Skip to main content
Erschienen in: Current Treatment Options in Gastroenterology 4/2018

08.11.2018 | Motility (H Parkman and R Schey, Section Editors)

The Role of Botulinum Toxin Injections for Esophageal Motility Disorders

verfasst von: Jessica L. Sterling, MD, Ron Schey, MD, Zubair Malik, MD

Erschienen in: Current Treatment Options in Gastroenterology | Ausgabe 4/2018

Einloggen, um Zugang zu erhalten

Abstract

Purpose of review

The advancement of high-resolution esophageal manometry has led to improvement in the diagnosis of esophageal motility disorders. We reviewed the recent medical literature regarding the use of botulinum toxin (BTx) injections in the esophagus and the indications, current outcomes, and reported complications of this therapy.

Recent findings

The response rates of BTx injection therapy vary depending on the esophageal motility disorder. Studies have shown that response is transient in achalasia patients and given the more effective therapies available, it is only recommended in patients who are not surgical candidates. In nonachalasia patients, studies of BTx injections have demonstrated improvement in dysphagia symptoms in patients with spastic disorders, though studies are small and largely retrospective. The available literature showed a variable response to BTx in esophagogastric junction outlet obstruction (EGJOO) and non-cardiac chest pain patients. Despite advances in diagnosing esophageal motility disorders, there is a need for further research in patient selection for esophageal BTx, dose and injection location, and disease-specific outcomes. Placebo-controlled trials are crucial to evaluate BTx efficacy and duration of response.

