Achalasia Cardia Treatment Surgery

It can be managed but not cured. There are 5 major treatment modalities

• Pharmacotherapy – Considered the least-effective treatment option, the clinical response to these agents is short-lived and their side effects are unfavourable. The two most commonly used medications include long-acting nitrates and calcium channel blockers.
• Botox Injections – It is a useful treatment strategy for those who cannot tolerate invasive therapies, such as surgical myotomy or pneumatic dilatation. This technique involves pushing a maximum of 100 units of toxin using a sclero-needle close to the squamo–columnar junction. The response rate in the first month is as high as 80%–90%; however, the effect wanes over time so that approximately 50% of the patients are symptomatic at the end of first year. Thus, recurrent treatments are usually required.
• Pneumatic Dilation
  1. Most effective non-operative treatment with a success rate of 55-70 percent for single dilation
  2. Stretches and ruptures your LES muscle fibers
  3. Most people need more than one dilation
  4. Adverse / Side Effects – Perforation rate ~1% (0.67 – 5.6%) – overall complication rate 11% (Perforation, GERD, intramural hematoma)
• Surgical – Surgical myotomy is a technique that involves the division of the LES circular muscle fibres. Today, Laparoscopic Heller Myotomy (LHM) has become the standard Achalasia Cardia surgery approach in Kolkata because of improved morbidity and quicker recovery time.

Esophagectomy – “End-stage” achalasia, characterized by a dilated and tortuous esophagus (megaesophagus or sigmoid esophagus), is often unresponsive to conventional treatments for achalasia. Although PD is ineffective, surgical myotomy should still be considered the initial treatment before consideration of the more morbid esophagectomy.