Pneumatic dilitation and laparoscopic myotomy are the most recommended treatments and have the highest success rates. Medical treatments, including nitrates, calcium channel blockers, and Botox, are recommended for the elderly and those unable to have surgery.Pneumatic dilitation involves inserting an inflatable balloon through the esophagus and using it to stretch and break the LES tissue. This will help the LES not contract as tightly. The procedure has a success rate of over 70%. However, it may need to be performed more than once. There is a risk of tearing the esophagus. If this happens immediate surgery is required to fix it.
Heller myotomy, a laparoscopic procedure, is a minimally invasive surgery in which the muscle fibers of the LES are cut in order to relax the valve. This procedure has a success rate of over 85%, and can provide relief for five or more years.
A non-surgical treatment involves the injection of botulinum toxin (Botox) into the LES. This paralyzes the muscle and then relaxes it. This treatment works well for short-term relief, but after one year less than one-third of patients are free of symptoms. The process can be repeated with good results, but eventually becomes ineffective.
Medications such as nitrates or calcium channel blockers may be prescribed. Nitrates and calcium channel blockers lower the pressure of the LES, but do not relax it. Only about 10% of patients receive relief through this treatment.
