What do you recommend for esophageal achalasia?

Hard question: Although there is no definite cure, several therapies have been shown to be effective - dilation of the esophagus, certain medications such as nitroglycerine, Nifedipine may be helpful and finally if all fails, especially esophageal dilations, surgery.

Surgery: For healthy patients, surgery (heller myotomy) is the best and most long-lasting treatment. Alternatives include endoscopic dilation and Botox injection at the lower esophageal sphincter. While these can also work, their effect is typically short-lived.

Depends: Endoscopic balloon dilation is less invasive, but slightly more risky and less effective than surgical myotomy. There is a new endoscopic method for myotomy called per oral endoscopic myotomy (poem) being done in a few centers in the us.