Achalasia Treatment – Methods and Therapies
Achalasia treatment includes several procedures aimed at relieving swallowing difficulties caused by achalasia. The goal is to relax the lower esophageal sphincter.
Things worth knowing about "Achalasia Treatment"
Achalasia treatment includes several procedures aimed at relieving swallowing difficulties caused by achalasia. The goal is to relax the lower esophageal sphincter.
What is Achalasia?
Achalasia is a rare esophageal motility disorder in which the lower esophageal sphincter (LES) fails to relax properly, preventing food from passing into the stomach. At the same time, the normal peristaltic movements of the esophageal wall are impaired. This leads to significant swallowing difficulties (dysphagia), regurgitation of undigested food, chest pain, and weight loss.
Goals of Achalasia Treatment
Since achalasia cannot be cured at its root cause, treatment aims to improve the function of the lower esophageal sphincter and facilitate pressure relief. This relieves symptoms and prevents complications such as esophageal dilation (megaesophagus) or aspiration pneumonia.
Treatment Options
Pneumatic Balloon Dilation
Pneumatic balloon dilation involves the endoscopic insertion of a balloon catheter into the lower esophageal sphincter, which is then inflated to stretch and loosen the muscle fibers. This minimally invasive procedure is one of the most effective non-surgical treatments for achalasia. Repeat treatments may be necessary over time.
Laparoscopic Heller Myotomy
Laparoscopic Heller myotomy is a minimally invasive surgical procedure in which the muscle fibers of the lower esophageal sphincter are cut through small incisions to permanently reduce pressure. To prevent gastroesophageal reflux, an anti-reflux procedure (fundoplication) is usually performed simultaneously. Heller myotomy provides good long-term outcomes for many patients.
Peroral Endoscopic Myotomy (POEM)
Peroral endoscopic myotomy (POEM) is a modern, minimally invasive endoscopic technique in which an endoscope is inserted through the mouth. The esophageal mucosa is incised to access and cut the sphincter muscle fibers underneath. POEM shows excellent short- and long-term results and is now considered a standard treatment for many patients. An increased risk of gastroesophageal reflux following the procedure should be taken into account.
Botulinum Toxin Injection
The endoscopic injection of botulinum toxin (type A) into the lower esophageal sphincter causes temporary paralysis of the muscle, reducing sphincter pressure. This approach is particularly suitable for elderly or high-risk patients who are not good candidates for surgery. The effect typically lasts 6 to 12 months, making repeat injections necessary.
Medical (Drug) Therapy
Medications such as calcium channel blockers (e.g., nifedipine) or nitrates (e.g., isosorbide dinitrate) can temporarily reduce lower esophageal sphincter pressure and relieve symptoms. However, drug therapy is less effective than interventional procedures and is therefore mainly used as a bridging therapy or for patients who cannot undergo other treatments.
Choosing the Right Treatment
The choice of the most appropriate therapy depends on the achalasia subtype (Type I, II, or III according to the Chicago Classification), the age and general health of the patient, and the expertise of the treating center. Type II achalasia responds particularly well to all treatment modalities, while Type III (spastic achalasia) often benefits especially from POEM. Close collaboration between gastroenterologists and visceral surgeons is recommended.
Follow-Up and Monitoring
Regular follow-up examinations are important after treatment, as achalasia carries a slightly elevated risk of developing esophageal cancer (esophageal carcinoma). Long-term surveillance with endoscopic examinations is therefore essential to detect complications at an early stage.
References
- Yadlapati R, Kahrilas PJ, Fox MR, et al. - Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0. Neurogastroenterol Motil. 2021;33(1):e14058.
- Werner YB, Hakanson B, Martinek J, et al. - Endoscopic or Surgical Myotomy in Patients with Idiopathic Achalasia. N Engl J Med. 2019;381(23):2219-2229.
- Moonen A, Annese V, Belmans A, et al. - Long-term results of the European achalasia trial: a multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy. Gut. 2016;65(5):732-735.
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