What is the best primary therapy for achalasia: medical or surgical treatment? Who owns achalasia?

This article reviews the medical and surgical modalities for the treatment of esophageal achalasia. It compares and critically analyzes the short- and long-term outcomes of pneumatic dilatation and laparoscopic Heller myotomy. Today, laparoscopic Heller myotomy is considered in most centers to be the procedure of choice for the treatment of achalasia. Nevertheless, the success of either procedure is based on the careful selection of the patients and on the surgeon's and gastroenterologist's level of expertise.