Botulinum toxin in the treatment of diffuse esophageal spasm

Dis Esophagus. 2010 Sep;23(7):554-60. doi: 10.1111/j.1442-2050.2010.01065.x. Epub 2010 May 4.


Diffuse esophageal spasm is a primary esophageal motility disorder. The prevalence is 3-10% in patients with dysphagia and treatment options are limited. This review summarizes the treatment of diffuse esophageal spasm, including pharmacotherapy, endoscopic treatment, and surgical treatment with a special focus on botulinum toxin injection. A PubMed search was performed to identify the literature using the search items diffuse esophageal spasm and treatment. Pharmacotherapy with smooth muscle relaxants, proton pump inhibitors, and antidepressants was suggested from small case series and uncontrolled clinical trials. Endoscopic injection of botulinum toxin is a well-studied treatment option and results in good symptomatic benefit in patients with diffuse esophageal spasm. Surgical treatment was reported in patients with very severe symptoms refractory to pharmacologic treatment. This article summarizes the present knowledge on the treatment of diffuse esophageal spasm with a special emphasis on botulinum toxin injection. Endoscopic injection of botulinum toxin is presently the best studied treatment option but many questions remain unanswered.

Publication types

  • Review

MeSH terms

  • Anti-Dyskinesia Agents / therapeutic use*
  • Botulinum Toxins / therapeutic use*
  • Esophageal Spasm, Diffuse / diagnosis
  • Esophageal Spasm, Diffuse / drug therapy*
  • Esophageal Spasm, Diffuse / physiopathology
  • Esophagoscopy
  • Humans


  • Anti-Dyskinesia Agents
  • Botulinum Toxins