Which of the following treatments is often used after botulinum toxin in achalasia management?

In the management of achalasia, after administering botulinum toxin to relieve esophageal muscle spasm, nitrates and calcium channel blockers are commonly used as additional treatments. These medications help to reduce the pressure in the lower esophageal sphincter (LES) and improve the ability to swallow by promoting relaxation of the smooth muscle.

Nitrates work by vasodilation, which can also help relax the sphincter muscle, while calcium channel blockers decrease intracellular calcium levels, further aiding in muscle relaxation. Together, these mechanisms can provide symptomatic relief for patients suffering from achalasia after the initial effect of botulinum toxin, which temporarily paralyzes the affected muscle.

In contrast, other options like nonsteroidal anti-inflammatory drugs, corticosteroids, and opioid medications do not address the specific motility issues of achalasia and are therefore not standard follow-up treatments after botulinum toxin injection. Nonsteroidal anti-inflammatory drugs are primarily used for pain relief and inflammation, corticosteroids are more suited for inflammatory conditions, and opioids can slow gut motility and would generally exacerbate the symptoms of achalasia, rather than alleviate them.