Treatment for achalasia associated with high rate of recurrence :
Treatment of Achalasia The aim of treatment is to relieve the functional obstruction at the cardio The two main methods to achieve this are Forceful dilatation or Esophageal myotomy (Heller's myotomy) with or without an antireflux procedure 1) Forceful dilatation (pneumatic dilatation) The aim is to weaken or rupture the circular muscle fibres of the LES by a forceful stretch. Perforation and bleeding are potential complications 2) Extramucosal cardiomyotomy (Heller's myotomy) this involves surgical division of the muscle fibres of the lower esophageal sphincter. this procedure can be performed through a laparoscopic or thoracoscopic approach (Open surgical procedure i.e. Laparotomy or thoracotomy can also be done, but the videoscopic procedure is better) major complication is gastro-esophageal reflux. paial fundoplication is done to prevent reflux "modified laparoscopic Heller myotomy is the operation of choice"- Sabiston Other methods of treatment Drugs Nitrates and calcium channel blockers can be used, but are ineffective for long-term use. They can be used for transient relief of symptoms and in patients unfit for surgery and pneumatic dilatation. Botulinum toxin Botulinum toxin is given by endoscopic injection into the LES. It reduces LES pressure by blocking the cholinergic excitatory nerves in the sphincter. Its effect is only sho-lived and repeated injections have to be given. Used only in patients unfit for surgery and pneumatic dilatation. Ref : Bailey & Love 25/e p1036
Pneumatic dilatation
Laproscopic myotomy
Open surgical myotomy
Botulinum toxin
G.I.T