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As a result, patients typically experience dysphagia, regurgitation, chest pain, and weight loss. Over the past 10\u201315\u2009years, there has been a resurgence of interest in the evaluation of therapies for achalasia. Unfortunately, little progress in the development of effective pharmacological treatments has been made. Botulinum toxin injection provides some relief of symptoms in many patients but requires periodic reinjection that may provide progressively less benefit over time. There are now three well\u2010established, safe, and effective therapies for the treatment of achalasia: pneumatic dilation (PD), laparoscopic Heller myotomy (LHM), and peroral endoscopic myotomy (POEM) which can lead to marked symptom improvement in most patients. Each treatment has a specific constellation of risks, benefits, and recurrence rate. The first\u2010line treatment used will depend on patient preference, achalasia subtype, and local expertise. The recent impressive advances in both the art and science of achalasia therapy are explored with a comprehensive review of the various treatment modalities and comparative controlled clinical trials. In addition, key technical pearls of the procedural treatments are demonstrated.<\/jats:p>","DOI":"10.1111\/nmo.14459","type":"journal-article","created":{"date-parts":[[2022,9,25]],"date-time":"2022-09-25T13:01:01Z","timestamp":1664110861000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Achalasia: Current therapeutic options"],"prefix":"10.1111","volume":"35","author":[{"given":"Sebastien","family":"Rolland","sequence":"first","affiliation":[{"name":"Division of Gastroenterology H\u00f4pital Maisonneuve\u2010Rosemont and Universit\u00e9 de Montreal  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Paterson","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and GI Diseases Research Unit Queen's University  Kingston Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4543-5580","authenticated-orcid":false,"given":"Robert","family":"Bechara","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and GI Diseases Research Unit Queen's University  Kingston Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,9,25]]},"reference":[{"key":"e_1_2_7_2_1","first-page":"261","article-title":"Achalasia in Zimbabwean blacks","volume":"67","author":"Stein CM","year":"1985","journal-title":"S Afr Med J"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2982.2010.01511.x"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2016.08.030"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2008.07.022"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1052-5157(18)30069-2"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.31.1.17"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(86)90869-3"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1023\/a:1018893206926"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1937.00170190109007"},{"key":"e_1_2_7_11_1","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1093\/oxfordjournals.qjmed.a067169","article-title":"Achalasia of the cardia: pharmacology and histopathology of isolated cardiac sphincteric muscle from patients with and without achalasia","volume":"38","author":"Misiewicz JJ","year":"1969","journal-title":"Q J Med"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2559.1999.035005445.x"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.33.2.150"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-199404000-00001"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1053\/gast.1996.v111.pm8780569"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12711"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2036.1999.00645.x"},{"key":"e_1_2_7_18_1","first-page":"1259","article-title":"The role of nifedipine therapy in achalasia: results of a randomized, double\u2010blind, placebo\u2010controlled study","volume":"84","author":"Traube M","year":"1989","journal-title":"Am J Gastroenterol"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01318193"},{"key":"e_1_2_7_20_1","first-page":"379","article-title":"Isosorbide dinitrate or nifedipine: which is preferable in the medical therapy of achalasia?","volume":"26","author":"Bortolotti M","year":"1994","journal-title":"Ital J Gastroenterol"},{"key":"e_1_2_7_21_1","first-page":"1093","article-title":"Use of isosorbide dinitrate for the symptomatic treatment of patients with Chagas' disease achalasia. 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