Achalasia. A new modality for treatment.

This lesion of the esophagus, first described in 1682 by Thomas Willis, been subject to many forms of therapy. We feel botulinum toxin injection to be an acceptable alternative treatment modality for select patients with primary esophageal achalasia. Traditional methods of treating achalasia consist of medical therapy for short-term relief, balloon dilation and myotomy. Botulinum toxin injection is an alternative method of treatment, suggested by Pasricha et al and used successfully in our patient, which does not seem to cause the significant complications of perforation or gastroesophageal reflux and which may be more attractive to patients less able to undergo dilation or myotomy. This method of injecting botulinum toxin directly into the LES appears to be a relatively safe modality of treatment. Reports suggest symptoms of achalasia may recur (in up to a year's time) and repeated injections may be needed. Even so, this would seem to be acceptable in the overall management of achalasia. We agree that long-term follow-up of these patients is indicated. Data to date, plus our personal experiences, have been encouraging. We feel this represents an option for non-surgical patients and may even be considered prior to the endoscopic balloon surgery approach. It is certainly more cost effective. We are currently evaluating a second patient for botulinum toxin therapy.