Old Achalasia question ...

[Guest guest]

Thanks for your responses.

Since in the last 10 years I've been out of touch with anyone with Achalasia I'm

surprised that the treatment landscape has changed re: Botox. I've always

thought that if it works keep doing it. Now I sense in this on-line group (but

not from my regular GI Dr in polis, Drs in my family, or my Hopkins Dr Kaloo

who is head of GI Dept) that Botox is no good. Why has view on Botox changed in

this group?

I met with Dr Kaloo on Tuesday and now I'm scheduled for a dilatation next

Tuesday. Hiis answer on treatment is that all you can do is to " treat the

symptoms " there is nothing beyond that to do. Also, that treatment methodology

since my onset in 1999 hasn't changed. Initially, at Hopkins I was treated by

head of GI Dr. Pashrica, who is now head of GI at Stanford. Both have led me

down the same path I'm on now. I read no different in this group save responses

to differences in severrity in individuals and general dislike for botox, Why

is botox now rejected? Thanks, Dick

[Guest guest]

Notan --

I sent your link below to my Dr. asking if he agreed with article...

Here's his response:

Tony Kalloo to Dickshow details 3:15 PM (2 hours ago)

I don't agree with the results of this study, maybe we need a poem.

http://www.ncbi.nlm.nih.gov/pubmed/20354937

<http://www.ncbi.nlm.nih.gov/pubmed/20354937>

N. Kalloo, MD

The Moses and Helen Golden son Professor of Gastroenterology

Director, Division of Gastroenterology & Hepatology

The s Hopkins Hospital

600 N. Wolfe Street, Blalock 465,

Baltimore MD 21287

Phone 410 955-9697 <tel:410%20955-9697>

FAX 410-614-7340 <tel:410-614-7340>

www.hopkins-gi.org <http://www.hopkins-gi.org/>

akalloo@... <mailto:akalloo@...>

>

> > ... Why is botox now rejected?

> >

>

> I wouldn't say it is rejected, but it wouldn't be first choice in most

> cases. In some cases it is not only a treatment but diagnostic. If the

> Botox works then other treatments should also work. Where there is

doubt

> that treatment can work Botox before surgery may be the right

decision.

> There are other reason to use it also. However, Botox is a protein and

> your immune system can learn to attack it. That immune response can

> result in inflammation and fibrosis (scarring). Fibrosis is not going

> help your LES work any better and it can make surgery more difficult.

> There is debate on whether that difficulty really matters or not. Some

> surgeons report that it does not. Here is a paper by a center where

they

> think it does matter.

>

> Endoscopic Therapy for Achalasia Before Heller Myotomy Results in

Worse

> Outcomes Than Heller Myotomy Alone

> From the Department of Surgery, Emory University School of Medicine,

> Atlanta, GA.

> http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1570551/

>

> As others have mentioned many patients get only short relief before

> needing another treatment. In that short time the benefit of the

> treatment falls and they live with less than optimal result after the

> benefit falls but before the next treatment. That time may also be

> putting the esophagus at risk. There is evidence that untreated or

> inadequately treated achalasia results in esophageal dilation. If

> patients wait too long to get retreated or learn to live with less

than

> optimal results that may be a problem.

>

> If it works for you and these are not your problems then we are happy

> that you are happy, but we are cautious for the sake of others.

>

> notan

>

>

>

>