{
  "schemaVersion": 2,
  "eyebrow": "Gastroenterology",
  "title": "Achalasia",
  "summary": "Confirm suspected achalasia with high-resolution manometry after excluding mechanical obstruction, then select pneumatic dilation, laparoscopic Heller myotomy with fundoplication, or POEM by subtype, anatomy, reflux tradeoff, prior therapy, and local expertise.",
  "seoDescription": "Physician guide to diagnosing achalasia, excluding pseudoachalasia, selecting POEM, Heller myotomy, or pneumatic dilation, and managing recurrence.",
  "clinicalQuestion": "How should physicians confirm achalasia, exclude pseudoachalasia, choose definitive therapy, and evaluate persistent symptoms after treatment?",
  "specialty": "Gastroenterology",
  "audience": "U.S. physicians and medical trainees",
  "tags": [
    "achalasia",
    "high-resolution manometry",
    "POEM",
    "pneumatic dilation",
    "Heller myotomy",
    "pseudoachalasia",
    "Eckardt score"
  ],
  "keyTakeaways": [
    "Perform upper endoscopy in suspected achalasia to exclude an obstructing mass causing pseudoachalasia; retained saliva and a puckered gastroesophageal junction are supportive findings, not confirmatory tests. [13][15]",
    "High-resolution manometry is the diagnostic gold standard and identifies the achalasia subtype that informs treatment selection. [13][15]",
    "For type I or II achalasia, POEM, laparoscopic Heller myotomy, and pneumatic dilation are effective definitive options; select through shared decision-making that includes expertise, retreatment expectations, and postprocedure reflux risk. [13][19]",
    "Prefer POEM for type III achalasia because conventional Heller myotomy and pneumatic dilation have historically had less successful outcomes in this spastic subtype. [17][19]",
    "Do not use botulinum toxin as routine durable therapy when the patient can undergo definitive treatment; its benefit commonly lasts only months. [5]",
    "Recurrent dysphagia after myotomy or dilation requires objective reassessment for residual outflow obstruction, reflux-related injury, progressive dilation, or an alternative diagnosis rather than empiric repeat intervention. [13][19]"
  ],
  "sections": [
    {
      "id": "confirm-the-diagnosis",
      "eyebrow": "Diagnosis",
      "heading": "Confirm achalasia and exclude pseudoachalasia before LES-directed therapy",
      "intro": "Do not treat a manometric pattern as idiopathic achalasia until structural obstruction has been assessed.",
      "paragraphs": [
        "Obtain esophagogastroduodenoscopy in every patient with suspected achalasia before definitive therapy. A retained saliva-filled esophagus and a puckered, tightly closed gastroesophageal junction support the diagnosis, but the critical procedural purpose is exclusion of pseudoachalasia from an obstructing mass. [13][15]",
        "Confirm primary achalasia with high-resolution manometry (HRM): impaired esophagogastric junction relaxation together with absent organized esophageal peristalsis establishes the diagnosis. HRM is the current gold standard and separates clinically relevant subtypes. [5][13][15]",
        "Use a timed barium esophagram when HRM is equivocal, when anatomy needs characterization before intervention, or when symptoms recur after therapy. In a symptomatic patient, aperistalsis, esophageal dilation, and distal \"bird-beak\" narrowing are characteristic radiographic findings. [4][13][14]"
      ],
      "bullets": [
        "Do not label dysphagia as refractory GERD solely because heartburn is present; achalasia can be erroneously diagnosed as gastroesophageal reflux disease. [8]",
        "Treat esophagogastric junction outflow obstruction without absent peristalsis as a separate manometric finding requiring symptom correlation and comprehensive evaluation; evidence for POEM in this setting is limited and should be individualized after less invasive approaches are exhausted. [19]"
      ],
      "subsections": [],
      "table": {
        "caption": "Tests that change the next diagnostic or therapeutic step in suspected achalasia. [4][13][15][19]",
        "columns": [
          "Test",
          "Actionable finding",
          "What it changes"
        ],
        "rows": [
          [
            "Upper endoscopy",
            "Retained saliva with puckered gastroesophageal junction supports achalasia; obstructing lesion raises pseudoachalasia. [13][15]",
