Materiały źródłowe

• #1 Achalasia

  https://www.rwjbh.org/rwj-university-hospital-new-brunswick/treatment-care/thoracic-center/achalasia-treatment/

  Treatment consists of medical therapy, pneumatic dilatation, Botox injection and surgery. […] Medical therapy consists of medications such as calcium channel blockers or beta blockers. These do not provide consistent, long-lived relief of symptoms. Therefore, medical therapy is reserved for patients who are unable or unwilling to undergo other treatment methods. […] Pneumatic dilatation is the most common initial treatment. About 70 percent of patients will have good or excellent relief after dilatation. However, the results may not be long-lived and dilatation may need to be repeated. The dilatation procedure carries a 1 to 2 percent morbidity rate from rupture of the esophagus. […] Botox injection into the lower esophageal sphincter muscle provides symptom relief in about 60 percent of patients. However, this relief lasts for a shorter period of time and needs to be repeated. Frequent Botox injections may make subsequent surgery more difficult.

• #2 Achalasia – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/achalasia/symptoms-causes/syc-20352850

  There’s no cure for achalasia. Once the esophagus is damaged, the muscles cannot work properly again. But symptoms can usually be managed with endoscopy, minimally invasive therapy or surgery. […] Overview of the treatment of achalasia. […] Achalasia: Surgery versus per-oral endoscopic myotomy.

• #3 ACG Clinical Guidelines: Diagnosis and Management of Achalasia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9896940/

  Achalasia is an esophageal motility disorder characterized by aberrant peristalsis and insufficient relaxation of the lower esophageal sphincter. […] In this American College of Gastroenterology guideline, we used the Grading of Recommendations Assessment, Development and Evaluation process to provide clinical guidance on how best to diagnose and treat patients with achalasia. […] We recommend that patients who are initially suspected of having GERD but do not respond to acid-suppressive therapy should be evaluated for achalasia. […] We recommend using esophageal pressure topography over conventional line tracing for the diagnosis of achalasia. […] We suggest that classifying achalasia subtypes by the Chicago Classification may help inform both prognosis and treatment choice. […] In patients with achalasia who are candidates for definite therapy: PD, LHM, and POEM are comparable effective therapies for type I or type II achalasia.

• #4 Management of treatment-naïve achalasia: choosing the right therapeutic option – Liu – Annals of Esophagus

  https://aoe.amegroups.org/article/view/5475/html

  The mainstay of treatment is by and large limited to surgical myotomy, balloon dilation and in palliative cases, botox injection. POEM is increasingly finding favor as an alternative to surgical myotomy but is early in evolution of long-term results. […] Given the range of treatment options available for achalasia, the choice of intervention should take into account patient, disease, procedural, and surgeon factors. […] Muscle relaxants are currently not recommended for the treatment of achalasia. […] SEMS have been recently proposed as a potential therapeutic strategy for achalasia. […] Botox injection may be recommended as first line therapy for achalasia in patients over 50 years of age, with low baseline sphincter pressures, who are co-morbid and unfit for other more invasive therapies.

• #5 Achalasia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/achalasia/diagnosis-treatment/drc-20352851

  Achalasia treatment focuses on relaxing or stretching open the lower esophageal sphincter so that food and liquid can move more easily through the digestive tract. […] Specific treatment depends on your age, health condition and the severity of the achalasia. […] Nonsurgical options include: Pneumatic dilation. During this outpatient procedure, a balloon is inserted into the center of the esophageal sphincter and inflated to enlarge the opening. Pneumatic dilation may need to be repeated if the esophageal sphincter doesn’t stay open. Nearly one-third of people treated with balloon dilation need repeat treatment within five years. This procedure requires sedation. […] OnabotulinumtoxinA (Botox). This muscle relaxant can be injected directly into the esophageal sphincter with a needle during an endoscopy. The injections may need to be repeated, and repeat injections may make it more difficult to perform surgery later if needed. Botox is generally recommended only for people who can’t have pneumatic dilation or surgery due to age or overall health. Botox injections typically do not last more than six months. A strong improvement from injection of Botox may help confirm a diagnosis of achalasia.

• #6 Achalasia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/achalasia/diagnosis-treatment/drc-20352851

  Achalasia treatment focuses on relaxing or stretching open the lower esophageal sphincter so that food and liquid can move more easily through the digestive tract. […] Specific treatment depends on your age, health condition and the severity of the achalasia. […] Nonsurgical options include: Pneumatic dilation. During this outpatient procedure, a balloon is inserted into the center of the esophageal sphincter and inflated to enlarge the opening. Pneumatic dilation may need to be repeated if the esophageal sphincter doesn’t stay open. Nearly one-third of people treated with balloon dilation need repeat treatment within five years. This procedure requires sedation. […] OnabotulinumtoxinA (Botox). This muscle relaxant can be injected directly into the esophageal sphincter with a needle during an endoscopy. The injections may need to be repeated, and repeat injections may make it more difficult to perform surgery later if needed. Botox is generally recommended only for people who can’t have pneumatic dilation or surgery due to age or overall health. Botox injections typically do not last more than six months. A strong improvement from injection of Botox may help confirm a diagnosis of achalasia.

• #7 Achalasia Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/169974-treatment

  Pneumatic dilation performed by a qualified gastroenterologist is a common treatment for achalasia. A balloon is inflated at the level of the gastroesophageal junction to blindly rupture the muscle fibers while leaving the mucosa intact. The success rate is 70-80%, and the perforation rate is approximately 5%. If a perforation occurs, emergency surgery is needed to close the perforation and to perform a myotomy. As many as 50% of patients may require more than one dilation. The incidence of pathologic gastroesophageal reflux after the procedure is approximately 30%. […] A laparoscopic Heller myotomy is considered by many to be the appropriate primary treatment of patients with achalasia […] Peroral endoscopic myotomy (POEM) has been introduced relatively recently as a novel approach to achalasia. This procedure is performed under general anesthesia with endotracheal intubation.

• #8 Achalasia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/achalasia/diagnosis-treatment/drc-20352851

  Achalasia treatment focuses on relaxing or stretching open the lower esophageal sphincter so that food and liquid can move more easily through the digestive tract. […] Specific treatment depends on your age, health condition and the severity of the achalasia. […] Nonsurgical options include: Pneumatic dilation. During this outpatient procedure, a balloon is inserted into the center of the esophageal sphincter and inflated to enlarge the opening. Pneumatic dilation may need to be repeated if the esophageal sphincter doesn’t stay open. Nearly one-third of people treated with balloon dilation need repeat treatment within five years. This procedure requires sedation. […] OnabotulinumtoxinA (Botox). This muscle relaxant can be injected directly into the esophageal sphincter with a needle during an endoscopy. The injections may need to be repeated, and repeat injections may make it more difficult to perform surgery later if needed. Botox is generally recommended only for people who can’t have pneumatic dilation or surgery due to age or overall health. Botox injections typically do not last more than six months. A strong improvement from injection of Botox may help confirm a diagnosis of achalasia.

• #9 ACG Clinical Guidelines: Diagnosis and Management of Achalasia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9896940/

  We recommend botulinum toxin injection as first-line therapy for patients with achalasia who are unfit for definitive therapies compared with other less effective pharmacological therapies. […] We recommend that myotomy with fundoplication is superior to myotomy without fundoplication in controlling distal esophageal acid exposure. […] We recommend against stent placement for management of long-term dysphagia in patients with achalasia. […] We recommend against obtaining routine gastrograffin esophagram after dilation. […] We recommend using TBE as the first-line test in evaluating continued or recurrent symptoms after definitive therapy for achalasia. […] We recommend that PD is an appropriate and safe treatment option for patients with achalasia post-initial surgical myotomy or POEM in need of retreatment. […] We recommend esophagectomy in surgically-fit patients with megaesophagus who have failed other interventions. […] We recommend against routine endoscopic surveillance for esophageal carcinoma in patients with achalasia.

• #10 Achalasia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/achalasia/diagnosis-treatment/drc-20352851

  Medicine. Your doctor might suggest muscle relaxants such as nitroglycerin (Nitrostat) or nifedipine (Procardia) before eating. These medicines have limited treatment effect and severe side effects. Medicines are generally considered only if you’re not a candidate for pneumatic dilation or surgery and Botox hasn’t helped. This type of therapy is rarely indicated. […] Surgical options for treating achalasia include: Heller myotomy. A Heller myotomy involves cutting the muscle at the lower end of the esophageal sphincter. This allows food to pass more easily into the stomach. The procedure can be done using a minimally invasive technique called a laparoscopic Heller myotomy. Some people who have a Heller myotomy may later develop gastroesophageal reflux disease (GERD). […] To avoid future problems with GERD, a surgeon might do a procedure known as fundoplication at the same time as a Heller myotomy. In fundoplication, the surgeon wraps the top of the stomach around the lower esophagus to create an anti-reflux valve, preventing acid from coming back into the esophagus. Fundoplication is usually done with a minimally invasive procedure, also called a laparoscopic procedure.

• #11 Medication for Achalasia | NYU Langone Health

  https://nyulangone.org/conditions/achalasia/treatments/medication-for-achalasia

  If achalasia is diagnosed early, your NYU Langone doctor may prescribe medication to help reduce pressure in the lower esophageal sphincter. Medication relaxes the valve between the esophagus and the stomach, enabling you to swallow more easily. […] Although medication can provide relief, some people may notice that it becomes less effective over time. Your doctor may prescribe several types of medication until you find one that works for you. […] Your doctor may recommend calcium channel blockers, which are often prescribed to lower blood pressure because they relax blood vessels. Nitrates, which are usually given for chest pain because they dilate, or open, heart arteries, may be another option. For people with achalasia, these medications relax the muscles of the lower esophageal sphincter, allowing food and liquid to pass more easily into the stomach. […] Calcium channel blockers and nitrates are taken by mouth 10 to 30 minutes before a meal. They are available in tablets that can be absorbed under the tongue.

• #12 Achalasia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/achalasia/diagnosis-treatment/drc-20352851

  Medicine. Your doctor might suggest muscle relaxants such as nitroglycerin (Nitrostat) or nifedipine (Procardia) before eating. These medicines have limited treatment effect and severe side effects. Medicines are generally considered only if you’re not a candidate for pneumatic dilation or surgery and Botox hasn’t helped. This type of therapy is rarely indicated. […] Surgical options for treating achalasia include: Heller myotomy. A Heller myotomy involves cutting the muscle at the lower end of the esophageal sphincter. This allows food to pass more easily into the stomach. The procedure can be done using a minimally invasive technique called a laparoscopic Heller myotomy. Some people who have a Heller myotomy may later develop gastroesophageal reflux disease (GERD). […] To avoid future problems with GERD, a surgeon might do a procedure known as fundoplication at the same time as a Heller myotomy. In fundoplication, the surgeon wraps the top of the stomach around the lower esophagus to create an anti-reflux valve, preventing acid from coming back into the esophagus. Fundoplication is usually done with a minimally invasive procedure, also called a laparoscopic procedure.

• #13 Achalasia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/achalasia/diagnosis-treatment/drc-20352851

  Medicine. Your doctor might suggest muscle relaxants such as nitroglycerin (Nitrostat) or nifedipine (Procardia) before eating. These medicines have limited treatment effect and severe side effects. Medicines are generally considered only if you’re not a candidate for pneumatic dilation or surgery and Botox hasn’t helped. This type of therapy is rarely indicated. […] Surgical options for treating achalasia include: Heller myotomy. A Heller myotomy involves cutting the muscle at the lower end of the esophageal sphincter. This allows food to pass more easily into the stomach. The procedure can be done using a minimally invasive technique called a laparoscopic Heller myotomy. Some people who have a Heller myotomy may later develop gastroesophageal reflux disease (GERD). […] To avoid future problems with GERD, a surgeon might do a procedure known as fundoplication at the same time as a Heller myotomy. In fundoplication, the surgeon wraps the top of the stomach around the lower esophagus to create an anti-reflux valve, preventing acid from coming back into the esophagus. Fundoplication is usually done with a minimally invasive procedure, also called a laparoscopic procedure.

