Botulinum toxin injection in dysphagia syndromes with preserved esophageal peristalsis and incomplete lower esophageal sphincter relaxation

Porter, Ryan; Gyawali, C. Prakash

doi:10.1111/j.1365-2982.2010.01604.x

Cited by 64 publications

(52 citation statements)

References 25 publications

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“…However, on further subgroup analysis, there is evidence to suggest that the best responses in type III achalasia can be achieved with HM rather than pneumatic dilation [6]. Our results do not disprove speculation that pathophysiologic processes underlying types I and II may be different from that in type III [14, 16, 23], but we concur with Greene et al [8] that type III achalasia patients respond symptomatically to HM at a rate not different from that seen with types I and II. Unless all the esophageal body sequences are premature and non-peristaltic, any retained esophageal body peristaltic response in type III achalasia will benefit esophageal emptying after HM.…”

Section: Discussioncontrasting

confidence: 65%

“…GSS was assessed using a ten-point visual analog scale. Both of these symptom-assessment tools have been extensively used by our group to assess initial and follow-up esophageal symptoms, both within the realm of achalasia spectrum disorders [14–16], and reflux disease [10, 13, 17]. These parameters were reassessed prospectively upon follow-up, and changes in individual symptoms as well as global symptoms (using GSS) were recorded.…”

Section: Methodsmentioning

confidence: 99%

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Achalasia symptom response after Heller myotomy segregated by high-resolution manometry subtypes

Patel

Mirza

et al. 2015

J Gastroenterol

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Background Achalasia is classified into three HRM subtypes that predict outcomes from diverse management strategies. We assessed if symptomatic response varied when a single management strategy—Heller myotomy (HM)—is employed. Methods Treatment-naive subjects with achalasia referred for HM were followed in this observational cohort study. Chicago criteria designated achalasia subtypes (subtype I: no esophageal pressurization; subtype II: panesophageal pressurization in ≥20 % swallows; subtype III: premature contractions in ≥20 % swallows). Symptom questionnaires assessed symptom burden before and after HM on five-point Likert scales (0 = no symptoms, 4 = severe symptoms) and on 10-cm visual analog scales (global symptom severity, GSS); satisfaction with HM was recorded similarly. Data were analyzed to determine predictors of GSS change across subtypes. Results Sixty achalasia subjects (56.1 ± 2.4 years, 55 % female) fulfilled inclusion criteria, 15 % with subtype I, 58 % with subtype II, and 27 % with subtype III achalasia. Baseline symptoms included dysphagia (solids: 85 %, liquids: 73 %), regurgitation (84 %), and chest pain (35 %); mean GSS was 7.1 ± 0.3. Upon follow-up 2.1 ± 0.2 years after HM, GSS declined to 1.9 ± 0.4 (p < 0.001), with surgical satisfaction score of 8.7 ± 0.3 out of 10; these were similar across achalasia subtypes. On univariate analysis, female gender, Eckardt score, severity of transit symptoms, and maximal IRP predicted linear GSS improvement; female gender (p = 0.003) and dysphagia for liquids (p = 0.043) remained predictive on multivariate analysis. Conclusions When a uniform surgical approach is utilized, symptomatic outcome and satisfaction with therapy are similar across achalasia subtypes. Female gender and severity of dysphagia for solids may predict better HM outcome.

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Section: Discussioncontrasting

confidence: 65%

Section: Methodsmentioning

confidence: 99%

Achalasia symptom response after Heller myotomy segregated by high-resolution manometry subtypes

Patel

Mirza

et al. 2015

J Gastroenterol

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“…Patients who received swallowing training for three months or more from admission, alternative nutrition, such as tube feeding, for three months or more and those who underwent botulinum toxin injection or surgery were assigned to the severe group, whereas patients whose oral intake was initiated within two weeks after the onset of disease were assigned to the mild group (20). All other patients were assigned to the moderate group.…”

Section: Classification Of the Functional Outcomementioning

confidence: 99%

“…Type 3 passage cases exhibit complete UES opening failure with triggering of the pharyngeal stage of swallowing. Such patients exhibit severe dysphagia and are candidates for electric stimulation, botulinum toxin injection or surgery (20).…”

