Introduction: Achalasia is a rare oesophageal motility disorder characterised by oesophageal aperistalsis and incomplete relaxation on swallowing of the lower oesophageal sphincter. This review aims to identify and critique literature detailing the available management options for these patients and provide an up to date account of current thoughts and controversies in the treatment of achalasia. Methods: An extensive literature search was performed for articles and reviews published on the management of achalasia, using Ovid MEDLINE, Cochrane library and PubMed search databases. Results: The management of achalasia is controversial. Simple options such as pharmacological treatments and Botulinum toxin A injections do not provide sufficient relief of symptoms but may serve to treat those not suitable for surgery or dilatation. However, in those who are deemed suitable, the literature suggests that the optimum treatment is laparoscopic transabdominal Heller myotomy which has demonstrated the best long term results with few complications or perforations. Conclusion: It is not possible to treat the underlying cause of achalasia but only to improve symptoms. Whilst the literature may suggest that the Heller myotomy is the best method to achieve this, it is clear that the outcomes are dependent on surgeon or physician technique and experience. It is important therefore that these patients are treated in a specialist centre with experience with such procedures. Recent advances in surgical and endoscopic technologies, with robotic Heller myotomy and per-oral endoscopic myotomy, provide promising progress for the treatment for achalasia
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