title: Ethanolamine oleate in resistant idiopathic achalasia:  a novel therapy.
abstract: OBJECTIVE
  Idiopathic achalasia (IA) is a chronic disease without definite therapy. Ethanolamine oleate (EO) has multiple biological effects, including inflammatory activities. We investigated the efficacy of EO injection in selected patients with IA.
  
  
  METHODS
  One hundred and thirty-six patients with IA were evaluated prospectively. We evaluated the efficacy of EO injection in 13 patients with IA that are resistant to or a poor candidate of pneumatic balloon dilation and/or cardiomyotomy at the Digestive Disease Research Center, Shariati Hospital, Tehran, as the major referral center for achalasia in Iran in an interventional study. Diluted EO was injected in a divided dose into each of four quadrants of lower esophageal sphincter, using a standard sclerotherapy needle. Injection was repeated at 2 and 4 weeks after first injection. The patients were evaluated with achalasia symptom score (ASS) and timed barium esophagogram (TBE) before and after injections. Good response was defined as a decrease in ASS of at least 50% of baseline and decrease in height and volume of barium of at least 50% of baseline in TBE, at 1.5 months after the last injection. Side-effects were recorded.
  
  
  RESULTS
  All patients (13 cases) had good ASS (decreased, ≥ 50%) and good TBE (decreased in height and volume of barium, ≥ 50%) response rate. The mean ASS decreased from 11.38 (± 1.5) to 3.23 (± 1.96) at 1.5 months after the last injection (P=0.001). The mean volume of barium in TBE decreased from 81.38 ml (± 51.11) to 40.69 ml (± 61.22) at 1.5 months after the last injection (P=0.016). The mean duration of follow-up was 17.83 (± 1.12) months. Symptoms of six patients relapsed; all of them were treated effectively with reinjection.
  
  
  CONCLUSIONS
  This study indicates that EO is well tolerated and potentially effective in patients with IA that might be explained by the local inflammatory properties of EO. As presented data are too preliminary to support the routine use of EO in the treatment of all patients with IA; its use in selected cases can be considered.
authors.affiliation: Digestive Disease Research Center, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Ramin
authors.initials: R
authors.lastname: Niknam
authors.forename: Javad
authors.initials: J
authors.lastname: Mikaeli
authors.forename: Narges
authors.initials: N
authors.lastname: Mehrabi
authors.forename: Laleh
authors.initials: L
authors.lastname: Mahmoudi
authors.forename: Elham
authors.initials: E
authors.lastname: Elahi
authors.forename: Shapoor
authors.initials: S
authors.lastname: Shirani
authors.forename: Reza
authors.initials: R
authors.lastname: Malekzadeh
mesh_terms: D000328:Adult; D003680:Deglutition Disorders / Q000209:etiology; D004931:Esophageal Achalasia / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D009829:Oleic Acids / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D012597:Sclerosing Solutions / Q000008:administration & dosage / Q000627:therapeutic use*; D015911:Sclerotherapy / Q000379:methods; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D009829:Oleic Acids; D012597:Sclerosing Solutions; C033343:ethanolamine oleate