I have a condition called achalasia. I even have problems swallowing liquids. I have had my esophageal muscle dilated twice. The first time, I saw improvement for six or seven years. The next time it only lasted about three years. Is there anything else I can do instead?

Loretta

Achalasia is a rare disorder that causes trouble swallowing both solids and liquids. The symptoms occur because the lower esophageal sphincter -- the muscular connection between the esophagus and the stomach -- fails to adequately open (relax) with swallowing. In addition, the body of the esophagus loses its ability to contract effectively, and so is less efficient a moving food down toward the stomach. The cause is unknown, though rarely it may occur in association with a tumor or other systemic condition.

Treatment, which is 85-90 percent effective, is aimed at reducing the pressure on the lower esophageal sphincter. This can be done by dilation to widen the opening (as you have had) or with an operation called myotomy in which the surgeon reduces the pressure in the muscle by making an incision in its outer layer. This operation can be performed using laparoscopy (as we now do routinely for gallbladder surgery), but it requires experience. Each treatment is equally effective.

In your case, if the second dilation was performed by an expert in achalasia, it may be time to consider surgery. There are some patients who obtain improvement with an injection of botulinum toxin, but this is usually short-term. In my experience, the 85-90 percent success rate is accurate, so if one treatment is unsuccessful, ask your doctor to refer you for another evaluation and opinion. Your swallowing should improve.