            "Exclude mechanical obstruction before LES-disrupting therapy; investigate a detected mass rather than proceeding directly to dilation or myotomy. [15]"
          ],
          [
            "High-resolution manometry",
            "Impaired EGJ relaxation plus absent organized peristalsis confirms achalasia and identifies subtype. [5][13][15]",
            "Use subtype in procedure selection; type III favors POEM. [15][19]"
          ],
          [
            "Timed barium esophagram",
            "Dilated, aperistaltic esophagus with distal bird-beak narrowing in a symptomatic patient. [4][14]",
            "Defines anatomic retention and provides an objective comparator when evaluating post-treatment symptoms. [13]"
          ]
        ]
      }
    },
    {
      "id": "select-definitive-therapy",
      "eyebrow": "Definitive treatment",
      "heading": "Choose LES-disrupting therapy by subtype, durability, reflux risk, and procedural context",
      "intro": "All established therapies are palliative and reduce outflow resistance at the nonrelaxing lower esophageal sphincter.",
      "paragraphs": [
        "For treatment-naive type I or II achalasia, offer pneumatic dilation (PD), laparoscopic Heller myotomy (LHM), or peroral endoscopic myotomy (POEM) as definitive options. The selection should explicitly weigh patient preference, local procedural expertise, anticipated need for retreatment, and risk of postprocedural reflux. [13][19]",
        "POEM is the preferred treatment for type III achalasia. Its endoscopic myotomy can be extended to address the spastic esophageal segment, whereas outcomes with conventional LHM and PD have historically been more limited in type III disease. [17][19]",
        "When LHM is selected, perform an anterior fundoplication with the myotomy. This operative approach is intended to relieve dysphagia while mitigating the reflux consequence of an unopposed surgical myotomy. [3][10]",
        "Discuss reflux explicitly when choosing POEM. Comparative evidence shows more post-treatment GERD symptoms and more endoscopic esophagitis after POEM than after LHM; in a large randomized comparison, the odds ratio for endoscopic esophagitis at 24 months was 2.00. [10] Post-POEM reflux may be endoscopic rather than symptom-detected, so absence of heartburn does not exclude clinically relevant reflux injury. [10][19]"
      ],
      "bullets": [
        "Reserve endoscopic botulinum toxin injection for patients who cannot undergo definitive therapy or require temporary palliation; it is generally safe, but response is transient, commonly lasting several months. [5]",
        "Pharmacologic therapy is not a durable substitute for LES-disrupting treatment. Available options include pharmacotherapy, botulinum toxin injection, PD, LHM, and POEM, but definitive mechanical therapies provide durable palliation for appropriate candidates. [5][16]",
        "Use the Eckardt score to standardize symptom burden and clinical response across visits; it sums dysphagia, regurgitation, chest pain, and weight loss on a 0-to-12 scale. [5][15]"
      ],
      "subsections": [],
      "table": {
        "caption": "Practical selection among established achalasia interventions. [5][10][13][17][19]",
        "columns": [
          "Intervention",
          "Best-fit clinical context",
          "Key tradeoff"
        ],
        "rows": [
          [
            "POEM",
            "Preferred for type III achalasia; also an effective option for type I or II disease. [17][19]",
            "Higher postprocedure GERD symptoms and endoscopic esophagitis than LHM in comparative studies; arrange reflux surveillance. [10][19]"
          ],
          [
            "Laparoscopic Heller myotomy with anterior fundoplication",
            "Effective definitive option for type I or II achalasia when surgical therapy is appropriate. [3][13][19]",
            "Requires laparoscopy but includes an antireflux procedure; comparative data favor lower reflux burden than POEM. [3][10]"
          ],
          [
            "Pneumatic dilation",
            "Effective definitive option for type I or II disease, particularly when an endoscopic, nonmyotomy strategy is preferred. [13][19]",
            "May require repeat treatment; outcomes are less favorable than POEM in some comparisons and are not preferred for type III disease. [7][17][19]"
          ],
          [
            "Botulinum toxin injection",
            "Temporary palliation when definitive treatment is unsuitable. [5]",
