Jan 18

The most common method for delivering BT involves visual estimation of the location of LES and injection of 1 mL aliquots (20 to 25 units BT/mL) into each of four quadrants approximately 1 cm above the Z-line. The Z-line is the squamocolumnar junction, which corresponds to the gastroesophageal junction in the absence of Barrett’s esophagus.

Initial response rates 70-90%
One Treatment = 50% relapse at 6m
Better outcomes with Vigorous (Type 3) Achalasia + Multiple Rx (esp if repeated at 1m) = 60-85% success at 2 year review

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Jan 13

We have been delighted with the results of our new high resolution manometry service. We have now investigated over 40 patients in the last few months. It has enabled us to diagnose a host of conditions that conventional manometry does not have the ability to define.
As one of the first district general hospitals to embrace this cutting edge technology we will auditing and publishing the results of our first year of service.
We are also starting additional research projects looking at oesophageal dysmotility and reflux as a major cause of;-
1) chronic cough, especially if this is predominantly troublesome during the night.
2) atypical chest pain

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Aug 30

Gastroenterology 2008;135:1528-1533

Type 1 – Classic achalasia with minimal oesophageal pressurization
Type 2 – Achalasia with oesophageal compression
Type 3 – Achalasia with spasm, functional obstruction, some peristalsis

Response to therapy
Type 1 – 56% overall
Type 2 – 71% BoTox, 91% Balloon Dilatation, 100% Heller’s Myotomy
Type 3 – 29% overall

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