Botulinum toxin for achalasia: long-term outcome and predictors of response

Gastroenterology. 1996 May;110(5):1410-5. doi: 10.1053/gast.1996.v110.pm8613045.


Background & aims: Botulinum toxin injection into the lower esophageal sphincter of patients with achalasia results in effective short-term relief of symptoms. The aims of this study were to examine the long-term outcome of these patients and to determine the predictors of response to this therapy.

Methods: Thirty-one patients with achalasia treated with botulinum toxin were followed up prospectively for a median duration of 890 days.

Results: Twenty-eight patients improved initially, but only 20 patients had sustained improvement beyond 3 months; the latter patients were classified as responders. The response rate was greater in patients older than 50 years of age (82% vs. 43% in younger patients; P = 0.03) and in patients with vigorous achalasia (100% vs. 52% with classic achalasia; P = 0.03). Duration of illness, previous dilation, and baseline radiological characteristics did not influence outcome. Nineteen responders eventually had relapse after a median duration of 468 days (range, 153 - 840 days). Fifteen of these patients received a second injection with satisfactory results obtained in the majority of patients.

Conclusions: Botulinum toxin is an effective treatment for achalasia in about two thirds of patients, with a duration of response averaging 1.3 years. Age and type of achalasia seem to be important predictors of response.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Anti-Dyskinesia Agents / therapeutic use*
  • Botulinum Toxins / therapeutic use*
  • Cohort Studies
  • Esophageal Achalasia / therapy*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Recurrence


  • Anti-Dyskinesia Agents
  • Botulinum Toxins