The purpose of this study was to determine if
botulinum toxin injection at the lower esophageal sphincter improves symptoms in patients with nonachalasia
spastic esophageal motility disorders. Fifteen patients with nonachalasia
spastic esophageal motility disorders (
diffuse esophageal spasm, nonspecific
esophageal motility disorders, and lower esophageal sphincter dysfunction) unresponsive to medical
therapy underwent endoscopic injection of
botulinum toxin at the level of the gastroesophageal junction. Symptoms were scored (0 = no symptoms, 1 = mild, 2 = moderate, 3 = severe and 4 = very severe) before treatment, at seven days and every 30 days
after treatment. There was significant improvement in
chest pain,
dysphagia, and regurgitation at 7,30,60 and 90 days
after treatment. At one month
after treatment, 11 of 15 (73%) patients had a good or excellent response to treatment. At the last patient interview (mean follow-up of 10.6 months), five (33%) patients continued to have a good to excellent response, whereas 10 (67%) underwent subsequent treatment with repeat
botulinum toxin, pneumatic dilation, or bougienage. We conclude that
botulinum toxin injection at the gastroesophageal junction leads to significant symptom improvement in patients with nonachalasia
esophageal motility disorders. These results suggest that
botulinum toxin may be an effective treatment option in some of these patients not responsive to conventional medical
therapy.