A surgical procedure called the Heller myotomy has become the treatment of choice and offers long-term symptomatic relief to those who have the disorder. This procedure weakens the muscles at the gastroesophageal junction, allowing the valve between the esophagus and stomach to remain open. Although there is no definitive medical treatment, medical therapies may help to relieve the symptoms of achalasia in its early stages.
Several treatment procedures are available for achalasia but these nonsurgical and surgical treatments cannot bring the normal (peristaltic) contractions of the esophagus. These treatment weakens the lower esophageal sphincter that can just allow the flow of food without becoming as a barrier for the passage of food. There are two ways of treatment for weakening the esophagus muscle such as nonsurgical drug therapy and surgical treatment where the LES muscle is cut down.
Non Surgical Treatments
- In this procedure the balloon is inserted into the lower esophageal sphincter(LES) and expanded to enlarge the opening.
- The procedure of expanding the LES is repeated if it is not properly stay open and difficulty in the flow of food.
- The patient has to repeat their treatment within six years that weakness the LES muscle.
- Botox is a muscle relaxant drug which can be injected using endoscope directly into the esophageal sphincter.
- The procedure of injecting the botox is repeated that make the muscle of LES to relax.
- The disadvantage of this procedure is repeating the injection can weaken the muscle that becomes difficult for the surgery later if needed any.
- The procedure is performed for the patients who cannot support the pneumatic dilation, age or lack in overall fitness.
- The achalasia cardia surgeon suggest the muscle relaxant drug such as nitroglycerin (nitrostat) or nifedipine (procardia) to weaken the LES muscle.
- This procedure has a limited treatment effect and also reflects severe side effects.
- The procedure is performed for the patients who aren’t good for dilation, botox injection and surgical treatments.
The surgical achalasia cardia treatment is recommended for younger people because the non- surgical treatment is ineffective for them.
- Heller mytomy is a procedure where the lower esophagus sphincter muscle is cut to allow the food to pass smoothly into the stomach.
- This procedure is performed as a laparoscopic heller mytomy where the surgeon cuts the muscle using the laparoscope incision.
- There is a possibility of the gastroesophageal reflux disease (GERD) developed after the heller mytomy procedure.
- The surgeon wraps top of the stomach around the lower esophageal sphincter which tightens the muscle and also prevents acid reflux.
- Fudoplication surgery is performed at the same time along with heller mytomy procedure to avoid the GERD problem in the future.
- The Fundoplication is performed as the laparoscopic procedure where the camera is inserted through a small incision made by laparoscope and wrap the stomach using the device at the other end.
Peroral Endoscope Myotomy(POEM):
- In this procedure the surgeon uses the endoscope which is inserted through mouth and down through the throat to provide an incision lining the esophagus and cut the muscle like heller mytomy procedure.
- But in POEM doesn’t include the anti-reflux procedure that leads to GERD in the future.