventional surgery. Each year, Mayo Clinic surgeons perform thousands of minimally invasive procedures in state-of-the-art facilities.

  Many patients who have a Heller myotomy develop GERD afterwards. So an additional procedure to wrap the upper stomach around the lower esophagus to prevent reflux of stomach content into the esophagus (Nissen fundoplication) is sometimes done at the same time that the esophageal sphincter muscle is cut.

• Aftercare. Treatment helps most people, but none of the treatments restores normal function. Periodic follow-up with your doctor and counseling are recommended to help you adjust to your condition.