Long-term follow-up of achalasia patients treated with botulinum toxin

被引:47
作者
D'Onofrio, V
Miletto, P
Leandro, G
Iaquinto, G
机构
[1] Osped San G Moscati, Serv Gastroenterol & Endoscopia Digest, I-83100 Avellino, Italy
[2] Osped San G Moscati, Nucl Med Serv, I-83100 Avellino, Italy
[3] De Bellis Hosp, IRCCS, Dept Med, Castellana Grotte, Italy
关键词
achalasia; botulinum toxin;
D O I
10.1016/S1590-8658(02)80238-9
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Aims. To evaluate long-term efficacy of intrasphincteric injection of botulinum toxin in untreated achalasia patients; to analyse whether age can be a predictor of response; and to verify whether any objective measurements correlate with symptom relief. Materials and Methods. A total of 3 7 patients (mean age 61.4+/-17.5 years) were enrolled, all of whom injected endoscopically with 100 U of botulinum toxin. Symptom score, oesophageal manometry and oesophageal radionuclide emptying were assessed prior to treatment and 4 weeks, 3 months and 1 year after botulinum toxin. In the case of failure or relapse (symptom score >2), treatment was repeated. Results. All but 6 patients (83.7%) were in clinical remission one month after botulinum toxin. At 12 months, mean symptom score was 0.9+/-0.5 (p<0.05 vs basal); mean lower oesophageal sphincter pressure was 22.0+/-6.3 (p<0.05 vs basal), and 10-min radionuclide retention was 14.0% +/-7.2 (p<0.05 vs basal), Of the 35 patients followed, 12 (34.3%) had a relapse and were re-treated; 4 out of 12 did not respond after re-treatment. Efficacy of first injection of botulinum toxin lasted for a mean period of 15.6 months (range 2-30). Up to day 31 (83.7%) patients were still in remission. We observed a trend towards a better response to botulinum toxin treatment in patients over 50 years (p=0.053). Moreover, no correlation was found between any objective achalasia measurements and symptom relief (r coefficient between 0.1 and 0.5) Conclusions. Results show that: 1) one or two intrasphincteric injections of botulinum toxin result in clinical and objective improvement in about 84% of achalasia patients and are not associated with serious side-effects; 2) patients over 50 years showed better benefit than younger patients; 3) no correlation was found between any objective measurements and symptom relief.
引用
收藏
页码:105 / 110
页数:6
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