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.