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

P. J. Pasricha, R. Rai, W. J. Ravich, T. R. Hendrix, A. N. Kalloo

Research output: Contribution to journalArticlepeer-review

336 Scopus citations


Background and Aims: Botulinum toxin injection into the lower esophageal sphincter of patients with achalasia results in effective short-term relief of symptoms. The aims of this study were to examine the long-term outcome of these patients and to determine the predictors of response to this therapy. Methods: Thirty-one patients with achalasia treated with botulinum toxin were followed up prospectively for a median duration of 890 days. Results: Twenty- eight patients improved initially, but only 20 patients had sustained improvement beyond 3 months; the latter patients were classified as responders. The response rate was greater in patients older than 50 years of age (82% vs. 43% in younger patients; P = 0.03) and in patients with vigorous achalasia (100% vs. 52% with classic achalasia; P = 0.03). Duration of illness, previous dilation, and baseline radiological characteristics did not influence outcome. Nineteen responders eventually had a relapse after a median duration of 468 days (range, 153-840 days). Fifteen of these patients received a second injection with satisfactory results obtained in the majority of patients. Conclusions: Botulinum toxin is an effective treatment for achalasia in about two thirds of patients, with a duration of response averaging 1.3 years. Age and type of achalasia seem to be important predictors of response.

Original languageEnglish (US)
Pages (from-to)1410-1415
Number of pages6
Issue number5
StatePublished - 1996

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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