Objectives: In this retrospective analysis, we explored
the effect of botulinum toxin A (BTA) injection to treat oropharyngeal dysphagia or esophageal
dysfunction caused by diseases of the upper (UES) and lower (LES) esophageal
sphincter. Methods: In total, 48 patients (17 patients with UES
disorders, and 31 patients with LES dysfunction; mean age 64 years) were
treated between 1996 and 2007 in our hospital. Comorbid diseases as well as
maintenance medication were documented to evaluate the overall health status of our
patients. The mean duration of symptoms, the number of pre-treatments and the specification
of dysphagia were considered. Results: One month after injection, the response
rates were 73.3% (UES group) and 76.6% (LES group). Most patients in the UES
group received 30-40 units BTA (Botox?) whereas most patients in the LES group
were treated with 100 units BTA. In cases of re-injection, 50% of patients in
the UES group experienced an escalation of dosage (up to 75 units),whereas
the other 50% received the same dosage. The dosages in the LES group were
mostly kept constant. Conclusion: Comparing the two groups with
esophageal dysfunction of fundamentally different etiologies (UES/LES), a
discrepancy in the level of symptom relief, onset and a longer cessation of
clinical benefit were observed in the LES group. In this analysis, we were able
to show that injection of BTA is an effective and safe treatment for disorders
of the UES and LES.
References
[1]
J. E. Leyden, A. C. Moss and P. Mac Mathuna, “Endoscopic Pneumatic Dilatation versus Botulinum Toxin Injection in the Management of Primary Achalasia,” Cochrane Database of Systematic Reviews, Vol. 18, No. 4, 2006, Article ID: CD005046. http://dx.doi.org/10.1002/14651858.CD005046.pub2
[2]
Z. H. Wen, E. Gardener and Y. P. Wang, “Nitrates for Achalasia,” Cochrane Database of Systematic Reviews, 2004, No. 1, Article ID: CD002299. http://dx.doi.org/10.1002/14651858.CD002299.pub2
[3]
N. Pehlivanov and P. J. Pasricha, “Achalasia: Botox, Dilatation or Laparoscopic Surgery in 2006,” Neurogastroenterology and Motility, Vol. 18, No. 9, 2006, pp. 799-804. http://dx.doi.org/10.1111/j.1365-2982.2006.00802.x
[4]
D. Dressler, “Pharmacological Aspects of Therapeutic Botulinum Toxin Preparations,” Nervenarzt, Vol. 77, No. 8, 2006, pp. 912-921. http://dx.doi.org/10.1007/s00115-006-2090-2
[5]
P. J. Pasricha, W. J. Ravich, T. R. Hendrix, S. Sostre, B. Jones and A. N. Kallo, “Intrasphincteric Botulinum Toxin for the Treatment of Achalasia,” New England Journal of Medicine, Vol. 322, No. 12, 1995, pp. 774-778. http://dx.doi.org/10.1056/NEJM199503233321203
[6]
P. J. Pasricha, R. Rai, W. J. Ravich, T. R. Hendrix and A. N. Kalloo, “Botulinum Toxin for Achalasia: Long-Term Outcome and Predictors of Response,” Gastroenterology, Vol. 110, No. 5, 1996, pp. 1410-1415. http://dx.doi.org/10.1053/gast.1996.v110.pm8613045
[7]
I. Schneider, W. Thumfart and H. E. Eckel, “Treatment of Dysfunction of the Cricopharyngeal Muscle with Botulinum Toxin. Introduction of a New, Non-Invasive Method,” Annals of Otology, Rhinology, and Laryngology, Vol. 103, 1994, pp. 31-35.
[8]
M. B. J. Moermann and B. J. Mieke, “Cricopharyngeal Botox Injection: Indication and Technique,” Current Opinion in Otolaryngology & Head and Neck Surgery, Vol. 14, No. 6, 2006, pp. 431-436. http://dx.doi.org/10.1097/MOO.0b013e328010b85b
[9]
S. I. Atkinson and J. Rees, “Botulinum Toxin for Cricopharyngeal Dysphagia: Case Reports of CT-Guided Injection,” Journal of Otolaryngology, Vol. 26, No. 4, 1997, pp. 273-276.
[10]
V. Annese and G. Bassotti, “Non-Surgical Treatment of Esophageal Achalasia,” World Journal of Gastroenterology, Vol. 12, No. 36, 2006, pp. 5763-5766.
[11]
V. Annese, G. Bassotti, G. Coccia, M. Dinelli, V. D’Onofrio, G. Gatto, et al. and the GISMAD Achalasia Study Group, “A Multicentre Randomised Study of Intrasphincteric Botulinum Toxin in Patients with Oesophageal Achalasia,” Gut, Vol. 46, No. 5, 2000, pp. 597-600. http://dx.doi.org/10.1136/gut.46.5.597
[12]
M. Storr, P. Born, E. Frimberger, N. Weigert, T. Rösch, A. Meining, et al., “Treatment of Achalasia: The ShortTerm Response to Botulinum Toxin Injection Seems to be Independent of Any Kind of Pre-Treatment,” BMC Gastroenterology, Vol. 2, 2002, p. 19. http://dx.doi.org/10.1186/1471-230X-2-19
[13]
G. Zaninotto, R. Marchese-Ragona, C. Briani, M. Costantini, C. Rizzetto, G. Portale, et al., “The Role of Botulinum Toxin Injection and Upper Esophageal Sphincter Myotomy in Treating Oropharyngeal Dysphagia,” Journal of Gastrointestinal Surgery, Vol. 8, No. 8, 2004, pp. 997-1006. http://dx.doi.org/10.1016/j.gassur.2004.09.037
[14]
C. Cuillere, P. Ducrotté, F. Zerbib, E. H. Metman, D. de Looze, F. Guillemot, et al., “Achalasia: Outcome of Patients Treated with Intrasphincteric Injection of Botulinum Toxin,” Gut, Vol. 41, No. 1, 1997, pp. 87-92. http://dx.doi.org/10.1136/gut.41.1.87
[15]
V. M. Fishman, H. P. Parkman, T. D. Schiano, C. Hills, M. A. Dabezies, S. Cohen, et al., “Symptomatic Improvement in Achalasia after Botulinum Toxin Injection of the Lower Esophageal Sphincter,” American Journal of Gastroenterology, Vol. 91, No. 9, 1996, pp. 1724-1730.
