Long-term follow-up of achalasia patients treated with botulinum toxin

Dig Liver Dis. 2002 Feb;34(2):105-10. doi: 10.1016/s1590-8658(02)80238-9.


Aims: To evaluate long-term efficacy of intrasphincteric injection of botulinum toxin in untreated achalasia patients; to analyse whether age can be a predictor of response; and to verify whether any objective measurements correlate with symptom relief

Materials and methods: A total of 37 patients (mean age 61.4+/-17.5 years) were enrolled, all of whom injected endoscopically with 100 U of botulinum toxin. Symptom score, oesophageal manometry and oesophageal radionuclide emptying were assessed prior to treatment and 4 weeks, 3 months and 1 year after botulinum toxin. In the case of failure or relapse (symptom score >2), treatment was repeated.

Results: All but 6 patients (83.7%) were in clinical remission one month after botulinum toxin. At 12 months, mean symptom score was 0.9+/-0.5 (p<0.05 vs basal); mean lower oesophageal sphincter pressure was 22.0+/-6.3 (p<0.05 vs basal), and 10-min radionuclide retention was 14.0%+/-7.2 (p<0.05 vs basal). Of the 35 patients followed, 12 (34.3%) had a relapse and were re-treated; 4 out of 12 did not respond after re-treatment. Efficacy of first injection of botulinum toxin lasted for a mean period of 15.6 months (range 2-30). Up to day 31 (83.7%) patients were still in remission. We observed a trend towards a better response to botulinum toxin treatment in patients over 50 years (p=0.053). Moreover no correlation was found between any objective achalasia measurements and symptom relief (r coefficient between 0.1 and 0.5)

Conclusions: Results show that: 1) one or two intrasphincteric injections of botulinum toxin result in clinical and objective improvement in about 84% of achalasia patients and are not associated with serious side-effects; 2) patients over 50 years showed better benefit than younger patients; 3) no correlation was found between any objective measurements and symptom relief.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Anti-Dyskinesia Agents / administration & dosage
  • Anti-Dyskinesia Agents / therapeutic use*
  • Botulinum Toxins / administration & dosage
  • Botulinum Toxins / therapeutic use*
  • Esophageal Achalasia / drug therapy*
  • Esophageal Achalasia / physiopathology
  • Esophagus / physiopathology
  • Female
  • Follow-Up Studies
  • Humans
  • Injections, Intralesional
  • Male
  • Manometry
  • Middle Aged
  • Time Factors
  • Treatment Outcome


  • Anti-Dyskinesia Agents
  • Botulinum Toxins