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Treatment of achalasia: the short-term response to botulinum toxin injection seems to be independent of any kind of pretreatment

BACKGROUND: It has been suggested that intrasphincteric injection of botulinum toxin (BTX) may represent an alternative therapy to balloon dilatation in achalasia. The aim of the present study was to test the effectiveness of botulinum toxin injections in achalasia patients, as assessed using lower...

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Autores principales: Storr, M, Born, P, Frimberger, E, Weigert, N, Rösch, T, Meining, A, Classen, M, Allescher, HD
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2002
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC122056/
https://www.ncbi.nlm.nih.gov/pubmed/12175425
http://dx.doi.org/10.1186/1471-230X-2-19
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author Storr, M
Born, P
Frimberger, E
Weigert, N
Rösch, T
Meining, A
Classen, M
Allescher, HD
author_facet Storr, M
Born, P
Frimberger, E
Weigert, N
Rösch, T
Meining, A
Classen, M
Allescher, HD
author_sort Storr, M
collection PubMed
description BACKGROUND: It has been suggested that intrasphincteric injection of botulinum toxin (BTX) may represent an alternative therapy to balloon dilatation in achalasia. The aim of the present study was to test the effectiveness of botulinum toxin injections in achalasia patients, as assessed using lower oesophageal sphincter pressure (LOSP) and symptom scores, and to compare the response in patients with different types of pretreatment (no previous treatment, balloon dilatation, myotomy, BTX injection). METHODS: Forty patients who presented with symptomatic achalasia were treated with BTX injection (48 injections in 40 patients). Some of the patients had received prior treatment (seven with myotomy, seven with dilatation and eight with BTX). The symptoms were assessed using a global symptom score (0–10), which was evaluated before treatment, 1 week afterwards, and 1 month afterwards. Manometry was also carried out before and after treatment. Three different selections of patients were studied: all patients; untreated patients; and patients with prior BTX, dilatation, or myotomy. RESULTS: After BTX injection, there was a significant reduction in LOSP (before, 38.2 ± 11.3 mmHg; 1 week after, 20.5 ± 6.9 mmHg; 1 month after, 17.8 ± 6.8 mmHg; P < 0.001). The global symptom score and symptom subscores (dysphagia, regurgitation, chest pain) were significantly decreased after 1 week and 1 month. When the beneficial effects following BTX injection were compared (untreated vs. pretreated), neither changes in LOSP nor beneficial effects on the symptom scores significantly differed. After 6 months, 67.7% of all treated patients were still in symptomatic remission (subgroups: previously untreated patients, 61.5%, n = 26; prior dilatation, 71.4%, n = 7; prior myotomy, 71.4%, n = 7; prior BTX, 73.9%, n = 8). CONCLUSIONS: BTX injection offers an alternative treatment for achalasia which is safe and can be performed in an outpatient setting. The initial response to BTX, in terms of symptom scores and LOSP, appears to be independent of any prior treatment. A number of patients do not adequately respond to balloon dilatation or myotomy, which are the first-line treatment modalities in achalasia patients. BTX injection can be performed in these patients, and symptomatic benefit can be expected in the same percentages as with BTX injection in untreated patients.
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spelling pubmed-1220562002-09-09 Treatment of achalasia: the short-term response to botulinum toxin injection seems to be independent of any kind of pretreatment Storr, M Born, P Frimberger, E Weigert, N Rösch, T Meining, A Classen, M Allescher, HD BMC Gastroenterol Research Article BACKGROUND: It has been suggested that intrasphincteric injection of botulinum toxin (BTX) may represent an alternative therapy to balloon dilatation in achalasia. The aim of the present study was to test the effectiveness of botulinum toxin injections in achalasia patients, as assessed using lower oesophageal sphincter pressure (LOSP) and symptom scores, and to compare the response in patients with different types of pretreatment (no previous treatment, balloon dilatation, myotomy, BTX injection). METHODS: Forty patients who presented with symptomatic achalasia were treated with BTX injection (48 injections in 40 patients). Some of the patients had received prior treatment (seven with myotomy, seven with dilatation and eight with BTX). The symptoms were assessed using a global symptom score (0–10), which was evaluated before treatment, 1 week afterwards, and 1 month afterwards. Manometry was also carried out before and after treatment. Three different selections of patients were studied: all patients; untreated patients; and patients with prior BTX, dilatation, or myotomy. RESULTS: After BTX injection, there was a significant reduction in LOSP (before, 38.2 ± 11.3 mmHg; 1 week after, 20.5 ± 6.9 mmHg; 1 month after, 17.8 ± 6.8 mmHg; P < 0.001). The global symptom score and symptom subscores (dysphagia, regurgitation, chest pain) were significantly decreased after 1 week and 1 month. When the beneficial effects following BTX injection were compared (untreated vs. pretreated), neither changes in LOSP nor beneficial effects on the symptom scores significantly differed. After 6 months, 67.7% of all treated patients were still in symptomatic remission (subgroups: previously untreated patients, 61.5%, n = 26; prior dilatation, 71.4%, n = 7; prior myotomy, 71.4%, n = 7; prior BTX, 73.9%, n = 8). CONCLUSIONS: BTX injection offers an alternative treatment for achalasia which is safe and can be performed in an outpatient setting. The initial response to BTX, in terms of symptom scores and LOSP, appears to be independent of any prior treatment. A number of patients do not adequately respond to balloon dilatation or myotomy, which are the first-line treatment modalities in achalasia patients. BTX injection can be performed in these patients, and symptomatic benefit can be expected in the same percentages as with BTX injection in untreated patients. BioMed Central 2002-08-13 /pmc/articles/PMC122056/ /pubmed/12175425 http://dx.doi.org/10.1186/1471-230X-2-19 Text en Copyright © 2002 Storr et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.
spellingShingle Research Article
Storr, M
Born, P
Frimberger, E
Weigert, N
Rösch, T
Meining, A
Classen, M
Allescher, HD
Treatment of achalasia: the short-term response to botulinum toxin injection seems to be independent of any kind of pretreatment
title Treatment of achalasia: the short-term response to botulinum toxin injection seems to be independent of any kind of pretreatment
title_full Treatment of achalasia: the short-term response to botulinum toxin injection seems to be independent of any kind of pretreatment
title_fullStr Treatment of achalasia: the short-term response to botulinum toxin injection seems to be independent of any kind of pretreatment
title_full_unstemmed Treatment of achalasia: the short-term response to botulinum toxin injection seems to be independent of any kind of pretreatment
title_short Treatment of achalasia: the short-term response to botulinum toxin injection seems to be independent of any kind of pretreatment
title_sort treatment of achalasia: the short-term response to botulinum toxin injection seems to be independent of any kind of pretreatment
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC122056/
https://www.ncbi.nlm.nih.gov/pubmed/12175425
http://dx.doi.org/10.1186/1471-230X-2-19
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