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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. You can find an information leaflet about having and endoscopy and dilation here. 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.