Efficacy of botulinum toxin A for treatment of upper esophageal sphincter dysfunction

Objectives: To investigate the efficacy of botulinum toxin A (BTA)-induced chemodenervation of the upper esophageal sphincter (UES) in patients with d ysphagia and UES dysfunction. Study Design: Prospective clinical trial in 1 0 selected patients with pure UES dysfunction. Methods: In each patient 30 units of BTA mere injected into the UES under brief general anesthesia. Vid eofluoroscopic swallowing study (VSS) was done and a clinical symptom score was deter-mined before and after treatment. Results: On VSS relative openi ng of the UES improved in all patients (mean +/- SD: 47 +/- 14% before vers us 71 +/- 24% after treatment; P < .01). Hypopharyngeal retention or laryng eal penetration of barium was significantly reduced in four of seven patien ts. Clinical symptom scores improved in all patients. One patient was free of symptoms, mild dysphagia persisted in six patients, and moderate dysphag ia persisted in three patients. Conclusions: Our results support the use of BTA in selected patients with pure UES dysfunction, Its efficacy is limite d by the possibility of a persistent structural stenosis of the UES and the risk of BTA diffusion into the larynx or hypopharynx.