            "Effective in about two-thirds of patients but typically lasts only months. [5]"
          ]
        ]
      }
    },
    {
      "id": "manage-failed-therapy",
      "eyebrow": "Persistent or recurrent symptoms",
      "heading": "Re-evaluate objectively before retreatment after dilation or myotomy",
      "intro": "Persistent dysphagia is not synonymous with recurrent LES obstruction.",
      "paragraphs": [
        "For persistent or recurrent dysphagia after PD, LHM, or POEM, reassess symptoms with the Eckardt score and obtain objective testing rather than selecting repeat therapy from symptoms alone. Timed barium esophagram and repeat HRM help identify persistent esophagogastric junction outflow obstruction, while endoscopy evaluates retained contents, inflammatory injury, structural complications, and alternative pathology. [5][13][19]",
        "After failed LHM, POEM is a reasonable salvage option. In a multicenter randomized study with 5-year follow-up after failed LHM, treatment success was 40% with POEM versus 11% with PD; grade B through D reflux esophagitis occurred in 11% and 9%, respectively. [20]",
        "After POEM, actively monitor for GERD, including endoscopic esophagitis. Persistent esophagitis or reflux-like symptoms despite proton pump inhibitor therapy should trigger testing for etiologies other than pathologic acid exposure and adjustment of reflux management rather than assuming inadequate acid suppression is the sole explanation. [19]"
      ],
      "bullets": [
        "Consider residual or inadequate myotomy, recurrent LES obstruction, progressive esophageal dilation, reflux-related injury, and nonachalasia causes when treatment response is incomplete. Objective reassessment determines whether repeat LES therapy is appropriate. [13][19]",
        "Use shared decision-making for salvage treatment; prior intervention, reflux risk, disease anatomy, and local expertise should influence selection between repeat endoscopic, surgical, and dilation-based strategies. [19][20]"
      ],
      "subsections": [],
      "table": {
        "caption": "Post-treatment symptoms: test-directed next steps. [13][19][20]",
        "columns": [
          "Clinical problem",
          "Objective assessment",
          "Management implication"
        ],
        "rows": [
          [
            "Persistent dysphagia after any intervention",
            "Eckardt score, timed barium esophagram, repeat HRM, and endoscopy as indicated. [5][13][19]",
            "Distinguish persistent obstruction from reflux injury, anatomic progression, or another disorder before retreatment. [13][19]"
          ],
          [
            "Failure after laparoscopic Heller myotomy",
            "Confirm ongoing symptom burden and objective abnormality before salvage therapy. [13][20]",
            "POEM produced higher 5-year treatment success than PD in a randomized post-LHM population. [20]"
          ],
          [
            "Esophagitis or reflux symptoms after POEM",
            "Endoscopic assessment and further reflux evaluation when symptoms or esophagitis persist despite PPI therapy. [19]",
            "Optimize reflux control and investigate nonacid or alternative causes when appropriate. [19]"
          ]
        ]
      }
    },
    {
      "id": "long-term-follow-up",
      "eyebrow": "Long-term care",
      "heading": "Monitor treatment response, reflux injury, and progressive esophageal disease",
      "intro": "Follow-up should target dysphagia recurrence and complications created by chronic stasis or LES-disrupting treatment.",
      "paragraphs": [
        "At follow-up, document the Eckardt score and determine whether dysphagia, regurgitation, chest pain, or weight loss has recurred. Pair clinically meaningful symptom recurrence with timed barium esophagram, HRM, and/or endoscopy according to the suspected mechanism rather than using symptoms alone to define procedural failure. [5][13][19]",
        "Maintain particular surveillance for reflux complications after POEM because esophagitis can occur without proportionate reflux symptoms. Persistent esophagitis warrants reassessment and management aimed at demonstrable reflux or an alternate cause. [10][19]",
