The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Long-term outcomes of balloon dilation versus botulinum toxin injection in patients with primary achalasia

  • Jung, Ho Eun (Institute for Digestive Research, Soonchunhyang University College of Medicine) ;
  • Lee, Joon Seong (Institute for Digestive Research, Soonchunhyang University College of Medicine) ;
  • Lee, Tae Hee (Institute for Digestive Research, Soonchunhyang University College of Medicine) ;
  • Kim, Jin Nyoung (Institute for Digestive Research, Soonchunhyang University College of Medicine) ;
  • Hong, Su Jin (Institute for Digestive Research, Soonchunhyang University College of Medicine) ;
  • Kim, Jin Oh (Institute for Digestive Research, Soonchunhyang University College of Medicine) ;
  • Kim, Hyeon Geon (Institute for Digestive Research, Soonchunhyang University College of Medicine) ;
  • Jeon, Seong Ran (Institute for Digestive Research, Soonchunhyang University College of Medicine) ;
  • Cho, Joo Young (Institute for Digestive Research, Soonchunhyang University College of Medicine)
  • Received : 2012.08.23
  • Accepted : 2014.04.16
  • Published : 2014.11.01
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Abstract

Background/Aims: We compared the long-term outcomes of balloon dilation versus botulinum toxin injection in Korean patients with primary achalasia and identified factors predicting remission. Methods: We included 73 patients with achalasia newly diagnosed between January 1988 and January 2011. We ultimately enrolled 37 of 55 patients with primary achalasia through telephone interviews, who were observed for over 1 year. Short-term outcomes were evaluated from the medical records based on symptom relief after 1 month of treatment. Long-term outcomes were evaluated in a telephone interview using a questionnaire. Results: Twenty-five patients were administered a botulinum toxin injection and 12 underwent balloon dilation. One month after the botulinum toxin injection, improvements were seen in chest pain (14 [56.0%] to 4 patients [16.0%]), regurgitation (16 [64.0%] to 4 [16.0%]), and dysphagia (25 [100.0%] to 5 [20.0%]). In the balloon dilation group, chest pain (8 [66.7%] to 1 [8.3%]), regurgitation (11 [91.7%] to 1 [8.3%]), and dysphagia (12 [100.0%] to 1 [8.3%]) had improved. A significant difference was observed in the mean remission duration between the botulinum toxin injection and balloon dilation groups (13 months [range, 1 to 70] vs. 29 months [range, 6 to 72], respectively; p = 0.036). Independent factors predicting long-term remission included treatment type (odds ratio [OR], 6.982; p = 0.036) and the difference in the lower esophageal sphincter pressure (OR, 7.198; p = 0.012). Conclusions: Balloon dilation may be more efficacious than botulinum toxin for providing long-term remission in Korean patients with achalasia. Follow-up manometry may predict the long-term outcome.

Keywords

References

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