Korean J Gastrointest Motil.  2001 Nov;7(2):188-196.

Factors involved in the Transition from Achalasia to Nutcracker Esophagus or Diffuse Esophageal Spasm after Intrasphincteric Injection of Botulinum Toxin

• Cha SW
• Lee JS
• Im HH
• Hwang KR
• Jung IS
• Cheon GJ
• Kim JO
• Cho JY
• Lee MS
• Shim CS
• Kim BS

Abstract

BACKGROUND/AIMS: To evaluate the factors which are related to the transition from achalasia to diffuse esophageal spasm (DES) or nutcracker esophagus (NE) after botulinum toxin injection to lower esophageal sphincter (LES).
METHODS
This study included the 23 patients with achalasia who received an intrasphincteric injection of botulinum toxin. Stational esophageal manometry, 24-hour ambulatory esophageal manometry with pH monitoring, barium esophagogram and endoscopic ultrasonography were performed before and after treatment. We analyzed the parameters from these studies between the cases that transformed to DES or NE within a week and the cases that do not transit. RESULT: Five patients (21.7%) transformed to DES (1) or NE (4) within a week. There were significant differences in contraction amplitude of esophageal body (median, 31 mmHg vs 23 mmHg, p < 0.05) and maximal diameter of esophageal body (median, 2.6 cm vs 4.4 cm, p < 0.05) between these five patients and the remaining patients. There were no significant differences in sex, LES pressure and thickness of muscle layer between two groups.
CONCLUSION
Factors involved in transition to NE or DES after botulinum toxin injection to LES of achalasia appears as high amplitude contractions in body of esophagus and less dilation of esophageal body.

Keyword

Achalasia; Botulinum toxin; Diffuse esophageal spasm; Nutcracker esophagus

MeSH Terms

Barium
Botulinum Toxins*
Endosonography
Esophageal Achalasia*
Esophageal Motility Disorders*
Esophageal Spasm, Diffuse*
Esophageal Sphincter, Lower
Esophagus
Humans
Hydrogen-Ion Concentration
Manometry
Barium
Botulinum Toxins