Intrasphincteric botulinum toxin injection in the treatment of chagasic achalasia*

Abstract

According to the WHO, 16-18 million people in Central and South America are infected by Trypanosoma cruzi. Chagasic achalasia affects between 7.1% and 10.6% of the population. The aim of this study was to evaluate the effects of Botox injections in the clinical response and esophageal function of patients with dysphagia due to chagasic achalasia. In total, 24 symptomatic patients with chagasic achalasia were randomly chosen to receive Botulinum Toxin (BT) or saline injected by endoscopy in the lower esophageal sphincter (LES). Patients were monitored with a clinical score of dysphagia and an objective assessment (esophagograms, scintillography, manometry, and nutritional assessment) for a period of 6 months. Clinical improvement of dysphagia was statistically significant (P < 0.001) in patients receiving BT when compared with the placebo. There was no significant difference in the placebo group regarding clinical score, LES basal pressure and esophageal emptying time. Esophageal emptying time in the toxin group was significantly lower than in the placebo (P=0.04) after 90 days. There were non-significant increases in esophageal emptying of 25.36% and 17.39%, respectively, at 90 and 180 days, in the BT group (P=0.266). Gender, age, and baseline LES pressure did not influence the response to BT. Our data strongly suggests that intrasphincteric injection of BT in LES is clinically effective in the treatment of chagasic achalasia.

Comparação entre acalásia idiopática e acalásia conseqüente à doença de Chagas: revisão de publicações sobre o tema

“…Na doença de Chagas ocorre hiposensibilidade do EIE à gastrina (38) , predomínio da inervação α-adrenérgica em relação à inervação ß-adrenérgica (21) , resposta parcial à atropina (9) e à toxina botulínica (4) . Nas duas formas de acalásia está demonstrada a perda da inervação não-adrenérgica não-colinérgica inibitória do esôfago (33)* .…”

“…Diminuídas (3) Receptores D2 da dopamina ? Diminuídos (41) Pressão basal Normal/Aumentada (15,31,34,40) Aumentada (6,10,29,31) Resposta à toxina botulínica Redução de pressão (23%) (4) Redução de pressão (32% a 45%) (39) Resposta ao edrofônio ? Presente (29) Resposta à atropina Parcial (9) Presente (29) Gastrina circulante Aumentada (42,43) Normal (6) Anticorpos anti M2 Presente (22) Ausente (22) ?…”

Botulinum toxin type A injections: Adverse events reported to the US Food and Drug Administration in therapeutic and cosmetic cases

“…Indications not approved by FDA, but studied and reported in the medical literature, include extracervical spasticities, 8,9 especially for patients with cerebral palsy, [10][11][12][13][14][15][16] poststroke spasticity, 17,18 and piriformis syndrome. 19,20 Other reports describe off-label uses for a wide range of neurologic, [21][22][23][24][25][26] dermatologic, [27][28][29][30][31][32] gastrointestinal, [33][34][35][36][37][38][39][40][41][42] and other clinical [43][44][45][46][47][48][49][50][51] disorders, often without controlled clinical trials. Off-label use of a licensed drug or biologic product occurs with a wide range of products.…”

Treatment of Gastrointestinal Sphincters Spasms with Botulinum Toxin A

“…Similar to idiopathic achalasia, in Chagas’ disease (CD), a common disease in South America [ 73 , 100 , 101 , 102 , 103 , 104 ], slow esophageal emptying is due to nonrelaxation of the LES. Only one representative series on 24 patients has been published regarding BT in esophageal CD.…”