What is the treatment for achalasia?

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I'm urgently in need of information on achalasia, especially treatment.

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Achalasia is a condition in which the lower esophageal sphincter (the strip of esophageal muscle that lies at the junction of the oesophagus or food tube with the stomach) fails after swallows of food to relax normally to allow the food passing down the oesophagus to enter the stomach. The condition may occur by itself (primary achalasia) or may accompany other diseases of the oesophagus (secondary achalasia, examples of which are cancer or Chagas disease, an infection). In addition to abnormal relaxation of the sphincter, there also is loss of the normal contractions of the muscles in the remaining oesophagus that are responsible for moving food through the oesophagus. This exacerbates the poor transfer of food through the oesophagus and into the stomach.

The cause of achalasia is degeneration of the nerves within the esophagus that control the contraction and relaxation of the esophageal muscles including the lower esophageal sphincter. The cause of the degeneration is not clearly known, but one theory suggests that it is an autoimmune process, that is, a process in which the body's immune system attacks itself.

The three treatment options are endoscopic botox injection (perhaps the most simple and safest treatment, although injections may need to be repeated), endoscopic pneumatic dilatation (passing an instrument into the esophagus through the mouth and stretching and tearing the sphincter open), and surgery (in which the sphincter is cut). The best results are obtained from open surgery, but many try simpler treatments first.

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Last Editorial Review: 1/11/2018