Botulinum toxin for suspected pseudoachalasia.

We describe a 74-yr-old man with stage III adenocarcinoma of the lung who presented with suspected malignancy-induced secondary achalasia and responded clinically to intrasphincteric injections of botulinum toxin type A (Botox, Allergen Inc., Irvine, CA). We discuss the use of botulinum toxin in this setting, as well as diagnostic strategies to differentiate achalasia from pseudoachalasia.