This treatment can cause an inflammatory reaction at the level of the gastroesophageal junction, making a subsequent myotomy very difficult. This treatment should be used in elderly patients who are poor candidates for dilatation or surgery. Pneumatic dilatation by a qualified gastroenterologist is the recommended treatment. A balloon is inflated at the level of the gastroesophageal junction to blindly rupture the muscle fibers while leaving the mucosa intact. If a perforation occurs, emergency surgery is needed to close the perforation and perform a myotomy.
Heller myotomy is the appropriate treatment for patients in whom pneumatic dilatation fails.
Because of excellent results, short hospital stay, and fast recovery time, a laparoscopic Heller myotomy and partial fundoplication is considered the primary treatment. Patients remain hospitalized for 24-48 hours and return to regular activities in about 2 weeks. Calcium channel blockers - These agents interfere with calcium uptake by smooth muscle cells that are dependent on intracellular calcium for contraction. They have a relaxant effect on the LES muscle. Nitrates - These agents relax vascular smooth muscle.