Section: Ppamentioning

confidence: 99%

Prediction of Dysphagia Severity: An Investigation of the Dysphagia Patterns in Patients with Lateral Medullary Infarction

et al. 2013

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Objective In order to identify the factors that influence the swallowing function in patients who develop Wallenberg syndrome (WS) following lateral medullary infarction (LMI), we examined various patient characteristics, including the passage pattern abnormality (PPA) of a bolus through the upper esophageal sphincter (UES). Methods Fifty-four pure LMI patients with dysphagia participated in this study. PPA, defined as the failure of bolus passage through the UES corresponding to the intact side of the medulla, was identified during videofluorographic swallowing evaluations of each patient. On brain magnetic resonance imaging, the subjects' lesions were classified vertically into three levels and horizontally into seven levels in relation to the involvement of the ambiguous and/or solitary nuclei. Logistic regression analyses were performed for age, sex, PPA and the vertical and horizontal sites of the lesions. Results In terms of severity, 15 subjects were categorized as having mild dysphagia, 26 subjects were categorized as having moderate dysphagia and 13 were categorized as having severe dysphagia. Subjects with cephalic lesions, greater vertical spread of the lesion and PPA were more likely to have severe dysphagia. PPA and a greater vertical spread of the lesion were related to the severity of the functional outcome (p<0.01). The horizontal extent of the lesion was not strongly related to the prognosis. Conclusion The presence of PPA in LMI patients is suggestive of abnormalities in the swallowing pattern and, in turn, damage to the medullary central pattern generator. The presence of PPA and a greater vertical spread of the lesion can be useful predictors of severe dysphagia.

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“…Относительно лече-ния таких пациентов придерживаются выжидательной тактики, так как у 20-40% пациентов, имеющих симпто-мы, клинические проявления разрешаются без терапев-тического вмешательства. Описана высокая эффектив-ность инъекций ботокса, однако обычно она недолго-срочна [11][12][13].…”

Section: нарушение проходимости пищеводно желудочного соединения (пжс)unclassified

High-resolution manometry in the diagnosis of oesophageal motility disorders

Barkalova¹,

Кучерявый²,

Маев³

2018

Med. sov.

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Манометрическое исследование на сегодняшний день является обязательным этапом обследования пациентов с подозрением на моторные расстройства пищевода наряду с клиническим, эндоскопическим и рентгеногра-фическим методами, порой превосходя их по своей диа-гностической ценности. Манометрия пищевода высокого разрешения (high resolution manometry, HRM) представ-ляет собой современный метод исследования с использо-ванием высокочувствительных многоканальных катете-ров, который позволяет детально оценить моторную функцию пищевода на всем его протяжении, включая верхний пищеводный сфинктер (ВПС), грудной отдел пищевода и нижний пищеводный сфинктер (НПС) (рис. 1).Манометрия высокого разрешения вошла в клиниче-скую практику с 1991 г. благодаря ее основоположнику Ray E. Clouse (1951Clouse ( -2007, впервые предложившему модифицировать традиционное манометрическое иссле-дование, где для оценки моторики использовалось гра-фическое изображение уровня давления различных участков пищевода [1]. Сегодня данные, полученные в процессе исследования, c помощью программного обе-спечения преобразуются в полихромное изображение, в полной мере демонстрирующее внутрипищеводную топографию давления [2], что в ряде случаев дает преи-мущество манометрии высокого разрешения перед тра-диционным методом [3,4] (рис. 2). ПОКАЗАНИЯ К ПРОВЕДЕНИЮ МАНОМЕТРИИ ПИЩЕВОДАМанометрическое исследование показано пациен-там с жалобами на дисфагию, при болях в грудной клет-

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Botulinum toxin injection in dysphagia syndromes with preserved esophageal peristalsis and incomplete lower esophageal sphincter relaxation

Abstract: Botulinum toxin injections can provide lasting symptom relief in dysphagia syndromes with incomplete LESR. Prominent perceptive symptoms and non-specific spastic features may predict shorter relief.

Cited by 64 publications

References 25 publications

Achalasia symptom response after Heller myotomy segregated by high-resolution manometry subtypes

Achalasia symptom response after Heller myotomy segregated by high-resolution manometry subtypes

Prediction of Dysphagia Severity: An Investigation of the Dysphagia Patterns in Patients with Lateral Medullary Infarction

High-resolution manometry in the diagnosis of oesophageal motility disorders

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