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Treatment of Achalasia with Intrasphincteric Injection of Botulinum Toxin: A Pilot Trial
- Pankaj J. Pasricha, MD;
- William J. Ravich, MD;
- Thomas R. Hendrix, MD;
- Samuel Sostre, MD;
- Bronwyn Jones, MD; and
- Anthony N. Kalloo, MD
- From Johns Hopkins Hospital, Baltimore, Maryland.\\\Requests for Reprints: Pankaj J. Pasricha, MD, Johns Hopkins Hospital, 600 North Wolfe Street, Blalock 4, Baltimore, MD 21287-4461.
Achalasia is a disorder characterized by a failure of the lower esophageal sphincter to relax with swallowing and by a lack of esophageal peristalsis. The sphincteric abnormalities in achalasia are thought to be caused by a selective loss of inhibitory neurons in the myenteric plexus, resulting in the relatively unopposed excitation of the smooth muscle by acetylcholine and other mediators. Our previous studies in animals [1] have shown that locally injected botulinum toxin, a potent inhibitor of acetylcholine release, can reduce lower esophageal sphincter tone. We report our initial experience with this agent for the treatment of achalasia in humans.
Methods
Ten symptomatic adult patients with achalasia were prospectively evaluated by barium video-esophagograms, esophageal scintigraphy, and manometry. Clinical response was evaluated by scoring three symptoms (dysphagia, regurgitation, and chest pain) on a scale ranging from 0 to 3 (0 = none, 1 = occasional, 2 = daily, and 3 = with each meal) [2]. At the time of upper endoscopy, 80 units of botulinum toxin was injected …
This 100-word excerpt has been provided in the absence of an abstract.
