CURRENT THERAPIES FOR ACHALASIA - COMPARISON AND EFFICACY

Achalasia is a primary esophageal motor disorder of unknown etiology p roducing complaints of dysphagia, regurgitation, and chest pain. The c urrent treatments for achalasia involve the reduction of lower esophag eal sphincter (LES) pressure resulting in improved esophageal emptying . Calcium channel blockers and nitrates, once used as initial treatmen t strategy for early achalasia, are now only used in patients who are not candidates for pneumatic dilation or surgery and those not respond ing to botulinum toxin injections. By virtue of the more rigid balloon s, the current pneumatic dilators are more effective and have better e fficacy than the older more compliant balloons. The graded approach to pneumatic dilation using the Rigiflex balloons (3.0, 3.5, and 4.0 cm) are now the most commonly used nonsurgical means of treating patients with achalasia, resulting in symptom improvement in up to 90% of pati ents. Surgical myotomy, once with high morbidity and long hospital sta y, can now be performed laparoscopically with similar efficacy to the open surgical approach (94% vs. 84%, respectively), reduced morbidity, and hospitalization time. Given the advances in both balloon dilation and laparoscopic myotomy, most patients with achalasia can now choose between these two equally efficacious treatment options. Botulinum to xin injection of the LES should be reserved for patients who cannot un dergo balloon dilation and are not surgical candidates.