BACKGROUND: @entity1318 is a @entity395 in which degenerating parasympathetic innervation of the lower esophageal sphincter (LES) leads to unopposed sympathetic tone and failure to relax on @entity1282 , resulting in a range of symptoms for the @entity1 , most notably @entity1282 , @entity662 , regurgitation, and @entity353 . Laparoscopic Heller's esophagomyotomy ( @entity3813 -HM) and botulinum toxin ( @entity9381 ) injection into the LES are two recently described methods for treating @entity1318 . No comparison of laparoscopic @entity195 and botulinum toxin has yet been presented. METHODS: A total of 22 @entity1 (15 @entity1 , 7 @entity1 ; mean age, 57.9 years) diagnosed with @entity1318 were given a choice of treatment modality: @entity3813 -HM or @entity9381 . @entity1 were prospectively assessed before and after treatment with esophageal manometry, barium swallow roentgenography, and @entity1282 score. @entity1 ' preferences and treatment efficacy were evaluated. RESULTS: Of the 22 @entity1 , 18 (81.8%) chose @entity9381 and 4 (18.2%) chose @entity3813 -HM. Five @entity1 in the @entity9381 group opted for @entity3813 -HM a mean of 565 +/- 212 days after the first injection, having received a median of four (range, 3-5) injections. Both @entity9381 and @entity3813 -HM were effective in improving @entity1282 score: before @entity9381 (median, 7; range, 0-10) and 2 months afterward (median, 2; range, 0-6) (p < 0. 01); before @entity3813 -HM (median, 9; range, 7-10) and 6 months afterward (median, 1.5; range, 0-4) (p < 0.05). Both methods also effectively reduced lower esophageal sphincter (LES) nadir pressure: before @entity9381 (mean mmHg, 22 +/- 9) and 2 months afterward (mean mmHg, 15 +/- 7) (p < 0.05); before @entity3813 -HM (mean mmHg, 24 +/- 10) and 6 months afterward (mean mmHg, 3 +/- 4) (p < 0.05). However, only @entity3813 -HM produced a significant reduction in LES basal pressure before (mean mmHg, 34 +/- 7) and afterward (mean mmHg, 3 +/- 3) (p < 0.01) and increased esophageal barium clearance (mean percentage of barium retained in esophagus at 5 min before (97% +/- 6%) and afterward (23% +/- 45%) (p < 0.05). CONCLUSIONS: @entity9381 injection and @entity3813 -HM both significantly reduce @entity1318 symptoms, but only @entity3813 -HM improves esophageal clearance of barium. @entity9381 injection is the most popular treatment method from a @entity1 perspective, although symptom recurrence or failure rates are high. @entity3813 -HM is favored by younger @entity1 and is equally effective after @entity9381 therapy failure.

XXXX or botulinum toxin injection for management of @entity1318 . @entity1 choice and treatment outcomes.

@entity1318 :: ('MESH:D004931', 'Disease') :: ['achalasia', 'Esophageal achalasia', 'idiopathic esophageal achalasia'] @entity1 :: ('9606', 'Species') :: ['men', 'women', 'Patients', 'patients', 'patient'] @entity662 :: ('MESH:D002637', 'Disease') :: ['chest pain'] @entity353 :: ('MESH:D015431', 'Disease') :: ['weight loss'] @entity9381 :: ('MESH:C542870', 'Chemical') :: ['BoTox'] @entity3813 :: ('7939', 'Gene') :: ['Lap'] @entity1282 :: ('MESH:D003680', 'Disease') :: ['deglutition', 'dysphagia'] @entity195 :: ('MESH:D000544', 'Disease') :: ["Heller's myotomy"] @entity395 :: ('MESH:D035583', 'Disease') :: ['rare disease']
@entity195 :: (MESH:D000544,Disease) :: ['Laparoscopic Heller's myotomy']