        "Achalasia is associated with esophageal squamous cell carcinoma, but routine endoscopic cancer screening is not recommended by ACG and ASGE guidance because absolute cancer yield is low; one estimate suggested more than 400 endoscopies would be required to detect one cancer. New progressive symptoms, unexplained weight loss, or suspicious endoscopic findings should instead prompt diagnostic evaluation for malignancy. [6][13]"
      ],
      "bullets": [
        "Do not describe current interventions as curative: PD, LHM, POEM, botulinum toxin, and pharmacologic options palliate symptoms by lowering outflow resistance. [16]",
        "Escalate new or progressive symptoms to endoscopy and objective physiologic/radiographic testing, especially when prior response was durable or when weight loss raises concern for pseudoachalasia or malignancy. [13][15]"
      ],
      "subsections": [],
      "table": {
        "caption": "Follow-up priorities after definitive achalasia treatment. [5][6][10][13][19]",
        "columns": [
          "Follow-up target",
          "Assessment",
          "Action when abnormal"
        ],
        "rows": [
          [
            "Recurrent symptom burden",
            "Eckardt score with targeted timed barium esophagram, HRM, or endoscopy. [5][13][19]",
            "Identify the mechanism before repeating dilation or myotomy. [13][19]"
          ],
          [
            "Post-POEM reflux injury",
            "Symptoms plus endoscopic assessment because esophagitis may not parallel symptoms. [10][19]",
            "Treat and investigate persistent esophagitis or symptoms despite PPI therapy. [19]"
          ],
          [
            "Cancer concern",
            "Diagnostic endoscopy for concerning new findings; do not use routine screening solely for achalasia. [6][13]",
            "Evaluate for esophageal malignancy or pseudoachalasia when clinical concern is present. [13][15]"
          ]
        ]
      }
    }
  ],
  "faq": [],
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  "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.",
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      "snippet": "... EGJ outflow obstruction. A ... Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography.",
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      "snippet": "Hypothesis Laparoscopic Heller myotomy with anterior fundoplication will alleviate the symptoms of achalasia and result in excellent patient satisfaction.",
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      "snippet": "Title: Pharmacologic Therapy in Treating Achalasia - ScienceDirect\n# Pharmacologic Therapy in Treating Achalasia. Author links open overlay panel,. https://doi.org/10.1016/S1052-5157(18)30073-430073-4 \"Persistent link using digital object identifier\")Get rights and content. This article focuses on t",
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      "host": "journals.lww.com",
      "snippet": "Title: Achalasia: A Risk Factor for Esophageal Squamous Cell... : Official journal of the American College of Gastroenterology | ACG\n# Official journal of the American College of Gastroenterology | ACG. Achalasia, a generally rare disorder with an incidence of 0.3 - 1.6/100,000 persons, has classica",
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      "title": "Erroneous Diagnosis of Gastroesophageal Reflux Disease in Achalasia - ScienceDirect",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S1542356511004502",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "### How to select patients for antireflux surgery? The ICARUS guidelines (international consensus regarding preoperative examinations and clinical characteristics assessment to select adult patients for antireflux surgery)\n\n### The pathogenesis and management of Achalasia: Current status and future ",
      "score": 0.5792344
    },
    {
      "number": 9,
      "title": "Extended indications and contraindications for peroral endoscopic myotomy",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S1096288313000351",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "Title: Extended indications and contraindications for peroral endoscopic myotomy\n# Extended indications and contraindications for peroral endoscopic myotomy☆. Peroral endoscopic myotomy (POEM) has proven a remarkably efficacious and safe therapy for patients with typical achalasia in preliminary, sh",
      "score": 0.81665546
    },
    {
      "number": 10,
      "title": "Peroral endoscopic myotomy compared to laparoscopic Heller myotomy and pneumatic dilation in the treatment of achalasia: a systematic review | Diseases of the Esophagus | Oxford Academic",
