Achalasia: Botulinum Toxin Injection or Balloon Dilation?

If a diagnosed swallowing problem has made shared meals difficult, the first treatment conversation may feel urgent. Ask the specialist to explain the options in terms of your diagnosis and health. Keep the questions you still have beside the proposed procedure name.

The injection can wear off

UCLH describes injecting botulinum toxin into the lower esophageal sphincter during endoscopy. This muscle normally opens to let food and drink reach the stomach. The injection aims to make passage easier, but its effect can fade and treatment may need repeating.¹

The ACG guideline recommends botulinum toxin for people with achalasia who are unfit for more definitive treatments. Ask why it is being proposed for you and what the team would review if swallowing becomes difficult again.²

Balloon dilation has a different risk discussion

Pneumatic dilation stretches the sphincter using a balloon. UCLH explains that more than one session may be needed and that bleeding or a tear in the esophagus is possible. Discuss the recovery plan and who will help if a complication occurs.¹

The ACG guideline describes balloon dilation as providing better long-term relief than botulinum toxin, based on comparative trials. It also stresses that candidates must be able to undergo surgery if a perforation needs repair. Longer-lasting relief therefore needs to be weighed against individual suitability.²

Ask how this fits the full treatment plan

These are two options within a broader discussion. The ACG guideline also describes muscle-cutting procedures, including Heller myotomy and POEM, and notes that the achalasia subtype can affect treatment choice. Ask which options fit your test results and health history.²

Confirm the preparation instructions for your own procedure, including fasting and whether someone must take you home. UCLH describes specific preparation for achalasia and an escort requirement when endoscopy uses sedation. Tell the team if either arrangement is difficult.¹

After dilation, severe chest pain, with or without fever, needs urgent contact with the treating team because a delayed tear is possible. Get the emergency contact instructions before leaving.²

Bloated by Dinner includes a visit script. Use it to organize digestive questions alongside the specialist’s swallowing-treatment plan. See the book.