• #14 Achalasia Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/169974-treatment

  Because of excellent results, a short hospital stay, and a fast recovery time, the primary treatment is considered by many to be a laparoscopic Heller myotomy and partial fundoplication. […] A partial fundoplication added to the myotomy entails better functional results when compared with a total fundoplication, with a lower risk of persistent or recurrent dysphagia. […] In the European Achalasia Trial, treatment with pneumatic dilation or laparoscopic Heller myotomy was successful in a higher percentage of patients with type II achalasia than in patients with the type I or III form of the disease. […] Minimally invasive surgery for achalasia is performed under general anesthesia with the use of five trocars. A controlled division of the muscle fibers (myotomy) of the lower esophagus (5 cm) and the proximal stomach (1.5 cm) is carried out, followed by a partial fundoplication to prevent reflux.

• #15 Achalasia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/achalasia/diagnosis-treatment/drc-20352851

  Medicine. Your doctor might suggest muscle relaxants such as nitroglycerin (Nitrostat) or nifedipine (Procardia) before eating. These medicines have limited treatment effect and severe side effects. Medicines are generally considered only if you’re not a candidate for pneumatic dilation or surgery and Botox hasn’t helped. This type of therapy is rarely indicated. […] Surgical options for treating achalasia include: Heller myotomy. A Heller myotomy involves cutting the muscle at the lower end of the esophageal sphincter. This allows food to pass more easily into the stomach. The procedure can be done using a minimally invasive technique called a laparoscopic Heller myotomy. Some people who have a Heller myotomy may later develop gastroesophageal reflux disease (GERD). […] To avoid future problems with GERD, a surgeon might do a procedure known as fundoplication at the same time as a Heller myotomy. In fundoplication, the surgeon wraps the top of the stomach around the lower esophagus to create an anti-reflux valve, preventing acid from coming back into the esophagus. Fundoplication is usually done with a minimally invasive procedure, also called a laparoscopic procedure.

• #16 Achalasia Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/169974-treatment

  Because of excellent results, a short hospital stay, and a fast recovery time, the primary treatment is considered by many to be a laparoscopic Heller myotomy and partial fundoplication. […] A partial fundoplication added to the myotomy entails better functional results when compared with a total fundoplication, with a lower risk of persistent or recurrent dysphagia. […] In the European Achalasia Trial, treatment with pneumatic dilation or laparoscopic Heller myotomy was successful in a higher percentage of patients with type II achalasia than in patients with the type I or III form of the disease. […] Minimally invasive surgery for achalasia is performed under general anesthesia with the use of five trocars. A controlled division of the muscle fibers (myotomy) of the lower esophagus (5 cm) and the proximal stomach (1.5 cm) is carried out, followed by a partial fundoplication to prevent reflux.

• #17 Achalasia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/achalasia/diagnosis-treatment/drc-20352851

  Peroral endoscopic myotomy (POEM). In the POEM procedure, the surgeon uses an endoscope inserted through the mouth and down the throat to create an incision in the inside lining of the esophagus. Then, as in a Heller myotomy, the surgeon cuts the muscle at the lower end of the esophageal sphincter. […] POEM may also be combined with or followed by later fundoplication to help prevent GERD. Some patients who have POEM and develop GERD after the procedure are treated with daily medicine taken by mouth.

• #18 Management of treatment-naïve achalasia: choosing the right therapeutic option – Liu – Annals of Esophagus

  https://aoe.amegroups.org/article/view/5475/html

  Pneumatic balloon dilatation may be recommended as first line therapy for achalasia in patients over 40 years of age with type 2 achalasia who decline laparoscopic Hellers myotomy or POEM and accept the risk of esophageal perforation associated with pneumatic balloon dilatation. […] POEM has been validated as a treatment option for achalasia. It achieves excellent outcomes in the short to medium term whilst being less invasive than laparoscopic Hellers myotomy. […] Laparoscopic Hellers myotomy with fundoplication is the current standard of care for patients with achalasia. This procedure should be recommended to patients who are young, fit for surgery, with high baseline LES pressures, and who are not prepared to accept the higher risk of GERD that is associated with pneumatic balloon dilatation and POEM.

• #19 ACG Clinical Guidelines: Diagnosis and Management of Achalasia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9896940/

  POEM would be a better treatment option in those with type III achalasia. […] Botulinum toxin injection is reserved for those who cannot undergo the above definitive therapies. […] We recommend that POEM and LHM result in comparable symptomatic improvement in patients with achalasia. […] We recommend tailored POEM or LHM for type III achalasia as a more efficacious alternative disruptive therapy at the LES compared to PD. […] We recommend that PD is superior to medical therapy in relieving symptoms and physiologic parameters of esophageal emptying. […] We recommend that PD or LHM are both effective and equivalent short- and long-term procedures for patients with achalasia who are candidates to undergo definitive therapy. […] We recommend LHM over botulinum toxin injection in patients with achalasia fit for surgery.

• #20 ACG Clinical Guidelines: Diagnosis and Management of Achalasia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9896940/

  Achalasia is an esophageal motility disorder characterized by aberrant peristalsis and insufficient relaxation of the lower esophageal sphincter. […] In this American College of Gastroenterology guideline, we used the Grading of Recommendations Assessment, Development and Evaluation process to provide clinical guidance on how best to diagnose and treat patients with achalasia. […] We recommend that patients who are initially suspected of having GERD but do not respond to acid-suppressive therapy should be evaluated for achalasia. […] We recommend using esophageal pressure topography over conventional line tracing for the diagnosis of achalasia. […] We suggest that classifying achalasia subtypes by the Chicago Classification may help inform both prognosis and treatment choice. […] In patients with achalasia who are candidates for definite therapy: PD, LHM, and POEM are comparable effective therapies for type I or type II achalasia.

• #21 ACG Clinical Guidelines: Diagnosis and Management of Achalasia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9896940/

  POEM would be a better treatment option in those with type III achalasia. […] Botulinum toxin injection is reserved for those who cannot undergo the above definitive therapies. […] We recommend that POEM and LHM result in comparable symptomatic improvement in patients with achalasia. […] We recommend tailored POEM or LHM for type III achalasia as a more efficacious alternative disruptive therapy at the LES compared to PD. […] We recommend that PD is superior to medical therapy in relieving symptoms and physiologic parameters of esophageal emptying. […] We recommend that PD or LHM are both effective and equivalent short- and long-term procedures for patients with achalasia who are candidates to undergo definitive therapy. […] We recommend LHM over botulinum toxin injection in patients with achalasia fit for surgery.

• #22 Overview of the treatment of achalasia – UpToDate

  https://www.uptodate.com/contents/overview-of-the-treatment-of-achalasia

  POEM has been proposed as the procedure of choice for type III achalasia because POEM can deliver a longer myotomy that is generally not possible with pneumatic dilation or the Heller procedure, and a longer myotomy might be more effective at controlling symptoms caused by the esophageal spasm of type III achalasia.

• #23 ACG Clinical Guidelines: Diagnosis and Management of Achalasia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9896940/

  POEM would be a better treatment option in those with type III achalasia. […] Botulinum toxin injection is reserved for those who cannot undergo the above definitive therapies. […] We recommend that POEM and LHM result in comparable symptomatic improvement in patients with achalasia. […] We recommend tailored POEM or LHM for type III achalasia as a more efficacious alternative disruptive therapy at the LES compared to PD. […] We recommend that PD is superior to medical therapy in relieving symptoms and physiologic parameters of esophageal emptying. […] We recommend that PD or LHM are both effective and equivalent short- and long-term procedures for patients with achalasia who are candidates to undergo definitive therapy. […] We recommend LHM over botulinum toxin injection in patients with achalasia fit for surgery.

• #24 ACG Clinical Guidelines: Diagnosis and Management of Achalasia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9896940/

  POEM would be a better treatment option in those with type III achalasia. […] Botulinum toxin injection is reserved for those who cannot undergo the above definitive therapies. […] We recommend that POEM and LHM result in comparable symptomatic improvement in patients with achalasia. […] We recommend tailored POEM or LHM for type III achalasia as a more efficacious alternative disruptive therapy at the LES compared to PD. […] We recommend that PD is superior to medical therapy in relieving symptoms and physiologic parameters of esophageal emptying. […] We recommend that PD or LHM are both effective and equivalent short- and long-term procedures for patients with achalasia who are candidates to undergo definitive therapy. […] We recommend LHM over botulinum toxin injection in patients with achalasia fit for surgery.

• #25 ACG Clinical Guidelines: Diagnosis and Management of Achalasia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9896940/

  POEM would be a better treatment option in those with type III achalasia. […] Botulinum toxin injection is reserved for those who cannot undergo the above definitive therapies. […] We recommend that POEM and LHM result in comparable symptomatic improvement in patients with achalasia. […] We recommend tailored POEM or LHM for type III achalasia as a more efficacious alternative disruptive therapy at the LES compared to PD. […] We recommend that PD is superior to medical therapy in relieving symptoms and physiologic parameters of esophageal emptying. […] We recommend that PD or LHM are both effective and equivalent short- and long-term procedures for patients with achalasia who are candidates to undergo definitive therapy. […] We recommend LHM over botulinum toxin injection in patients with achalasia fit for surgery.

• #26 Tailoring Therapy for Achalasia – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/may-2020/tailoring-therapy-for-achalasia/

  The primary focus of this article is to review treatments for achalasia, including botulinum toxin A (BTX), pneumatic dilation (PD), laparoscopic Heller myotomy, and peroral endoscopic myotomy (POEM), and to discuss how to tailor therapy for patients with achalasia. […] There are no curative options for achalasia. […] Current treatments reduce the obstruction at the EGJ by some degree of disruption to the LES while trying not to worsen symptoms with a new disease—GERD. […] I propose that patients with achalasia are currently best treated by a multidisciplinary team of specialists, particularly in multispecialty esophageal centers of excellence, where the team can select the best treatment based on age, type of achalasia, and comorbid diseases, rather than using the same treatment approach for all patients.

• #27 Achalasia Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/169974-treatment

  Pneumatic dilation performed by a qualified gastroenterologist is a common treatment for achalasia. A balloon is inflated at the level of the gastroesophageal junction to blindly rupture the muscle fibers while leaving the mucosa intact. The success rate is 70-80%, and the perforation rate is approximately 5%. If a perforation occurs, emergency surgery is needed to close the perforation and to perform a myotomy. As many as 50% of patients may require more than one dilation. The incidence of pathologic gastroesophageal reflux after the procedure is approximately 30%. […] A laparoscopic Heller myotomy is considered by many to be the appropriate primary treatment of patients with achalasia […] Peroral endoscopic myotomy (POEM) has been introduced relatively recently as a novel approach to achalasia. This procedure is performed under general anesthesia with endotracheal intubation.

• #28 Tailoring Therapy for Achalasia – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/may-2020/tailoring-therapy-for-achalasia/

  A more commonly used pharmacologic treatment for achalasia is BTX, a neurotoxin that blocks the release of acetylcholine from the nerve terminals. […] BTX injection is the most common endoscopic therapy for achalasia, especially in the community setting, due to its ease of administration, high initial response rate, and excellent safety profile. […] PD has good to excellent symptom relief in 74%, 86%, and 90% of patients treated with 30-, 35-, and 40-mm balloons, respectively. […] This approach of on-demand redilation is particularly popular in Europe and Australia among centers very experienced in PD that have an economic model that lacks monetary incentive to pursue surgical myotomy. […] Surgical myotomy of the muscle layers of the distal esophagus and LES, known as Heller myotomy, is the traditional treatment for achalasia.

