Purpose of review: Achalasia is a chronic esophageal motility disorder characterized by incomplete lower esophageal sphincter relaxation and aperistalsis resulting in delayed esophageal emptying. Management is aimed at palliation of symptoms and improvement in quality of life. Multiple factors including demographics, severity of disease, and existing comorbidities influence management options.
Recent findings: Given its low rates of complications, surgical myotomy has become the preferred primary treatment, particularly in young males. However, recent studies describing favorable long-term outcomes for pneumatic dilation make this a reasonable option to consider as first-line therapy for achalasia.
Summary: Pneumatic dilation and surgical myotomy are the most effective therapeutic options for achalasia. Depending on local expertise, either option is acceptable as first-line therapy. There continues to be a limited role for other treatment modalities such as pharamacologic agents and botulinum toxin in certain patient populations.