Treatment of achalasia – the current approach and personal experience

Abstract

Achalasia is a primary oesophageal motor disorder of unknown etiology. It is characterized by incomplete lower oeso-phageal sphincter (LES) relaxation and aperistalsis of the oesophageal body. The cause of the disease remains elusive and there is no intervention that improves the oesophageal body function. Because of that, treatment options remain strictly palliative. Current treatments aim to reduce distal oesophageal obstruction, facilitate oesophageal emptying and improve dilation of the oesophagus. The two most effective treatment options are graded pneumatic dilation and surgical myotomy.Thismulticenter, randomized, international trial has confirmed the similar efficacy of these treatments, at least in the short term. Owing to a lack of long-term benefit, endoscopic botulinum toxin injection and pharmacologic therapy are reserved for those who are unable to undergo more effective invasive therapies. Clinical predictors of the outcome, patient preferences and local expertise should be considered when making a decision on the most appropriate treatment option. The value of new endoscopic and radiologie techniques, such as peroral endoscopic myotomy and oesophageal stenting, has not been fully established.