Botulinum toxin treatment of oesophageal achalasia in the old old and oldest old: a 1-year follow-up study.
BACKGROUND
Intrasphincteric injection of botulinum toxin (BTX) has become one of the most frequent therapeutic approaches for the treatment of oesophageal achalasia. This treatment seems particularly effective in elderly patients who are not candidates for more invasive procedures.


OBJECTIVE
There are few or no data on BTX treatment of achalasia in the old old and oldest old. Therefore, we evaluated BTX treatment in a group of patients with achalasia in the extreme age range who were too ill or frail to undergo surgery or pneumatic dilatation.


METHODS
Twelve elderly achalasic patients (age range 81-94 years, average age 86 years) with American Society of Anesthesiologists (ASA) class III-IV status were recruited for the study. After baseline clinical and instrumental evaluations, BTX 100U was injected at time 0 and 1 month later. Clinical follow-up was carried out after 3, 6 and 12 months.


RESULTS
A significant improvement in symptom score was documented at each follow-up step. On the basis of improvements in scores, approximately 70% of patients were considered responders at the end of follow-up.


CONCLUSIONS
BTX treatment is an effective treatment in a substantial proportion of achalasic patients >80 years of age, in whom benefits are still detectable after 12 months. BTX is a therapeutic option in patients unsuitable for surgery or pneumatic dilatation.
Dughera
Luca
L
Department of Gastroenterology and Clinical Nutrition, University of Torino, Torino, Italy.
Battaglia
Edda
E
Maggio
Dario
D
Cassolino
Paola
P
Mioli
Pier Roberto
PR
Morelli
Antonio
A
Emanuelli
Giorgio
G
Bassotti
Gabrio
G
D000368:Aged; D000369:Aged, 80 and over; D018726:Anti-Dyskinesia Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D001905:Botulinum Toxins / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D004931:Esophageal Achalasia / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins