Recurrent achalasia

Achalasia is characterized by impaired LES relaxation and by the lack of peristalsis in the distal esophagus it is accompanied by the loss of myenteric ganglion of the distal esophagus. it is not yet known why myenteric plexuses degenerate. is supposed to be an autoimmune process driven by a viral infection on a genetically vulnerable subject. Heller myotomy achieves a significant improvement in patient signs but 5-year barium surveillance shows relapse is not uncommon and goes up to 90% for the third type. 69% of patients after surgery have at least one symptom after myotomy. The study reviewed the literature for 2013 to 2019 and assessed the role of Redo Heller. Botox Poem and esophagectomy. There are few studies of reintervention after Heller myotomy in patients with achalasia. Therapeutic Dilemma: What to Do After a Heller Myotomy? Balloon? Botox? , Poem? Esophagectomy? 69% of patients after surgery have at least one symptom after myotomy. Reintervention in some studies over 5 years goes up to 62% for the first type, 74% for the second type, and 87% for the third type. After reintervention the chances of reintervention are 50% for the next 2 years. An annual barium survey is recommended. Keywords:Achalasia, myotomy, balloon, esophagotomy.