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Early experience with intrasphincteric botulinum toxin in the treatment of achalasia
Author(s) -
Greaves,
Mulcahy,
Patchett,
Gorard,
Pauline Fairclough,
Alstead,
Farthing
Publication year - 1999
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1046/j.1365-2036.1999.00609.x
Subject(s) - medicine , achalasia , botulinum toxin , interquartile range , dysphagia , adverse effect , surgery , anesthesia , single center , esophagus
Background : Recent reports have suggested that intrasphincteric injection of botulinum toxin is effective and long‐lasting in the treatment of achalasia. Aim : To report our experience of botulinum toxin injection in a prospective series of consecutive patients with achalasia. Methods : Eleven consecutive patients with achalasia (eight male, mean age 55 years, range 20–87) were treated with 60 units of botulinum toxin (Dysport; Speywood Pharmaceuticals Ltd, UK) into each of four quadrants at the lower oesophageal sphincter. Patients were assessed pre‐treatment and 1 month after treatment using a symptom score and oesophageal manometry. Median follow‐up was 12 months (range 6–28). Results : The injection procedure was simple to perform and free of adverse effects. Although treatment had a beneficial effect on dysphagia (median pre‐treatment score 3 [interquartile range 3–3]; post‐treatment score 2 [0–3]: P =0.03) 1 month following therapy, there was no significant improvement in chest pain or regurgitation scores. Similarly, no significant reduction in median lower oesophageal sphincter pressure was observed (29.5 mmHg [21–42] pre‐treatment, 28.5 [17.5–55.5] post‐treatment P =0.67). Four patients (36%) required further therapy within 3 months and the overall relapse rate was 73% (eight of 11) within 2 years. Conclusion : Although botulinum toxin injection was well tolerated, these results using Dysport at a dose of 240 mouse units question its efficacy as a treatment for achalasia.