General and Gastrointestinal Surgery

Treatment Options: Botulinum Injection

Botulinum is a toxin produced by the bacteria Clostridia botulinum which is responsible for the disease botulism. The toxin affects muscle contraction by stopping the release of chemicals at nerve endings. Used for many years to treat eyelid spasm and other muscle problems, it was first used successfully to treat achalasia in 1994. The technique involves four injections of a small amount of Botulinum toxin in four different areas of the lower esophageal sphincter. The injections are done via an endoscope. The toxin blocks the release of chemicals from nerve endings, thereby making the sphincter relax.

What are the results?

Botulinum toxin injection produces an excellent result in 90 percent of patients. Unfortunately, the treatment may be short lived; 40 percent of patients who respond to the injection have the result fail within 3 months and only 50 to 60 percent experience relief at 6 months, despite multiple injections. Patients who respond to the first injection often notice less response to each subsequent injection and a shorter period of symptom relief. Although long-term success is seen in some patients, botulinum toxin injection appears most suitable for short term relief.

What are the risks?

This is a very safe procedure with minimal side effects. It is important to note that botulinum toxin injection does not affect subsequent treatment with other therapies such as dilatation or surgery.

When are botulinum toxin injections not recommended?

All patients are candidates for botulinum toxin injections. It is the least invasive and safest of all the treatments available.

Other treatment options