Treatment of Achalasia with Intrasphincteric Injection of Botulinum Toxin: A Pilot Trial (1994)

Brief Communications15 October 1994Treatment of Achalasia with Intrasphincteric Injection of Botulinum Toxin: A Pilot TrialPankaj J. Pasricha, MD, William J. Ravich, MD, Thomas R. Hendrix, MD, Samuel Sostre, MD, Bronwyn Jones, MD, and Anthony N. Kalloo, MDPankaj J. Pasricha, MD, William J. Ravich, MD, Thomas R. Hendrix, MD, Samuel Sostre, MD, Bronwyn Jones, MD, and Anthony N. Kalloo, MDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-121-8-199410150-00006 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Achalasia is a disorder characterized by a failure of the lower esophageal sphincter to relax with swallowing and by a lack of esophageal peristalsis. The sphincteric abnormalities in achalasia are thought to be caused by a selective loss of inhibitory neurons in the myenteric plexus, resulting in the relatively unopposed excitation of the smooth muscle by acetylcholine and other mediators. Our previous studies in animals [1] have shown that locally injected botulinum toxin, a potent inhibitor of acetylcholine release, can reduce lower esophageal sphincter tone. We report our initial experience with this agent for the treatment of achalasia in humans.... References1. Pasricha PJ, Ravich WJ, Kalloo AN. Effects of intrasphincteric botulinum toxin on the lower esophageal sphincter in piglets. Gastroenterology. 1993; 105:1045-9. Google Scholar2. Eckardt VF, Aignherr C, Bernhard G. Predictors of outcome in patients with achalasia treated with pneumatic dilation. Gastroenterology. 1992; 103:1732-8. Google Scholar3. Wong RK, Maydonovitch CL. Achalasia. In: Castell DO, ed. The Esophagus. Boston: Little, Brown; 1992:233. Google Scholar4. 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Janckovic J, Brin MF. Therapeutic uses of botulinum toxin. N Engl J Med. 1991; 324:1186-94. Google Scholar Author, Article, and Disclosure InformationAuthors: Pankaj J. Pasricha, MD; William J. Ravich, MD; Thomas R. Hendrix, MD; Samuel Sostre, MD; Bronwyn Jones, MD; Anthony N. Kalloo, MDFrom Johns Hopkins Hospital, Baltimore, Maryland.\\\Corresponding Author: Pankaj J. Pasricha, MD, Johns Hopkins Hospital, 600 North Wolfe Street, Blalock 4, Baltimore, MD 21287-4461. 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