The last 3 decades have witnessed major progress in the diagnosis and treatment of esophageal achalasia. Today we have 3 excellent treatment modalities to improve the quality of life of patients affected by achalasia: penumatic dilatation, laparsocopic Heller myotomy with partial fundoplication, and per oral endoscopic myotomy (POEM). We feel that the best results are obtained in multidisciplinary centers where expertise in the diagnosis and treatment of esophageal achalasia is present, and treatment can be tailored to the individual patient. The goal of treatment is to improve the patient’s quality of life and avoid an esophagectomy which should be considered as a last resort only after the failure of all the other treatment modalities.