What is the treatment of Achalasia?

March 29 01:20 2019 Print This Article

There are many treatments available for this condition. There are certain medicines which are very useful during LES as they are given before the surgery.

It includes the CCB like nifedipines and nitrate drugs like isosorbide bi nitrate and nitro glycerin. They may cause certain side effects like headache and swollen feet. There use must be discontinued for a while.

The Botox must be injected into the lower part of esophagus sphincter so to paralyze the muscles which hold them. In case of esthetics the effect of Botox is temporary and last for half a year. They cause scarring in the sphincter which creates a problem in the Heller myotomy. This treatment is recommended for the elder patients who cannot withstand the impact of surgery and have poor health.

The pneumatic dilation is also known as the balloon dilation. In this the muscle fibers are stretched and are torn by the forceful inflation of balloon which is situated in the lower esophageal sphincter. The specialists of this condition have done these operations and have proved to be successful as they have caused few perforations. There is a small chance of perforation which requires an immediate surgery. The dilatation may cause scar formation which pose a problem to the Heller myotomy. The dilatation may lead to the GERD.

The dilatation is effective in the patients above 40 years old and in the young patients the results are not long lived. The large balloons must be used again and again so they could be effective. The Heller myotomy is effective in the 90 percent of the cases and is done by the key hole approach and by the use of laparoscope. In this a cut is given along the length above the LES and down to the stomach. The esophagus is many layered. The myotomy involves the cuts through the muscle layers. It leaves the inner mucosal layer and a wrap is added to prevent reflux and is referred as a fundoplication. It causes a severe injury to the esophagus over time. The patient must be kept on the soft diet after the surgery and it should be extended for few weeks and months.

The food which increases the reflux must be avoided. There are some temporary measures which can improve the condition and include the acupuncture. There must be a change in the life style of achalasia patient. He must eat slowly and chew properly. He must take a lot of water along with the meals. He should not eat just before sleeping. He should raise the head before sleeping and or use a wedge pillow which promotes the emptying of esophagus by gravity. When the surgery or dilatation is over the proton pump inhibitors must be used. They prevent the reflux damage by inhibiting the secretion of gastric acid, avoiding the food which can increase the reflux, like the use of citrus, mint, alcohol, coffee and chocolates. After the procedures the follow up must be done.

After the treatment is successful the swallowing may still deteriorate over time and the esophagus must be checked after every two years. The barium swallow technique is quite useful in this regard. A myotomy and esophagectomy can be done after few years. The ph testing and endoscopy must be done to check the reflux damage. This is recommended by some physicians. This condition may lead to the pre malignant changes which are referred as a Barrett’s esophagus. It can also form the strictures if it is not treated properly.

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