Treatment options for Achalasia

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The type of treatment you receive depends on the type of achalasia you have. You can discuss the options with your specialist.

Please note: The Kimble Clinic does not offer POEM (Peroral Endoscopic Myotomy). If POEM is appropriate, your consultant can refer you to Dr Rami Sweis in London who performs this procedure.

Pneumatic Dilatation (Balloon)

• A balloon stretches the lower oesophageal muscle to help food pass more easily
• Performed under sedation as a day-case procedure
• Soft diet for 2 weeks, then gradually normal diet over 6 weeks
• High-dose anti-acid medication for 2 weeks after procedure
• Often needs to be repeated for long-term benefit

Heller’s Myotomy (Keyhole Surgery)

• Cuts the tight oesophageal muscle via keyhole surgery under general anaesthetic
• Success rate ~90%
• Anti-reflux procedure may be added if required
• Can be performed robotically in some centres

POEM (Peroral Endoscopic Myotomy) – Specialist Centres Only

• Endoscopic procedure cutting the oesophageal muscle from the inside
• Effective symptom relief, but higher risk of reflux
• Long-term outcomes still under study
• Referral to a specialist centre is required. The Kimble Clinic refers to Dr Rami Sweis in London.

Preparing for treatment

Because food clears slowly in achalasia:

• Liquids only for 3 days before surgery
• Clear fluids only in the last 24 hours
• Nothing to eat or drink for 6 hours before surgery

This reduces the risk of lung infection during anaesthesia.

On the day of treatment

• Admitted by the nursing team
• Surgeon and anaesthetist will review the procedure, risks, and answer questions
• You will sign a consent form but may withdraw consent at any time

Possible Complications of treatments

Most patients do not experience serious complications. Your doctor will discuss your individual risk factors and help you choose the most suitable treatment.

Risks of a Heller’s Myotomy (Surgery)

• Mild abdominal or shoulder pain for a few days
• Temporary difficulty swallowing may occur
• Heartburn or reflux is common
• Rare risks: bleeding, injury to the oesophagus, stomach, liver, spleen, bowel, vagus nerve, or lung lining
• Very rare: oesophageal tear requiring further surgery or ICU care, conversion to open surgery, infections, blood clots, or death (approx. 1 in 1,000–1,100)
• Long-term: reflux may persist, and symptoms can recur

Risks of Pneumatic Dilatation (Balloon)

• Mild chest or abdominal discomfort is common
• Heartburn may increase
• Rare risk of oesophageal tear (approx. 5%), which may require emergency surgery
• Symptoms may recur, and repeated dilatation may be necessary
• Very rare: bleeding, infection, blood clots, or death

Risks of POEM (Endoscopic Myotomy)

• Mild chest or abdominal discomfort; usually less than surgery
• Swallowing may take several weeks to improve
• Reflux or heartburn is common, often requiring medication
• Rare risks: bleeding, oesophageal or nearby tissue injury, oesophageal tear requiring repair
• Symptoms may recur, sometimes requiring a repeat procedure
• Very rare: infection, blood clots, or death

After Surgery or Procedure

• Hospital stay: 0 to 2 days for Heller’s myotomy; usually day-case for pneumatic dilatation or POEM
• Diet: Puree → soft → normal over 6 weeks (avoid fizzy drinks)
• Pain relief: Provided on discharge
• Recovery: Normal activities in 6–8 weeks
• Driving: Usually safe after 1 week if comfortable and off strong painkillers

Follow-Up

• Outpatient appointment about 6 weeks after surgery or procedure
• Annual monitoring is required for recurrence of symptoms