Comparison of Pneumatic Dilation with Pneumatic Dilation Plus Botulinum Toxin for Treatment of Achalasia

Among the therapeutic options for achalasia are pneumatic dilatation (pd), an appropriate long- term therapy, and botulinum toxin injection (bt) that is a relatively short-term therapy. this study aimed to compare therapeutic effect of repetitive pneumatic dilation with a combined method (botulinum toxin injec- tion and pneumatic dilation) in a group of achalasia patients who are low responder to two initial pneumatic dilations. thirty- four patients with documented primary achalasia that had low response to two times pd (<50% decrease in symptom score and barium height at 5 minute in timed esophagogram after 3month of late pd) were randomized to receive pneumatic dilation (n=18) or botulinum toxin injection and pneumatic dila- tion by four weeks interval (n=16), pd and bt+pd groups respectively. symptom scores were evaluated be- fore and at 1, 6 and 12 months after treatment. clinical remission was defined as a decrease in symptom score . 50% of baseline. there were no significant differences between the two groups in gender, age and achalasia type. remission rate of patients in bt-pd group in comparison with pd group were 87.5% vs. 67.1% (p = 0.7), 87.5% vs. 61.1% (p = 0.59) and 87.5% vs. 55.5% (p = 0.53) at 1, 6 and 12 months respectively .there were no major complications in either group. the mean symptom score decreased by 62.71% in the bt-pd group (p < 0.002) and 50.77% in the pd group (p < 0.01) at the end of the first year. despite a better re- sponse rate in bt+pd group, a difference was not statistically significant. a difference may be meaningful if a large numbers of patients are included in the study.