• #29

  https://link.springer.com/article/10.1007/s00268-022-06495-z

  This method was used extensively in the 90s because: it is safer and easier than other endoscopic techniques, such as PD; and it does not involve a steep learning curve, so it can also be performed at non-specialist centers. […] The treatments efficacy in lowering LES pressure has been demonstrated in several studies. […] The main disadvantage of PD is, therefore, that symptoms recur over 46 years in more than one in two patients, although a better long-term remission rate can be achieved with a strategy of repeat dilations on demand. […] With the minimally invasive surgery revolution in the early 90s, a videoendoscopic approach was promptly applied to myotomy of the LES. […] Early success rates with LHM have been high, with a mean of 89% after a median of 35 months (range 838), but they may decrease over time.

• #30 Achalasia Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/169974-treatment

  Pneumatic dilation performed by a qualified gastroenterologist is a common treatment for achalasia. A balloon is inflated at the level of the gastroesophageal junction to blindly rupture the muscle fibers while leaving the mucosa intact. The success rate is 70-80%, and the perforation rate is approximately 5%. If a perforation occurs, emergency surgery is needed to close the perforation and to perform a myotomy. As many as 50% of patients may require more than one dilation. The incidence of pathologic gastroesophageal reflux after the procedure is approximately 30%. […] A laparoscopic Heller myotomy is considered by many to be the appropriate primary treatment of patients with achalasia […] Peroral endoscopic myotomy (POEM) has been introduced relatively recently as a novel approach to achalasia. This procedure is performed under general anesthesia with endotracheal intubation.

• #31 Achalasia Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/169974-treatment

  Pneumatic dilation performed by a qualified gastroenterologist is a common treatment for achalasia. A balloon is inflated at the level of the gastroesophageal junction to blindly rupture the muscle fibers while leaving the mucosa intact. The success rate is 70-80%, and the perforation rate is approximately 5%. If a perforation occurs, emergency surgery is needed to close the perforation and to perform a myotomy. As many as 50% of patients may require more than one dilation. The incidence of pathologic gastroesophageal reflux after the procedure is approximately 30%. […] A laparoscopic Heller myotomy is considered by many to be the appropriate primary treatment of patients with achalasia […] Peroral endoscopic myotomy (POEM) has been introduced relatively recently as a novel approach to achalasia. This procedure is performed under general anesthesia with endotracheal intubation.

• #32 Achalasia Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/169974-treatment

  Pneumatic dilation performed by a qualified gastroenterologist is a common treatment for achalasia. A balloon is inflated at the level of the gastroesophageal junction to blindly rupture the muscle fibers while leaving the mucosa intact. The success rate is 70-80%, and the perforation rate is approximately 5%. If a perforation occurs, emergency surgery is needed to close the perforation and to perform a myotomy. As many as 50% of patients may require more than one dilation. The incidence of pathologic gastroesophageal reflux after the procedure is approximately 30%. […] A laparoscopic Heller myotomy is considered by many to be the appropriate primary treatment of patients with achalasia […] Peroral endoscopic myotomy (POEM) has been introduced relatively recently as a novel approach to achalasia. This procedure is performed under general anesthesia with endotracheal intubation.

• #33 Achalasia Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/169974-treatment

  The operation relieves symptoms in 85-95% of patients, and the incidence of postoperative reflux is about 20%. […] For patients in whom surgery fails, they may be treated with an endoscopic dilation first. If this fails, a second operation (extending the previous myotomy onto the anterior gastric wall) can be attempted once the cause of failure has been identified with imaging studies. […] Esophagectomy was the standard treatment in patients with achalasia and a markedly dilated or sigmoid-shaped esophagus, with Heller myotomy considered to be ineffective in such cases. However, in a study by Sweet and colleagues of 113 patients with achalasia, the investigators reported that (1) in most of the study’s patients, even those with achalasia and a dilated esophagus, a laparoscopic Heller myotomy relieved dysphagia; (2) additional treatment was needed in about 20% of patients; and (3) in the end, 90% of patients had attained good swallowing ability. Esophagectomy was not required in any of the patients to maintain clinically adequate swallowing.

• #34 Achalasia | Columbia Surgery

  https://columbiasurgery.org/conditions-and-treatments/achalasia

  Because the results of pneumatic dilatation are unpredictable, laparoscopic myotomy is a far better treatment option. Laparoscopic myotomy is safe and results are more predictable. […] The most effective treatment for achalasia is Heller myotomy (esophagomyotomy), a procedure in which the muscle fibers of the lower esophageal sphincter (LES) are divided. After completing the myotomy, a partial fundoplication or „wrap” at the area of the LES is added in order to prevent acid reflux, which may cause esophagitis and lead to serious damage to the esophagus over time. […] Although Heller myotomy can done through the chest, today it is always performed laparoscopically through small incisions in the abdomen, which affords a faster recovery and return to normal activities. Long term studies have shown over 90% of patients still have improved swallowing, eating, and quality of life, ten years after a laparoscopic Heller myotomy.

• #35 Tailoring Therapy for Achalasia – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/may-2020/tailoring-therapy-for-achalasia/

  Laparoscopic Heller myotomy is a remarkably safe operation with a mortality rate of less than 0.1%. […] POEM is a relatively new endoscopic procedure in which the endoscopist creates a submucosal tunnel through a small mucosal incision. […] POEM has equal efficacy to laparoscopic Heller myotomy for types I and II achalasia, where a single point of obstruction occurs. […] However, it is type III achalasia where POEM is clearly superior, as there is the potential to extend the myotomy proximally as far as necessary to eliminate spastic obstructing contractions. […] The main disadvantage with POEM is the substantial increased risk of GERD. […] Despite the wide proliferation of HRM, many older and even recently trained gastroenterologists may have some difficulty understanding the intricacies and limitations of this new technology.

• #36 Achalasia Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/169974-treatment

  The operation relieves symptoms in 85-95% of patients, and the incidence of postoperative reflux is about 20%. […] For patients in whom surgery fails, they may be treated with an endoscopic dilation first. If this fails, a second operation (extending the previous myotomy onto the anterior gastric wall) can be attempted once the cause of failure has been identified with imaging studies. […] Esophagectomy was the standard treatment in patients with achalasia and a markedly dilated or sigmoid-shaped esophagus, with Heller myotomy considered to be ineffective in such cases. However, in a study by Sweet and colleagues of 113 patients with achalasia, the investigators reported that (1) in most of the study’s patients, even those with achalasia and a dilated esophagus, a laparoscopic Heller myotomy relieved dysphagia; (2) additional treatment was needed in about 20% of patients; and (3) in the end, 90% of patients had attained good swallowing ability. Esophagectomy was not required in any of the patients to maintain clinically adequate swallowing.

• #37 Achalasia Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/169974-treatment

  Pneumatic dilation performed by a qualified gastroenterologist is a common treatment for achalasia. A balloon is inflated at the level of the gastroesophageal junction to blindly rupture the muscle fibers while leaving the mucosa intact. The success rate is 70-80%, and the perforation rate is approximately 5%. If a perforation occurs, emergency surgery is needed to close the perforation and to perform a myotomy. As many as 50% of patients may require more than one dilation. The incidence of pathologic gastroesophageal reflux after the procedure is approximately 30%. […] A laparoscopic Heller myotomy is considered by many to be the appropriate primary treatment of patients with achalasia […] Peroral endoscopic myotomy (POEM) has been introduced relatively recently as a novel approach to achalasia. This procedure is performed under general anesthesia with endotracheal intubation.

• #38 Tailoring Therapy for Achalasia – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/may-2020/tailoring-therapy-for-achalasia/

  Laparoscopic Heller myotomy is a remarkably safe operation with a mortality rate of less than 0.1%. […] POEM is a relatively new endoscopic procedure in which the endoscopist creates a submucosal tunnel through a small mucosal incision. […] POEM has equal efficacy to laparoscopic Heller myotomy for types I and II achalasia, where a single point of obstruction occurs. […] However, it is type III achalasia where POEM is clearly superior, as there is the potential to extend the myotomy proximally as far as necessary to eliminate spastic obstructing contractions. […] The main disadvantage with POEM is the substantial increased risk of GERD. […] Despite the wide proliferation of HRM, many older and even recently trained gastroenterologists may have some difficulty understanding the intricacies and limitations of this new technology.

• #39 Achalasia – Esophageal Health | UCLA Health

  https://www.uclahealth.org/medical-services/gastro/esophageal-health/diseases-we-treat/achalasia

  POEM may also be appropriate for other motility disorders of the esophagus (such as diffuse spasm, jackhammer esophagus, or other conditions). […] POEM is exciting for patients with achalasia and other motility disorders of the esophagus because it has potential significant advantages over other options. […] It is estimated that adverse events happen in less than 1-2% of patients undergoing POEM. […] The major new symptom after any myotomy, including POEM, is potential reflux (GERD, gastroesophageal reflux disease). […] After the procedure you are taken to the recovery room where you are monitored for post anesthesia care. […] Current studies of POEM for achalasia have indicated a 90% favorable response with normalization or near normalization of swallowing symptoms.

• #40 Achalasia – Esophageal Health | UCLA Health

  https://www.uclahealth.org/medical-services/gastro/esophageal-health/diseases-we-treat/achalasia

  POEM may also be appropriate for other motility disorders of the esophagus (such as diffuse spasm, jackhammer esophagus, or other conditions). […] POEM is exciting for patients with achalasia and other motility disorders of the esophagus because it has potential significant advantages over other options. […] It is estimated that adverse events happen in less than 1-2% of patients undergoing POEM. […] The major new symptom after any myotomy, including POEM, is potential reflux (GERD, gastroesophageal reflux disease). […] After the procedure you are taken to the recovery room where you are monitored for post anesthesia care. […] Current studies of POEM for achalasia have indicated a 90% favorable response with normalization or near normalization of swallowing symptoms.

• #41

  https://link.springer.com/article/10.1007/s00268-022-06495-z

  As in the case of PD, patients with type II achalasia have better clinical outcomes after LHM than those with type I, and especially those with type III. […] POEM would appear to be ideal for treating longer-segment disorders of esophageal peristalsis like type III achalasia, or diffuse esophageal spasm. […] POEM seems to be a safe technique. […] GERD is the main drawback of POEM reported to date, since no anti-reflux procedure is associated with the myotomy. […] BoT injection therapy has been compared with both PD and surgical myotomy. […] Until recently, the choice between PD and LHM as the most appropriate treatment for a given patient was based mainly on the locally available endoscopic or surgical expertise. […] PD has also been retrospectively compared with POEM. […] Only a few years after its introduction in 2010, and its rapid and widespread diffusion, POEM was compared with LHM in several studies and meta-analyses.

• #42 Tailoring Therapy for Achalasia – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/may-2020/tailoring-therapy-for-achalasia/

  Laparoscopic Heller myotomy is a remarkably safe operation with a mortality rate of less than 0.1%. […] POEM is a relatively new endoscopic procedure in which the endoscopist creates a submucosal tunnel through a small mucosal incision. […] POEM has equal efficacy to laparoscopic Heller myotomy for types I and II achalasia, where a single point of obstruction occurs. […] However, it is type III achalasia where POEM is clearly superior, as there is the potential to extend the myotomy proximally as far as necessary to eliminate spastic obstructing contractions. […] The main disadvantage with POEM is the substantial increased risk of GERD. […] Despite the wide proliferation of HRM, many older and even recently trained gastroenterologists may have some difficulty understanding the intricacies and limitations of this new technology.

