Treatments for achalasia include oral medications, stretching of the lower esophageal sphincter under endoscopic guidance (endoscopic dilatation), surgery to cut the sphincter (Heller’s Cardiomyotomy), and the injection of botulinum toxin into the sphincter. All four treatments reduce the pressure within the lower esophageal sphincter to allow easier passage of food from the esophagus into the stomach. I would stress that no treatment improves the contraction of the foodpipe. This means only one problem, the lower end not opening on swallowing is addressed in each treatment modality. We still don’t have an answer to the non functioning of the foodpipe muscle. This explains some recurrence that we see with each modality. Patient needs some diet modification after treatment. A newer method of cutting the muscle of LES by endoscopic method called POEM (Per Oral Endoscopic Myotomy) has been developed. This method hold promise for future but is still not fully standardized and accepted.