Achalasia is a primary motor disorder of the esophagus, in which esophageal emptying is impaired. Diagnosis of
achalasia is based on clinical findings. The diagnosis is confirmed by radiographic, endoscopic, and manometric evaluations. Several treatments for
achalasia have been introduced. We searched the PubMed Database for original articles and meta-analyses about
achalasia to summarize the current knowledge regarding this disease, with particular focus on different procedures that are used for treatment of
achalasia. We also report the Iranian experience of treatment of this disease, since it could be considered as a model for medium-resource countries.
Myotomy, particularly laparoscopic
myotomy with
fundoplication, is the most effective treatment for
achalasia. Compared to other treatments, however, the initial cost of
myotomy is usually higher and the recovery period is longer. When performing
myotomy is not indicated or not possible, graded pneumatic dilation with slow rate of balloon inflation seems to be an effective and safe initial alternative. Injection of
botulinum toxin into the lower esophageal sphincter before pneumatic dilation may increase remission rates. However, this needs to be confirmed in further studies. Due to lack of adequate information regarding the role of expandable
stents in the treatment of
achalasia, insertion of
stents does not currently seem to be a recommended treatment. In summary, laparoscopic
myotomy can be considered as the procedure of choice for treatment of
achalasia. Graded pneumatic dilation is an effective alternative when the performance of
myotomy is not possible for any reason.