• #43 Achalasia Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/169974-treatment

  Endoscopic treatment includes an intrasphincteric injection of botulinum toxin to block the release of acetylcholine at the level of the LES, thereby restoring the balance between excitatory and inhibitory neurotransmitters. This treatment has limited value. Only 30% of patients treated endoscopically still have relief of dysphagia 1 year after treatment. Most patients need repeated botulinum toxin injections, with short-lasting clinical benefits. This treatment can cause an inflammatory reaction at the level of the gastroesophageal junction, making a subsequent myotomy very difficult. Compared with pneumatic dilation, botulinum toxin injection is associated with significantly higher symptom recurrence rates at 12 months. Similarly, this treatment modality is less effective than laparoscopic Heller myotomy at 2-year follow-up. Use this treatment in elderly patients who are poor candidates for dilation or surgery.

• #44 Patient education: Achalasia (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/achalasia-beyond-the-basics

  Achalasia treatment options include drug therapy, balloon dilation, surgery (myotomy), and botulinum toxin injection. […] Drug therapy involves using nitrates and calcium channel blockers to relax the lower esophageal sphincter (LES) muscle, but it is often inconvenient and less effective over time. […] Balloon dilation is performed during endoscopy, where a deflated balloon is inflated at the LES to relieve swallowing difficulties, with a success rate of about 60% after one year. […] Surgery (myotomy) is considered a more definitive treatment, relieving symptoms in 70 to 90% of people, with sustained relief in about 85% of patients ten years post-surgery. […] Botulinum toxin injection temporarily paralyzes the nerves of the LES, providing symptom relief in 65 to 90% of patients in the short term, but is not a definitive treatment.

• #45 Achalasia Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/169974-treatment

  Endoscopic treatment includes an intrasphincteric injection of botulinum toxin to block the release of acetylcholine at the level of the LES, thereby restoring the balance between excitatory and inhibitory neurotransmitters. This treatment has limited value. Only 30% of patients treated endoscopically still have relief of dysphagia 1 year after treatment. Most patients need repeated botulinum toxin injections, with short-lasting clinical benefits. This treatment can cause an inflammatory reaction at the level of the gastroesophageal junction, making a subsequent myotomy very difficult. Compared with pneumatic dilation, botulinum toxin injection is associated with significantly higher symptom recurrence rates at 12 months. Similarly, this treatment modality is less effective than laparoscopic Heller myotomy at 2-year follow-up. Use this treatment in elderly patients who are poor candidates for dilation or surgery.

• #46 Achalasia Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/169974-treatment

  Endoscopic treatment includes an intrasphincteric injection of botulinum toxin to block the release of acetylcholine at the level of the LES, thereby restoring the balance between excitatory and inhibitory neurotransmitters. This treatment has limited value. Only 30% of patients treated endoscopically still have relief of dysphagia 1 year after treatment. Most patients need repeated botulinum toxin injections, with short-lasting clinical benefits. This treatment can cause an inflammatory reaction at the level of the gastroesophageal junction, making a subsequent myotomy very difficult. Compared with pneumatic dilation, botulinum toxin injection is associated with significantly higher symptom recurrence rates at 12 months. Similarly, this treatment modality is less effective than laparoscopic Heller myotomy at 2-year follow-up. Use this treatment in elderly patients who are poor candidates for dilation or surgery.

• #47 Achalasia Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/169974-treatment

  The American College of Gastroenterology released new guidelines for the diagnosis and management of achalasia in September, 2020. Treatment recommendations are as follows: […] Initial therapy options include medical therapy, pneumatic dilation (PD), surgical myotomy, and peroral endoscopic myotomy (POEM) […] Botulinum toxin therapy is recommended for patients not suited to PD or surgery […] Pharmacologic therapy can be used for patients not undergoing PD or myotomy and who have failed botulinum toxin therapy (nitrates and calcium channel blockers most common) […] The goal of therapy for achalasia is to relieve symptoms by eliminating the outflow resistance caused by the hypertensive and nonrelaxing lower esophageal sphincter (LES) […] Calcium channel blockers and nitrates are used to decrease LES pressure. Approximately 10% of patients benefit from this treatment. This treatment is used primarily in elderly patients who have contraindications to either pneumatic dilation or surgery

• #48 Achalasia Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/169974-treatment

  The American College of Gastroenterology released new guidelines for the diagnosis and management of achalasia in September, 2020. Treatment recommendations are as follows: […] Initial therapy options include medical therapy, pneumatic dilation (PD), surgical myotomy, and peroral endoscopic myotomy (POEM) […] Botulinum toxin therapy is recommended for patients not suited to PD or surgery […] Pharmacologic therapy can be used for patients not undergoing PD or myotomy and who have failed botulinum toxin therapy (nitrates and calcium channel blockers most common) […] The goal of therapy for achalasia is to relieve symptoms by eliminating the outflow resistance caused by the hypertensive and nonrelaxing lower esophageal sphincter (LES) […] Calcium channel blockers and nitrates are used to decrease LES pressure. Approximately 10% of patients benefit from this treatment. This treatment is used primarily in elderly patients who have contraindications to either pneumatic dilation or surgery

• #49 Medication for Achalasia | NYU Langone Health

  https://nyulangone.org/conditions/achalasia/treatments/medication-for-achalasia

  If achalasia is diagnosed early, your NYU Langone doctor may prescribe medication to help reduce pressure in the lower esophageal sphincter. Medication relaxes the valve between the esophagus and the stomach, enabling you to swallow more easily. […] Although medication can provide relief, some people may notice that it becomes less effective over time. Your doctor may prescribe several types of medication until you find one that works for you. […] Your doctor may recommend calcium channel blockers, which are often prescribed to lower blood pressure because they relax blood vessels. Nitrates, which are usually given for chest pain because they dilate, or open, heart arteries, may be another option. For people with achalasia, these medications relax the muscles of the lower esophageal sphincter, allowing food and liquid to pass more easily into the stomach. […] Calcium channel blockers and nitrates are taken by mouth 10 to 30 minutes before a meal. They are available in tablets that can be absorbed under the tongue.

• #50 Achalasia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/achalasia/diagnosis-treatment/drc-20352851

  Medicine. Your doctor might suggest muscle relaxants such as nitroglycerin (Nitrostat) or nifedipine (Procardia) before eating. These medicines have limited treatment effect and severe side effects. Medicines are generally considered only if you’re not a candidate for pneumatic dilation or surgery and Botox hasn’t helped. This type of therapy is rarely indicated. […] Surgical options for treating achalasia include: Heller myotomy. A Heller myotomy involves cutting the muscle at the lower end of the esophageal sphincter. This allows food to pass more easily into the stomach. The procedure can be done using a minimally invasive technique called a laparoscopic Heller myotomy. Some people who have a Heller myotomy may later develop gastroesophageal reflux disease (GERD). […] To avoid future problems with GERD, a surgeon might do a procedure known as fundoplication at the same time as a Heller myotomy. In fundoplication, the surgeon wraps the top of the stomach around the lower esophagus to create an anti-reflux valve, preventing acid from coming back into the esophagus. Fundoplication is usually done with a minimally invasive procedure, also called a laparoscopic procedure.

• #51 Achalasia Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/169974-treatment

  The American College of Gastroenterology released new guidelines for the diagnosis and management of achalasia in September, 2020. Treatment recommendations are as follows: […] Initial therapy options include medical therapy, pneumatic dilation (PD), surgical myotomy, and peroral endoscopic myotomy (POEM) […] Botulinum toxin therapy is recommended for patients not suited to PD or surgery […] Pharmacologic therapy can be used for patients not undergoing PD or myotomy and who have failed botulinum toxin therapy (nitrates and calcium channel blockers most common) […] The goal of therapy for achalasia is to relieve symptoms by eliminating the outflow resistance caused by the hypertensive and nonrelaxing lower esophageal sphincter (LES) […] Calcium channel blockers and nitrates are used to decrease LES pressure. Approximately 10% of patients benefit from this treatment. This treatment is used primarily in elderly patients who have contraindications to either pneumatic dilation or surgery

• #52 Tailoring Therapy for Achalasia – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/may-2020/tailoring-therapy-for-achalasia/

  Therefore, in my opinion, achalasia patients are best managed with a multispeciality approach, such as in an esophageal center of excellence with a multidiscipline gastrointestinal and surgical team. […] The treatment of achalasia now has multiple options with excellent scientific efficacy, which allows for the opportunity to tailor therapy for patients with this condition.

• #53 ACG Clinical Guidelines: Diagnosis and Management of Achalasia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9896940/

  Achalasia is an esophageal motility disorder characterized by aberrant peristalsis and insufficient relaxation of the lower esophageal sphincter. […] In this American College of Gastroenterology guideline, we used the Grading of Recommendations Assessment, Development and Evaluation process to provide clinical guidance on how best to diagnose and treat patients with achalasia. […] We recommend that patients who are initially suspected of having GERD but do not respond to acid-suppressive therapy should be evaluated for achalasia. […] We recommend using esophageal pressure topography over conventional line tracing for the diagnosis of achalasia. […] We suggest that classifying achalasia subtypes by the Chicago Classification may help inform both prognosis and treatment choice. […] In patients with achalasia who are candidates for definite therapy: PD, LHM, and POEM are comparable effective therapies for type I or type II achalasia.

• #54 ACG Clinical Guidelines: Diagnosis and Management of Achalasia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9896940/

  Achalasia is an esophageal motility disorder characterized by aberrant peristalsis and insufficient relaxation of the lower esophageal sphincter. […] In this American College of Gastroenterology guideline, we used the Grading of Recommendations Assessment, Development and Evaluation process to provide clinical guidance on how best to diagnose and treat patients with achalasia. […] We recommend that patients who are initially suspected of having GERD but do not respond to acid-suppressive therapy should be evaluated for achalasia. […] We recommend using esophageal pressure topography over conventional line tracing for the diagnosis of achalasia. […] We suggest that classifying achalasia subtypes by the Chicago Classification may help inform both prognosis and treatment choice. […] In patients with achalasia who are candidates for definite therapy: PD, LHM, and POEM are comparable effective therapies for type I or type II achalasia.

• #55 Achalasia Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/169974-treatment

  Because of excellent results, a short hospital stay, and a fast recovery time, the primary treatment is considered by many to be a laparoscopic Heller myotomy and partial fundoplication. […] A partial fundoplication added to the myotomy entails better functional results when compared with a total fundoplication, with a lower risk of persistent or recurrent dysphagia. […] In the European Achalasia Trial, treatment with pneumatic dilation or laparoscopic Heller myotomy was successful in a higher percentage of patients with type II achalasia than in patients with the type I or III form of the disease. […] Minimally invasive surgery for achalasia is performed under general anesthesia with the use of five trocars. A controlled division of the muscle fibers (myotomy) of the lower esophagus (5 cm) and the proximal stomach (1.5 cm) is carried out, followed by a partial fundoplication to prevent reflux.

• #56 ACG Clinical Guidelines: Diagnosis and Management of Achalasia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9896940/

  POEM would be a better treatment option in those with type III achalasia. […] Botulinum toxin injection is reserved for those who cannot undergo the above definitive therapies. […] We recommend that POEM and LHM result in comparable symptomatic improvement in patients with achalasia. […] We recommend tailored POEM or LHM for type III achalasia as a more efficacious alternative disruptive therapy at the LES compared to PD. […] We recommend that PD is superior to medical therapy in relieving symptoms and physiologic parameters of esophageal emptying. […] We recommend that PD or LHM are both effective and equivalent short- and long-term procedures for patients with achalasia who are candidates to undergo definitive therapy. […] We recommend LHM over botulinum toxin injection in patients with achalasia fit for surgery.

