The best achalasia treatment for you depends on your doctor's evaluation, your own personal preferences, and what approaches you may have already tried. This rare disorder, which affects the function of the esophagus, may sometimes be addressed with medications or injections. Other patients may require a minimally invasive procedure, called a balloon dilatation. Surgery may be attempted if other approaches are unsuccessful.
Achalasia occurs when the esophagus is unable to properly move food from a person's mouth toward the stomach. This is caused by a malfunction of the lower esophageal sphincter, which is a muscular ring located at the junction of the stomach and esophagus. Normally, this ring relaxes when a person swallows. In patients with this disorder, the ring does not relax.
There is no cure for this disorder, but achalasia treatment may help relieve symptoms, such as chest pain, heartburn, and difficulty swallowing. It is important to address other complications of achalasia as well, including regurgitation of food, unintentional weight loss, and possible malnutrition. Some patients may prefer to try oral medications first, although they are often not sufficient. Certain drugs may help relax the lower esophageal sphincter. These include calcium channel blockers and long-acting nitrates. Unfortunately, these can also cause side effects, such as low blood pressure, headaches, and swollen feet.
If you have tried oral medications and still need additional achalasia treatment, ask your doctor about botulinum injections. This is a toxin that is injected into the esophageal sphincter, forcing it to relax. Botulinum injections are not a permanent solution; they will need to be repeated after several months. Be aware that if you need surgery later, this treatment option could make an operation more likely to fail. Usually, a doctor will recommend these injections if you are already a poor candidate for surgery or if you are elderly.
Achalasia treatment may also include balloon dilatation. In this procedure, the doctor will insert a special type of balloon into the lower esophageal sphincter and inflate it. This enlarges the narrow ring. Occasionally, patients may need repeat treatments. In most cases, when this procedure is successful, you will notice permanent results.
A type of invasive surgery called an esophagomyotomy is another option for achalasia treatment. It is usually successful, often with permanent results. An esophagomyotomy involves cutting the esophageal sphincter muscle. This surgery may be performed through either a large incision in the chest or abdomen, or several smaller incisions in the abdomen. Before undergoing any procedure to treat achalasia, talk to your doctor about the potential risks and side effects.