PMID: 11897930Mar 19, 2002Paper

Treatment of achalasia with botulinum A toxin

American Journal of Therapeutics
Eduardo B V Da Silveira, Arvey I Rogers

Abstract

Achalasia is an idiopathic neuromuscular disorder of the esophagus which is associated with absence of esophageal peristalsis and incomplete relaxation of a normal or raised lower esophageal sphincter (LES). Dysphagia is the most commonly associated symptom. Conventional therapeutic approaches are directed to reducing LES pressure and include orally-administered smooth muscle relaxants, forceful sphincter dilation with balloon dilators, and open or laparoscopic-assisted myotomy of the LES. Pharmacologic therapies have a low success rate. Forceful dilation has a perforation complication rate of 2% to 5%, and myotomies may precipitate significant gastroesophageal reflux, a complication minimized when a partial fundal wrap is employed simultaneously. In recent years, botulinum toxin, utilized widely as a striated muscle relaxant in managing blepharospasm, anal sphincter spasm, and muscle spasm complicating CVAs, and in smoothening facial wrinkles, has been extended to the management of achalasia on the basis that it impairs smooth muscle responsiveness to acetylcholine. Eighty units of Botox (botulinum toxin) are injected directly into the endoscopically (endoscopic ultrasound techniques may facilitate localization) located LES re...Continue Reading

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Citations

Jun 16, 2011·General Thoracic and Cardiovascular Surgery·Hideyuki Kashiwagi, Nobuo Omura
Apr 25, 2007·Annals of Plastic Surgery·Halil Ibrahim CanterMehmet Emin Mavili
Nov 9, 2010·Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons·Massimo Robiony
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May 26, 2004·Clinics in Dermatology·Boris BentsianovAndrew Blitzer
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Aug 1, 2006·The Journal of Craniofacial Surgery·Ibrahim VargelYucel Erk
Jun 30, 2004·Dermatologic Clinics·Craig ZalvanAndrew Blitzer

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