Background. Lower esophagial sphincter (LES) balloons dilation with a diameter of 30–40 mm or the introduction of botulinum toxin in this area are more efficient methods that allow to remove manifestations of dysphagia during the period from 3 to 12 months. However, after the expiration period the therapy sessions should be repeated or surgical treatment with the performance of cardiomyotomy should be performed.
The aim was studying effectiveness of botulinum toxin on the performance of pressure in the NPC to develop prognostic criteria for botulinum toxin therapy effectiveness.
Methods. The study included 32 patients (22 men, 10 women) with the 1st and early 2nd stage of AK, which were treated by endoscopic injections of botulinum toxin type A in the area of NPC (the drug Dysport, MO 500/3 mb.)
Results. Analysis of symptoms and level of pressure in the cardia showed no correlation between them and the stage of achalasia. A higher rate of transient relaxations of esophageal-gastric junction in comparison occurred at the 1st and early 2nd stage of achalasia cardia (AC) with later stages. Response to therapy is to reduce the pressure in the cardia, the restoration of peristaltic function of the esophagus, reducing the time delay of barium in the esophagus, which correlated with a decrease in severity of symptoms.
Conclusions. The pressure in the cardia and the evacuation of barium from the esophagus on the first day after injection of botulinum toxin is an important prognostic indicator of the effectiveness of its patients with AC. Patients with good response to the introduction of botulinum toxin treatment should be continued, and in patients with poor response after the resumption of symptoms cardiomyotomy will be performed. Widespread introduction of suitable botulinum toxin therapy in clinical practice, development schemes of performing minimally invasive endoscopic procedures and indications for their use in the treatment of achalasia of the esophagus.