[Achalasia: which treatment to choose in 2015?]

Achalasia is a rare disorder, whose diagnostic Gold standard is high-resolution cesophageal manometry. The proposed treatment must take into account the patient's health condition and the type of achalasia determined by HRM. Heller's laparoscopic myotomy and pneumatic dilation are the first line treatments for most of the patients, whereas Botulinum toxin injections and pharmacologic therapy are only indicated for patients with a high surgical risk who cannot undergo first line treatments. Peroral endoscopic myotomy (POEM) is a recent and promising endoscopic technique reserved for expert endoscopy centers, whose exact role is still to be determined by randomized prospective studies. Oesophagectomy has only a marginal role in rare patients with extremely advanced achalasia or at risk of neoplastic degeneration.