Efficacy of Botulinum Toxin A for Treatment of Upper Esophageal Sphincter Dysfunction

Abstract

Objectives: To investigate the efficacy of botulinum toxin A (BTA)-induced chemodenervation of the upper esophageal sphincter (UES) in patients with dysphagia and UES dysfunction. Study Design: Prospective clinical trial in 10 selected patients with pure UES dysfunction. Methods: In each patient 30 units of BTA were injected into the UES under brief general anesthesia. Videofluoroscopic swallowing s tudy (VSS) was done and a clinical symptom score was determined before and after treatment. Results: On VSS relative opening of the UES improved in all pa· tients (mean± SD: 47 ± 14% before versus 71 ± 24% after treatment; P < .01). Hypopharyngeal retention or laryngeal penetration of barium was significantly reduced in four of seven patients. Clinical symptom scores improved in all patients. One patient was free of symptoms, mild dysphagia persist ed in six patients, and moderate dysphagia persisted in three patients. Conclusions: Our results support the u se of BTA in selected patients with pure UES dysfunction. Its efficacy is limited by the possibility of a persistent s tructural stenosis of the UES and the risk ofBTA diffusion into the larynx or hypopharynx.

Botulinum Toxin Treatment for Cricopharyngeal Dysfunction

“…The patients in our study received 25±50 units. The higher dosage is consistent with the higher dosages used for lower esophageal sphincter (LES) achalasia which is generally 80 units [18].…”

“…Other reports did not specify duration of eect, but one can infer a duration of 4±6 months from the dosing schedule of Blitzer et al [13] and Alberty et al [18]. One might speculate that the higher dosage used in the present study could have resulted in the longer duration of eect (comparable to that seen in LES injections).…”

“…Schneider et al [16] used 80±160 units of Dysport Ò (Speywood Biopharm, North Wales, UK) which is equivalent to 20± 40 units of BTA. Most recently, Alberty et al [18] used 30 units of BTA in their study of ten patients. The patients in our study received 25±50 units.…”

Einsatz von Botulinumtoxin A im Gastrointestinaltrakt

“…In kleineren Patien- [1,6,10]. Jedoch werden für alle Methoden bisher nur Einzelfallberichte oder kleine Kollektive mit sehr unterschiedlichen, lediglich teilweise erfolgversprechenden Resultaten beschrieben, so dass auch hier noch kontrollierte Studien abgewartet werden müssen.…”

Botulinumtoxin: Internistische Indikationen

“…B. perkutan gesteuert mit Elektromyographie, computertomographisch gezielt, videofluoroskopisch, endoskopisch starr bzw. flexibel [45,46,47], jedoch werden für alle Methoden bisher nur Einzelfallberichte oder kleine Kollektive mit sehr unterschiedlichen, lediglich teilweise erfolgversprechenden Resultaten beschrieben, sodass auch hier noch kontrollierte Studien abgewartet werden müssen.…”