Early experience with intrasphincteric botulinum toxin in the treatment of achalasia.
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.
Greaves
R R
RR
Digestive Diseases Research Centre, St. Bartholomew's and the Royal London School of Medicine and Dentistry, Turner Street, London, UK.
Mulcahy
H E
HE
Patchett
S E
SE
Gorard
D A
DA
Fairclough
P D
PD
Alstead
E M
EM
Farthing
M J
MJ
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
D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins