Botulinum toxin for achalasia in children

Background: Injection of botulinum toxin (BTx) into the lower esophageal sphincter (LES) of adult patients with achalasia results in the effective relief of symptoms. The aim of the present study was to examine the effectiveness of BTx in pediatric patients suffering from achalasia. Methods: Seven patients suffering from achalasia with or without prior treatment were treated with intrasphincteric injection of BTx. The median duration of follow up was 15 months. Results: All seven patients improved. The median interval before recurrence of symptoms was 4 months (range 1-14 months). There was an inverse relationship between the pretreatment LES pressure and the duration of response (r = -0.6). The mean pretreatment LES pressure in the subgroup with a response greater than 6 months was 38 +/- 10 mmHg compared with 61 +/- 12 mmHg in the other four patients (P = 0.05). All seven patients required retreatment. Conclusion: Botulinum toxin is effective in relieving symptoms in pediatric patients suffering from achalasia, producing a sustained response beyond 6 months in 43% of patients. (C) 2000 Blackwell Science Asia Pty Ltd.