Medscape is available in 5 Language Editions – Choose your Edition here.


Achalasia Follow-up

  • Author: Marco Ettore Allaix, MD, PhD; Chief Editor: Julian Katz, MD  more...
Updated: Dec 29, 2015


Pneumatic dilatation and laparoscopic myotomy are effective for managing achalasia. If adequate expertise is available, surgery is preferred.

Do not use botulinum toxin and medications if performing a pneumatic dilatation or laparoscopic Heller myotomy.

Contributor Information and Disclosures

Marco Ettore Allaix, MD, PhD Research Fellow in General Surgery, Department of Surgery, University of Chicago, The Pritzker School of Medicine

Marco Ettore Allaix, MD, PhD is a member of the following medical societies: American College of Surgeons, Society for Surgery of the Alimentary Tract

Disclosure: Nothing to disclose.


Marco G Patti, MD Professor of Surgery, Director, Center for Esophageal Diseases, University of Chicago Pritzker School of Medicine

Marco G Patti, MD is a member of the following medical societies: American Association for the Advancement of Science, American Surgical Association, American College of Surgeons, American Gastroenterological Association, American Medical Association, Association for Academic Surgery, Pan-Pacific Surgical Association, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Southwestern Surgical Congress, Western Surgical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Julian Katz, MD Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

David Eric Bernstein, MD Director of Hepatology, North Shore University Hospital; Professor of Clinical Medicine, Albert Einstein College of Medicine

David Eric Bernstein, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

  1. Gyawali CP. Achalasia: new perspectives on an old disease. Neurogastroenterol Motil. 2016 Jan. 28 (1):4-11. [Medline].

  2. Gockel I, Becker J, Wouters MM, Niebisch S, Gockel HR, Hess T, et al. Common variants in the HLA-DQ region confer susceptibility to idiopathic achalasia. Nat Genet. 2014 Aug. 46(8):901-4. [Medline].

  3. Mysterious esophagus disease is autoimmune after all. Ku Leuven. Available at Accessed: Oct 29 2014.

  4. Radulovic M, Schilero GJ, Yen C, et al. Greatly increased prevalence of esophageal dysmotility observed in persons with spinal cord injury. Dis Esophagus. 2015 Oct. 28 (7):699-704. [Medline].

  5. Sato Y, Fukudo S. Gastrointestinal symptoms and disorders in patients with eating disorders. Clin J Gastroenterol. 2015 Oct 26. [Medline].

  6. Herbella FA, Colleoni R, Bot L, Vicentine FP, Patti MG. High resolution manometry findings in patients after sclerotherapy for esophageal varices. J Neurogastroenterol Motil. 2015 Nov 10. [Medline].

  7. Smits M, van Lennep M, Vrijlandt R, et al. Pediatric achalasia in the Netherlands: incidence, clinical course, and quality of life. J Pediatr. 2015 Nov 23. [Medline].

  8. Ferri LE, Cools-Lartigue J, Cao J, Miller L, Mayrand S, Fried GM, et al. Clinical predictors of achalasia. Dis Esophagus. 2009 Aug 28. [Medline].

  9. Pandolfino JE, Gawron AJ. Achalasia: a systematic review. JAMA. 2015 May 12. 313 (18):1841-52. [Medline].

  10. Hand L. Achalasia: New Guidelines Address Diagnosis, Treatment. Medscape Medical News. Available at Accessed: October 22, 2014.

  11. Vaezi MF, Pandolfino JE, Vela MF. ACG Clinical Guideline: Diagnosis and Management of Achalasia. Am J Gastroenterol. 2013 Aug. 108(8):1238-49. [Medline]. [Full Text].

  12. Carlson DA, Ravi K, Kahrilas PJ, et al. Diagnosis of esophageal motility disorders: esophageal pressure topography vs. conventional line tracing. Am J Gastroenterol. 2015 Jul. 110 (7):967-77; quiz 978. [Medline].

  13. Pandolfino JE, Ghosh SK, Rice J, Clarke JO, Kwiatek MA, Kahrilas PJ. Classifying esophageal motility by pressure topography characteristics: a study of 400 patients and 75 controls. Am J Gastroenterol. Jan 2008. 103 (1):27-37. [Medline].

  14. Patti MG, Arcerito M, Tong J, De Pinto M, de Bellis M, Wang A, et al. Importance of preoperative and postoperative pH monitoring in patients with esophageal achalasia. J Gastrointest Surg. Nov-Dec 1997. 1 (6):505-10. [Medline].

