title: Clinical study on combined therapy of botulinum toxin injection and small balloon dilation in patients with esophageal achalasia.
abstract: OBJECTIVE
  To compare the efficiency of pneumatic balloon dilation, botulinum toxin (BT) injection, and the combination of the two modalities in the management of esophageal achalasia.
  
  
  METHODS
  Ninety patients with esophageal achalasia were randomly divided into three groups according to different interventions, i.e. patients in group A received 100 U BT injection; patients in group B were given balloon dilation, and patients in group C were subjected to balloon dilation plus 100 U BT injection 15 days after the dilation. Clinical assessment and esophageal manometry were performed by experienced gastroenterologists. All patients were followed-up for more than 2 years.
  
  
  RESULTS
  At any time after the treatment, the lower esophageal sphincter pressure and symptom score in group C were lower compared with those in group A or group B (p < 0.05). At 2 years after treatment, the response rate in group C remained 56.67%, still higher than those in the other groups (p < 0.05); the response rate in group B was only 35.71% (10/28); the response rate in group A was 13.79%, the lowest among the three groups.
  
  
  CONCLUSIONS
  The efficiency of the combination of 100 U BT administration and small balloon dilation is superior to the single modality approach.
authors.affiliation: Department of Gastroenterology, Provincial Hospital affiliated to Shandong University, No. 324 Jing 5 Wei 7 Road, Ji'nan, Shandong, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Zhu
authors.forename: Jiyong
authors.initials: J
authors.lastname: Liu
authors.forename: Chongmei
authors.initials: C
authors.lastname: Yang
mesh_terms: D000328:Adult; D000465:Algorithms; D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use*; D001905:Botulinum Toxins / Q000627:therapeutic use*; D002404:Catheterization; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D011312:Pressure; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018726:Anti-Dyskinesia Agents; D009465:Neuromuscular Agents; D001905:Botulinum Toxins