• #57 Overview of the treatment of achalasia – UpToDate

  https://www.uptodate.com/contents/overview-of-the-treatment-of-achalasia

  POEM has been proposed as the procedure of choice for type III achalasia because POEM can deliver a longer myotomy that is generally not possible with pneumatic dilation or the Heller procedure, and a longer myotomy might be more effective at controlling symptoms caused by the esophageal spasm of type III achalasia.

• #58 Tailoring Therapy for Achalasia – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/may-2020/tailoring-therapy-for-achalasia/

  Achalasia is a rare esophageal motility disorder with impaired lower esophageal sphincter (LES) opening and aperistalsis. […] The presence of multiple treatment options with excellent scientific efficacy now offers the opportunity to tailor therapy for patients with achalasia. […] Drug therapy, especially botulinum toxin A, should be reserved for elderly patients with short life expectancy. […] Pneumatic dilation and surgical myotomy are equally effective for patients with types I and II achalasia. […] Surgical myotomy is effective across all groups, especially young men. […] Laparoscopic Heller myotomy with fundoplication is preferred in patients with megaesophagus, diverticulum, or hiatal hernia. […] Peroral endoscopic myotomy is the treatment of choice for patients with type III achalasia, but requires advanced endoscopic skills, and the risk of gastroesophageal reflux disease is high.

• #59 Achalasia – An Update

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2010.16.3.232

  Achalasia cannot be cured. Instead, our goal is to relieve symptoms, improve esophageal emptying and prevent the development of megaesophagus. The most successful therapies are pneumatic dilation and surgical myotomy. The overall success rate of graded pneumatic dilation is 78%, with women and older patients responding best. Laparoscopic myotomy, usually combined with a partial fundoplication, has an overall success rate of 87%. Young patients, especially men, are the best candidates for surgical myotomy. Botulinum toxin injection into the lower esophageal sphincter and smooth muscle relaxants are usually reserved for older patients or those with co-morbid illness. The prognosis for achalasia patients to return to near normal swallowing is good, but the disease is rarely cured with a single procedure and intermittent touch-up procedures may be required.

• #60

  https://link.springer.com/article/10.1007/s00268-022-06495-z

  From the above analysis of the pros and cons of the techniques available for treating achalasia, it seems they are all appropriate apart from BoT injections, which should be reserved for patients too ill to undergo more invasive options. […] Patients with achalasia can be offered PD, LHM (with fundoplication) or POEM, after illustrating the merits and drawbacks of the different options. […] The rate of GERD after POEM (always reportedly higher than after LHM with fundoplication) should deter doctors from offering POEM as a first-line therapy in younger people (and especially children) with a long life expectancy. […] POEM is still most indicated for the treatment of type III achalasia, or after LHM has failed in patients unresponsive to PD.

• #61 Achalasia – An Update

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2010.16.3.232

  Achalasia cannot be cured. Instead, our goal is to relieve symptoms, improve esophageal emptying and prevent the development of megaesophagus. The most successful therapies are pneumatic dilation and surgical myotomy. The overall success rate of graded pneumatic dilation is 78%, with women and older patients responding best. Laparoscopic myotomy, usually combined with a partial fundoplication, has an overall success rate of 87%. Young patients, especially men, are the best candidates for surgical myotomy. Botulinum toxin injection into the lower esophageal sphincter and smooth muscle relaxants are usually reserved for older patients or those with co-morbid illness. The prognosis for achalasia patients to return to near normal swallowing is good, but the disease is rarely cured with a single procedure and intermittent touch-up procedures may be required.

• #62 Achalasia – An Update

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2010.16.3.232

  Achalasia cannot be cured. Instead, our goal is to relieve symptoms, improve esophageal emptying and prevent the development of megaesophagus. The most successful therapies are pneumatic dilation and surgical myotomy. The overall success rate of graded pneumatic dilation is 78%, with women and older patients responding best. Laparoscopic myotomy, usually combined with a partial fundoplication, has an overall success rate of 87%. Young patients, especially men, are the best candidates for surgical myotomy. Botulinum toxin injection into the lower esophageal sphincter and smooth muscle relaxants are usually reserved for older patients or those with co-morbid illness. The prognosis for achalasia patients to return to near normal swallowing is good, but the disease is rarely cured with a single procedure and intermittent touch-up procedures may be required.

• #63 Achalasia Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/169974-treatment

  The American College of Gastroenterology released new guidelines for the diagnosis and management of achalasia in September, 2020. Treatment recommendations are as follows: […] Initial therapy options include medical therapy, pneumatic dilation (PD), surgical myotomy, and peroral endoscopic myotomy (POEM) […] Botulinum toxin therapy is recommended for patients not suited to PD or surgery […] Pharmacologic therapy can be used for patients not undergoing PD or myotomy and who have failed botulinum toxin therapy (nitrates and calcium channel blockers most common) […] The goal of therapy for achalasia is to relieve symptoms by eliminating the outflow resistance caused by the hypertensive and nonrelaxing lower esophageal sphincter (LES) […] Calcium channel blockers and nitrates are used to decrease LES pressure. Approximately 10% of patients benefit from this treatment. This treatment is used primarily in elderly patients who have contraindications to either pneumatic dilation or surgery

• #64 Managing recurrent symptoms after treatment of achalasia – Watson – Annals of Esophagus

  https://aoe.amegroups.org/article/view/5328/html

  Recurrent dysphagia and/or regurgitation occurs in some patients after all treatments for achalasia. Further treatment following botulinum toxin or pneumatic dilatation is generally not difficult, and surgical or transoral endoscopic myotomy are feasible and can generally be undertaken as the next step. […] Following a failed myotomy, the authors preference is for pneumatic dilatation, with revision myotomy considered if this is not successful. […] Symptom improvement can be achieved in 80-90% of individuals after revision treatments. However, a small group continue to experience troublesome symptoms, and if fit should be considered for esophagectomy. […] It is clear, however, that all treatments can be followed by failure, and a strategy to deal with these issues will be addressed. […] Treatment with botulinum toxin is always temporary, and recurrent symptoms generally develop 6-12 months after treatment.

• #65 Tailoring Therapy for Achalasia – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/may-2020/tailoring-therapy-for-achalasia/

  Achalasia is a rare esophageal motility disorder with impaired lower esophageal sphincter (LES) opening and aperistalsis. […] The presence of multiple treatment options with excellent scientific efficacy now offers the opportunity to tailor therapy for patients with achalasia. […] Drug therapy, especially botulinum toxin A, should be reserved for elderly patients with short life expectancy. […] Pneumatic dilation and surgical myotomy are equally effective for patients with types I and II achalasia. […] Surgical myotomy is effective across all groups, especially young men. […] Laparoscopic Heller myotomy with fundoplication is preferred in patients with megaesophagus, diverticulum, or hiatal hernia. […] Peroral endoscopic myotomy is the treatment of choice for patients with type III achalasia, but requires advanced endoscopic skills, and the risk of gastroesophageal reflux disease is high.

• #66 Achalasia Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/169974-treatment

  The operation relieves symptoms in 85-95% of patients, and the incidence of postoperative reflux is about 20%. […] For patients in whom surgery fails, they may be treated with an endoscopic dilation first. If this fails, a second operation (extending the previous myotomy onto the anterior gastric wall) can be attempted once the cause of failure has been identified with imaging studies. […] Esophagectomy was the standard treatment in patients with achalasia and a markedly dilated or sigmoid-shaped esophagus, with Heller myotomy considered to be ineffective in such cases. However, in a study by Sweet and colleagues of 113 patients with achalasia, the investigators reported that (1) in most of the study’s patients, even those with achalasia and a dilated esophagus, a laparoscopic Heller myotomy relieved dysphagia; (2) additional treatment was needed in about 20% of patients; and (3) in the end, 90% of patients had attained good swallowing ability. Esophagectomy was not required in any of the patients to maintain clinically adequate swallowing.

• #67 Managing recurrent symptoms after treatment of achalasia – Watson – Annals of Esophagus

  https://aoe.amegroups.org/article/view/5328/html

  If pneumatic dilatation is chosen, this generally proceeds in the same manner as a primary dilatation procedure. […] If revision surgery is to be undertaken, any revision via the same surgical cavity will be more difficult than a primary procedure. […] The authors preference would be to undertake a laparoscopic cardiomyotomy and anterior partial fundoplication, with the expectation that this approach will be no more difficult than in an untreated patient. […] It should be remembered that the approaches described above do not cure achalasia. […] In a small subset, dysphagia, regurgitation and sometimes aspiration are particularly troublesome. […] If these patients remain reasonably fit, and their esophagus is demonstrably failing, the best option is generally esophagectomy. […] In appropriately selected patients, removal of the majority of the esophagus, and restoration of continuity with a gastric conduit can be life changing.

• #68 Managing recurrent symptoms after treatment of achalasia – Watson – Annals of Esophagus

  https://aoe.amegroups.org/article/view/5328/html

  Following initial treatment with botulinum toxin or pneumatic dilatation, myotomy can generally be undertaken as the next step. […] Following a failed myotomy, the authors preference is to try pneumatic dilatation first. […] Good outcomes are expected for approximately 80-90% of individuals after revision treatments.

• #69 ACG Clinical Guidelines: Diagnosis and Management of Achalasia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9896940/

  We recommend botulinum toxin injection as first-line therapy for patients with achalasia who are unfit for definitive therapies compared with other less effective pharmacological therapies. […] We recommend that myotomy with fundoplication is superior to myotomy without fundoplication in controlling distal esophageal acid exposure. […] We recommend against stent placement for management of long-term dysphagia in patients with achalasia. […] We recommend against obtaining routine gastrograffin esophagram after dilation. […] We recommend using TBE as the first-line test in evaluating continued or recurrent symptoms after definitive therapy for achalasia. […] We recommend that PD is an appropriate and safe treatment option for patients with achalasia post-initial surgical myotomy or POEM in need of retreatment. […] We recommend esophagectomy in surgically-fit patients with megaesophagus who have failed other interventions. […] We recommend against routine endoscopic surveillance for esophageal carcinoma in patients with achalasia.

• #70 Managing recurrent symptoms after treatment of achalasia – Watson – Annals of Esophagus

  https://aoe.amegroups.org/article/view/5328/html

  If pneumatic dilatation is chosen, this generally proceeds in the same manner as a primary dilatation procedure. […] If revision surgery is to be undertaken, any revision via the same surgical cavity will be more difficult than a primary procedure. […] The authors preference would be to undertake a laparoscopic cardiomyotomy and anterior partial fundoplication, with the expectation that this approach will be no more difficult than in an untreated patient. […] It should be remembered that the approaches described above do not cure achalasia. […] In a small subset, dysphagia, regurgitation and sometimes aspiration are particularly troublesome. […] If these patients remain reasonably fit, and their esophagus is demonstrably failing, the best option is generally esophagectomy. […] In appropriately selected patients, removal of the majority of the esophagus, and restoration of continuity with a gastric conduit can be life changing.

• #71 Achalasia (Esophagus Disorder): Symptoms, Causes, Treatments

  https://my.clevelandclinic.org/health/diseases/17534-achalasia

  If you arent a candidate for balloon dilation or surgery or choose not to undergo these procedures, you may benefit from Botox (botulinum toxin) injections. […] Removal of your esophagus is a last resort treatment. […] Long-term follow-up is needed regardless of which treatment you receive. […] Balloon dilation improves symptoms in 50% to 93% of people with achalasia. […] Minimally invasive surgery/laparoscopic Heller myotomy is effective in 76% to 100% of people with achalasia. […] Botox injection successfully relaxes spastic esophageal sphincter muscles in up to 35% of people with achalasia. […] Medications, such as nifedipine, improve symptoms in 0% to 75% of people with achalasia; isosorbide improves symptoms in 53% to 87%. […] No treatment cures achalasia.

