[Clinical management of esophageal achalasia]

In this report, we describe the clinical management of esophageal achalasia in Japan. Both balloon dilation and surgical myotomy or myectomy with antireflux procedures are accepted as the standard treatment for esophageal achalasia. In most patients balloon dilation is attempted first. If that is not sufficiently effective, they than undergo surgery. The most important point in treatment is not to repeat the dilation procedure more than twice, because patients who do not respond significantly to the first two dilation procedures are unlikely to improve after subsequent ones. Recently, many physicians and surgeons in Western countries have investigated the effects of botulinum toxin in patients with esophageal achalasia. If the safety of this treatment is confirmed in the near future, it will become a new treatment option for esophageal achalasia.