TREATMENT OF ACHALASIA WITH BOTULINUM TOXIN

We studied the efficacy of local injections of botulinum toxin in the treatment of patients with achalasia. Four patients diagnosed of achal asia using manometric, radiologic and endoscopic criteria, were treate d with botulinum toxin (80 U) injected directly into lower esophageal sphincter (LES), via a sclerotherapy injector. Response to treatment w as assessed by changes in symptom scores and LES pressure. All determi nations were repeated after 10, 30, 90, 120 and 180 days of treatment. The patients improved after the initial injection. This improvement w as accompanied by improved relaxation of the LES. Two patients relapse d after 30 and 45 days and the other two patients remained symptom-fre e 5 months after treatment. Conclusion: Botulinum toxin is probably a safe and effective alternative for the treatment of achalasia and shou ld be considered in patients in whom pneumatic dilation has failed or who are poor surgical candidates. Long-term evaluation of the safety a nd efficacy of botulinum toxin in the treatment of achalasia is requir ed.