• #72 Achalasia – Esophageal Health | UCLA Health

  https://www.uclahealth.org/medical-services/gastro/esophageal-health/diseases-we-treat/achalasia

  POEM may also be appropriate for other motility disorders of the esophagus (such as diffuse spasm, jackhammer esophagus, or other conditions). […] POEM is exciting for patients with achalasia and other motility disorders of the esophagus because it has potential significant advantages over other options. […] It is estimated that adverse events happen in less than 1-2% of patients undergoing POEM. […] The major new symptom after any myotomy, including POEM, is potential reflux (GERD, gastroesophageal reflux disease). […] After the procedure you are taken to the recovery room where you are monitored for post anesthesia care. […] Current studies of POEM for achalasia have indicated a 90% favorable response with normalization or near normalization of swallowing symptoms.

• #73 Esophageal achalasia: Symptoms, diagnosis, and treatment

  https://www.medicalnewstoday.com/articles/219314

  The American Journal of Gastroenterology state that surgical myotomy has a success rate of 6094%. […] Peroral endoscopy myotomy (POEM): The surgeon passes an electrical scalpel through an endoscope. […] Botox: A person can receive injections of the botulinum toxin, or Botox. This can relax the muscles at the lower end of the esophagus. […] Following noninvasive surgery, a person can expect to spend 2448 hours in the hospital. […] After surgery or some procedures, a doctor might prescribe a medication known as a proton pump inhibitor (PPI). This can help reduce the amount of acid involved in digestion and the risk of acid reflux. […] Since there is no cure for esophageal achalasia, people should seek regular follow-up appointments to detect and treat any complications in the early stages.

• #74 Achalasia | Achalasia Treatment | Achalasia Treatment London

  https://drrehanhaidry.com/achalasia/

  Botox injections Performed via endoscopy, botulinum toxin (Botox) is injected into the sphincter to help loosen the muscle. This is used very infrequently now as it often does not work or needs to be repeated every 3-6 months […] Heller myotomy A surgeon cuts the muscle at the end of the oesophagus and top of the stomach. It is performed via an incision on the patients abdomen and has a high rate of success (90% of patients will have improved swallowing) […] A newer and far more effective treatment is to use the endoscope to create a tunnel in the layers of the oesophagus and to cut the muscles away that way this is a minimally invasive procedure called POEM. It does not need surgery and is very safe, but unfortunately is not available on the NHS yet. […] Per-oral endoscopic myotomy (POEM) is a new and permanent minimally invasive endoscopic solution for achalasia. The procedure does not need to be repeated and in 90% of cases complete symptom resolution is achieved. POEM is performed via endoscope which means no scars on the abdomen and a lower risk of complications than traditional myotomy surgery. The procedure takes less than 45 minutes and patients can expect to be discharged 24 hours after the procedure and describe it as a life changing experience.

• #75 Surgery for Achalasia | NYU Langone Health

  https://nyulangone.org/conditions/achalasia/treatments/surgery-for-achalasia

  NYU Langone gastroenterologists may recommend surgery to treat people with severe symptoms of achalasia, a neuromuscular condition that makes swallowing difficult. […] NYU Langone surgeons use a minimally invasive procedure, called a laparoscopic Heller myotomy, to widen the lower esophageal sphincter the muscular valve in the esophagus that allows food to pass into the stomach. […] After a Heller myotomy, most people are able to return home within one to two days. […] Most people experience relief almost immediately after surgery, and studies show that the majority continue to have symptom relief a decade later. […] Peroral endoscopic myotomy, also called POEM, is the newest and least invasive surgical approach for severe achalasia. […] Esophagectomy involves removing the lower portion of the esophagus and reconstructing it with a portion of the stomach or colon. This is a major operation that rarely needs to be performed. It is only recommended for people with end-stage achalasia or an almost complete inability to eat whose symptoms do not respond to other treatments. […] After leaving the hospital, many people may need to eat soft foods and remain upright one to three hours after eating for several weeks. Full recovery can take up to six months.

• #76 Esophageal achalasia: Symptoms, diagnosis, and treatment

  https://www.medicalnewstoday.com/articles/219314

  The American Journal of Gastroenterology state that surgical myotomy has a success rate of 6094%. […] Peroral endoscopy myotomy (POEM): The surgeon passes an electrical scalpel through an endoscope. […] Botox: A person can receive injections of the botulinum toxin, or Botox. This can relax the muscles at the lower end of the esophagus. […] Following noninvasive surgery, a person can expect to spend 2448 hours in the hospital. […] After surgery or some procedures, a doctor might prescribe a medication known as a proton pump inhibitor (PPI). This can help reduce the amount of acid involved in digestion and the risk of acid reflux. […] Since there is no cure for esophageal achalasia, people should seek regular follow-up appointments to detect and treat any complications in the early stages.

• #77 Achalasia Treatment | 700 Children’s Blog

  https://www.nationwidechildrens.org/family-resources-education/700childrens/2023/09/achalasia-treatment-poem

  Achalasia continues to worsen with time. Severe cases may require a full liquid diet, either to drink or give through a feeding tube. Unfortunately, medications do not help. Procedures and surgeries aim to make the tight sphincter at the bottom of the esophagus more open, to let food pass into the stomach. This may be done with multiple dilations using very large balloons, or with invasive surgeries. […] Today, a less invasive endoscopic procedure is used, called Per Oral Endoscopic Myotomy (or POEM for short). POEM creates a small incision in the lining of the esophagus, allowing the endoscope camera to safely travel underneath the lining of the esophagus, down to the bottom of the esophagus to then cut the tight sphincter. A few tiny clips are used to close the small incision. […] POEM is safer and less invasive than surgery, and has better results than dilation, allowing patients to quickly return to eating more normal again. Most patients will spend just one night in the hospital afterward and are eating regular food again in one week! The treatments for achalasia today make this condition much easier to swallow!

• #78 Surgery for Achalasia | NYU Langone Health

  https://nyulangone.org/conditions/achalasia/treatments/surgery-for-achalasia

  NYU Langone gastroenterologists may recommend surgery to treat people with severe symptoms of achalasia, a neuromuscular condition that makes swallowing difficult. […] NYU Langone surgeons use a minimally invasive procedure, called a laparoscopic Heller myotomy, to widen the lower esophageal sphincter the muscular valve in the esophagus that allows food to pass into the stomach. […] After a Heller myotomy, most people are able to return home within one to two days. […] Most people experience relief almost immediately after surgery, and studies show that the majority continue to have symptom relief a decade later. […] Peroral endoscopic myotomy, also called POEM, is the newest and least invasive surgical approach for severe achalasia. […] Esophagectomy involves removing the lower portion of the esophagus and reconstructing it with a portion of the stomach or colon. This is a major operation that rarely needs to be performed. It is only recommended for people with end-stage achalasia or an almost complete inability to eat whose symptoms do not respond to other treatments. […] After leaving the hospital, many people may need to eat soft foods and remain upright one to three hours after eating for several weeks. Full recovery can take up to six months.

• #79 Surgery for Achalasia | NYU Langone Health

  https://nyulangone.org/conditions/achalasia/treatments/surgery-for-achalasia

  NYU Langone gastroenterologists may recommend surgery to treat people with severe symptoms of achalasia, a neuromuscular condition that makes swallowing difficult. […] NYU Langone surgeons use a minimally invasive procedure, called a laparoscopic Heller myotomy, to widen the lower esophageal sphincter the muscular valve in the esophagus that allows food to pass into the stomach. […] After a Heller myotomy, most people are able to return home within one to two days. […] Most people experience relief almost immediately after surgery, and studies show that the majority continue to have symptom relief a decade later. […] Peroral endoscopic myotomy, also called POEM, is the newest and least invasive surgical approach for severe achalasia. […] Esophagectomy involves removing the lower portion of the esophagus and reconstructing it with a portion of the stomach or colon. This is a major operation that rarely needs to be performed. It is only recommended for people with end-stage achalasia or an almost complete inability to eat whose symptoms do not respond to other treatments. […] After leaving the hospital, many people may need to eat soft foods and remain upright one to three hours after eating for several weeks. Full recovery can take up to six months.

• #80 Surgery for Achalasia | NYU Langone Health

  https://nyulangone.org/conditions/achalasia/treatments/surgery-for-achalasia

  NYU Langone gastroenterologists may recommend surgery to treat people with severe symptoms of achalasia, a neuromuscular condition that makes swallowing difficult. […] NYU Langone surgeons use a minimally invasive procedure, called a laparoscopic Heller myotomy, to widen the lower esophageal sphincter the muscular valve in the esophagus that allows food to pass into the stomach. […] After a Heller myotomy, most people are able to return home within one to two days. […] Most people experience relief almost immediately after surgery, and studies show that the majority continue to have symptom relief a decade later. […] Peroral endoscopic myotomy, also called POEM, is the newest and least invasive surgical approach for severe achalasia. […] Esophagectomy involves removing the lower portion of the esophagus and reconstructing it with a portion of the stomach or colon. This is a major operation that rarely needs to be performed. It is only recommended for people with end-stage achalasia or an almost complete inability to eat whose symptoms do not respond to other treatments. […] After leaving the hospital, many people may need to eat soft foods and remain upright one to three hours after eating for several weeks. Full recovery can take up to six months.

• #81 Achalasia – Esophageal Health | UCLA Health

  https://www.uclahealth.org/medical-services/gastro/esophageal-health/diseases-we-treat/achalasia

  POEM may also be appropriate for other motility disorders of the esophagus (such as diffuse spasm, jackhammer esophagus, or other conditions). […] POEM is exciting for patients with achalasia and other motility disorders of the esophagus because it has potential significant advantages over other options. […] It is estimated that adverse events happen in less than 1-2% of patients undergoing POEM. […] The major new symptom after any myotomy, including POEM, is potential reflux (GERD, gastroesophageal reflux disease). […] After the procedure you are taken to the recovery room where you are monitored for post anesthesia care. […] Current studies of POEM for achalasia have indicated a 90% favorable response with normalization or near normalization of swallowing symptoms.

• #82 Achalasia – Esophageal Health | UCLA Health

  https://www.uclahealth.org/medical-services/gastro/esophageal-health/diseases-we-treat/achalasia

  POEM may also be appropriate for other motility disorders of the esophagus (such as diffuse spasm, jackhammer esophagus, or other conditions). […] POEM is exciting for patients with achalasia and other motility disorders of the esophagus because it has potential significant advantages over other options. […] It is estimated that adverse events happen in less than 1-2% of patients undergoing POEM. […] The major new symptom after any myotomy, including POEM, is potential reflux (GERD, gastroesophageal reflux disease). […] After the procedure you are taken to the recovery room where you are monitored for post anesthesia care. […] Current studies of POEM for achalasia have indicated a 90% favorable response with normalization or near normalization of swallowing symptoms.

• #83 Esophageal achalasia: Symptoms, diagnosis, and treatment

  https://www.medicalnewstoday.com/articles/219314

  The American Journal of Gastroenterology state that surgical myotomy has a success rate of 6094%. […] Peroral endoscopy myotomy (POEM): The surgeon passes an electrical scalpel through an endoscope. […] Botox: A person can receive injections of the botulinum toxin, or Botox. This can relax the muscles at the lower end of the esophagus. […] Following noninvasive surgery, a person can expect to spend 2448 hours in the hospital. […] After surgery or some procedures, a doctor might prescribe a medication known as a proton pump inhibitor (PPI). This can help reduce the amount of acid involved in digestion and the risk of acid reflux. […] Since there is no cure for esophageal achalasia, people should seek regular follow-up appointments to detect and treat any complications in the early stages.

