Sterling Jessica L, Schey Ron, Malik Zubair
Gastroenterology Section, Department of Medicine, Lewis Katz School of Medicine at Temple University, 3401 N. Broad St., 8th floor Parkinson Pavilion, Philadelphia, PA, 19140, USA.
Curr Treat Options Gastroenterol. 2018 Dec;16(4):528-540. doi: 10.1007/s11938-018-0212-0.
The advancement of high-resolution esophageal manometry has led to improvement in the diagnosis of esophageal motility disorders. We reviewed the recent medical literature regarding the use of botulinum toxin (BTx) injections in the esophagus and the indications, current outcomes, and reported complications of this therapy.
The response rates of BTx injection therapy vary depending on the esophageal motility disorder. Studies have shown that response is transient in achalasia patients and given the more effective therapies available, it is only recommended in patients who are not surgical candidates. In nonachalasia patients, studies of BTx injections have demonstrated improvement in dysphagia symptoms in patients with spastic disorders, though studies are small and largely retrospective. The available literature showed a variable response to BTx in esophagogastric junction outlet obstruction (EGJOO) and non-cardiac chest pain patients. Despite advances in diagnosing esophageal motility disorders, there is a need for further research in patient selection for esophageal BTx, dose and injection location, and disease-specific outcomes. Placebo-controlled trials are crucial to evaluate BTx efficacy and duration of response. Esophageal-directed BTx injections are beneficial in improving dysphagia in spastic motility disorders and in achalasia patients who are elderly or have multiple co-morbidities. There is a lack of evidence to support use in patients with EGJOO and non-cardiac chest pain, or for young or healthy achalasia patients.
高分辨率食管测压技术的进步提高了食管动力障碍的诊断水平。我们回顾了近期关于食管内注射肉毒杆菌毒素（BTx）的医学文献，以及该疗法的适应症、当前疗效和报道的并发症。
BTx注射疗法的有效率因食管动力障碍类型而异。研究表明，贲门失弛缓症患者对BTx的反应是短暂的，鉴于有更有效的治疗方法，仅推荐用于不适合手术的患者。在非贲门失弛缓症患者中，BTx注射研究表明，痉挛性疾病患者的吞咽困难症状有所改善，不过研究规模较小且大多为回顾性研究。现有文献显示，食管胃交界部出口梗阻（EGJOO）患者和非心源性胸痛患者对BTx的反应不一。尽管在食管动力障碍的诊断方面取得了进展，但在食管BTx治疗的患者选择、剂量和注射部位以及疾病特异性疗效方面仍需进一步研究。安慰剂对照试验对于评估BTx的疗效和反应持续时间至关重要。食管定向BTx注射有助于改善痉挛性动力障碍患者以及老年或有多种合并症的贲门失弛缓症患者的吞咽困难。目前缺乏证据支持将其用于EGJOO患者和非心源性胸痛患者，或年轻或健康的贲门失弛缓症患者。
