Center for Minimally Invasive Esophageal Therapies

Diseases & Conditions

Achalasia – Treatments

How is Achalasia Treated?

Achalasia can be treated surgically and non-surgically. Neither technique is able to completely cure the condition, but both have the ability to improve symptoms.

Drug therapy—specifically with nitrates and calcium channel blockers—is sometimes able to relax the lower esophageal sphincter (LES) muscles enough to ease achalasia. Recent research has suggested that injections of botulinum toxin (Botox) can also relax the LES by temporarily paralyzing the hyperactive cells that cause contraction.

Pneumatic (balloon) dilatation is another non-surgical treatment method. After you are given a local anesthetic, the surgeon inserts a special high-pressure balloon into the esophagus to stretch it. Although there is a risk of tearing, the procedure is successful 50 percent to 80 percent of the time.

Myotomy, or surgery, is the most effective long-term achalasia treatment. The surgeon directly cuts the muscle fibers in the lower esophageal sphincter (LES), which allows food to pass more easily into the stomach, correcting the condition.

There are three ways to perform a myotomy:

• Open surgery, by means of thoracotomy or incision. When used to treat achalasia, this is called a Heller myotomy.
• Laparoscopically, through tiny incisions in the abdomen. A thin, lighted tube called a laparoscope, and other surgical tools, are inserted through the incisions to allow the surgeon to work on the esophagus.
• Robotic myotomy, when a surgeon guides robotic instruments in the abdomen using a computer console. The surgeon's natural hand movements are conveyed to the robotic instruments, which mimick the same movements that would be used if larger incisions, big enough for the surgeons hands, were used. Boston Medical Center was the first center in New England to perform thoracic procedures—such as Heller myotomy—using robotics.

Drug therapy—specifically with nitrates and calcium channel blockers—is sometimes able to relax the lower esophageal sphincter (LES) muscles enough to ease achalasia. Recent research has suggested that injections of botulinum toxin (Botox) can also relax the LES by temporarily paralyzing the hyperactive cells that cause contraction.

What is achalasia, its symptoms and causes?
How is achalasia diagnosed?

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