Summary

Esophageal-directed BTx injections are beneficial in improving dysphagia in spastic motility disorders and in achalasia patients who are elderly or have multiple co-morbidities. There is a lack of evidence to support use in patients with EGJOO and non-cardiac chest pain, or for young or healthy achalasia patients.
Literatur
5.
Zurück zum Zitat • van Hoeij FB, Tack JF, Pandolfino JE, Sternbach JM, Roman S, Smout AJ, et al. Complications of botulinum toxin injections for treatment of esophageal motility disorders†. Dis Esophagus. 2017;30(3):1–5. https://doi.org/10.1111/dote.12491 This is the only analysis that highlights the important complications of esophageal BTX injections.CrossRefPubMed • van Hoeij FB, Tack JF, Pandolfino JE, Sternbach JM, Roman S, Smout AJ, et al. Complications of botulinum toxin injections for treatment of esophageal motility disorders†. Dis Esophagus. 2017;30(3):1–5. https://​doi.​org/​10.​1111/​dote.​12491 This is the only analysis that highlights the important complications of esophageal BTX injections.CrossRefPubMed
7.
Zurück zum Zitat Zerbib FM, Roman SM. Current therapeutic options for esophageal motor disorders as defined by the Chicago classification. J Clin Gastroenterol. 2015;49(6):451–60.PubMed Zerbib FM, Roman SM. Current therapeutic options for esophageal motor disorders as defined by the Chicago classification. J Clin Gastroenterol. 2015;49(6):451–60.PubMed
12.
Zurück zum Zitat Okeke FC, Raja S, Lynch KL, Dhalla S, Nandwani M, Stein EM et al. What is the clinical significance of esophagogastric junction outflow obstruction? evaluation of 60 patients at a tertiary referral center. Neurogastroenterol Motil. 2017;29(6). https://doi.org/10.1111/nmo.13061.CrossRef Okeke FC, Raja S, Lynch KL, Dhalla S, Nandwani M, Stein EM et al. What is the clinical significance of esophagogastric junction outflow obstruction? evaluation of 60 patients at a tertiary referral center. Neurogastroenterol Motil. 2017;29(6). https://​doi.​org/​10.​1111/​nmo.​13061.CrossRef
15.
22.
Zurück zum Zitat Stavropoulos SN, Friedel D, Modayil R, Parkman HP. Diagnosis and management of esophageal achalasia. BMJ. 2016;354:i2785.CrossRefPubMed Stavropoulos SN, Friedel D, Modayil R, Parkman HP. Diagnosis and management of esophageal achalasia. BMJ. 2016;354:i2785.CrossRefPubMed
26.
Zurück zum Zitat Zaninotto G, Annese V, Costantini M, Del Genio A, Costantino M, Epifani M, et al. Randomized controlled trial of botulinum toxin versus laparoscopic heller myotomy for esophageal achalasia. Ann Surg. 2004;239(3):364–70.CrossRefPubMedPubMedCentral Zaninotto G, Annese V, Costantini M, Del Genio A, Costantino M, Epifani M, et al. Randomized controlled trial of botulinum toxin versus laparoscopic heller myotomy for esophageal achalasia. Ann Surg. 2004;239(3):364–70.CrossRefPubMedPubMedCentral
35.
Zurück zum Zitat D’Onofrio V, Miletto P, Leandro G, Iaquinto G. Long-term follow-up of achalasia patients treated with botulinum toxin. Dig Liver Dis. 2002;34(2):105–10.CrossRefPubMed D’Onofrio V, Miletto P, Leandro G, Iaquinto G. Long-term follow-up of achalasia patients treated with botulinum toxin. Dig Liver Dis. 2002;34(2):105–10.CrossRefPubMed
41.
Zurück zum Zitat • Vanuytsel T, Bisschops R, Farré R, Pauwels A, Holvoet L, Arts J, et al. Botulinum toxin reduces Dysphagia in patients with nonachalasia primary esophageal motility disorders. Clin Gastroenterol Hepatol. 2013;11(9):1115–21.e2. https://doi.org/10.1016/j.cgh.2013.03.021 This is the only double-blinded, placebo-controlled trial to evaluate BTX injection therapy for nonachalasia motility disorders.CrossRefPubMed • Vanuytsel T, Bisschops R, Farré R, Pauwels A, Holvoet L, Arts J, et al. Botulinum toxin reduces Dysphagia in patients with nonachalasia primary esophageal motility disorders. Clin Gastroenterol Hepatol. 2013;11(9):1115–21.e2. https://​doi.​org/​10.​1016/​j.​cgh.​2013.​03.​021 This is the only double-blinded, placebo-controlled trial to evaluate BTX injection therapy for nonachalasia motility disorders.CrossRefPubMed
44.
Zurück zum Zitat Storr M, Allescher HD, Rösch T, Born P, Weigert N, Classen M. Treatment of symptomatic diffuse esophageal spasm by endoscopic injection of botulinum toxin: a prospective study with long term follow-up. Gastrointest Endosc. 2001;54(6):18ACrossRefPubMed Storr M, Allescher HD, Rösch T, Born P, Weigert N, Classen M. Treatment of symptomatic diffuse esophageal spasm by endoscopic injection of botulinum toxin: a prospective study with long term follow-up. Gastrointest Endosc. 2001;54(6):18ACrossRefPubMed
56.
Zurück zum Zitat Kahrilas PJ, Pandolfino JE. Treatments for achalasia in 2017: how to choose among them. Curr Opin Gastroenterol. 2017;33(4):270–6. https://doi.org/10.1097/MOG.0000000000000365CrossRefPubMedPubMedCentral Kahrilas PJ, Pandolfino JE. Treatments for achalasia in 2017: how to choose among them. Curr Opin Gastroenterol. 2017;33(4):270–6. https://​doi.​org/​10.​1097/​MOG.​0000000000000365​CrossRefPubMedPubMedCentral
Metadaten
Titel
The Role of Botulinum Toxin Injections for Esophageal Motility Disorders
verfasst von
Jessica L. Sterling, MD
Ron Schey, MD
Zubair Malik, MD
Publikationsdatum
08.11.2018
Verlag
Springer US
Erschienen in
Current Treatment Options in Gastroenterology / Ausgabe 4/2018
Print ISSN: 1092-8472
Elektronische ISSN: 1534-309X
DOI
https://doi.org/10.1007/s11938-018-0212-0

Weitere Artikel der Ausgabe 4/2018

Current Treatment Options in Gastroenterology 4/2018 Zur Ausgabe

Stomach (P Malfertheiner, Section Editor)

Gastric Cancer: an Evolving Disease

Motility (H Parkman and R Schey, Section Editors)

Migraine, Cyclic Vomiting Syndrome, and Other Gastrointestinal Disorders

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.