Korean J Intern Med.  2014 Nov;29(6):738-745. 10.3904/kjim.2014.29.6.738.

Long-term outcomes of balloon dilation versus botulinum toxin injection in patients with primary achalasia

• Jung HE
• Lee JS
• Lee TH
• Kim JN
• Hong SJ
• Kim JO
• Kim HG
• Jeon SR
• Cho JY

• KMID: 2070131
• DOI: http://doi.org/10.3904/kjim.2014.29.6.738

Abstract

BACKGROUND/AIMS
We compared the long-term outcomes of balloon dilation versus botulinum toxin injection in Korean patients with primary achalasia and identified factors predicting remission.
METHODS
We included 73 patients with achalasia newly diagnosed between January 1988 and January 2011. We ultimately enrolled 37 of 55 patients with primary achalasia through telephone interviews, who were observed for over 1 year. Short-term outcomes were evaluated from the medical records based on symptom relief after 1 month of treatment. Long-term outcomes were evaluated in a telephone interview using a questionnaire.
RESULTS
Twenty-five patients were administered a botulinum toxin injection and 12 underwent balloon dilation. One month after the botulinum toxin injection, improvements were seen in chest pain (14 [56.0%] to 4 patients [16.0%]), regurgitation (16 [64.0%] to 4 [16.0%]), and dysphagia (25 [100.0%] to 5 [20.0%]). In the balloon dilation group, chest pain (8 [66.7%] to 1 [8.3%]), regurgitation (11 [91.7%] to 1 [8.3%]), and dysphagia (12 [100.0%] to 1 [8.3%]) had improved. A significant difference was observed in the mean remission duration between the botulinum toxin injection and balloon dilation groups (13 months [range, 1 to 70] vs. 29 months [range, 6 to 72], respectively; p = 0.036). Independent factors predicting long-term remission included treatment type (odds ratio [OR], 6.982; p = 0.036) and the difference in the lower esophageal sphincter pressure (OR, 7.198; p = 0.012).
CONCLUSIONS
Balloon dilation may be more efficacious than botulinum toxin for providing long-term remission in Korean patients with achalasia. Follow-up manometry may predict the long-term outcome.

Keyword

Achalasia; Balloon dilation; Botulinum toxins

MeSH Terms

Adult
Aged
Aged, 80 and over
Botulinum Toxins/*administration & dosage/adverse effects
Dilatation/adverse effects/*methods
Esophageal Achalasia/diagnosis/epidemiology/*therapy
Female
Humans
Injections
Kaplan-Meier Estimate
Male
Medical Records
Middle Aged
Neuromuscular Agents/*administration & dosage/adverse effects
Odds Ratio
Proportional Hazards Models
Questionnaires
Remission Induction
Republic of Korea/epidemiology
Retrospective Studies
Risk Factors
Telephone
Time Factors
Treatment Outcome
Young Adult
Botulinum Toxins
Neuromuscular Agents