Long-term follow-up of achalasia patients treated with botulinum toxin.

Abstract

AIMS:

To evaluate long-term efficacy of intrasphincteric injection of botulinum toxin in untreated achalasia patients; to analyse whether age can be a predictor of response; and to verify whether any objective measurements correlate with symptom relief

MATERIALS AND METHODS:

A total of 37 patients (mean age 61.4+/-17.5 years) were enrolled, all of whom injected endoscopically with 100 U of botulinum toxin. Symptom score, oesophageal manometry and oesophageal radionuclide emptying were assessed prior to treatment and 4 weeks, 3 months and 1 year after botulinum toxin. In the case of failure or relapse (symptom score >2), treatment was repeated.

RESULTS:

All but 6 patients (83.7%) were in clinical remission one month after botulinum toxin. At 12 months, mean symptom score was 0.9+/-0.5 (p<0.05 vs basal); mean lower oesophageal sphincter pressure was 22.0+/-6.3 (p<0.05 vs basal), and 10-min radionuclide retention was 14.0%+/-7.2 (p<0.05 vs basal). Of the 35 patients followed, 12 (34.3%) had a relapse and were re-treated; 4 out of 12 did not respond after re-treatment. Efficacy of first injection of botulinum toxin lasted for a mean period of 15.6 months (range 2-30). Up to day 31 (83.7%) patients were still in remission. We observed a trend towards a better response to botulinum toxin treatment in patients over 50 years (p=0.053). Moreover no correlation was found between any objective achalasia measurements and symptom relief (r coefficient between 0.1 and 0.5)

CONCLUSIONS:

Results show that: 1) one or two intrasphincteric injections of botulinum toxin result in clinical and objective improvement in about 84% of achalasia patients and are not associated with serious side-effects; 2) patients over 50 years showed better benefit than younger patients; 3) no correlation was found between any objective measurements and symptom relief.

• Authors: V D'Onofrio, P Miletto, G Leandro, G Iaquinto
• Journal: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver (Dig Liver Dis) Vol. 34 Issue 2 Pg. 105-10 (Feb 2002) ISSN: 1590-8658 [Print] Netherlands
• PMID: 11926552 (Publication Type: Journal Article)

Chemical References

• Anti-Dyskinesia Agents
• Botulinum Toxins

Topics

• Adult
• Age Factors
• Aged
• Aged, 80 and over
• Anti-Dyskinesia Agents (administration & dosage, therapeutic use)
• Botulinum Toxins (administration & dosage, therapeutic use)
• Esophageal Achalasia (drug therapy, physiopathology)
• Esophagus (physiopathology)
• Female
• Follow-Up Studies
• Humans
• Injections, Intralesional
• Male
• Manometry
• Middle Aged
• Time Factors
• Treatment Outcome