How is achalasia treated?
How is achalasia treated?
Several treatments are available for achalasia including nonsurgical options (balloon dilation, medications, and botulinum toxin injection) and surgical options. The goal of treatment is to relieve your symptoms by relaxing your lower esophageal sphincter (LES).
Your healthcare provider will discuss these options so you both can decide the best treatment for you based on the severity of your condition and your preferences.
Minimally Invasive Surgery
The surgery used to treat achalasia is called laparoscopic esophagomyotomy or laparoscopic Heller myotomy. In this minimally invasive surgery, a thin, telescopic-like instrument called an endoscope is inserted through a small incision. The endoscope is connected to a tiny video camera – smaller than a dime –that projects a view of the operative site onto video monitors located in the operating room. In this operation, the muscle fibers of the LES are cut. The addition of another procedure called a partial fundoplication helps prevent gastroesophageal reflux, a side effect of the Heller myotomy procedure.
Peroral endoscopic myotomy (POEM) is a minimally invasive alternative to laparascopic Heller myotomy. In this procedure, muscles on the side of the esophagus, the LES and the upper part of the stomach are cut with a knife. The cuts in these areas loosen the muscles, allowing the esophagus to empty like it normally should, passing food down into your stomach.
Balloon dilation
In this non-surgical procedure, you’ll be put under light sedation while a specifically designed balloon is inserted through the LES and then inflated. The procedure relaxes the muscle sphincter, which allows food to enter your stomach. Balloon dilation is usually the first treatment option in people in whom surgery fails.
You may have to undergo several dilation treatments to relieve your symptoms, and every few years to maintain relief.
Medication
If you aren’t a candidate for balloon dilation or surgery or choose not to undergo these procedures, you may benefit from Botox® (botulinum toxin) injections. Botox is a protein made by the bacteria that cause botulism. When injected into muscles in very small quantities, Botox can relax spastic muscles. It works by blocking the signal from the nerves to the sphincter muscles that tell them to contract. Injections need to be repeated to maintain symptom control.
Other medication treatments include nifedipine (Procardia XL®, Adalat CC®) or isosorbide (Imdur®, Monoket®). These medications relax the spastic esophageal muscles by lowering LES pressure. These treatments are less effective than surgery or balloon dilation and provide only short-term relief of your symptoms.
Esophagectomy
Removal of your esophagus is a last resort treatment.