  15. Kroupa R, Hep A, Dolina J, Valek V, Matyasova Z, Prokesova J, et al. Combined treatment of achalasia - botulinum toxin injection followed by pneumatic dilatation: long-term results. Dis Esophagus. Feb 2010. 23 (2):100-5. [Medline].

  16. Vaezi MF, Richter JE, Wilcox CM, Schroeder PL, Birgisson S, Slaughter RL, et al. Botulinum toxin versus pneumatic dilatation in the treatment of achalasia: a randomised trial. Gut. Feb 1999. 44(2):231-9. [Medline].

  17. Zaninotto G, Annese V, Costantini M, Del Genio A, Costantino M, Epifani M, et al. Randomized controlled trial of botulinum toxin versus laparoscopic heller myotomy for esophageal achalasia. Ann Surg. Mar 2004. 239(3):364-70. [Medline].

  18. Pastor AC, Mills J, Marcon MA, Himidan S, Kim PC. A single center 26-year experience with treatment of esophageal achalasia: is there an optimal method?. J Pediatr Surg. Jul 2009. 44(7):1349-54. [Medline].

  19. Patti MG, Arcerito M, De Pinto M, Feo CV, Tong J, Gantert W, et al. Comparison of thoracoscopic and laparoscopic Heller myotomy for achalasia. J Gastrointest Surg. Nov-Dec 1998. 2 (6):561-6. [Medline].

  20. Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. Apr 2010. 42 (4):265-71. [Medline].

  21. Familiari P, Gigante G, Marchese M, et al. Peroral endoscopic myotomy for esophageal achalasia: outcomes of the first 100 patients with short-term follow-up. Ann Surg. 2016 Jan. 263 (1):82-7. [Medline].

  22. Bhayani NH, Kurian AA, Dunst CM, Sharata AM, Rieder E, Swanstrom LL. A comparative study on comprehensive, objective outcomes of laparoscopic Heller myotomy with per-oral endoscopic myotomy (POEM) for achalasia. Ann Surg. 2014 Jun. 259 (6):1098-103. [Medline].

  23. Worrell SG, Alicuben ET, Boys J, DeMeester SR. Peroral endoscopic myotomy for achalasia in a thoracic surgical practice. Ann Thorac Surg. 2016 Jan. 101 (1):218-25. [Medline].

  24. Eckardt VF, Aignherr C, Bernhard G. Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology. Dec. 1992. 103 (6):1732-8. [Medline].

  25. Hunter JG, Trus TL, Branum GD, Waring JP. Laparoscopic Heller myotomy and fundoplication for achalasia. Ann Surg. Jun 1997. 225(6):655-64; discussion. [Medline].

  26. Patti MG, Fisichella PM, Perretta S, Galvani C, Gorodner MV, Robinson T, et al. Impact of minimally invasive surgery on the treatment of esophageal achalasia: a decade of change. J Am Coll Surg. May 2003. 196(5):698-703;. [Medline].

  27. Richards WO, Torquati A, Holzman MD, Khaitan L, Byrne D, Lutfi R, et al. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg. Sep 2004. 240(3):405-12; discussion 412-5. [Medline].

  28. Torquati A, Lutfi R, Khaitan L, Sharp KW, Richards WO. Heller myotomy vs Heller myotomy plus Dor fundoplication: cost-utility analysis of a randomized trial. Surg Endosc. Mar 2006. 20(3):389-93. [Medline].

  29. Rebecchi F, Giaccone C, Farinella E, Campaci R, Morino M. Randomized controlled trial of laparoscopic Heller myotomy plus Dor fundoplication versus Nissen fundoplication for achalasia. Ann Surg. Dec 2008. 248 (6):1023–30. [Medline].

  30. Rawlings A, Soper NJ, Oelschlager B, Swanstrom L, Matthews BD, Pellegrini C, et al. Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter, prospective, randomized-controlled trial. Surg Endosc. Jan 2012. 26(1):18-26. [Medline].

  31. Patti MG, Herbella FA. Fundoplication after laparoscopic Heller myotomy for esophageal achalasia: what type?. J Gastrointest Surg. Sep 2010. 14(9):1453-8. [Medline].

  32. Rohof WO, Salvador R, Annese V, Bruley des Varannes S, Chaussade S, Costantini M, et al. Outcomes of treatment for achalasia depend on manometric subtype. Gastroenterology. 2013 Apr. 144(4):718-25; quiz e13-4. [Medline].

