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1. Focus treatment for achalasia on opening the LES, usually by pneumatic dilation, surgical myotomy or Botox injection.

2. A large, 3-4-cm diameter balloon is inflated within the LES to tear the sphincter muscle fibers. There is a 5% risk of perforation.

3. Surgical myotomy is also very effective and can be done via laparoscope.

4. Botulinum toxin is effective in 65% of cases but requires repeat therapy within 6-12 months. It is an alternative therapy in high-risk
surgical patients.

5. Calcium channel blockers and nitrates have been used with minimal relief.


1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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