Treatment options for achalasia
The treatments aim to reduce the resistance in the esophageal sphincter. Which treatment is suitable depends on the extent of the symptoms, but also on your general state of health, age and individual wishes. The following treatment options are available for achalasia:
Balloon dilation
Doctors carefully insert a small balloon into the esophagus and push it up to the sphincter muscle. Then they inflate the balloon and mechanically dilate the sphincter. Most of them experience a significant improvement in their swallowing problems. The effect often lasts for months or even years. Sometimes doctors repeat the treatment after some time. The method can be performed without surgery during a gastroscopy. Balloon dilatation is often a good treatment option, especially for older people who have other illnesses. It harbors a number of risks: Injury to the esophagus, bleeding or reflux disease. Because the pressure in the esophageal muscle decreases, acidic, aggressive gastric juice can flow back into the esophagus more easily.
Surgery
It can be considered if repeated stretching has not brought sufficient success or complications have arisen. A surgeon makes a longitudinal incision in the lower sphincter muscle. Myotomy is the technical term for this. The operation is usually minimally invasive (“keyhole surgery”) as part of a laparoscopy. The advantage of the operation is that the effect lasts for a very long time, often for several years. During surgery, the risk of reflux disease can be averted immediately by placing a sleeve around the upper part of the stomach. This procedure is called fundoplication.
Peroral endoscopic myotomy (POEM)
This relatively new treatment involves splitting the esophageal muscles and the lower sphincter via endoscopy. POEM is only performed in a few specialized centers and can sometimes replace the otherwise necessary surgery. The disadvantage of POEM is the frequently observed increase in reflux symptoms, because acidic gastric juice can flow back into the esophagus more easily after the sphincter muscle has split.
Botulinum toxin (Botox)
This is a very strong neurotoxin produced by certain bacteria: Clostridium botulinum. It is life-threatening in higher doses, but can be used as a therapeutic agent in low doses. Doctors inject Botox into the esophageal muscle, paralyzing the nerves and causing the muscle to relax. Doctors administer the Botox injection as part of an esophageal and gastric endoscopy. Doctors often repeat the treatment some time later. However, many patients respond less and less to Botox over time. The treatment is suitable for patients for whom other therapies, such as surgery or balloon dilatation, are not an option.
Medication
They reduce the pressure in the esophageal muscle and ensure that it relaxes again and can open better. They accelerate the passage of food towards the stomach. Active substances from the group of calcium antagonists (e.g. nifedipine) and nitrates (isosorbide dinitrate) are used. However, medication only plays a limited role in achalasia. Doctors use them in the early stages or shortly before other treatment. They are also an option if other treatment options fail or are not suitable for patients.
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