      "detail": "academic.oup.com",
      "url": "https://academic.oup.com/dote/article/37/1/doad055/7236686",
      "authors": "academic.oup.com",
      "host": "academic.oup.com",
      "snippet": "# Peroral endoscopic myotomy compared to laparoscopic Heller myotomy and pneumatic dilation in the treatment of achalasia: a systematic review *Open Access*. Adam North, Nilanjana Tewari, Peroral endoscopic myotomy compared to laparoscopic Heller myotomy and pneumatic dilation in the treatment of ac",
      "score": 0.72629017
    },
    {
      "number": 11,
      "title": "Efficacy and safety of pneumatic dilation in achalasia",
      "detail": "journals.lww.com",
      "url": "https://journals.lww.com/00043897-201907000-00002",
      "authors": "journals.lww.com",
      "host": "journals.lww.com",
      "snippet": "Long‐term results of the European achalasia trial: a multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy.",
      "score": 0.6698534
    },
    {
      "number": 12,
      "title": "Symptomatic and Physiological Outcomes Following... - Ovid",
      "detail": "journals.lww.com",
      "url": "https://journals.lww.com/surgical-laparoscopy/fulltext/2022/06000/symptomatic_and_physiological_outcomes_following.3.aspx",
      "authors": "journals.lww.com",
      "host": "journals.lww.com",
      "snippet": "Long-term results of the European achalasia trial: a multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy.",
      "score": 0.66045773
    },
    {
      "number": 13,
      "title": "ACG Clinical Guidelines: Diagnosis and Management of Achalasia - PMC",
      "detail": "www.ncbi.nlm.nih.gov",
      "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9896940",
      "authors": "www.ncbi.nlm.nih.gov",
      "host": "www.ncbi.nlm.nih.gov",
      "snippet": "Achalasia is one of the most studied esophageal motility disorders. In this guideline, we address the diagnosis, treatment, and overall management of adult patients with achalasia. This guideline is structured in the format of recommendations, key concepts, and summaries of the evidence. Each recomm",
      "score": 0.6816637
    },
    {
      "number": 14,
      "title": "ACG clinical guideline: diagnosis and management of achalasia - PubMed",
      "detail": "www.ncbi.nlm.nih.gov",
      "url": "https://www.ncbi.nlm.nih.gov/pubmed/23877351",
      "authors": "www.ncbi.nlm.nih.gov",
      "host": "www.ncbi.nlm.nih.gov",
      "snippet": "Title: ACG clinical guideline: diagnosis and management of achalasia - PubMed\nAn official website of the United States government. **The .gov means it’s official.**. Federal government websites often end in .gov or .mil. sharing sensitive information, make sure you’re on a federal. The **https://** ",
      "score": 0.6429039
    },
    {
      "number": 15,
      "title": "An Overview of Achalasia and Its Subtypes - PMC",
      "detail": "pmc.ncbi.nlm.nih.gov",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC5572971",
      "authors": "pmc.ncbi.nlm.nih.gov",
      "host": "pmc.ncbi.nlm.nih.gov",
      "snippet": "to report weight loss compared to patients with type I achalasia. Although achalasia cannot be permanently cured, palliation of symptoms is possible in over 90% of patients with the treatment modalities currently available (pneumatic dilation, Heller myotomy, or peroral endoscopic myotomy). This art",
      "score": 0.42133808
    },
    {
      "number": 16,
      "title": "Achalasia - StatPearls - NCBI Bookshelf - NIH",
      "detail": "www.ncbi.nlm.nih.gov",
      "url": "https://www.ncbi.nlm.nih.gov/books/NBK519515",
      "authors": "www.ncbi.nlm.nih.gov",
      "host": "www.ncbi.nlm.nih.gov",
      "snippet": "Achalasia is a rare esophageal motility disorder characterized by failure of the lower esophageal sphincter to relax and absence of peristalsis in the esophageal body, leading to obstruction at the gastroesophageal junction and progressive dysphagia. The disorder is primarily idiopathic but may also",
      "score": 0.33112025
    },
    {
      "number": 17,
      "title": "Peroral endoscopic myotomy provides effective palliation in type III ...",
      "detail": "www.jtcvs.org",
      "url": "https://www.jtcvs.org/article/S0022-5223(21)00229-4/pdf",
      "authors": "www.jtcvs.org",
      "host": "www.jtcvs.org",
      "snippet": "achalasia outcomes have historically been met with limited success after conventional laparoscopic Heller myotomy (LHM) and pneumatic dilation.",
