Botulinum Toxin Treatment of Oesophageal Achalasia in the Old Old and Oldest Old

L, Dughera; Battaglia, Edda; Maggio, Dario; Cassolino, Paola; Mioli, P; Morelli, Antonio; Emanuelli, G; Bassotti, Gabrio

doi:10.2165/00002512-200522090-00006

Cited by 28 publications

(12 citation statements)

References 23 publications

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“…Surgeons have reported that Heller myotomy could be more difficult in patients who undergo repeated botulinum toxin A injection, due to increased adhesion of the muscular layer, but, so far, this therapeutic option has to be chosen as a first step in all patients who are eligible for it 31. In contrast, botulinum toxin A is widely demonstrated to be the most effective treatment option in elderly patients or in patients with comorbid illnesses, in whom dilatation or surgery is high-risk 32.…”

Section: Endoscopic Therapiesmentioning

confidence: 99%

Management of achalasia

L¹,

Chiaverina²,

Cacciotella³

et al. 2011

CEG

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Several theories on the etiology and pathophysiology of achalasia have been reported but, to date, it is widely accepted that loss of peristalsis and absence of swallow-induced relaxation of the lower esophageal sphincter are the main functional abnormalities. Treatment of achalasia often aims to alleviate the symptoms of achalasia and not to correct the underlying disorder. Medical therapy has poor efficacy, so patients who are good surgical candidates should be offered either laparoscopic myotomy or pneumatic balloon dilatation. Their own preference should be included in the decision-making process, and treatment should meet the local expertise with these procedures. Laparoscopic surgical esophagomyotomy is a safe and effective modality. It can be considered as initial management or as secondary treatment if the patient does not respond to less invasive modalities. Pneumatic dilatation has proven to be a safe, effective, and durable modality of treatment when performed by experienced individuals, and appears to be the most cost-effective alternative. For patients with multiple comorbidities and for elderly patients, who are not good surgical candidates, endoscopic injection of botulinum toxin should be considered a safe and effective procedure. However, its positive effect diminishes over time, and the need for multiple repeated sessions must be taken into consideration. In the management of patients with achalasia, nutritional aspects play an important role. When lifestyle changes are insufficient, it is necessary to proceed to percutaneous gastrostomy under radiological guidance. In the future, intraluminal myotomy or endoscopic mucosectomy will possibly be an option. Further studies are needed to investigate the role of immunosuppressive therapies in those cases in which an autoimmune etiology is suspected.

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Section: Endoscopic Therapiesmentioning

confidence: 99%

Management of achalasia

L¹,

Chiaverina²,

Cacciotella³

et al. 2011

CEG

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“…Patients were asked to complete a semistructured questionnaire surveying the presence and frequency of three oesophageal symptoms, namely dysphagia, regurgitation and chest pain, as previously described 18 . A score of 0–3 was attributed to each symptom depending on its occurrence: ‘never’, ‘occasionally’, ‘more than once weekly’ or ‘daily’.…”

Section: Methodsmentioning

confidence: 99%

“…Assessment of oesophageal symptoms was performed at baseline, and at 1 and 2 years after the second injection of BTX (see below). The efficacy of BTX was evaluated on clinical criteria; more specifically, response to treatment was arbitrary defined as a total symptom score of ≤2, whereas a total score of ≥3 was considered suggestive of treatment failure (or relapse) 5, 18, 19 . A barium oesophagogram was performed at baseline in all patients to assess oesophageal diameter.…”

Section: Methodsmentioning

confidence: 99%

“…In a previous study on 12 such achalasic patients we have demonstrated that BTX treatment represents a reasonable therapeutic option, with benefits still detectable in about 70% of patients after 1 year of follow‐up 18 . We therefore studied a larger group of aged achalasic patients in whom follow‐up was extended over a 2‐year period.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Treatment with botulinum toxin of octo‐nonagerians with oesophageal achalasia: a two‐year follow‐up study

Bassotti

D'Onofrio

Battaglia³

et al. 2006

Aliment Pharmacol Ther

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“…One review looked at 12 frail and elderly patients aged 81-94 years with an American Society of Anaesthesiologists (ASA) class score of III-IV; 100U of botox was injected at two sessions a month apart, patients were followed up for a year and 70% responded symptomatically, albeit to varying degrees. 5 There is a growing enthusiasm to opt straight for a surgical myotomy as the treatment of choice, providing there are no general anaesthetic contraindications. In the elderly patient, most would advocate this approach, with botulinum injections reserved for the frail and those for whom it is contraindicated by frailty or co-morbidity.…”

Section: Oesophageal Dysmotilitymentioning

confidence: 99%