ACHALASIA THERAPY

Therapy for achalasia

1. Drug therapy of the Achalasia :
Medication are mainly helpful at the beginning of achalasia disease. The long-term results are rather disappointing. For use with a Achalasia come drugs that reduce the tension (Muscle tone) of the smooth muscles (muscles of the esophageal sphincter). The available preparations, such as Calcium antagonists and nitrates are usually used in blood pressure therapy. These preparations can therefore have strong side effects (dizziness, Drop in blood pressure, a headache), which is particularly problematic in patients with already low blood pressure.

Since the success (improvement of the function of the esophagus / better food intake) of drug therapy for achalasia is limited and at the same time severe side effects can arise for the patient, treatment is more often discontinued.

2. Pneumatic dilatation (widening of the esophagus) in one Achalasia:
When the esophagus dilates (Balloon dilatation) a balloon catheter (tube with an inflatable balloon end) is advanced into the area of the lower esophageal sphincter. The sphincter is then irreversibly expanded by the balloon, i.e. widened over the long term. Some of them tear through this maneuver muscle fibers in the esophageal sphincter and it becomes looser overall. This type of treatment is successful in 80% of patients, but in 2-3% it leads to a tear in the esophagus (perforation). In order to identify this complication as quickly as possible, an X-ray contrast medium examination (swallowing of porridge) is always carried out after the dilation.

Another difficulty with this achalasia therapy is the correct dosage of stretching. Excessive stretching can cause the esophageal sphincter to slacken excessively. This in turn can cause heartburn. In permanent persistence with constant reflux of acidic gastric juice into the esophagus, a develops Reflux disease.

The therapeutic effect of balloon dilatation lasts for a few months or years, after which a new dilatation must be performed. The therapeutic success of balloon dilatation, which is limited in time, is less in children and adolescents than in adults.

3. Injection of botulinum toxin (Botox / BTX) with a Achalasia:
In this therapy, the diluted neurotoxin (neurotoxin) is removed with an injection needle during an endoscopy of the esophagus. Botulinum toxin Injected (injected) into the lower esophageal sphincter. The nerve poison leads to long-lasting muscle relaxation and thus better food transport into the stomach. The improvement in symptoms lasts for about 6-12 months, depending on the stage of the disease in which it is carried out, after which the therapy must be repeated.

4. Laparoscopic cardiomyotomy in one Achalasia:
This procedure is especially used in younger patients (<25 years) with achalasia, or in patients in whom other therapies have failed. During the operation, the lower esophageal sphincter is split lengthways, thereby removing the tightness it has caused.

The operation one Achalasia is performed using a laparoscopy, which means that several small incisions are made on the abdomen through which a camera and various special instruments are inserted. This type of operation is also called minimally invasive surgery referred to because large skin incisions and openings in the abdominal cavity are no longer necessary. The surgeon uses the image material to orient himself, which the camera he controls transmits to a monitor in the operating room.