Long-term outcomes of balloon dilation versus botulinum toxin injection in patients with primary achalasia.
10.3904/kjim.2014.29.6.738
- Author:
Ho Eun JUNG
1
;
Joon Seong LEE
;
Tae Hee LEE
;
Jin Nyoung KIM
;
Su Jin HONG
;
Jin Oh KIM
;
Hyeon Geon KIM
;
Seong Ran JEON
;
Joo Young CHO
Author Information
1. Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea. joonlee@schmc.ac.kr
- Publication Type:Original Article ; Comparative Study
- Keywords:
Achalasia;
Balloon dilation;
Botulinum toxins
- MeSH:
Adult;
Aged;
Aged, 80 and over;
Botulinum Toxins/*administration & dosage/adverse effects;
Dilatation/adverse effects/*methods;
Esophageal Achalasia/diagnosis/epidemiology/*therapy;
Female;
Humans;
Injections;
Kaplan-Meier Estimate;
Male;
Medical Records;
Middle Aged;
Neuromuscular Agents/*administration & dosage/adverse effects;
Odds Ratio;
Proportional Hazards Models;
Questionnaires;
Remission Induction;
Republic of Korea/epidemiology;
Retrospective Studies;
Risk Factors;
Telephone;
Time Factors;
Treatment Outcome;
Young Adult
- From:The Korean Journal of Internal Medicine
2014;29(6):738-745
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: We compared the long-term outcomes of balloon dilation versus botulinum toxin injection in Korean patients with primary achalasia and identified factors predicting remission. METHODS: We included 73 patients with achalasia newly diagnosed between January 1988 and January 2011. We ultimately enrolled 37 of 55 patients with primary achalasia through telephone interviews, who were observed for over 1 year. Short-term outcomes were evaluated from the medical records based on symptom relief after 1 month of treatment. Long-term outcomes were evaluated in a telephone interview using a questionnaire. RESULTS: Twenty-five patients were administered a botulinum toxin injection and 12 underwent balloon dilation. One month after the botulinum toxin injection, improvements were seen in chest pain (14 [56.0%] to 4 patients [16.0%]), regurgitation (16 [64.0%] to 4 [16.0%]), and dysphagia (25 [100.0%] to 5 [20.0%]). In the balloon dilation group, chest pain (8 [66.7%] to 1 [8.3%]), regurgitation (11 [91.7%] to 1 [8.3%]), and dysphagia (12 [100.0%] to 1 [8.3%]) had improved. A significant difference was observed in the mean remission duration between the botulinum toxin injection and balloon dilation groups (13 months [range, 1 to 70] vs. 29 months [range, 6 to 72], respectively; p = 0.036). Independent factors predicting long-term remission included treatment type (odds ratio [OR], 6.982; p = 0.036) and the difference in the lower esophageal sphincter pressure (OR, 7.198; p = 0.012). CONCLUSIONS: Balloon dilation may be more efficacious than botulinum toxin for providing long-term remission in Korean patients with achalasia. Follow-up manometry may predict the long-term outcome.
