Use of botulinum toxin in esophageal achalasia

Esophageal achalasia is a rare neuromuscular disease characterized by the irreversible loss of peristaltic contractions and impaired relaxation of lower esophageal sphincter (LES). The purpose of therapy is focused on reducing the basal and residual LES pressure. Standard therapies are pneumatic dilatation or surgical miotomy with fundoplicatio. However, in selected clinical setting, endoscopically injected Botulinum toxin is very safe and well tolerated. It may achieve a 75% of symptoms remission in the long term, with the need to repeat the injection on year basis.