title: Controversies in management of achalasia.
abstract: BACKGROUND
  Esophageal achalasia is a primary motility disorder of unknown etiology. It is characterized by lack of esophageal peristalsis and failure of the lower esophageal sphincter to relax appropriately in response to swallowing. The goal of treatment is to improve esophageal emptying and patient's symptoms by decreasing the functional obstruction at the level of the gastroesophageal junction. This can be accomplished by either endoscopic modalities (intra-sphincteric injection of botulinum toxin, pneumatic dilatation, per oral endoscopic myotomy) or by a laparoscopic Heller myotomy.
  
  
  RESULTS
  Review of the current literature suggests that a laparoscopic Heller myotomy should be considered today the primary form of treatment for achalasia and recommends a treatment algorithm for this disease.
authors: Department of Surgery, Center for Esophageal Diseases, Pritzker School of Medicine, University of Chicago, 5841 S. Maryland Ave, MC 5095, Room G-207, Chicago, IL, 60637, USA, mpatti@surgery.bsd.uchicago.edu.
authors: Marco G
authors: MG
authors: Patti
authors: Piero M
authors: PM
authors: Fisichella
mesh_terms: D065087:Acetylcholine Release Inhibitors / Q000008:administration & dosage; D001905:Botulinum Toxins / Q000008:administration & dosage; D004106:Dilatation; D004931:Esophageal Achalasia / Q000628:therapy*; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D004945:Esophagoscopy; D006801:Humans; D007273:Injections, Intramuscular
chemical_list: D065087:Acetylcholine Release Inhibitors; D001905:Botulinum Toxins