Endoscopic injection of botulinum toxin has shown benefits for patients with diffuse esophageal spasm and nutcracker esophagus in small uncontrolled trials.
Dr Tim Vanuytsel from Belgium investigated the effect of botulinum toxin on symptoms of patients with diffuse esophageal spasm or nutcracker esophagus.
The team assessed manometry findings in a prospective, double-blind, randomized, controlled study.
The research team evaluated 22 patients with dysphagia-predominant, manometry-confirmed diffuse esophageal spasm or nutcracker esophagus at a tertiary care medical center.
|50% of patients had a response 1 month after botulinum toxin injection|
|Clinical Gastroenterology and Hepatology|
Patients were given injections of botulinum toxin or saline in 4 quadrants, at 2 and 7 cm above the esophagogastric junction.
After 1 month, patients crossed over between groups and received endoscopic injections of botulinum toxin or saline.
When the study began and 4 weeks after each injection, the patients were assessed by esophageal manometry and completed a symptom questionnaire.
The doctors analyzed the responders that were defined based on modified Vantrappen criteria for achalasia.
After botulinum toxin injections, the team noted that patients had significant decreases in total symptom scores, this decrease was not observed in patients who received saline injections.
Moreover, botulinum toxin injection stabilized unintentional weight loss.
The researchers found that 50% of patients had a response 1 month after botulinum toxin injection, compared with 10% after saline injection.
The team observed that 30% of patients still had a response 1 year after botulinum toxin injection.
Botulinum toxin injection also caused a significant decrease in the mean esophagogastric junction pressure, compared with baseline.
Dr Vanuytsel's team concludes, "In a prospective controlled study of patients with diffuse esophageal spasm and nutcracker esophagus, injections of botulinum toxin reduced symptoms and stabilized unintentional weight loss."