Assessment and treatment choices
Achalasia is a defined motility disorder. Assessment generally uses the symptom history, endoscopy to exclude other causes, and tests such as oesophageal manometry; imaging may also be needed. Similar symptoms can arise from other conditions, so a diagnosis should be established before choosing a treatment.
Guidance describes botulinum toxin mainly as an option for people with achalasia who are not fit for more definitive therapies, or in selected circumstances after discussion. For people able to undergo definitive treatment, options such as pneumatic dilation, Heller myotomy or POEM may offer more durable relief; the best choice depends on the clinical situation and patient preferences.
How injection is given
The injection is delivered through an endoscope, often with sedation or anaesthesia. Several small injections are placed into the sphincter muscle. The exact plan, setting, fasting instructions and recovery advice come from the treating team; do not use another person’s instructions.
Swallowing may improve, but response and duration vary. Relief is often short-lived and symptoms can return, so further injections or another treatment may later be considered. Botulinum toxin relaxes muscle rather than opening a persistent narrowing mechanically.
Benefits, limits and choices
Endoscopy and injection can cause chest discomfort, reflux, bleeding, infection or, rarely, perforation; sedation or anaesthesia has its own risks. Discuss allergies, medicines, pregnancy, prior procedures and heart or lung conditions with the team.
Ask what diagnosis is being treated, what outcome is realistic, how long benefit may last, whether repeat treatment is likely, and how this option compares with dilation or myotomy. Seek urgent help for severe chest pain, fever, breathing difficulty or inability to swallow liquids after a procedure.
Professional guidance
Related conditions
A related condition does not mean this procedure is suitable; decisions require individual assessment.