title: Achalasia treatment in the elderly: is botulinum toxin injection the best option?
abstract: BACKGROUND
  Achalasia treatment in elderly patients is a matter of controversy. Botulinum toxin injection has been proposed as the best option in this group of patients as it is a safe procedure. However, concern persists regarding its short-term effect.
  
  
  OBJECTIVE
  To analyse the clinical and economic effectiveness of botulinum toxin injection in the treatment of achalasia patients who are elderly.
  
  
  METHODS
  Seventeen consecutive achalasia patients older than 65 years were treated with 80 units of botulinum toxin. Clinical follow-up at 1, 6 and 12 months was performed. Control manometry when symptoms recurred was carried out. Results were compared with those of an historical control group of 16 achalasia patients also older than 65 years and who had been treated with endoscopic dilation. The costs of both procedures were compared.
  
  
  RESULTS
  Twenty-nine botulinum toxin injections were performed in the 17 patients of the botulinum toxin group (follow-up, 12-36 months). In the dilation group only two patients had to be retreated (follow-up, 12-108 months). No major complications were observed in either group. The average duration of symptom alleviation was 48 +/- 33 months for endoscopic dilation and 13.8 +/- 9.5 months for botulinum toxin injection. Maintaining a patient free of symptoms cost E348.31 per year for botulinum toxin injection, whilst if endoscopic dilation was chosen the cost was only E117.47 per year.
  
  
  CONCLUSIONS
  The effect of botulinum toxin injections wanes with time in elderly patients, necessitating repeated injections to keep the patients symptom-free. Due to the required repeated injections this procedure is more expensive than endoscopic dilation.
authors.affiliation: Digestive System Research Unit, Hospital General Vall d'Hebron, Barcelona, Spain.
authors.forename: Natalia
authors.initials: N
authors.lastname: Zárate
authors.forename: Fermín
authors.initials: F
authors.lastname: Mearin
authors.forename: Francisco
authors.initials: F
authors.lastname: Baldovino
authors.forename: Jose-Ramón
authors.initials: JR
authors.lastname: Armengol
authors.forename: Juan-Ramón
authors.initials: JR
authors.lastname: Malagelada
mesh_terms: D000368:Aged; D001905:Botulinum Toxins / Q000191:economics / Q000627:therapeutic use*; D016022:Case-Control Studies; D004106:Dilatation / Q000191:economics / Q000295:instrumentation; D004931:Esophageal Achalasia / Q000188:drug therapy* / Q000191:economics; D004945:Esophagoscopy / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008365:Manometry; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D001905:Botulinum Toxins