아칼라지아 환자에서 내시경적 하부식도 괄약근내 보툴리늄독소 주사의 효과 = Esophagus, Stomach & Intestine;Intrasphincteric Injection of Botulinum Toxin in Patients with Achalasia

다국어 초록 (Multilingual Abstract)

Background/Aims: Botulinum toxin(Botox) has long been known as one of the most potent paralytic agents of skeletal muscle, and acts by inhibiting the acetylcholine release from nerve terminals. Recently lacally injected Botox has been found to be effective in the reduction of lower esophageal sphincter(LES) tone in patients with achalasia. The aim of this study was to examine the effects of Botox on patients with achalasia in terms of symptomatic relief and improvement of esophageal function. Methods: Nine patients with achalasia were given endoscopic injections of 100 units of Botox into the LES. One week later, the response to treatment was assessed on the basis of changes in the symptomatic scores, maximal diameters of esophagus clilation on esophagograms, and results of esophageal manometric and scintigraphic studies. Three months later, the symptomatic scores and esophageal manometric results were assessed. Responders to Botox were defined as patients with a decrease in the total symptom score of 50% or more at 1 month of past-treatment without a subsequent treatment. Results: All of the 9 patients improved initially, but only 7 patients had sustained improvement beyond 3 months. One week after treatment, the mean decrease in the symptomatic score was 4.6 points(from 6.7 to 2.7 p$lt;0.05). The mean decrease in the resting LES pressure was 15.5 mmHg(from 42.4 to 26.9 p$lt;0.05) and the mean increase in swallow-induced LES relaxation was 34.4%(from 36.9 to 71.3, p$lt;0.05). The mean decrease in 5-minute retention of 99 m-Tc sulfur colloid was 33%(from 39.6 to 6.6 p$lt;0.05). And the mean decrease in esophageal diameter was 1.3cm(from 4.3 to 3.0 p$lt;0.05). Three months later, the seven responders were still in remission in symptom scores and manometirc findings. One of these 7 responders reported relapsing to the previous symptoms 6 months later. Conclusions: Botulinum toxin is an effective, simple, and safe treatment for achalasia in 78%(7/9) of patients, with a duration of response averaging 9 months. Lon-term studies on the use of Botox need to be conducted.