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. Author manuscript; available in PMC: 2014 Mar 1.
Published in final edited form as: Gastroenterol Clin North Am. 2013 Jan 4;42(1):27–43. doi: 10.1016/j.gtc.2012.11.002

Table 3. Therapeutic options for spastic disorders.

Therapeutic option Impaired EGJ relaxation (spastic [type III] achalasia) Normal EGJ relaxation (distal esophageal spasm, jackhammer esophagus)
Pharmacologic Phosphodiesterase-5 inhibitors? Nitrates
Phosphodiesterase-5 inhibitors
 Calcium channel blockers
 Peppermint oil
Low-dose antidepressants PPIs
Endoscopic Pneumatic dilation
Toxin botulinum at the EGJ level
POEM		 Botulinum toxin in the esophageal body
Extended POEM?
Surgical Myotomy Extended myotomy?