title: The role of Botulinum toxin injection in the management of achalasia.
abstract: OBJECTIVE
  Botulinum toxin injection into the lower esophageal sphincter is an established therapy for the treatment of achalasia. This review will highlight recent studies that shed light on the role of Botulinum toxin injection in the management of achalasia.
  
  
  RESULTS
  Recent studies have shown that Botulinum toxin injection is the most common initial endoscopic therapy for achalasia, most likely due to its safety and ease of administration. However, this trend represents a deviation from recent guidelines which consider Botulinum toxin injection less efficacious than alternative treatments like pneumatic dilation and laparoscopic Heller myotomy. Over the past decade, multiple commercial formulations of Botulinum toxin injection have been introduced, but the techniques, indications, and therapeutic efficacy for Botulinum toxin have largely remained unchanged. This review will evaluate recent guidelines, consensus articles, meta-analyses, and landmark studies to expound on the short and long-term efficacy of Botulinum toxin, injection dosages, and technique, as well as its efficacy compared to pneumatic dilation, myotomy, and combination therapy.
  
  
  CONCLUSIONS
  Despite its relatively poor long-term efficacy, Botulinum toxin injection continues to play an important role in elderly patients with comorbidities and as salvage therapy for achalasia.
authors.affiliation: Department of Internal Medicine, UT Southwestern Medical Center, Gastroenterology Faculty, Dallas, Texas 75216, USA. zeeshanramzan@hotmail.com
authors.forename: Zeeshan
authors.initials: Z
authors.lastname: Ramzan
authors.forename: Ammar B
authors.initials: AB
authors.lastname: Nassri
mesh_terms: D018726:Anti-Dyskinesia Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001905:Botulinum Toxins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004106:Dilatation; D004305:Dose-Response Relationship, Drug; D004931:Esophageal Achalasia / Q000188:drug therapy* / Q000628:therapy; D006801:Humans; D015552:Injections, Intralesional; D016896:Treatment Outcome
chemical_list: D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins