Treatment & Prognosis

The overall goal of all treatment options is to reduce the tightness of the lower esophageal sphincter

Surgery

A Heller esophagomyotomy is used to lower the pressure of the lower esophagus sphincter.  During this procedure, which is done laparoscopically in most cases, the muscles at the lower end of the esophagus are divided while leaving the inner lining of the esophagus intact.  A partial fundoplication is usually performed to prevent reflux at the same time.  This is a safe, reliable, time-tested procedure that is considered the gold-standard by many physicians for the treatment of achalasia.  In the most severe cases of achalasia, when the esophagus is so dilated that it is no longer functional, an esophagectomy can be required.




Other treatment options include:

 
Medication
Long-acting nitrates or calcium channel blockers can be used in order to relax the lower esophagus sphincter. However, medical treatment alone has a low rate of relieving symptoms in most patients.
Injection of Botox
Botox (botulinum toxin) can be used to relax the muscles that relate to the lower sphincter in the esophagus. This is typically a temporary solution; however it may be appropriate in selected patients.
Dilation
Dilation or widening of the esophagus at the site of narrowing can be an effective method of treating achalasia. This procedure is known as esophagogastroduodenoscopy and involves placing a scope though your mouth to guide dilators that stretch the area of esophagus that does not fully relax.

Prognosis

The final results of surgical treatment and non-surgical treatments are similar but surgery usually has a longer lasting effect. Laparoscopic Heller Myotomy is the preferred approach to achalasia in the properly selected patient. Most patients achieve the ability to eat normally again. Unfortunately, in some patients, achalasia can be progressive and symptoms can return months or years later. This can result in the need for removal of the esophagus with reconstruction.