Terre Rosa, Valles Margarida, Panades Agusti, Mearin Fermin
Unit of Functional Digestive Rehabilitation, Institut Guttmann (attached to the Autonomous University of Barcelona), Badalona, Spain.
Scand J Gastroenterol. 2008;43(11):1296-303. doi: 10.1080/00365520802245403.
To evaluate the efficacy of botulinum toxin (BTX-A) injection in the cricopharyngeus muscle in patients with neurological dysphagia caused by alteration in the upper esophageal sphincter (UES) opening and with preserved pharyngeal contraction.
A prospective pilot study was undertaken in 10 patients (7 brain lesions and 3 cervical spinal cord injuries), with a minimum time-lapse of 6 months from neurological lesion to BTX-A injection. Dysfunction of the UES opening and the presence of pharyngeal contraction were diagnosed by videofluoroscopy (VDF) and esophageal manometry (EM). The BTX-A (100 U) injection was guided by endoscopy. Clinical, VDF, and EM follow-ups were carried out at 3 weeks, 3 and 6 months, and at 1 year post-injection.
Prior to treatment, 6 patients were fed by nasogastric tube. VDF showed impairment of the UES opening, residue in pyriform sinuses, and aspiration in all cases. During follow-up, there was a decrease in the number of patients that had aspiration: 3 patients at one year. During swallowing, EM showed a mean UES relaxation of 90% (range: 74.5-100%), residual pressure 3.2 mmHg (range: 0-13 mmHg) and pharyngeal amplitude 52 mmHg (range: 25-80 mmHg). At follow-up, a significant improvement in UES relaxation (98% (89-100%)) and pharyngeal contraction (97 mmHg (35-165 mmHg)) was observed. At 3 months, 6 patients were eating exclusively by mouth.
One single injection of BTX-A in the UES has long-lasting effectiveness in patients with neurological dysphagia caused by alteration in the UES opening and with pharyngeal contraction. Nevertheless, a randomized control trial should be done to confirm these results and rule out the effect of potential spontaneous improvement of neurological injury.
评估肉毒杆菌毒素（BTX-A）注射至环咽肌对因食管上括约肌（UES）开口改变导致神经源性吞咽困难且咽部收缩功能保留的患者的疗效。
对10例患者（7例脑损伤和3例颈脊髓损伤）进行前瞻性初步研究，从神经损伤至BTX-A注射的最短时间间隔为6个月。通过电视荧光吞咽造影检查（VDF）和食管测压（EM）诊断UES开口功能障碍和咽部收缩情况。在内镜引导下注射BTX-A（100单位）。在注射后3周、3个月、6个月和1年进行临床、VDF和EM随访。
治疗前，6例患者通过鼻饲管进食。VDF显示所有病例均存在UES开口受损、梨状窝残留和误吸。在随访期间，发生误吸的患者数量减少：1年后为3例。吞咽时，EM显示UES平均松弛率为90%（范围：74.5 - 100%），残余压力为3.2 mmHg（范围：0 - 13 mmHg），咽部幅度为52 mmHg（范围：25 - 80 mmHg）。随访时，观察到UES松弛（98%（89 - 100%））和咽部收缩（97 mmHg（35 - 165 mmHg））有显著改善。3个月时，6例患者仅经口进食。
单次向UES注射BTX-A对因UES开口改变且咽部收缩功能保留导致神经源性吞咽困难的患者具有长期疗效。然而，应进行随机对照试验以证实这些结果并排除神经损伤潜在自发改善的影响。
