Q: I have been diagnosed with achalasia cardia. My first dilation was done a year ago. The symptoms had started appearing a year and half ago. I was doing absolutely fine till a month after dilation, but same symptoms appeared again. Now I have regurgitations, nasal dripping especially at night. I get vomiting after eating all kinds of food. Nicardia doesn't help either. I need to decide whether the second dilation will be safe or should I opt for myotomy. All doctors have varied opinions. Please advise.

A:Approximately 50% patients with achalasia who are treated initially with a single pneumatic dilation will require further therapy within 5 years, and subsequent pneumatic dilations are progressively less likely to result in a sustained remission. Therefore, other forms of therapy should be considered after two or three unsuccessful pneumatic dilations. I suggest a repeat dilatation, with a larger balloon size (the range is 2.4 to 5.0 cm) and if that again results in recurrence, you should consider surgical myotomy.