  33. Elliott TR, Wu PI, Fuentealba S, Szczesniak M, de Carle DJ, Cook IJ. Long-term outcome following pneumatic dilatation as initial therapy for idiopathic achalasia: an 18-year single-centre experience. Aliment Pharmacol Ther. 2013 Jun. 37(12):1210-9. [Medline].

  34. Reynoso JF, Tiwari MM, Tsang AW, Oleynikov D. Does illness severity matter? A comparison of laparoscopic esophagomyotomy with fundoplication and esophageal dilation for achalasia. Surg Endosc. May 2011. 25(5):1466-71. [Medline].

  35. Sweet MP, Nipomnick I, Gasper WJ, Bagatelos K, Ostroff JW, Fisichella PM, et al. The outcome of laparoscopic Heller myotomy for achalasia is not influenced by the degree of esophageal dilatation. J Gastrointest Surg. Jan 2008. 12 (1):159-65. [Medline].

  36. Cowgill SM, Villadolid D, Boyle R, Al-Saadi S, Ross S, Rosemurgy AS 2nd. Laparoscopic Heller myotomy for achalasia: results after 10 years. Surg. Endosc. Dec 2009. 23 (12):2644-9. [Medline].

  37. Patti MG, Pellegrini CA, Arcerito M, Tong J, Mulvihill SJ, Way LW. Comparison of medical and minimally invasive surgical therapy for primary esophageal motility disorders. Arch Surg. Jun 1995. 130 (6):609-15; discussion 615-6. [Medline].

  38. Boeckxstaens GE, Annese V, des Varannes SB, et al. Pneumatic dilation versus laparoscopic Heller's myotomy for idiopathic achalasia. N Engl J Med. May 2011. 364(19):1807-16. [Medline].

  39. West RL, Hirsch DP, Bartelsman JFWM, de Borst J, Ferwerda G, Tytgat GNJ, et al. Long term results of pneumatic dilation in achalasia followed for more than 5 years. Am J Gastroenterol. Jun 2002. 97 (6):1346-51. [Medline].

  40. Patti MG, Feo CV, Arcerito M, De Pinto M, Tamburini A, Diener U, et al. Effects of previous treatment on results of laparoscopic Heller myotomy for achalasia. Dig Dis Sci. Nov 1999. 44(11):2270-6. [Medline].

  41. Smith CD, Stival A, Howell DL, Swafford V. Endoscopic therapy for achalasia before Heller myotomy results in worse outcomes than heller myotomy. Ann Surg. May 2006. 243(5):579-84; discussion 584-6. [Medline].

  42. Katz PO, Gilbert J, Castell DO. Pneumatic dilatation is effective long-term treatment for achalasia. Dig Dis Sci. Sep 1998. 43(9):1973-7. [Medline].

  43. Eckardt VF, Gockel I, Bernhard G. Pneumatic dilation for achalasia: late results of a prospective follow-up investigation. Gut. May 2004. 53 (5):629-33. [Medline].

  44. Hungness ES, Teitelbaum EN, Santos BF, Arafat FO, Pandolfino JE, Kahrilas PJ, et al. Comparison of Perioperative Outcomes Between Peroral Esophageal Myotomy (POEM) and Laparoscopic Heller Myotomy. J Gastrointest Surg. Feb 2013. 17 (2):228-35. [Medline].

  45. Gelfond M, Rozen P, Gilat T. Isosorbide dinitrate and nifedipine treatment of achalasia: a clinical, manometric and radionuclide evaluation. Gastroenterology. Nov 1982. 83(5):963-9. [Medline].

  46. Nassri A, Ramzan Z. Pharmacotherapy for the management of achalasia: Current status, challenges and future directions. World J Gastrointest Pharmacol Ther. 2015 Nov 6. 6 (4):145-55. [Medline].

Barium swallow demonstrating the bird-beak appearance of the lower esophagus, dilatation of the esophagus, and stasis of barium in the esophagus.
Manometric evaluation of the esophagus in a patient with achalasia. Pertinent findings include absence of propulsive peristalsis in the body of the esophagus (note simultaneous contractions), elevated resting lower esophageal sphincter (LES) pressure, and the absence of LES relaxation.
Heller myotomy extending 1.5 cm onto the gastric wall.
Dor fundoplication, left row of sutures (after division of short gastric vessels).
Completed Dor fundoplication.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.