• #84 How can Achalasia be Treated? | Treatment Options

  https://www.achalasia-action.org/treatment-options/

  Achalasia is a long-term condition that cannot be cured at present, but there are treatments that can improve the symptoms. Treatments can range from lifestyle changes to surgery. […] Dilatation often results in at least some relief from symptoms and can bring significant improvement, but sometimes the benefits can be only short-term. […] A laparoscopic Heller myotomy (LHM) consists of cutting the muscles in the lining of the oesophagus and stomach that control the lower oesophageal sphincter (LOS). […] This surgery has been well established and often provides sustained benefits for the longer term. […] To prevent this from happening after the myotomy, a fundoplication is carried out. […] If reflux occurs after the surgery this can be controlled by PPI (proton pump inhibitor) medication like Omeprazole that is designed to reduce stomach acid.

• #85 Achalasia (Esophagus Disorder): Symptoms, Causes, Treatments

  https://my.clevelandclinic.org/health/diseases/17534-achalasia

  If you arent a candidate for balloon dilation or surgery or choose not to undergo these procedures, you may benefit from Botox (botulinum toxin) injections. […] Removal of your esophagus is a last resort treatment. […] Long-term follow-up is needed regardless of which treatment you receive. […] Balloon dilation improves symptoms in 50% to 93% of people with achalasia. […] Minimally invasive surgery/laparoscopic Heller myotomy is effective in 76% to 100% of people with achalasia. […] Botox injection successfully relaxes spastic esophageal sphincter muscles in up to 35% of people with achalasia. […] Medications, such as nifedipine, improve symptoms in 0% to 75% of people with achalasia; isosorbide improves symptoms in 53% to 87%. […] No treatment cures achalasia.

• #86 Achalasia (Esophagus Disorder): Symptoms, Causes, Treatments

  https://my.clevelandclinic.org/health/diseases/17534-achalasia

  If you arent a candidate for balloon dilation or surgery or choose not to undergo these procedures, you may benefit from Botox (botulinum toxin) injections. […] Removal of your esophagus is a last resort treatment. […] Long-term follow-up is needed regardless of which treatment you receive. […] Balloon dilation improves symptoms in 50% to 93% of people with achalasia. […] Minimally invasive surgery/laparoscopic Heller myotomy is effective in 76% to 100% of people with achalasia. […] Botox injection successfully relaxes spastic esophageal sphincter muscles in up to 35% of people with achalasia. […] Medications, such as nifedipine, improve symptoms in 0% to 75% of people with achalasia; isosorbide improves symptoms in 53% to 87%. […] No treatment cures achalasia.

• #87 Esophageal achalasia: Symptoms, diagnosis, and treatment

  https://www.medicalnewstoday.com/articles/219314

  The American Journal of Gastroenterology state that surgical myotomy has a success rate of 6094%. […] Peroral endoscopy myotomy (POEM): The surgeon passes an electrical scalpel through an endoscope. […] Botox: A person can receive injections of the botulinum toxin, or Botox. This can relax the muscles at the lower end of the esophagus. […] Following noninvasive surgery, a person can expect to spend 2448 hours in the hospital. […] After surgery or some procedures, a doctor might prescribe a medication known as a proton pump inhibitor (PPI). This can help reduce the amount of acid involved in digestion and the risk of acid reflux. […] Since there is no cure for esophageal achalasia, people should seek regular follow-up appointments to detect and treat any complications in the early stages.

• #88 ACG Clinical Guidelines: Diagnosis and Management of Achalasia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9896940/

  We recommend botulinum toxin injection as first-line therapy for patients with achalasia who are unfit for definitive therapies compared with other less effective pharmacological therapies. […] We recommend that myotomy with fundoplication is superior to myotomy without fundoplication in controlling distal esophageal acid exposure. […] We recommend against stent placement for management of long-term dysphagia in patients with achalasia. […] We recommend against obtaining routine gastrograffin esophagram after dilation. […] We recommend using TBE as the first-line test in evaluating continued or recurrent symptoms after definitive therapy for achalasia. […] We recommend that PD is an appropriate and safe treatment option for patients with achalasia post-initial surgical myotomy or POEM in need of retreatment. […] We recommend esophagectomy in surgically-fit patients with megaesophagus who have failed other interventions. […] We recommend against routine endoscopic surveillance for esophageal carcinoma in patients with achalasia.

• #89 Treatment and surveillance strategies in achalasia: an update | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/nrgastro.2011.68

  Controversy exists with regard to the optimal treatment for achalasia and whether surveillance for early recognition of late complications is indicated. Currently, surgical myotomy and pneumatic dilation are the most effective treatments for patients with idiopathic achalasia, and a multicenter, randomized, international trial has confirmed similar efficacy of these treatments, at least in the short term. […] Clinical predictors of outcome, patient preferences and local expertise should be considered when making a decision on the most appropriate treatment option. Owing to a lack of long-term benefit, endoscopic botulinum toxin injection and medical therapies are reserved for patients of advanced age and those with clinically significant comorbidities. […] The value of new endoscopic, radiologic or surgical treatments, such as peroral endoscopic myotomy, esophageal stenting and robotic-assisted myotomy has not been fully established. […] Finally, long-term follow-up data in patients with achalasia support the notion that surveillance strategies might be beneficial after a disease duration of more than 10-15 years.

• #90 ACG Clinical Guidelines: Diagnosis and Management of Achalasia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9896940/

  We recommend botulinum toxin injection as first-line therapy for patients with achalasia who are unfit for definitive therapies compared with other less effective pharmacological therapies. […] We recommend that myotomy with fundoplication is superior to myotomy without fundoplication in controlling distal esophageal acid exposure. […] We recommend against stent placement for management of long-term dysphagia in patients with achalasia. […] We recommend against obtaining routine gastrograffin esophagram after dilation. […] We recommend using TBE as the first-line test in evaluating continued or recurrent symptoms after definitive therapy for achalasia. […] We recommend that PD is an appropriate and safe treatment option for patients with achalasia post-initial surgical myotomy or POEM in need of retreatment. […] We recommend esophagectomy in surgically-fit patients with megaesophagus who have failed other interventions. […] We recommend against routine endoscopic surveillance for esophageal carcinoma in patients with achalasia.

• #91 Achalasia – An Update

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2010.16.3.232

  Achalasia cannot be cured. Instead, our goal is to relieve symptoms, improve esophageal emptying and prevent the development of megaesophagus. The most successful therapies are pneumatic dilation and surgical myotomy. The overall success rate of graded pneumatic dilation is 78%, with women and older patients responding best. Laparoscopic myotomy, usually combined with a partial fundoplication, has an overall success rate of 87%. Young patients, especially men, are the best candidates for surgical myotomy. Botulinum toxin injection into the lower esophageal sphincter and smooth muscle relaxants are usually reserved for older patients or those with co-morbid illness. The prognosis for achalasia patients to return to near normal swallowing is good, but the disease is rarely cured with a single procedure and intermittent touch-up procedures may be required.

• #92 Achalasia – An Update

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2010.16.3.232

  Achalasia cannot be cured. Instead, our goal is to relieve symptoms, improve esophageal emptying and prevent the development of megaesophagus. The most successful therapies are pneumatic dilation and surgical myotomy. The overall success rate of graded pneumatic dilation is 78%, with women and older patients responding best. Laparoscopic myotomy, usually combined with a partial fundoplication, has an overall success rate of 87%. Young patients, especially men, are the best candidates for surgical myotomy. Botulinum toxin injection into the lower esophageal sphincter and smooth muscle relaxants are usually reserved for older patients or those with co-morbid illness. The prognosis for achalasia patients to return to near normal swallowing is good, but the disease is rarely cured with a single procedure and intermittent touch-up procedures may be required.

• #93 Achalasia – An Update

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2010.16.3.232

  Achalasia cannot be cured. Instead, our goal is to relieve symptoms, improve esophageal emptying and prevent the development of megaesophagus. The most successful therapies are pneumatic dilation and surgical myotomy. The overall success rate of graded pneumatic dilation is 78%, with women and older patients responding best. Laparoscopic myotomy, usually combined with a partial fundoplication, has an overall success rate of 87%. Young patients, especially men, are the best candidates for surgical myotomy. Botulinum toxin injection into the lower esophageal sphincter and smooth muscle relaxants are usually reserved for older patients or those with co-morbid illness. The prognosis for achalasia patients to return to near normal swallowing is good, but the disease is rarely cured with a single procedure and intermittent touch-up procedures may be required.

• #94 Achalasia (Esophagus Disorder): Symptoms, Causes, Treatments

  https://my.clevelandclinic.org/health/diseases/17534-achalasia

  If you arent a candidate for balloon dilation or surgery or choose not to undergo these procedures, you may benefit from Botox (botulinum toxin) injections. […] Removal of your esophagus is a last resort treatment. […] Long-term follow-up is needed regardless of which treatment you receive. […] Balloon dilation improves symptoms in 50% to 93% of people with achalasia. […] Minimally invasive surgery/laparoscopic Heller myotomy is effective in 76% to 100% of people with achalasia. […] Botox injection successfully relaxes spastic esophageal sphincter muscles in up to 35% of people with achalasia. […] Medications, such as nifedipine, improve symptoms in 0% to 75% of people with achalasia; isosorbide improves symptoms in 53% to 87%. […] No treatment cures achalasia.

• #95 Achalasia – An Update

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2010.16.3.232

  Achalasia cannot be cured. Instead, our goal is to relieve symptoms, improve esophageal emptying and prevent the development of megaesophagus. The most successful therapies are pneumatic dilation and surgical myotomy. The overall success rate of graded pneumatic dilation is 78%, with women and older patients responding best. Laparoscopic myotomy, usually combined with a partial fundoplication, has an overall success rate of 87%. Young patients, especially men, are the best candidates for surgical myotomy. Botulinum toxin injection into the lower esophageal sphincter and smooth muscle relaxants are usually reserved for older patients or those with co-morbid illness. The prognosis for achalasia patients to return to near normal swallowing is good, but the disease is rarely cured with a single procedure and intermittent touch-up procedures may be required.

• #96 Achalasia (Esophagus Disorder): Symptoms, Causes, Treatments

  https://my.clevelandclinic.org/health/diseases/17534-achalasia

  If you arent a candidate for balloon dilation or surgery or choose not to undergo these procedures, you may benefit from Botox (botulinum toxin) injections. […] Removal of your esophagus is a last resort treatment. […] Long-term follow-up is needed regardless of which treatment you receive. […] Balloon dilation improves symptoms in 50% to 93% of people with achalasia. […] Minimally invasive surgery/laparoscopic Heller myotomy is effective in 76% to 100% of people with achalasia. […] Botox injection successfully relaxes spastic esophageal sphincter muscles in up to 35% of people with achalasia. […] Medications, such as nifedipine, improve symptoms in 0% to 75% of people with achalasia; isosorbide improves symptoms in 53% to 87%. […] No treatment cures achalasia.

• #97 Achalasia (Esophagus Disorder): Symptoms, Causes, Treatments

  https://my.clevelandclinic.org/health/diseases/17534-achalasia

  If you arent a candidate for balloon dilation or surgery or choose not to undergo these procedures, you may benefit from Botox (botulinum toxin) injections. […] Removal of your esophagus is a last resort treatment. […] Long-term follow-up is needed regardless of which treatment you receive. […] Balloon dilation improves symptoms in 50% to 93% of people with achalasia. […] Minimally invasive surgery/laparoscopic Heller myotomy is effective in 76% to 100% of people with achalasia. […] Botox injection successfully relaxes spastic esophageal sphincter muscles in up to 35% of people with achalasia. […] Medications, such as nifedipine, improve symptoms in 0% to 75% of people with achalasia; isosorbide improves symptoms in 53% to 87%. […] No treatment cures achalasia.

