Greaves R R, Mulcahy H E, Patchett S E, Gorard D A, Fairclough P D, Alstead E M, Farthing M J
Digestive Diseases Research Centre, St. Bartholomew's and the Royal London School of Medicine and Dentistry, Turner Street, London, UK.
Aliment Pharmacol Ther. 1999 Sep;13(9):1221-5. doi: 10.1046/j.1365-2036.1999.00609.x.
Recent reports have suggested that intrasphincteric injection of botulinum toxin is effective and long-lasting in the treatment of achalasia.
To report our experience of botulinum toxin injection in a prospective series of consecutive patients with achalasia.
Eleven consecutive patients with achalasia (eight male, mean age 55 years, range 20-87) were treated with 60 units of botulinum toxin (Dysport; Speywood Pharmaceuticals Ltd, UK) into each of four quadrants at the lower oesophageal sphincter. Patients were assessed pre-treatment and 1 month after treatment using a symptom score and oesophageal manometry. Median follow-up was 12 months (range 6-28).
The injection procedure was simple to perform and free of adverse effects. Although treatment had a beneficial effect on dysphagia (median pre-treatment score 3 [interquartile range 3-3]; post-treatment score 2 [0-3]: P=0.03) 1 month following therapy, there was no significant improvement in chest pain or regurgitation scores. Similarly, no significant reduction in median lower oesophageal sphincter pressure was observed (29.5 mmHg [21-42] pre-treatment, 28.5 [17.5-55.5] post-treatment P=0.67). Four patients (36%) required further therapy within 3 months and the overall relapse rate was 73% (eight of 11) within 2 years.
Although botulinum toxin injection was well tolerated, these results using Dysport at a dose of 240 mouse units question its efficacy as a treatment for achalasia.
最近的报告表明，食管括约肌内注射肉毒杆菌毒素在治疗贲门失弛缓症方面有效且持久。
报告我们对一系列连续性贲门失弛缓症患者进行肉毒杆菌毒素注射的经验。
11例连续性贲门失弛缓症患者（8例男性，平均年龄55岁，范围20 - 87岁）在食管下括约肌的四个象限各注射60单位肉毒杆菌毒素（Dysport；英国斯皮伍德制药有限公司）。治疗前及治疗后1个月，采用症状评分和食管测压对患者进行评估。中位随访时间为12个月（范围6 - 28个月）。
注射操作简单，无不良反应。尽管治疗后1个月对吞咽困难有有益影响（治疗前中位评分为3[四分位间距3 - 3]；治疗后评分为2[0 - 3]：P = 0.03），但胸痛或反流评分无显著改善。同样，食管下括约肌压力中位数无显著降低（治疗前为29.5 mmHg[21 - 42]，治疗后为28.5[17.5 - 55.5]，P = 0.67）。4例患者（36%）在3个月内需要进一步治疗，2年内总体复发率为73%（11例中的8例）。
尽管肉毒杆菌毒素注射耐受性良好，但使用240鼠单位剂量的Dysport的这些结果质疑了其作为贲门失弛缓症治疗方法的疗效。
