title: Early experience with intrasphincteric botulinum toxin in the treatment of achalasia.
abstract: BACKGROUND
  Recent reports have suggested that intrasphincteric injection of botulinum toxin is effective and long-lasting in the treatment of achalasia.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Digestive Diseases Research Centre, St. Bartholomew's and the Royal London School of Medicine and Dentistry, Turner Street, London, UK.
authors.forename: R R
authors.initials: RR
authors.lastname: Greaves
authors.forename: H E
authors.initials: HE
authors.lastname: Mulcahy
authors.forename: S E
authors.initials: SE
authors.lastname: Patchett
authors.forename: D A
authors.initials: DA
authors.lastname: Gorard
authors.forename: P D
authors.initials: PD
authors.lastname: Fairclough
authors.forename: E M
authors.initials: EM
authors.lastname: Alstead
authors.forename: M J
authors.initials: MJ
authors.lastname: Farthing
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018726:Anti-Dyskinesia Agents / Q000008:administration & dosage*; D001905:Botulinum Toxins / Q000008:administration & dosage*; D018572:Disease-Free Survival; D004931:Esophageal Achalasia / Q000188:drug therapy*; D004943:Esophagogastric Junction; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011795:Surveys and Questionnaires
chemical_list: D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins