Achalasia treatment in the elderly: is botulinum toxin injection the best option?
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.
Zárate
Natalia
N
Digestive System Research Unit, Hospital General Vall d'Hebron, Barcelona, Spain.
Mearin
Fermín
F
Baldovino
Francisco
F
Armengol
Jose-Ramón
JR
Malagelada
Juan-Ramón
JR
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
D001905:Botulinum Toxins