Long-term outcomes of balloon dilation versus botulinum toxin injection in patients with primary achalasia.
OBJECTIVE
We compared the long-term outcomes of balloon dilation versus botulinum toxin injection in Korean patients with primary achalasia and identified factors predicting remission.


METHODS
We included 73 patients with achalasia newly diagnosed between January 1988 and January 2011. We ultimately enrolled 37 of 55 patients with primary achalasia through telephone interviews, who were observed for over 1 year. Short-term outcomes were evaluated from the medical records based on symptom relief after 1 month of treatment. Long-term outcomes were evaluated in a telephone interview using a questionnaire.


RESULTS
Twenty-five patients were administered a botulinum toxin injection and 12 underwent balloon dilation. One month after the botulinum toxin injection, improvements were seen in chest pain (14 [56.0%] to 4 patients [16.0%]), regurgitation (16 [64.0%] to 4 [16.0%]), and dysphagia (25 [100.0%] to 5 [20.0%]). In the balloon dilation group, chest pain (8 [66.7%] to 1 [8.3%]), regurgitation (11 [91.7%] to 1 [8.3%]), and dysphagia (12 [100.0%] to 1 [8.3%]) had improved. A significant difference was observed in the mean remission duration between the botulinum toxin injection and balloon dilation groups (13 months [range, 1 to 70] vs. 29 months [range, 6 to 72], respectively; p = 0.036). Independent factors predicting long-term remission included treatment type (odds ratio [OR], 6.982; p = 0.036) and the difference in the lower esophageal sphincter pressure (OR, 7.198; p = 0.012).


CONCLUSIONS
Balloon dilation may be more efficacious than botulinum toxin for providing long-term remission in Korean patients with achalasia. Follow-up manometry may predict the long-term outcome.
Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea.
Ho Eun
HE
Jung
Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea.
Joon Seong
JS
Lee
Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea.
Tae Hee
TH
Lee
Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea.
Jin Nyoung
JN
Kim
Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea.
Su Jin
SJ
Hong
Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea.
Jin Oh
JO
Kim
Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea.
Hyeon Geon
HG
Kim
Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea.
Seong Ran
SR
Jeon
Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea.
Joo Young
JY
Cho
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001905:Botulinum Toxins / Q000008:administration & dosage* / Q000009:adverse effects; D004106:Dilatation / Q000009:adverse effects / Q000379:methods*; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007267:Injections; D053208:Kaplan-Meier Estimate; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage* / Q000009:adverse effects; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012074:Remission Induction; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013689:Telephone; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D009465:Neuromuscular Agents; D001905:Botulinum Toxins
Achalasia; Balloon dilation; Botulinum toxins