Several theories on the etiology and pathophysiology of achalasia have been reported but, to date, it is widely accepted that loss of peristalsis and absence of swallow-induced relaxation of the lower esophageal sphincter are the main functional abnormalities.
Treatment of achalasia often aims to alleviate the symptoms of achalasia and not to correct the underlying disorder.
Medical therapy has poor efficacy, so patients who are good surgical candidates should be offered either laparoscopic myotomy or pneumatic balloon dilatation.
Their own preference should be included in the decision-making process, and treatment should meet the local expertise with these procedures.
Laparoscopic surgical esophagomyotomy is a safe and effective modality.
It can be considered as initial management or as secondary treatment if the patient does not respond to less invasive modalities.
Pneumatic dilatation has proven to be a safe, effective, and durable modality of treatment when performed by experienced individuals, and appears to be the most cost-effective alternative.
For patients with multiple comorbidities and for elderly patients, who are not good surgical candidates, endoscopic injection of botulinum toxin should be considered a safe and effective procedure.
However, its positive effect diminishes over time, and the need for multiple repeated sessions must be taken into consideration.
In the management of patients with achalasia, nutritional aspects play an important role.
When lifestyle changes are insufficient, it is necessary to proceed to percutaneous gastrostomy under radiological guidance.
In the future, intraluminal myotomy or endoscopic mucosectomy will possibly be an option.
Further studies are needed to investigate the role of immunosuppressive therapies in those cases in which an autoimmune etiology is suspected.
KOSA’s Understanding & Treatment
Unhealthy stomach and liver are the root problems.
On July 20, 2013, an acquaintance called me to ask me to visit his home to treat his mother in law who is 105 years old.
He told me that she had not been able to swallow anything including water for 24 hours.
He used a word, choke to explain her symptom, which was that water and any form of food get stuck in her esophagus and she ended up throwing up.
While I was stepping into his house, he was talking with a physician over the phone.
He told me that the physician told him that there is no remedy for conventional medicine for that kind of symptom.
She was not able to swallow anything even including water for 24 hours and I started to treat her with fostering large intestine, which was Ascetic Saahm’s formula #1 and added subduing points of KI2, ST41, SP2, BL60, and LR2.
10 minutes after all the needles have been inserted and manipulated, I asked her to try to drink water and she did not have any problem with drinking.
After removing all needles I asked her to eat dinner and she did not have any problem at all either.
Until she died a year later, she had never had achalasia again.
Based on Ascetic Saahm’s formula #1, fostering large intestine, subdue ST41 and LR2.
The treatment described in the above testimonial was modified to treat her other conditions at once.
If the patient had overlapping conditions they need to be treated at once and of course, the treatment needs to be changed accordingly.