Botox Injections for Achalasia
Botulinum toxin A (Botox) injections: In achalasia, the muscle at the end of the esophagus (lower esophageal sphincter) is in a status of continuous excitation. All procedures used to treat achalasia are based on disrupting that muscle. Botox injections can relax the spastic lower esophageal sphincter and provide some relief in patients with achalasia. The Botox injections produce satisfactory initial results that predictably wear off within a period of few months, necessitating further injections. Endoscopic Botox injection is a safe procedure but less effective than other treatment options.
Botox injections can cause scarring in the lower esophageal sphincter. If surgical treatment (laparoscopic Heller myotomy) is chosen, there is an increased risk of mucosal perforation (a tear in the esophagus) and thus an inferior outcome in patients who had prior Botox injections. At the Memorial Hermann Southeast Esophageal Disease Center, we use Botox injections in high-risk patients with severe associated medical conditions who are not surgical candidates.
Below is a schematic presentation of a Botox injection:
By Michel Kafrouni, M.D.