Pasricha P J, Rai R, Ravich W J, Hendrix T R, Kalloo A N
Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Gastroenterology. 1996 May;110(5):1410-5. doi: 10.1053/gast.1996.v110.pm8613045.
BACKGROUND & AIMS: Botulinum toxin injection into the lower esophageal sphincter of patients with achalasia results in effective short-term relief of symptoms. The aims of this study were to examine the long-term outcome of these patients and to determine the predictors of response to this therapy.
Thirty-one patients with achalasia treated with botulinum toxin were followed up prospectively for a median duration of 890 days.
Twenty-eight patients improved initially, but only 20 patients had sustained improvement beyond 3 months; the latter patients were classified as responders. The response rate was greater in patients older than 50 years of age (82% vs. 43% in younger patients; P = 0.03) and in patients with vigorous achalasia (100% vs. 52% with classic achalasia; P = 0.03). Duration of illness, previous dilation, and baseline radiological characteristics did not influence outcome. Nineteen responders eventually had relapse after a median duration of 468 days (range, 153 - 840 days). Fifteen of these patients received a second injection with satisfactory results obtained in the majority of patients.
Botulinum toxin is an effective treatment for achalasia in about two thirds of patients, with a duration of response averaging 1.3 years. Age and type of achalasia seem to be important predictors of response.
向贲门失弛缓症患者的食管下括约肌注射肉毒杆菌毒素可有效缓解短期症状。本研究的目的是检查这些患者的长期预后，并确定对该治疗反应的预测因素。
对31例接受肉毒杆菌毒素治疗的贲门失弛缓症患者进行前瞻性随访，中位随访时间为890天。
28例患者最初有所改善，但只有20例患者在3个月后仍持续改善；后一组患者被归类为反应者。50岁以上患者的反应率更高（82%对年轻患者的43%；P = 0.03），以及强力型贲门失弛缓症患者的反应率更高（100%对经典型贲门失弛缓症患者的52%；P = 0.03）。病程、先前的扩张情况和基线放射学特征不影响预后。19例反应者最终在中位468天（范围153 - 840天）后复发。其中15例患者接受了第二次注射，大多数患者取得了满意的结果。
肉毒杆菌毒素对约三分之二的贲门失弛缓症患者是一种有效的治疗方法，反应持续时间平均为1.3年。年龄和贲门失弛缓症的类型似乎是反应的重要预测因素。
