Treatment at Mayo Clinic

By Mayo Clinic Staff


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Achalasia treatment focuses on relaxing or forcing open the valve between the esophagus and stomach (lower esophageal sphincter) so that food and liquid can move more easily through your digestive tract.

Specific treatment depends on your age and the severity of the condition. The options include:

  • Balloon dilation. A balloon is inserted into the esophageal sphincter and inflated to enlarge the opening. This outpatient procedure may need to be repeated if the esophageal sphincter doesn't stay open. Between one-third and one-half of the people treated need a repeat balloon dilation within 10 years.
  • Surgery. Mayo Clinic surgeons use a minimally invasive procedure (laparoscopic Heller myotomy) to cut the muscle at the lower end of the esophageal sphincter. People who have a Heller myotomy may later develop gastroesophageal reflux disease (GERD).

    To prevent reflux problems, surgeons at Mayo Clinic sometimes do a second procedure (fundoplication) during the surgery when the esophageal sphincter muscle is cut. Surgery may be the preferred option for younger people, because balloon dilation tends to be less effective in this group. Surgery can be used to treat all age groups.

    A newer procedure, called peroral endoscopic myotomy (POEM), doesn't require incisions on the outside of your body or digestive tract. Instead, doctors use an endoscope inserted through your mouth and down your throat and create an incision in the inside lining of your esophagus. Then, as in the Heller myotomy, the surgeon cuts the muscle at the lower end of the esophageal sphincter.

    Gastroesophageal reflux is a common side effect of this procedure. Because this technique was recently developed, more studies need to be done, particularly on the long-term outcomes of this type of surgery.

  • Botox (botulinum toxin). This muscle relaxant can be injected directly into the esophageal sphincter with an endoscope. Studies indicate that the injections may need to be repeated, and repeat injections may make it more difficult to perform surgery later if needed. Specialists at Mayo Clinic usually use Botox only for older adults and those who aren't good candidates for surgery.
March 31, 2015