From the Guidelines
Botulinum toxin injection for achalasia can cause several side effects, though most are mild and temporary, including chest pain, heartburn, and difficulty swallowing immediately after the procedure, typically lasting a few days, as reported in guidelines on the use of oesophageal dilatation in clinical practice 1. The side effects of botulinum toxin in the treatment of achalasia can be categorized into common and rare complications. Common side effects include:
- Chest pain
- Heartburn
- Difficulty swallowing immediately after the procedure, typically lasting a few days Some patients experience reflux symptoms as the lower esophageal sphincter relaxes. Rarely, more serious complications can occur, including:
- Perforation of the esophagus
- Bleeding
- Infection at the injection site
- Systemic botulism-like symptoms such as muscle weakness, blurred vision, or breathing difficulties are extremely rare but possible if the toxin spreads beyond the injection site. The procedure may also cause inflammation or hematoma formation at the injection site. Most patients tolerate the procedure well, with side effects resolving within days to weeks, as the therapeutic effect of botulinum toxin typically lasts only 3-6 months and repeat injections are often necessary, as noted in the guidelines on the use of oesophageal dilatation in clinical practice 1.
From the Research
Side Effects of Botulinum Toxin in Achalasia Treatment
- The side effects of botulinum toxin in the treatment of achalasia are generally mild and infrequent, with transient chest pain being the most commonly reported symptom 2.
- Other studies have also reported a low incidence of adverse effects, with no serious complications noted 3, 4.
- The use of botulinum toxin in achalasia treatment has been shown to be safe and effective, with a significant reduction in lower esophageal sphincter pressure and improvement in symptom scores 2, 4.
- Long-term results have shown that botulinum toxin treatment can provide sustained relief from symptoms, with some patients experiencing benefits for more than 1 year 5.
Factors Influencing Side Effects and Efficacy
- The initial response to botulinum toxin injection appears to be independent of any prior treatment, with similar benefits seen in untreated and pretreated patients 4.
- However, long-term success may be influenced by factors such as age and lower esophageal sphincter pressure, with elderly patients and those with lower pressure values tend to have better outcomes 5.
- Younger patients with severe increases in lower esophageal sphincter pressure may not benefit as much from botulinum toxin injection and may require alternative treatments such as pneumatic dilation or myotomy 5.