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The Role of Botulinum Toxin Injections for Esophageal Motility Disorders

  • Motility (H Parkman and R Schey, Section Editors)
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Abstract

Purpose of review

The advancement of high-resolution esophageal manometry has led to improvement in the diagnosis of esophageal motility disorders. We reviewed the recent medical literature regarding the use of botulinum toxin (BTx) injections in the esophagus and the indications, current outcomes, and reported complications of this therapy.

Recent findings

The response rates of BTx injection therapy vary depending on the esophageal motility disorder. Studies have shown that response is transient in achalasia patients and given the more effective therapies available, it is only recommended in patients who are not surgical candidates. In nonachalasia patients, studies of BTx injections have demonstrated improvement in dysphagia symptoms in patients with spastic disorders, though studies are small and largely retrospective. The available literature showed a variable response to BTx in esophagogastric junction outlet obstruction (EGJOO) and non-cardiac chest pain patients. Despite advances in diagnosing esophageal motility disorders, there is a need for further research in patient selection for esophageal BTx, dose and injection location, and disease-specific outcomes. Placebo-controlled trials are crucial to evaluate BTx efficacy and duration of response.

Summary

Esophageal-directed BTx injections are beneficial in improving dysphagia in spastic motility disorders and in achalasia patients who are elderly or have multiple co-morbidities. There is a lack of evidence to support use in patients with EGJOO and non-cardiac chest pain, or for young or healthy achalasia patients.

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Authors and Affiliations

  1. Gastroenterology Section, Department of Medicine, Lewis Katz School of Medicine at Temple University, 3401 N. Broad St., 8th floor Parkinson Pavilion, Philadelphia, PA, 19140, USA

    Jessica L. Sterling MD, Ron Schey MD & Zubair Malik MD

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  1. Jessica L. Sterling MD
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  2. Ron Schey MD
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Correspondence to Zubair Malik MD.

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Jessica Sterling declares that she has no conflict of interest. Ron Schey declares that he has no conflict of interest. Zubair Malik declares that he has no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Motility

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Sterling, J.L., Schey, R. & Malik, Z. The Role of Botulinum Toxin Injections for Esophageal Motility Disorders. Curr Treat Options Gastro 16, 528–540 (2018). https://doi.org/10.1007/s11938-018-0212-0

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