There are a few drugs on the market that have a side effect of partially relaxing the LES; however, the majority of them are not very successful. Achalasia medications frequently fail to be effective and must be used for the rest of the patient’s life. They are reserved for high risk patients that are not candidates for more effective options.
Botox can be used to treat Achalasia temporarily. Botox is injected into the esophageal muscle at the junction of the stomach and esophagus to relax the LES. Botox generally provides short-term improvement for achalasia sufferers, but it is not a long term solution.
The best nonsurgical treatment for Achalasia is balloon dilation, which should be investigated for those who are not surgical candidates. A balloon is inserted through the mouth and into the valve between the esophagus and stomach during an endoscopy combined with fluoroscopy. The balloon is then inflated to a large size in order to tear the muscle fibers of the valve to weaken it. Patients undergoing balloon dilation run a slight chance of rupturing their esophagus during the treatment, a known complication that may require surgical correction. Balloon dilations are not as effective as surgery in giving long-term Achalasia relief and improvement in swallowing, but they generally provide Achalasia relief and improvement for a reasonable amount of time.
The most common operation used to treat Achalasia is the robotic Heller myotomy, a robotic procedure involving the severing of the LES muscle to alleviate difficulty swallowing, allow food and liquids to flow into the stomach. During the process, the LES is partially reconstructed to prevent severe reflux after surgery. Surgery has proven to be the most effective long-term treatment for Achalasia, and the majority of patients see almost immediate improvement in swallowing function.
Another procedure that can be used to treat Achalasia is the POEM or PerOral Endoscopic Myotomy. This procedure is performed completely endoscopically. In certain subtypes of achalasia, the POEM procedure is very effective at treating patients symptoms. It does come with some increased reflux compared to a Heller myotomy. If after testing and discussion with patients that are good candidate for the POEM procedure, Dr. Grandhige will refer them to a specific physician in the Tampa area who specializes in this form of therapy.