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Efficacy of Botulinum Toxin A for Treatment of Upper Esophageal Sphincter Dysfunction
Author(s) -
Alberty Jürgen,
Oelerich Michael,
Ludwig Karl,
Hartmann Sabine,
Stoll Wolfgang
Publication year - 2000
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1097/00005537-200007000-00016
Subject(s) - dysphagia , medicine , swallowing , botulinum toxin , larynx , anesthesia , reflux , prospective cohort study , clinical trial , surgery , disease
Objectives To investigate the efficacy of botulinum toxin A (BTA)–induced chemodenervation of the upper esophageal sphincter (UES) in patients with dysphagia and UES dysfunction. Study Design Prospective clinical trial in 10 selected patients with pure UES dysfunction. Methods In each patient 30 units of BTA were injected into the UES under brief general anesthesia. Videofluoroscopic swallowing study (VSS) was done and a clinical symptom score was determined before and after treatment. Results On VSS relative opening of the UES improved in all patients (mean ± SD: 47 ± 14% before versus 71 ± 24% after treatment; P < .01). Hypopharyngeal retention or laryngeal penetration of barium was significantly reduced in four of seven patients. Clinical symptom scores improved in all patients. One patient was free of symptoms, mild dysphagia persisted in six patients, and moderate dysphagia persisted in three patients. Conclusions Our results support the use of BTA in selected patients with pure UES dysfunction. Its efficacy is limited by the possibility of a persistent structural stenosis of the UES and the risk of BTA diffusion into the larynx or hypopharynx.