Achalasia treatment in the elderly:: is botulinum toxin injection the best option?

Background Achalasia treatment in elderly patients is a of controversy. Botulinum toxin injection has been as the best option in this group of patients as it a safe procedure. However, concern persists regarding short-term effect. Aims To analyse the clinical and economic effectiveness of toxin injection in the treatment of achalasia who are elderly. Methods Seventeen consecutive achalasia patients older 65 years were treated with 80 units of botulinum Clinical follow-up at 1, 6 and 12 months was Control manometry when symptoms recurred carried out. Results were compared with those of an control group of 16 achalasia patients also older 65 years and who had been treated with endoscopic The costs of both procedures were compared. Results Twenty-nine botulinum toxin injections were in the 17 patients of the botulinum toxin group (follow-up 12-36 months). In the dilation group only two had to be retreated (follow-up, 12-108 months). No major complications were observed in either group. The average duration of symptom alleviation was 48 +/- 33 months for endoscopic dilation and 13.8 +/- 9.5 months for botulinum toxin injection. Maintaining a patient free of symptoms cost Euro 348.31 per year for botulinum toxin injection, whilst if endoscopic dilation was chosen the cost was only Euro 117.47 per year. Conclusions The effect of botulinum toxin injections wanes with time in elderly patients, necessitating repeated injections to keep the patients symptom-free. Due to the required repeated injections this procedure is more expensive than endoscopic dilation.