On drugs and dilators for achalasia

Intrasphincteric Botulinum Toxin for the Treatment of Achalasia

“…The usual treatment for achalasia -balloon dilation or myotomy of the lower esophageal sphincter -is aimed at lowering the resting pressure of the sphincter. 1 We hypothesized that locally injected botulinum toxin, a potent inhibitor of the release of acetylcholine from nerve endings, could be effective in the treatment of achalasia. This hypothesis was based on the concept that the net sphincter tone in the gut results from a balance between excitatory influences (acetylcholine and substance P) and inhibitory influences (vasoactive intestinal peptide and nitric oxide).…”

Laparoscopic myotomy vs endoscopic dilation in the treatment of achalasia

“…Pharmacological treatments such as calcium blockers and botulinum toxin are less effective than endoscopic dilation or surgery [8]. Calcium antagonists are useful while waiting for the definitive procedure or in patients with clinically significant concomitant disease that makes dilatation or surgery too risky [17]. Botulinum toxin injection requires repeated sessions to maintain its efficacy [14].…”

Candida Esophagitis in a Child with Achalasia

“…Pneumatic dilatation remains the treatment of choice for achalasia (10,19,20), and myotomy should be reserved for therapeutic failures (10,19). Our patient was initially placed on a combination of nifedipine with antifungal therapy because of his Candida esophagitis.…”