Botulinum toxin and pneumatic dilation in the treatment of achalasia

Achalasia is an esophageal motility disorder characterized by complete absence of peristalsis in the esophageal smooth muscle and a functional esophagogastric junction outflow obstruction. Treatment is directed at improving this outflow obstruction with the goal of improving symptoms in an incurable disease. Multiple treatment options are available to meet this goal. Long-term success can be achieved with effective use of endoscopic pneumatic dilation. In the appropriate patient, botulinum toxin injection can afford short-term relief. This review addresses the use of and techniques for performing these therapies as treatment for achalasia.