All types of therapy seek to reduce LES pressure to allow for improved esophageal clearance by gravity because the normal swallow is impaired.
Current treatments for achalasia include:
Medications: Smooth muscle relaxants such as calcium channel antagonists, nitraits, and anti-cholinergic agents. Nifedipine and isosorbide dinitrate have also been shown to reduce LES pressure, however the long term effectiveness of the medications may be limited by both side effects and decreased efficiency compared to the more invasive therapies.
Botox injection: Was introduced in 1995 as a therapy for achalasia. Significant benefit has been seen in 2/3rds of the patients treated in this manner, however long term studies have shown that repeated injections are needed to retain relief. If you question your diagnoses this may be an option.
Pneumatic Balloon Dilatation: Provides symptom relief in 70-80% of people. Larger balloon diameters provide greatest response rates but also increase the chance of perferation of the esophagus (which means you are now automatically getting the crack open chest version of myotomy).
Surgical Myotomy: First performed in 1913 by Heller, provides relief for approximately 90%, and can be performed laparoscopically so only should require 1-3 days in hospital.