Document Detail

Achalasia: outcome of patients treated with intrasphincteric injection of botulinum toxin.
MedLine Citation:
PMID:  9274478     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: To evaluate the safety and clinical efficacy of botulinum toxin (BT) in patients with achalasia followed up for six months. METHODS: Fifty five symptomatic patients with manometrically proven achalasia were included in a multicentre prospective trial. Before and two weeks and two months after intrasphincteric injection of BT, symptoms of dysphagia, regurgitation, and chest pain were scored on a 0-3 scale, and lower oesophageal sphincter pressure (LOSP) was assessed. The symptom score was determined again at six months, clinical improvement being defined by < or = 3, relapse by > 3, and failure as a relapse after two injections or loss to follow up. RESULTS: Except for transient chest or epigastric pain (22%), no side effects were observed. There was a significant decrease in LOSP after treatment. Symptom scores were significantly improved at two weeks (2.0 (SD 1.6)), two months (1.7 (1.8)), and six months (1.9 (2.0)) compared with pretreatment values (5.1 (1.8), p < 0.001). At six months, 33 patients had clinical improvement (27 after one injection), 17 were considered failures, and five had just relapsed. Although there was a trend for age (older patients being more responsive), age, sex, prior duration of symptoms, initial symptom score, weight loss, LOSP, magnitude of oesophageal contractions, vigorous or non-vigorous achalasia, previous dilatations, and radiological features were not predictive of results. CONCLUSIONS: This multicentre series confirms that intrasphincteric injection of BT is a safe procedure, resulting in clinical improvement in 60% of patients with achalasia at six months. The therapeutic role of BT in achalasia needs further evaluation with regard to other alternatives.
C Cuillière; P Ducrotté; F Zerbib; E H Metman; D de Looze; F Guillemot; H Hudziak; H Lamouliatte; J C Grimaud; A Ropert; M Dapoigny; R Bost; M Lémann; M A Bigard; P Denis; J L Auget; J P Galmiche; S Bruley des Varannes
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Gut     Volume:  41     ISSN:  0017-5749     ISO Abbreviation:  Gut     Publication Date:  1997 Jul 
Date Detail:
Created Date:  1997-09-09     Completed Date:  1997-09-09     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  2985108R     Medline TA:  Gut     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  87-92     Citation Subset:  AIM; IM    
University Hospital Centre, Nantes, France.
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MeSH Terms
Anti-Dyskinesia Agents / administration & dosage*
Botulinum Toxins / administration & dosage*
Esophageal Achalasia / therapy*
Esophagogastric Junction*
Feasibility Studies
Middle Aged
Prospective Studies
Treatment Outcome
Reg. No./Substance:
0/Anti-Dyskinesia Agents; 0/Botulinum Toxins
Comment In:
Gut. 1997 Jul;41(1):131-2   [PMID:  9274487 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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