Botulinum Toxin Injection for the Treatment of Upper Esophageal Sphincter Dysfunction

Abstract

Objectives We sought to review the dysphagia-related outcomes and quality of life in a series of patients with upper esophageal sphincter (UES) dysfunction treated with cricopharyngeal (CP) botulinum toxin (BTX) injection, and to identify patient characteristics or CP muscle histologic features that predict efficacy of BTX injection. Methods A retrospective chart review was performed on patients with UES dysfunction who underwent CP BTX injection. Dysphagia-related quality-of-life questionnaires based on the Eating Assessment Tool (EAT-10) were mailed to patients. Results Forty-nine patients (30 female, 19 male; average age, 59 ± 16 years) with UES dysfunction have been treated at our institution with CP BTX injection since 2000. Seventeen of these patients also underwent CP myotomy. Injections of BTX were occasionally repeated after the treatment effect subsided, and the BTX dose varied widely (average, 39 ± 19 units). Improvement in symptoms was noted by 65% of patients. The overall complication rate was minimal, although many patients complained of transient worsening of dysphagia after CP BTX injection. Biopsy specimens of the CP muscle were evaluated in the subset of patients with CP BTX injection who proceeded to myotomy, with results of neuropathic, myopathic, and mixed histologic subtypes. The EAT-10 scores demonstrated a general trend toward improved swallowing outcomes after CP BTX injection. Conclusions This study reviewed findings from the largest published series of BTX treatment of UES dysfunction and evaluated the efficacy, patient satisfaction, and complications of this procedure. Dysphagia-related quality-of-life outcomes appear to be improved after CP BTX injection.

Upper esophageal sphincter mechanical states analysis: a novel methodology to describe UES relaxation and opening

“…Methodology to better assess UES function is clinically relevant for diagnosis of motor dysfunctions causal of dysphagia symptoms. Appropriately diagnosed UES dysfunctions may be treatable through interventions such as dilatation (Hatlebakk et al, 1998 ; Clary et al, 2011 ; Lan et al, 2013 ), Botox injection (Kelly et al, 2013 ), surgical intervention (e.g., myotomy) to ablate cricopharyngeal tone (Mason et al, 1998 ; Kelly, 2000 ) or swallow manoeuvrers and exercise. For example, the Mendelsohn maneuver to augment UES opening (Kahrilas et al, 1991 ) and the Shaker suprahyoid muscle strengthening exercise (Shaker et al, 1997 , 2002 ).…”

Ultrasonography-guided botulinum toxin injection to the cricopharyngeus muscle: a case report and technical notes

“…This high-pressure region must relax and the lumen must open for smooth food passage. The CPm is therefore a common target of interventions for dysphagia, including balloon dilation, myotomy and chemodenervation with BTX [7,8]. Recently, ultrasonography-guided injection is attracting more attention because of several advantages such as free from radiation exposure, sparing general or local anesthesia, and real-time visualization of the neurovascular anatomy, thus minimizing the risk of unintentional injury to these vital structures [9].…”

Treatment of Gastrointestinal Sphincters Spasms with Botulinum Toxin A

“…Dysphagia associated with cricopharingeal (CP) muscle dysfunction has a significant impact on overall patient quality of life [ 18 ]. CP dysphagia, either idiopathic or secondary to various neurologic or muscular conditions, is characterized by incomplete or poorly coordinated opening of the upper esophageal sphincter (UES) during swallowing.…”