Botulinum toxin for achalasia in children.
BACKGROUND
Injection of botulinum toxin (BTx) into the lower esophageal sphincter (LES) of adult patients with achalasia results in the effective relief of symptoms. The aim of the present study was to examine the effectiveness of BTx in pediatric patients suffering from achalasia.


METHODS
Seven patients suffering from achalasia with or without prior treatment were treated with intrasphincteric injection of BTx. The median duration of follow up was 15 months.


RESULTS
All seven patients improved. The median interval before recurrence of symptoms was 4 months (range 1-14 months). There was an inverse relationship between the pretreatment LES pressure and the duration of response (r=-0.6). The mean pretreatment LES pressure in the subgroup with a response greater than 6 months was 38+/-10 mmHg compared with 61+/-12 mmHg in the other four patients (P= 0.05). All seven patients required retreatment.


CONCLUSIONS
Botulinum toxin is effective in relieving symptoms in pediatric patients suffering from achalasia, producing a sustained response beyond 6 months in 43% of patients.
Ip
K S
KS
Department of Paediatric Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Victoria, Australia.
Cameron
D J
DJ
Catto-Smith
A G
AG
Hardikar
W
W
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001905:Botulinum Toxins / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D002404:Catheterization; D002648:Child; D002675:Child, Preschool; D003627:Data Interpretation, Statistical; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D004943:Esophagogastric Junction / Q000187:drug effects / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D016014:Linear Models; D008297:Male; D008365:Manometry; D012008:Recurrence; D013997:Time Factors
D001905:Botulinum Toxins