Treatment of chest pain in patients with noncardiac, nonreflux, nonachalasia spastic esophageal motor disorders using botulinum toxin injection into the gastroesophageal junction.
OBJECTIVE
The aim of this study was to determine if botulinum toxin injection in the gastroesophageal junction improves symptoms in patients with noncardiac chest pain with a spastic esophageal motility disorder.


METHODS
Twenty-nine noncardiac chest pain patients with nonachalasia, nonreflux-related spastic esophageal motility disorders were enrolled in this open label trial of botulinum toxin injection at the gastroesophageal junction. Chest pain was the major complaint in all patients. Symptoms of chest pain, dysphagia, regurgitation, and heartburn were scored before and 1 month after botulinum toxin injection. A response to botulinum toxin was defined as at least a 50% reduction in the symptom score with a possible total chest pain score of 4. The duration of response was defined as the time period, between the time of injection and the point in time, at which the severity of the symptoms returned to the preinjection score.


RESULTS
Seventy-two percent of the patients responded with at least 50% reduction in chest pain. In these responders, there was a 79% reduction in the mean chest pain score from a preinjection score of 3.7 to a postinjection score of 0.78 (p < 0.0001). The mean duration of the response for chest pain in these patients was 7.3+/-4.1 months (range 1-18 months). There was also a significant reduction in the mean regurgitation score, dysphagia score, and total symptom score (p < 0.0001).


CONCLUSIONS
Botulinum toxin injection at the gastroesophageal junction leads to significant symptomatic improvement in patients with spastic esophageal motility disorders whose major complaint is chest pain.
Department of Gastroenterology, Temple University Hospital, Philadelphia, Pennsylvania 19401, USA.
Larry S
LS
Miller
Sujata V
SV
Pullela
Henry P
HP
Parkman
Thomas D
TD
Schiano
Michael J
MJ
Cassidy
Sidney
S
Cohen
Robert S
RS
Fisher
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018726:Anti-Dyskinesia Agents / Q000008:administration & dosage*; D001905:Botulinum Toxins / Q000008:administration & dosage*; D002637:Chest Pain / Q000188:drug therapy* / Q000209:etiology; D015154:Esophageal Motility Disorders / Q000150:complications / Q000188:drug therapy*; D004943:Esophagogastric Junction; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged
D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins