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

Pasricha, P. J.; Rai, Rudra; Ravich, W. J.; Hendrix, T R; Kalloo, AN

doi:10.1053/gast.1996.v110.pm8613045

Cited by 366 publications

(225 citation statements)

References 1 publication

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“…The treatment is effective in 70% of patients, and the average duration of symptom remission is 16 months. Patients over 50 years of age respond better to this treatment (279) (280) . Botulinum toxin treatment of megaesophagus has worse outcomes than those of dilation or surgery (level IIB).…”

Section: Botulinum Toxinmentioning

confidence: 99%

2 nd Brazilian Consensus on Chagas Disease, 2015

Dias

Ramos

Gontijo

et al. 2016

Rev. Soc. Bras. Med. Trop.

289

677

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Section: Botulinum Toxinmentioning

confidence: 99%

2 nd Brazilian Consensus on Chagas Disease, 2015

Dias

Ramos

Gontijo

et al. 2016

Rev. Soc. Bras. Med. Trop.

289

677

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“…A randomized controlled trial published in 2017 comparing POEM with pneumatic dilation found the POEM procedure to be more efficacious in terms of therapeutic success, but also more likely to result in post-procedure reflux oesophagitis 61 . The preceding discussion makes no mention of medical treatments for achalasia, specifically botulinum toxin [62][63][64][65] , calcium-channel blockers 66 , nitrates 66 and phosphodiesterase type 5 inhibitors 67 primarily because, although these agents provide some symptomatic benefit, they are not durable therapies and they do not halt the disease progression toward oesophageal decompensation characterized by dilatation and food retention. For example, in the case of botulinum toxin injected into the LES, about two-thirds of patients with achalasia report an improvement in dysphagia, but most relapse within a year and repeat treatments have diminished effectiveness, making it a poor firstline therapy [62][63][64][65] .…”

Section: Poemmentioning

confidence: 99%

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Kahrilas

Bredenoord

Fox

et al. 2017

Nat Rev Gastroenterol Hepatol

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High-resolution manometry (HRM), along with the analysis algorithms characterized in the Chicago Classification (CC) first proposed in 2008, have led to a major restructuring of the classification of oesophageal motility disorders. The inherently quantitative output of HRM devices fuelled enthusiastic expectation among motility experts that these advances would add a level of precision to the diagnosis of oesophageal motility disorders that was not previously possible. Nowhere was this advance more evident than in our concept of achalasia, now differentiated into subtypes as a direct result of HRM. Coincident with the assimilation of HRM into clinical practice was the development of a major therapeutic intervention for the management of oesophageal motility disorders, per-oral endoscopic myotomy (POEM). Not only does the POEM procedure provide a therapeutic option for myotomy with reduced morbidity relative to laparoscopic or open myotomy, but it also enables a calibrated intervention that is customized to patient-specific physiology. Together, these develop ments fostered an increasing emphasis on targeting therapy to specific aspects of oesophageal dysfunction, as measured by physiological testing, rather than discrete diagnoses. Again, nowhere is this evolution more evident than in our strategies for managing achalasia. This Consensus Statement examines the effect of HRM on our current understanding of oesophageal motility disorders with a focus on how this technology has affected the diagnosis, epidemiology and management of achalasia and achalasia-like syndromes. on behalf of the International Working Group for Disorders of Gastrointestinal Motility and FunctionAbstract | High-resolution manometry (HRM) and new analysis algorithms, summarized in the Chicago Classification, have led to a restructured classification of oesophageal motility disorders. This advance has led to increased detection of clinically relevant disorders, in particular achalasia. It has become apparent that the cardinal feature of achalasia -impaired lower oesophageal sphincter (LES) relaxation -can occur in several disease phenotypes: without peristalsis (type I), with pan-oesophageal pressurization (type II), with premature (spastic) distal oesophageal contractions (type III), or with preserved peristalsis (outlet obstruction). Furthermore, no manometric pattern is perfectly sensitive or specific for achalasia caused by a myenteric plexopathy, and there is no biomarker for this pathology. Consequently, physiological testing reveals other syndromes not meeting achalasia criteria that also benefit from therapies formerly reserved for achalasia. These findings have become particularly relevant with the development of a minimally invasive technique for performing a long oesophageal myotomy, the per-oral endoscopic myotomy (POEM). Optimal management is to render treatment in a phenotype-specific manner; that is, POEM calibrated to patient-specific physiology for spastic achalasia and the spastic disorders, and more conservative strategies...

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“…These therapies are now reserved for short-term treatment in patients who cannot tolerate invasive methods, or as a bridge to more definitive treatment [27]. Endoscopic botulinum toxin injection is still an accepted method for symptom relief, however the effects are often short lived [28,29]. As with oral pharmacologic agents, Botox injection should be reserved for patients who cannot tolerate more invasive methods.…”

Section: Treatmentmentioning

confidence: 99%

Current status of achalasia management: a review on diagnosis and treatment

Tuason

Inoue

2017

J Gastroenterol

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Background Achalasia is a rare esophageal motility disorder that is characterized by loss of peristalsis and failure of relaxation of the lower esophageal sphincter (LES), particularly during swallowing. This review focuses on the diagnosis of esophageal motility disorders as defined by the Chicago Classification ver 3.0, and presents management options with regard to per-oral endoscopic myotomy (POEM) as the treatment of choice. Methods A concise review of literature was performed for articles related to the management of achalasia, and this was contrasted with our institution's current practice. Results Achalasia is still incompletely understood, and management is focused on establishing a proper diagnosis, and relieving the obstructive symptoms. Conclusions Achalasia should be considered when dysphagia is present, and not otherwise caused by an obstruction or inflammation, and when criteria is met as per the Chicago Classification ver 3.0. Lowering LES tone and disruption of LES can be accomplished by various methods, most notably pneumatic balloon dilatation and surgical myotomy. POEM has been gaining momentum as a first line therapy for achalasia symptoms, and can be considered an important tool for motility disorders of the esophagus.

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

Cited by 366 publications

References 1 publication

2 nd Brazilian Consensus on Chagas Disease, 2015

2 nd Brazilian Consensus on Chagas Disease, 2015

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Current status of achalasia management: a review on diagnosis and treatment

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