Anticholinergics, nitroglycerin, and long-acting nitrates have had limited success. Pneumatic dilation and bougienage may be helpful. Narcotic analgesics are often needed but may be habit-forming. Medical management is usually sufficient, but surgical myotomy along the full length of the esophagus may be needed in intractable cases. Botulinum toxin injection into the lower esophageal sphincter is a new approach being used for some patients.
Some patients show symptom complexes that fit neither typical achalasia nor typical diffuse spasm.
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