Achalasia

Achalasia is a chronic illness that can be treated effectively in 65 to 90 per cent of patients with either pneumatic dilatation or Heller esophagomyotomy. Prior to institution of therapy, clinicians must rule out secondary achalasia, especially malignancy-associated achalasia, with upper endoscopy, and if the clinical history is worrisome for malignancy, with a computerized tomography scan of the chest and abdomen. Medical therapy with isosorbide dinitrate or nifedipine is occasionally useful for temporary control of dysphagia prior to a more definitive treatment or for the elderly or medically complicated patient who has increased risks for surgery. Complications of pneumatic dilatation, though rare, can be recognized with the use of postprocedure contrast studies of the esophagus and monitoring the patient for 6 hours after the dilatation. The appropriate long-term management of the patient must include personal support and a clear understanding of the potential for developing complications.