Therapy of achalasia
1. drug therapy of achalasia: drugs are helpful especially at the beginning of an achalasia disease. The long-term results are rather disappointing. In the case of achalasia, drugs are used to reduce the tension (muscle tone) of the smooth muscles (the muscles of the oesophageal sphincter).
The available preparations, such as calcium antagonists and nitrates, are normally used in blood pressure therapy. These preparations can therefore have strong side effects (dizziness, drop in blood pressure, headaches), which is particularly problematic for patients with already low blood pressure. Since the success (improvement of oesophagus function/better food intake) of the drug therapy of achalasia is limited and at the same time strong side effects for the patient can occur, premature discontinuation of therapy is more frequent.
2. pneumatic dilatation (oesophageal dilatation) in case of achalasia:In oesophageal dilatation (balloon dilatation) a balloon catheter (tube with inflatable balloon end) is advanced into the area of the lower oesophageal sphincter. The sphincter muscle is then irreversibly expanded by the balloon, i.e. permanently dilated. As a result of this manoeuvre, some muscle fibres in the oesophageal sphincter tear and it becomes generally looser.
This type of treatment is successful in 80% of patients, but in 2-3% it leads to a rupture of the oesophagus (perforation). In order to detect this complication as quickly as possible, an X-ray contrast medium examination (pap smear) is always performed after dilatation. A further difficulty of this achalasia therapy is the correct dosage of the dilatation.
Too much stretching can cause excessive relaxation of the oesophageal sphincter. This in turn can cause heartburn. If the distension is permanent, a reflux disease develops with constant backflow of acid gastric juice into the esophagus.
The therapeutic effect of the balloon dilatation lasts for several months to years, then a new dilatation must be performed. The temporary therapeutic success of balloon dilatation is less in children and adolescents than in adults. 3. injection of botulinus toxin (Botox /BTX) in the case of achalasia: In this therapy, the diluted nerve toxin (neurotoxin) botulinus toxin is injected into the lower oesophageal sphincter during an endoscopy of the oesophagus.
The nerve toxin leads to a long-lasting muscle relaxation and thus to a better transport of food into the stomach. Depending on the stage of the disease, the improvement of symptoms lasts for about 6-12 months, after which the therapy must be repeated. 4 Laparoscopic cardiomyotomy for achalasia: This procedure is used especially in younger patients (< 25 years) with achalasia, or in patients where other therapies have failed.
During the operation, the lower esophageal sphincter is split lengthwise, thereby eliminating the tightness it causes. Achalasia surgery is performed by means of laparoscopy, i.e. several small incisions are made in the abdomen through which a camera and various special instruments are inserted. This type of surgery is also known as minimally invasive surgery because large skin incisions and abdominal openings are no longer necessary. The surgeon orientates himself by means of the image material, which the camera he controls transmits to a monitor in the operating room.
