Treatment
The options for treatment include lifestyle modification,
endoscopic treatment and surgery.
Lifestyle modification
If your symptoms are mild or the risks of treatment are
considered to be very high, achalasia may be best managed with
changes in diet to maintain enough food and drink intake, and
minimise symptoms. You may be referred to a dietitian to help with
this.
Endoscopic treatment
One common treatment for achalasia is to perform an upper GI
endoscopy and use a balloon to stretch the ring of muscle at the
bottom of the oesophagus, to open it up and allow food and drink to
pass through more easily. This is usually done in the endoscopy
room with some sedation and pain relief, and you can normally go
home the same day provided you have someone to take you home and
stay with you overnight. There are some risks associated with the
procedure, such as a chance of bleeding or making a hole in the
oesophagus (called a perforation). Your doctor can explain the
risks and benefits of this treatment in more detail. At University
Hospitals Bristol and Weston, we do not provide balloon dilation
service for achalasia, so if you would like to have this treatment,
please discuss it with your doctor who can refer you to another
hospital (such as Southmead Hospital).
Another endoscopic treatment that can be performed is the
injection of a drug (botulinum toxin, or Botox) into the ring of
muscle between the oesophagus and stomach. This injection can help
this muscle to relax, allowing food and drink to pass through more
easily. However, the injection wears off after approximately 3
months, so it is not considered to be an effective long-term
treatment. However, it may provide your surgeon with an indication
of how effective an operation is likely to be.
Surgery
An operation is the other main way of treating achalasia. The
operation is called a Heller's cardiomyotomy. This is done under a
general anaesthetic, usually by key hole surgery, and involves a
long cut in the muscle of the oesophagus, starting at the top of
the stomach and going upwards along the oesophagus. This opens up
the ring of muscle at the bottom of the oesophagus and allows food
and drink to pass more easily. Many surgeons combine this operation
with a form of anti-reflux operation called a fundoplication. As
with endoscopic balloon treatment, there are some risks, including
bleeding and making a hole in the oesophagus or stomach. Your
doctor can explain to you more about the benefits and risks of the
operation.
