The Limited Role for Botox in Achalasia: A Gastroenterologist’s Perspective

Botox injection during endoscopy is highly effective in patients with achalasia. However, treatment response is short in duration which poses a challenge in this chronic disease. There is limited data to suggest botox increases subsequent procedure technical difficulty or adverse events, and short term efficacy appears to be equal to other therapies. Therefore, botox is an appropriate therapy for those who require a bridge, like pregnant patients, or in high risk patients who are not candidates for myotomy. However, long term outcomes of treatment naïve patients undergoing definitive therapy may be better than previously treated patients, therefore, avoidance of botox is recommended when definitive therapy is possible. When the diagnosis of achalasia is in question, or if the presentation is not clear, botox could elucidate the treatment plan without major consequence on future therapies.