title: Ethanolamine oleate versus botulinum toxin in the treatment of idiopathic achalasia.
abstract: BACKGROUND
  Botulinum toxin (BT) injection reduces lower esophageal sphincter pressure and alleviates symptoms in idiopathic achalasia (IA). Ethanolamine oleate (EO) has also been introduced for the treatment of IA. We compared the long-term efficacy of BT and EO injections in the treatment of IA.
  
  
  METHODS
  A total of 189 IA patients were evaluated prospectively, of whom 21 were unwilling to undergo or were poor candidates for pneumatic balloon dilation and Heller myotomy and were enrolled in the study. Eleven patients were treated by BT, and 10 by EO injections. Patients were followed up by achalasia symptom score (ASS), timed barium esophagogram (TBE), and high-resolution manometry at baseline and post-treatment. A good initial response was defined as a decrease in ASS to 4 or less, and a reduction in barium column height and volume in TBE by >50%.
  
  
  RESULTS
  All 10 EO group patients and 10 of 11 BT group patients showed a good initial response. Four EO group relapsers and 6 BT group relapsers were managed effectively by re-injections. Mean duration of follow up was 27.38 months. On completion of the study, a sustained good response was seen in 9 and 6 patients in EO and BT groups, respectively (P=0.149).
  
  
  CONCLUSIONS
  This study revealed that BT and EO have comparable efficacy in the treatment of IA. However, the cost of EO is about 2 times lower than BT.
authors.affiliation: Department of Gastroenterology, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences (Javad Mikaeli, Arash Kazemi Veisari, Narges Fazlollahi, Narges Mehrabi, Hossein Asl Soleimani, Reza Malekzadeh), Tehran, Iran.
authors.forename: Javad
authors.initials: J
authors.lastname: Mikaeli
authors.affiliation: Department of Gastroenterology, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences (Javad Mikaeli, Arash Kazemi Veisari, Narges Fazlollahi, Narges Mehrabi, Hossein Asl Soleimani, Reza Malekzadeh), Tehran, Iran.
authors.forename: Arash Kazemi
authors.initials: AK
authors.lastname: Veisari
authors.affiliation: Department of Gastroenterology, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences (Javad Mikaeli, Arash Kazemi Veisari, Narges Fazlollahi, Narges Mehrabi, Hossein Asl Soleimani, Reza Malekzadeh), Tehran, Iran.
authors.forename: Narges
authors.initials: N
authors.lastname: Fazlollahi
authors.affiliation: Department of Gastroenterology, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences (Javad Mikaeli, Arash Kazemi Veisari, Narges Fazlollahi, Narges Mehrabi, Hossein Asl Soleimani, Reza Malekzadeh), Tehran, Iran.
authors.forename: Narges
authors.initials: N
authors.lastname: Mehrabi
authors.affiliation: Department of Gastroenterology, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences (Javad Mikaeli, Arash Kazemi Veisari, Narges Fazlollahi, Narges Mehrabi, Hossein Asl Soleimani, Reza Malekzadeh), Tehran, Iran.
authors.forename: Hossein Asl
authors.initials: HA
authors.lastname: Soleimani
authors.affiliation: Department of Radiology (Shapoor Shirani), Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Shapoor
authors.initials: S
authors.lastname: Shirani
authors.affiliation: Department of Gastroenterology, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences (Javad Mikaeli, Arash Kazemi Veisari, Narges Fazlollahi, Narges Mehrabi, Hossein Asl Soleimani, Reza Malekzadeh), Tehran, Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Malekzadeh
keywords: Achalasia; botulinum toxin; esophagus; ethanolamine oleate
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