Background: Achalasia, a rare motility disorder characterized by impaired lower esophageal sphincter relaxation, significantly impacts patients’ quality of life. Pneumatic dilatation (PD) is a cost-effective and minimally invasive treatment, yet long-term prospective data from resource-limited settings remain scarce. This study aimed to evaluate the efficacy of PD in improving health-related quality of life (HRQoL) and patient satisfaction among achalasia patients in a peripheral Pakistani hospital. Materials and methods: A single-center, quasi-experimental study was conducted at Madina Teaching Hospital, Faisalabad, from 2017 to 2021. Eighty patients (mean age: 37.03 ± 10.49 years) diagnosed via high-resolution manometry or barium swallow were enrolled. Pneumatic dilatation was performed under fluoroscopic and endoscopic guidance using 35 and 40 mm balloons. Outcomes were assessed at baseline, 6 months, and 24 months using the Eckardt score and Short Form-8 Health Survey Questionnaire. Statistical analyses included repeated measures analysis of variance, Kaplan-Meier survival analysis, and Spearman’s correlation. Results: Pneumatic dilatation resulted in a 75.1% reduction in Eckardt scores at 24 months (p < 0.001), with sustained symptom relief. Health-related quality of life scores improved significantly, from 18.05 ± 1.39 at baseline to 37.00 ± 1.08 at 24 months (p < 0.001). A strong negative correlation was observed between Eckardt scores and HRQoL (r = -0.40, p < 0.001). Minor complications occurred in 12.5% of patients, with no major adverse events. Symptom recurrence was observed in 8.75% of cases, successfully managed with repeat PD. Subgroup analyses revealed no significant differences in outcomes based on gender or age. Conclusion: Pneumatic dilatation is a safe, effective, and sustainable intervention for achalasia in resource-limited settings. It provides durable symptom relief, significantly improves HRQoL, and achieves high patient satisfaction over 24 months, with minimal complications. These findings highlight PD’s viability as a first-line treatment in regions with limited access to advanced therapeutic options.