Outpatient Procedure to Treat Reflux Disease



Can Botox Help Heartburn?

Other conditions besides GERD can cause heartburn, and at least two may be helped with Botox therapy.

By Madeline R. Vann, MPH

Medically Reviewed by Lindsey Marcellin, MD, MPH

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Botox (botulinum toxin) is so popular as a wrinkle-fighter in Hollywood that a number of celebrities — from Jenny McCarthy to David Hasselhoff — have gone on record to extol its virtues. But beyond its use to smooth wrinkles, Botox can be used to treat a number of conditions that have nothing to do with vanity, including excessive sweating, incontinence, and migraines. And for certain people, Botox may even help treat heartburn.

Before you turn in the antacids and ask your gastroenterologist for this treatment, make sure you know what is causing your heartburn symptoms. While Botox isn’t a treatment for simple reflux caused by GERD, it is being used to help two conditions that also have heartburn as a symptom: achalasia and esophageal spasm.

What Is Achalasia?

Achalasia is relatively rare, occurring in about 2,000 people in the United States each year. It’s a condition in which the muscles of the esophagus don’t move food down to the stomach and the lower esophageal sphincter (LES) muscle fails to relax properly. This is the muscle at the lower end of the esophagus that relaxes to allow food to pass from your esophagus into your stomach, and then tightens up again to keep stomach acid and food from coming back up into the esophagus. It’s that backward flow which is called reflux.

Typically the LES automatically relaxes in order to let swallowed food pass through into the stomach — but in achalasia, this does not happen. Instead, saliva, liquids, and chewed food may stay trapped in the esophagus.

Initial symptoms typically include difficulty swallowing as well as symptoms that can be confused with those of GERD, such as chest pain or heartburn.

There are several standard treatment options for achalasia. Typically, medications to relax the LES are tried first, and other treatments, including dilation of the LES with a balloon, a surgical treatment called myotomy, may also be successful.

Botox injections into the LES are yet another option for treatment of achalsia. The injection is done during an endoscopy, a procedure which involves inserting a long, thin lighted tube through the mouth and into the esophagus. Botox injections relax the LES muscles, making it possible for food and liquid to pass into the stomach instead of getting trapped.

Botox for Esophageal Spasm

Another group of esophageal conditions, collectively called esophageal spasm, are also occasionally treated with Botox injections. These spasms, which come on suddenly and cause chest pain and sometimes difficulty swallowing, are usually treated with medications to relax the esophageal muscles. Sometimes Botox is used if these medications don’t have the desired effect.

Achalasia and GERD

The confusion between achalasia and GERD arises because some of the early symptoms of achalasia closely resemble GERD. About 40 percent of patients with achalasia have heartburn, largely due to the fermentation of the food trapped in their esophagus.

“Patients with achalasia can present with symptoms of reflux and be misdiagnosed as such for several years before achalasia is detected,” explains gastroenterologist Lauren B. Gerson, MD, associate professor of medicine at Stanford University in Stanford, Calif.

However, in contrast to the increased tension of the esophageal muscles in achalasia, people with GERD may have an LES muscle that relaxes too much, at the wrong time, or which fails to tighten and close completely after the food has already passed through. This allows stomach contents — including harsh stomach acids and undigested food — to splash back up into the esophagus.

Botox for Achalasia: Pros

“Botox can be effective for people with achalasia,” says Dr. Gerson. A Botox injection may also be used to help make the achalasia diagnosis if other tests have not shown a clear result. If it improves the symptoms, achalasia is likely the culprit.

More than 60 percent of people with achalasia who get a Botox injection find relief for at least a year. Some patients need to be retreated to prevent a return of the condition.

Botox for Achalasia: Cons

Some patients may have chest pain after the procedure, and a very small number could develop heartburn from reflux. Some patients may also develop scar tissue from the procedure.

As a result of the risks, a Botox injection is not the first line treatment for achalasia. But it is often useful as a short-term treatment in someone who wants to postpone having a surgical treatment performed.

For many of these same reasons, Botox is also not considered first-line therapy for those with esophageal spasm, but it may be beneficial in some cases.

Bottom line: People with GERD cannot look to Botox for a solution. “There is currently no role for Botox in the management of GERD,” cautions Gerson. But for those who actually have achalasia or esophageal spasm, it may be an option.






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Date: 16.12.2018, 02:16 / Views: 92275