Treatment of achalasia with botulinum toxin.
We studied the efficacy of local injections of botulinum toxin in the treatment of patients with achalasia. Four patients diagnosed of achalasia using manometric, radiologic and endoscopic criteria, were treated with botulinum toxin (80 U) injected directly into lower esophageal sphincter (LES), via a sclerotherapy injector. Response to treatment was assessed by changes in symptom scores and LES pressure. All determinations were repeated after 10, 30, 90, 120 and 180 days of treatment. The patients improved after the initial injection. This improvement was accompanied by improved relaxation of the LES. Two patients relapsed after 30 and 65 days and the other two patients remained symptom-free 5 months after treatment.


CONCLUSIONS
Botulinum toxin is probably a safe and effective alternative for the treatment of achalasia and should be considered in patients in whom pneumatic dilation has failed or who are poor surgical candidates. Long-term evaluation of the safety and efficacy of botulinum toxin in the treatment of achalasia is required.
López
P
P
Service of Digestive Diseases, Ntra. Sra. de Aránzazu Hospital, San Sebastián, Spain.
Castiella
A
A
Montalvo
I
I
Bujanda
L
L
Alzate
L F
LF
Gil
I
I
Arenas
J I
JI
D000328:Adult; D000368:Aged; D001905:Botulinum Toxins / Q000627:therapeutic use*; D004931:Esophageal Achalasia / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged
D001905:Botulinum Toxins