[16]
J. Kolbasnik, E. W. Waterfall, B. Fachnie, Y. Chen and G. Tougas, “Long-Term Efficacy of Botulinum Toxin in Classical Achalasia: A Prospective Study,” American Journal of Gastroenterology, Vol. 94, No. 12, 2004, pp. 3434-3439. http://dx.doi.org/10.1111/j.1572-0241.1999.01605.x
[17]
V. F. Eckardt, C. Aignherr and G. Bernhard, “Predictors of Outcome in Patients with Achalasia Treated by Pneumatic Dilation,” Gastroenterology, Vol. 103, 1992, pp. 1732-1738.
[18]
M. Naumann, W. H. Jost and K. V. Toyka, “Botulinum Toxin in the Treatment of Neurological Disorders of the Autonomic Nervous System,” Archives of Neurology, Vol. 56, 1999, pp. 914-916. http://dx.doi.org/10.1001/archneur.56.8.914
[19]
C. F. Torbey, C. Singaram, P. Bass and E. A. Gaumnitz, “Action of Botulinum Toxin on Gut Smooth Muscle Involves Cholinergic and Non-Cholinergic Neural Pathway,” Gastroenterology, Vol. 112, 1997, p. A840.
[20]
A. Blitzer and M. F. Brin, “Use of Botulinum Toxin for Diagnosis and Management of Cricopharyngeal Achalasia,” Otolaryngology—Head and Neck Surgery, Vol. 116, No. 3, 1997, pp. 328-330. http://dx.doi.org/10.1016/S0194-5998(97)70267-5
[21]
G. Y. Shaw and J. P. Searl, “Botulinum Toxin Treatment for Cricopharyngeal Dysfunction,” Dysphagia, Vol. 16, No. 3, 2001, pp. 161-167. http://dx.doi.org/10.1007/s00455-001-0074-8
[22]
J. Alberty, M. Oelrich, K. Ludwig, S. Hartmann and W. Stoll, “Efficacy of Botulinum Toxin A for the Treatment of Upper Esophageal Sphincter Dysfunction,” Laryngoscope, Vol. 110, No. 7, 2000, pp. 1151-1156. http://dx.doi.org/10.1097/00005537-200007000-00016
[23]
M. Moermann, Y. Callier, C. Dick and H. Vermeersch, “Botulinum Toxin for Dysphagia Due to Cricopharyngeal Dysfunction,” European Archives of Oto-Rhino-Laryngology, Vol. 259, No. 1, 2002, pp. 1-3. http://dx.doi.org/10.1007/PL00007520
[24]
R. Marchese-Ragona, G. Marioni, D. A. Restivo and A. Staffieri, “Solving Dysphagia Due to Cricopharyngeal Muscle Dysfunction with Botulinum Toxin,” European Archives of Oto-Rhino-Laryngology, Vol. 262, No. 3, 2005, pp. 250-251. http://dx.doi.org/10.1007/s00405-004-0776-2
[25]
F. Mancini, G. Sandrini, A. Moglia, G. Nappi and C. Pacchetti, “A Randomized, Double-Blind, Dose-Ranging Study to Evaluate Efficacy and Safety of Three Doses of Botulinum Toxin Type A (Botox) for the Treatment of Spastic Foot,” Neurological Sciences, Vol. 26, No. 1, 2005, pp. 26-31. http://dx.doi.org/10.1007/s10072-005-0378-9
[26]
D. Dressler and J. C. Rothwell, “Electromyographic Quantification of the Paralysing Effect of Botulinum Toxin in the Sternomastoid Muscle,” European Neurology, Vol. 43, No. 1, 2000, pp. 13-16. http://dx.doi.org/10.1159/000008122
[27]
W. E. Waterfall, G. Tougas, B. Fachnie and U. Chauhan, “Clinical and Manometric Response to Botulinum Toxin (Botox) Used as Primary Treatment for Achalasia,” Gastroenterology, Vol. 108, 1995, p. A225.
[28]
R. Mac Ever, M. Liptay and Y. Johnson, “A Case of Mediastinitis Following Botulinum Toxin Type A Treatment for Achalasia,” Nature Clinical Practice Gastroenterology & Hepatology, Vol. 4, No. 10, 2007, pp. 579-582. http://dx.doi.org/10.1038/ncpgasthep0951
[29]
L. Dughera, E. Battaglia, D. Maggio, P. Cassolino, P. R. Mioli, A. Morelli, G. Emanuelli, et al., “Botulinum Toxin Treatment of Oesophageal Achalasia in the Old Old and Oldest Old: A 1-Year Follow-Up Study,” Drugs Aging, 2005, Vol. 22, No. 9, pp. 779-783. http://dx.doi.org/10.2165/00002512-200522090-00006
