Treatment of symptomatic nonachalasia esophageal motor disorders with botulinum toxin injection at the lower esophageal sphincter.
The purpose of this study was to determine if botulinum toxin injection at the lower esophageal sphincter improves symptoms in patients with nonachalasia spastic esophageal motility disorders. Fifteen patients with nonachalasia spastic esophageal motility disorders (diffuse esophageal spasm, nonspecific esophageal motility disorders, and lower esophageal sphincter dysfunction) unresponsive to medical therapy underwent endoscopic injection of botulinum toxin at the level of the gastroesophageal junction. Symptoms were scored (0 = no symptoms, 1 = mild, 2 = moderate, 3 = severe and 4 = very severe) before treatment, at seven days and every 30 days after treatment. There was significant improvement in chest pain, dysphagia, and regurgitation at 7,30,60 and 90 days after treatment. At one month after treatment, 11 of 15 (73%) patients had a good or excellent response to treatment. At the last patient interview (mean follow-up of 10.6 months), five (33%) patients continued to have a good to excellent response, whereas 10 (67%) underwent subsequent treatment with repeat botulinum toxin, pneumatic dilation, or bougienage. We conclude that botulinum toxin injection at the gastroesophageal junction leads to significant symptom improvement in patients with nonachalasia esophageal motility disorders. These results suggest that botulinum toxin may be an effective treatment option in some of these patients not responsive to conventional medical therapy.
Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania 19140, USA.
L S
LS
Miller
H P
HP
Parkman
T D
TD
Schiano
M J
MJ
Cassidy
R B
RB
Ter
M A
MA
Dabezies
S
S
Cohen
R S
RS
Fisher
D000293:Adolescent; D000328:Adult; D000368:Aged; D001905:Botulinum Toxins / Q000008:administration & dosage*; D015154:Esophageal Motility Disorders / Q000188:drug therapy* / Q000503:physiopathology; D015155:Esophageal Spasm, Diffuse / Q000188:drug therapy; D004943:Esophagogastric Junction; D004947:Esophagus / Q000503:physiopathology; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies
D001905:Botulinum Toxins