• #98 Achalasia (Esophagus Disorder): Symptoms, Causes, Treatments

  https://my.clevelandclinic.org/health/diseases/17534-achalasia

  If you arent a candidate for balloon dilation or surgery or choose not to undergo these procedures, you may benefit from Botox (botulinum toxin) injections. […] Removal of your esophagus is a last resort treatment. […] Long-term follow-up is needed regardless of which treatment you receive. […] Balloon dilation improves symptoms in 50% to 93% of people with achalasia. […] Minimally invasive surgery/laparoscopic Heller myotomy is effective in 76% to 100% of people with achalasia. […] Botox injection successfully relaxes spastic esophageal sphincter muscles in up to 35% of people with achalasia. […] Medications, such as nifedipine, improve symptoms in 0% to 75% of people with achalasia; isosorbide improves symptoms in 53% to 87%. […] No treatment cures achalasia.

• #99 Achalasia – An Update

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2010.16.3.232

  The only absolute contraindication to pneumatic dilation is poor cardiopulmonary status or other comorbid illnesses preventing surgery, should an esophageal perforation occur. […] For the newly diagnosed patient with achalasia, a suggested treatment algorithm is shown. Symptomatic healthy patients with achalasia should be given the option of graded pneumatic dilation or laparoscopic Heller myotomy since a review of the literature suggests relatively similar efficacy in the hands of experienced gastroenterologists and surgeons.

• #100 Achalasia – An Update

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2010.16.3.232

  Achalasia cannot be cured. Instead, our goal is to relieve symptoms, improve esophageal emptying and prevent the development of megaesophagus. The most successful therapies are pneumatic dilation and surgical myotomy. The overall success rate of graded pneumatic dilation is 78%, with women and older patients responding best. Laparoscopic myotomy, usually combined with a partial fundoplication, has an overall success rate of 87%. Young patients, especially men, are the best candidates for surgical myotomy. Botulinum toxin injection into the lower esophageal sphincter and smooth muscle relaxants are usually reserved for older patients or those with co-morbid illness. The prognosis for achalasia patients to return to near normal swallowing is good, but the disease is rarely cured with a single procedure and intermittent touch-up procedures may be required.

• #101 Achalasia – An Update

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2010.16.3.232

  Achalasia cannot be cured. Instead, our goal is to relieve symptoms, improve esophageal emptying and prevent the development of megaesophagus. The most successful therapies are pneumatic dilation and surgical myotomy. The overall success rate of graded pneumatic dilation is 78%, with women and older patients responding best. Laparoscopic myotomy, usually combined with a partial fundoplication, has an overall success rate of 87%. Young patients, especially men, are the best candidates for surgical myotomy. Botulinum toxin injection into the lower esophageal sphincter and smooth muscle relaxants are usually reserved for older patients or those with co-morbid illness. The prognosis for achalasia patients to return to near normal swallowing is good, but the disease is rarely cured with a single procedure and intermittent touch-up procedures may be required.

• #102 How can Achalasia be Treated? | Treatment Options

  https://www.achalasia-action.org/treatment-options/

  POEM (per oral endoscopic myotomy) is a relatively new procedure that is performed with an endoscope passed down into the oesophagus through your mouth under sedation or general anaesthetic. […] Botulin toxin injections (Botox) into the LOS take three or four minutes and can reduce the muscle tone in the LOS, decrease LOS pressure and improve the flow of food into the stomach, but the relapse rate within three months is about 50%. […] Very much at the extreme end of experience and a last resort for people with achalasia, an oesophagectomy involves removal of the oesophagus. […] Achalasia is a long-term condition that does not have a definitive cure, so decisions about what treatment to undertake need to be long-term, and should be discussed carefully with your medical practitioner. […] After treatment, better digestion will normally be achieved largely because the obstruction in the digestive tract has been removed so that gravity will cause food to make progress into the stomach. […] The surgery will not allow you to completely ignore that aspect of a busy lifestyle. […] After treatment you will be given instructions about having sloppy or mushy food including soup for a period, and you should then be able gradually to progress to more solid food.

• #103 How can Achalasia be Treated? | Treatment Options

  https://www.achalasia-action.org/treatment-options/

  POEM (per oral endoscopic myotomy) is a relatively new procedure that is performed with an endoscope passed down into the oesophagus through your mouth under sedation or general anaesthetic. […] Botulin toxin injections (Botox) into the LOS take three or four minutes and can reduce the muscle tone in the LOS, decrease LOS pressure and improve the flow of food into the stomach, but the relapse rate within three months is about 50%. […] Very much at the extreme end of experience and a last resort for people with achalasia, an oesophagectomy involves removal of the oesophagus. […] Achalasia is a long-term condition that does not have a definitive cure, so decisions about what treatment to undertake need to be long-term, and should be discussed carefully with your medical practitioner. […] After treatment, better digestion will normally be achieved largely because the obstruction in the digestive tract has been removed so that gravity will cause food to make progress into the stomach. […] The surgery will not allow you to completely ignore that aspect of a busy lifestyle. […] After treatment you will be given instructions about having sloppy or mushy food including soup for a period, and you should then be able gradually to progress to more solid food.

• #104 Achalasia – An Update

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2010.16.3.232

  No treatment can restore muscular activity to the denervated esophagus in achalasia. Esophageal aperistalsis and impaired LES relaxation are rarely, if ever, reversed by any mode of therapy. Therefore, every treatment for achalasia is directed to reducing the pressure gradient across the LES with 3 goals of: (1) relieving patients’ symptoms, especially dysphagia and bland regurgitation, (2) improving esophageal emptying by disrupting the poorly relaxing LES and (3) preventing the development of megaesophagus. […] Pneumatic dilation aims at disrupting the LES by forceful dilation using air filled balloons. This procedure has become easier and more standardized with the development of the Rigiflex balloon system. […] The first successful surgery for achalasia was performed in 1913, by the German surgeon Ernest Heller. This surgery consisted of an anterior and posterior (double) lower esophageal myotomy through a laparotomy.

• #105 Achalasia – An Update

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2010.16.3.232

  No treatment can restore muscular activity to the denervated esophagus in achalasia. Esophageal aperistalsis and impaired LES relaxation are rarely, if ever, reversed by any mode of therapy. Therefore, every treatment for achalasia is directed to reducing the pressure gradient across the LES with 3 goals of: (1) relieving patients’ symptoms, especially dysphagia and bland regurgitation, (2) improving esophageal emptying by disrupting the poorly relaxing LES and (3) preventing the development of megaesophagus. […] Pneumatic dilation aims at disrupting the LES by forceful dilation using air filled balloons. This procedure has become easier and more standardized with the development of the Rigiflex balloon system. […] The first successful surgery for achalasia was performed in 1913, by the German surgeon Ernest Heller. This surgery consisted of an anterior and posterior (double) lower esophageal myotomy through a laparotomy.

• #106 Achalasia – An Update

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2010.16.3.232

  Achalasia cannot be cured. Instead, our goal is to relieve symptoms, improve esophageal emptying and prevent the development of megaesophagus. The most successful therapies are pneumatic dilation and surgical myotomy. The overall success rate of graded pneumatic dilation is 78%, with women and older patients responding best. Laparoscopic myotomy, usually combined with a partial fundoplication, has an overall success rate of 87%. Young patients, especially men, are the best candidates for surgical myotomy. Botulinum toxin injection into the lower esophageal sphincter and smooth muscle relaxants are usually reserved for older patients or those with co-morbid illness. The prognosis for achalasia patients to return to near normal swallowing is good, but the disease is rarely cured with a single procedure and intermittent touch-up procedures may be required.

• #107 Achalasia | Symptoms, Causes, Diagnosis and Treatment | Guts UK

  https://gutscharity.org.uk/advice-and-information/conditions/achalasia/

  Botox: a substance called Botulinum toxin is injected into the sphincter, at the time of endoscopy. […] Endoscopy: new endoscopy therapies (e.g. POEM – per-oral endoscopic myotomy) are suitable for some patients as a permanent non-surgical treatment. […] Surgery: a procedure called a Heller myotomy is used to cut muscle fibres of the sphincter, aiming to permanently improve swallowing. […] Unfortunately, all these treatments can lead to other side effects such as heartburn or reflux and persistent chest pain.

• #108 Tailoring Therapy for Achalasia – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/may-2020/tailoring-therapy-for-achalasia/

  Therefore, in my opinion, achalasia patients are best managed with a multispeciality approach, such as in an esophageal center of excellence with a multidiscipline gastrointestinal and surgical team. […] The treatment of achalasia now has multiple options with excellent scientific efficacy, which allows for the opportunity to tailor therapy for patients with this condition.

• #109

  https://journals.lww.com/co-gastroenterology/fulltext/2021/07000/long_term_outcomes_of_treatments_for_achalasia.17.aspx

  Data concerning the long-term outcomes of these interventions comparing one therapeutic option to another have been published during the past few years, as our knowledge on the long-term efficacy of POEM is expanding rapidly. […] Long-term follow-up studies of subjects who underwent POEM are still in progress, as it is a relatively new technique. […] Long-term outcomes for POEM in other nonachalasia esophageal motility disorders such as esophageal spasms, esophagogastric junction outflow obstruction, and hypercontractile disorders were initially thought to be inferior, however, more recently Filicori et al. were able to refute these assumptions in a retrospective single-center cohort study that included 40 patients with nonachalasia motility disorders. […] However, Hu et al. demonstrated that in a group of 32 consecutive patients with a sigmoid-type achalasia esophagus, treatment success (as was defined by an Eckardt-score 3) at a mean follow-up of 30 months was achieved in 96.8% of patients, and no serious complications were reported despite the procedure being more challenging in this case series, all procedures were successful. […] Treatment options such as LHM (with Dor fundoplication) and POEM have excellent long-term outcomes with low morbidity and complication rates, but graded stepwise PD remains a valid option in the treatment of achalasia, as its outcomes are reasonably good.

• #110 Achalasia – An Update

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2010.16.3.232

  Achalasia cannot be cured. Instead, our goal is to relieve symptoms, improve esophageal emptying and prevent the development of megaesophagus. The most successful therapies are pneumatic dilation and surgical myotomy. The overall success rate of graded pneumatic dilation is 78%, with women and older patients responding best. Laparoscopic myotomy, usually combined with a partial fundoplication, has an overall success rate of 87%. Young patients, especially men, are the best candidates for surgical myotomy. Botulinum toxin injection into the lower esophageal sphincter and smooth muscle relaxants are usually reserved for older patients or those with co-morbid illness. The prognosis for achalasia patients to return to near normal swallowing is good, but the disease is rarely cured with a single procedure and intermittent touch-up procedures may be required.

• #111 Achalasia (Esophagus Disorder): Symptoms, Causes, Treatments

  https://my.clevelandclinic.org/health/diseases/17534-achalasia

  If you arent a candidate for balloon dilation or surgery or choose not to undergo these procedures, you may benefit from Botox (botulinum toxin) injections. […] Removal of your esophagus is a last resort treatment. […] Long-term follow-up is needed regardless of which treatment you receive. […] Balloon dilation improves symptoms in 50% to 93% of people with achalasia. […] Minimally invasive surgery/laparoscopic Heller myotomy is effective in 76% to 100% of people with achalasia. […] Botox injection successfully relaxes spastic esophageal sphincter muscles in up to 35% of people with achalasia. […] Medications, such as nifedipine, improve symptoms in 0% to 75% of people with achalasia; isosorbide improves symptoms in 53% to 87%. […] No treatment cures achalasia.

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