Pharmacological effects of intrasphincteric botulinum toxin on the lower esophageal sphincter response to CCK, atropine and edrophonium in achalasia

Bulat, Robert; Chen, Y; Fachnie, Beth; Tougas, Gervais; Crowell,; Kalloo, AN; Pasricha, P. J.

doi:10.1016/s0016-5085(98)82986-7

Cited by 2 publications

(1 citation statement)

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“…The theoretic appeal of this approach is that focal injections of botulinum toxin into the LES should block acetylcholine release from neurons at this site, thus inhibiting the cholinergically mediated LES tone that persists in patients with achalasia [10]. Surprisingly, at least two studies published in abstract form have not been able to demonstrate a significant reduction in atropine-sensitive tone in the LES following botulinum toxin therapy [11,12]. This finding, along with the observation that symptom improvement is greater than objective improvement in This article reviews current trends in management of esophageal achalasia, highlighting short-term outcome and cost comparisons of three treatments: botulinum toxin injection, pneumatic dilation, and laparoscopic myotomy.…”

Section: Botulinum Toxinmentioning

confidence: 99%

Management of idiopathic achalasia: Short-term and long-term outcomes

Massey

2000

Curr Gastroenterol Rep

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Without consensus guidelines for surveillance in patients with resected melanoma, much debate exists on the appropriate short-term and long-term management of melanoma. When discussing surveillance, it is also important to keep in mind the long-term impact of ongoing surveillance in terms of improved survival, patient quality of life, cost effectiveness, and exposure to risks associated with certain surveillance methods. Most studies recommend frequent follow-up visits with dermatologic surveillance to detect potentially curable recurrence, especially resectable locoregional recurrences. Surveillance laboratory tests and chest x-rays (CXR) can have limited value while producing a relatively high false-positive rate. Lymph node ultrasonography is a valuable imaging modality in patients with equivocal lymphatic nodal basin physical examinations. In patients with early stages of melanoma, the benefit of routine surveillance imaging studies is questionable; however, close surveillance with detailed medical history and physical examination is necessary, with special attention to regional recurrences every 3-12 months, depending on the American Joint Committee on Cancer (AJCC) stage category the patient falls into and the risk of recurrence. In Stage III or greater, more frequent surveillance in the form of more frequent physical examination , laboratory tests based on symptomatology, and cross-sectional imaging In: Cutaneous Melanoma: Etiology and Therapy. William H. Ward and Jeffrey M. Farma (Editors), Codon Publications, Brisbane, Australia. ISBN: 978-0-9944381-4-0; Doi: http://dx.doi. Licence: This open access article is licenced under Creative Commons Attribution 4.0 International (CC BY 4.0). https://creativecommons.org/licenses/by-nc/4.0/ Management of Melanoma 162 may be indicated because of the higher risk of recurrence in this population. CT, MRI, and/or PET/CT are often a component of the overall follow-up for these high-risk patients. Additional studies are needed to better define the role of surveillance in the asymptomatic patient with resected melanoma.

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Section: Botulinum Toxinmentioning

confidence: 99%