      "score": 0.6762998
    },
    {
      "number": 18,
      "title": "Life in a world with per oral endoscopic myotomy",
      "detail": "www.jtcvs.org",
      "url": "https://www.jtcvs.org/article/S0022-5223(20)30737-6/fulltext",
      "authors": "www.jtcvs.org",
      "host": "www.jtcvs.org",
      "snippet": "Medium and long-term outcomes after pneumatic dilation or laparoscopic Heller myotomy for achalasia: a meta-analysis. Surg Laparosc Endosc",
      "score": 0.63804686
    },
    {
      "number": 19,
      "title": "Blown-out myotomy: an adverse event of laparoscopic Heller myotomy and peroral endoscopic myotomy for achalasia",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S0016510720346368",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "and esophagitis. All patients should undergo monitoring for gastroesophageal reflux disease after POEM. Patients with persistent esophagitis and/or reflux-like symptoms despite proton pump inhibitor use, should undergo additional testing to evaluate for other etiologies besides pathologic acid expos",
      "score": 0.78413767
    },
    {
      "number": 20,
      "title": "Long-Term Outcomes of Peroral Endoscopic Myotomy vs Pneumatic Dilation After Prior Laparoscopic Heller Myotomy for Achalasia",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/pii/S154235652600234X",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "Title: Long-Term Outcomes of Peroral Endoscopic Myotomy vs Pneumatic Dilation After Prior Laparoscopic Heller Myotomy for Achalasia\n## Clinical Gastroenterology and Hepatology. Image 4: Clinical Gastroenterology and Hepatology. Long-Term Outcomes of Peroral Endoscopic Myotomy vs Pneumatic Dilation A",
      "score": 0.7253574
    },
    {
      "number": 21,
      "title": "Factors Associated With Achalasia Treatment Outcomes: Systematic Review and Meta-Analysis - ScienceDirect",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S1542356519311073",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "### Aliment Pharmacol Ther\n\n### A multicentre randomised study of intrasphincteric botulinum toxin in patients with oesophageal achalasia. GISMAD Achalasia Study Group\n\n### Gut\n\n### Long-term follow-up after pneumatic dilation for achalasia cardia: factors associated with treatment failure and recur",
      "score": 0.7018975
    },
    {
      "number": 22,
      "title": "Peroral endoscopic myotomy versus pneumatic dilation in treatment-naive patients with achalasia: 5-year follow-up of a randomised controlled trial - ScienceDirect",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S2468125322003004",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "### Kaohsiung J Med Sci\n\n### Clinical presentations and complications of achalasia\n\n### Gastrointest Endosc Clin N Am\n\n### Long-term outcome of pneumatic dilation in the treatment of achalasia\n\n### Clin Gastroenterol Hepatol\n\n### Factors associated with achalasia treatment outcomes: systematic revie",
      "score": 0.6578248
    },
    {
      "number": 23,
      "title": "New Trends and Concepts in Diagnosis and Treatment of Achalasia - ScienceDirect",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S2173507713002056",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "### Am J Gastroenterol\n\n### Treatment of achalasia: botulinum toxin injection vs pneumatic balloon dilation. A prospective study with longterm follow-up\n\n### Endoscopy\n\n### Effects of previous treatment on results of laparoscopic Heller myotomy for achalasia\n\n### Dig Dis Sci\n\n### Endoscopic therapy ",
      "score": 0.64344186
    },
    {
      "number": 24,
      "title": "Comparison of Perioperative Outcomes Between Peroral Esophageal Myotomy (POEM) and Laparoscopic Heller Myotomy - ScienceDirect",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S1091255X2306972X",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "### Achalasia: update on the disease and its treatment\n\n### Gastroenterology\n\n### Pneumatic dilation versus laparoscopic Heller’s myotomy for idiopathic achalasia\n\n### The New England Journal of Medicine\n\n### Pneumatic dilatation or laparoscopic cardiomyotomy in the management of newly diagnosed idi",
      "score": 0.5602773
    }
  ],
  "publishedAt": "2026-09-16T00:39:26.756899+00:00",
  "updatedAt": "2026-09-16T00:39:26.756899+00:00",
  "readingMinutes": 4,
  "slug": "achalasia"
}