Achalasia: Drug Therapy

Therapy goals

  • Removal of the obstacle to passage
  • Decrease muscle tone (muscle tension) of the esophageal muscles (muscles of the esophagus).
  • Symptomatic therapy

Therapy recommendations

  • Note: Drug therapy of halal them plays only a very minor role.
  • The results of drug therapy in the context of achalasia are unsatisfactory and the side effects too burdensome. Drug therapy (see below) is therefore used only in mild forms of achalasia or in patients who refuse invasive therapy or for whom invasive therapy is out of the question because of poor physical condition.
  • To relax the lower esophageal sphincter (LES) serve: Calcium antagonists (e.g., nifedipine) or nitrates (isosorbide dinitrate/ISDN), but controlled studies are lacking regarding nitrates!
    • Taken approximately 15-30 minutes before food intake (10-20 mg sublingually (under the tongue) before meals).
    • Disadvantage: short effectiveness
    • Cave: long-term therapy with nifedipine (calcium antagonist) to lower lower esophageal sphincter (LES) pressure is not recommended due to poor long-term outcomes.
  • Injection of botulinum toxin (so far no significance for standard therapy).