Factors involved in the Transition from Achalasia to Nutcracker Esophagus or Diffuse Esophageal Spasm after Intrasphincteric Injection of Botulinum Toxin.
- Author:
Sang Woo CHA
1
;
Joon Seong LEE
;
Hee Hyuk IM
;
Kyung Ran HWANG
;
In Sup JUNG
;
Gab Jin CHEON
;
Jin Oh KIM
;
Joo Young CHO
;
Moon Sung LEE
;
Chan Sup SHIM
;
Boo Sung KIM
Author Information
1. Department of Internal Medicine, Soon Chun Hyang University, College of Medicine, Seoul, Korea. schidr@hosp.sch.ac.kr
- Publication Type:Original Article
- Keywords:
Achalasia;
Botulinum toxin;
Diffuse esophageal spasm;
Nutcracker esophagus
- MeSH:
Barium;
Botulinum Toxins*;
Endosonography;
Esophageal Achalasia*;
Esophageal Motility Disorders*;
Esophageal Spasm, Diffuse*;
Esophageal Sphincter, Lower;
Esophagus;
Humans;
Hydrogen-Ion Concentration;
Manometry
- From:Korean Journal of Gastrointestinal Motility
2001;7(2):188-196
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND/AIMS: To evaluate the factors which are related to the transition from achalasia to diffuse esophageal spasm (DES) or nutcracker esophagus (NE) after botulinum toxin injection to lower esophageal sphincter (LES). METHODS: This study included the 23 patients with achalasia who received an intrasphincteric injection of botulinum toxin. Stational esophageal manometry, 24-hour ambulatory esophageal manometry with pH monitoring, barium esophagogram and endoscopic ultrasonography were performed before and after treatment. We analyzed the parameters from these studies between the cases that transformed to DES or NE within a week and the cases that do not transit. RESULT: Five patients (21.7%) transformed to DES (1) or NE (4) within a week. There were significant differences in contraction amplitude of esophageal body (median, 31 mmHg vs 23 mmHg, p < 0.05) and maximal diameter of esophageal body (median, 2.6 cm vs 4.4 cm, p < 0.05) between these five patients and the remaining patients. There were no significant differences in sex, LES pressure and thickness of muscle layer between two groups. CONCLUSION: Factors involved in transition to NE or DES after botulinum toxin injection to LES of achalasia appears as high amplitude contractions in body of esophagus and less dilation of esophageal body.
