Achalasia (cont.)

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What is the treatment for achalasia?

Treatments for achalasia include oral medications, stretching of the lower esophageal sphincter (dilation), surgery to cut the sphincter (esophagomyotomy), and the injection of botulinum toxin (Botox) into the sphincter. All four treatments reduce the pressure within the lower esophageal sphincter to allow easier passage of food from the esophagus into the stomach.

Diet, oral medications, and botulinum toxin (Botox) to treat achalasia

What about achalasia and diet?

There is no specific diet for treating achalasia, though dietary alterations often are made by patients as they learn what foods seem to pass more easily. Usually, the more liquid foods pass more easily, and patients sometimes drink more water with their meals. Early in the progression of the disease they may find that carbonated liquids help food pass, probably because of the increased intra-esophageal pressure caused by the carbonation that "pushes" food through the sphincter. If loss of weight is substantial it is reasonable to supplement food with a liquid diet supplement that is complete, i.e., contains all necessary nutrients, to prevent malnutrition.

Oral medications

Oral medications that help to relax the lower esophageal sphincter include groups of drugs called nitrates, for example, isosorbide dinitrate (Isordil) and calcium channel blockers (CCBs), for example, nifedipine (Procardia) and verapamil (Calan). Although some patients with achalasia, particularly early in the disease, have improvement of symptoms with medications, most do not. By themselves, oral medications are likely to provide only short-term and not long-term relief of the symptoms of achalasia, and many patients experience side-effects from the medications.

Botulinum toxin

Another treatment for achalasia is the endoscopic injection of botulinum toxin into the lower sphincter to weaken it. Injection is quick, nonsurgical, and requires no hospitalization. Treatment with botulinum toxin is safe, but the effects on the sphincter often last only for months, and additional injections with botulinum toxin may be necessary. Injection is a good option for patients who are very elderly or are at high risk for surgery, for example, patients with severe heart or lung disease. It also allows patients who have lost substantial weight to eat and improve their nutritional status prior to "permanent" treatment with surgery. This may reduce post-surgical complications.

Medically Reviewed by a Doctor on 7/24/2015

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