[Is complex therapy of achalasia using botulinum toxin combined with balloon dilatation an effective approach?]

Achalasia (ACHL) is not a very frequent disease and its etiology is still unclear. In addition to the oldest therapeutical approach represented by myotomy, two conservative methods are commonly used--balloon dilatation and application of botulotoxin. So far, both methods have been used only separately, and their effects have been compared. Literature provides no evidence of the renewal of oesophageal propulsive peristalsis in result of conservative treatment.

The aim is to use both approaches subsequently within a short period of time, in order to potentiate their effects and at the same time to reduce the risk of possible complications.

The group was formed by 9 patients. Achalasia was diagnosed by flow manometry. Pseudoachalasia was excluded endoscopically and endosonographically. The treatment included application of 250 J of botulotoxin (Dysport) into the region of the lower oesophageal sphincter, and balloon dilatation which was applied 7 days later. Following this treatment, patients were observed for 24 hours. The clinical and manometric examinations were performed in 3-month intervals.

All patients felt significantly better after treatment. The clinical state in two patients required the performance of Heller's myotomy. After 1 year, evident clinical and manometric improvement was observed in 7 patients. The longest improvement so far lasted for 36 months. The treatment has renewed the propulsive oesophageal peristalsis in two women.

The treatment of primary achalasia by means of combining the application of botulotoxin (Dysport) and balloon dilatation is effective, and it is possible to assume that the clinical remission will last longer than that in result of separate use of just one of the methods. The synchronous treatment of functional blocks in the cervical and thoracic regions of the spine and continuous rehabilitation can participate in the favourable clinical effect. The renewal of primary peristalsis of the oesophagus was achieved in two out of 9 patients. No such change has been either manometrically verified or described in literature. (Fig. 5, Tab. 1, Ref. 39.)