Ursol G. The selection of methods and application of botulinum toxin in esophageal achalasia treatment

The dissertation presents the data about the treatment of 123 patients with achalasia of the esophagus that were treated using endoscopic techniques (injection of botulinum toxin in 32 patients and balloon dilatation in 34 patients) and surgical correction (esophagocardiomiotomy in 57 patients). Initial examination included assessment of symptoms, radiologic, endoscopic and manometric techniques, also studied the distensibility of the cardia and the presence of fibrosis in the zone of the lower esophageal sphincter with histologic methods at various stages of achalasia. Revealed that the impaired patency of the cardia due to two components: a spastic caused by spasm of the lower esophageal sphincter and fibrous, due to the development of connective tissue in the area of LES. Established that at ІІІ-ІV stages of achalasia cardia due to impaired patency of fibrous component, and the development of fibrosis leads to decompensation of the motor-evacuation function of the esophagus, which is the characteristic of these stages achalasia. The study of elongation of the cardia after treatment revealed that the use of botulinum toxin affects the spastic component of violations of terrain, and its use is especially effective for spastic achalasia. Balloon dilatation affects the fibrous component due to the destruction of areas of scarring. Cardiomoitomy affects both components. The data allowed the algorithm to justify the use of endoscopic techniques, depending on the stage of achalasia, the presence of fibrotic changes in the area of LES and disorders of esophageal peristaltic function.