Treatment of symptomatic diffuse esophageal spasm by endoscopic injectionsof botulinum toxin: a prospective study with long-term follow-up

Background: Diffuse esophageal spasm is a rare esophageal motility disorder for which there are no satisfactory pharmacologic alternatives for treatme nt. The aim of this study was to investigate whether botulinum toxin (BTX) injection is an effective short- and long-term treatment for patients with symptoms caused by diffuse esophageal spasm. Whether recurrence of clinical symptoms can be successfully retreated by BTX injection was also studied. Methods: Nine symptomatic patients (6 women, 3 men; 57-86 years) with manom etrically proven diffuse esophageal spasm underwent BTX injection. One hund red IU BTX were diluted in 10 mL of saline solution and injected endoscopic ally at multiple sites along the esophageal wall beginning in the region of the lower esophageal sphincter and moving proximally in 1-to 1.5-cm interv als, and into endoscopically visible contraction rings. Symptom scores base d on an analogue scale for dysphagia, regurgitation, and noncardiac chest p ain were assessed before and after therapy, 1 day thereafter, and at 1 and 6 months. Results: Symptoms improved immediately in 7 (78%) patients after 1 injectio n session. After 4 weeks 8 (89%) patients were in remission with a decrease in total symptom score. The total symptom score decreased from a median 8. 0 (interquartile range: 6.75; 9.0) before treatment to 2.0 (1.5; 3.75) afte r 1 day (p < 0.01) and to 2.0 (interquartile range: 0.75; 3.0) after 1 mont h (p < 0.01). After 6 months all 8 patients with a response at 1 month stil l had a symptom score of 3 or less without further treatment. Subsequently 4 patients required reinjection 8, 12, 15, or 24 months after the initial t reatment with similarly good results. No serious adverse effects were obser ved.