The present-day treatment of achalasia is palliative and is aimed at reducing the lower esophageal sphincter pressure. Drug therapy with nitrates and nifedipine is beneficial for short-term relief in patients with relatively mild symptoms or as a temporary measure before a more definitive form of therapy. Balloon dilatation is the traditional non-surgical treatment of achalasia. Balloon dilatation is a safe procedure that can be used even when the esophagus is widened and tortuous, or when the patient is cachectic. The method of balloon dilatation used by the authors is described in detail. The immediate and late clinical, manometric and radiographic results of such dilatation are excellent and compare favorably with those of surgery. With balloon dilatation improvement is immediate, complications are rare and the risks are low. Morbidity and costs and the occurrence of stenosing reflux are considerably less than after surgical cardiomyotomy. Balloon dilatation is considered the treatment of choice for most patients with achalasia.