P1393 - A Unique Presentation of Aperistalsis of the Esophagus Secondary to Myobloc Injection

Bianca Varda, MD¹, Brett Hughes, MD², Ashish Sadolikar, MD¹, Layth Al-Jashaami, MD¹, Shifat Ahmed, MD^1
1St. Joseph's Hospital and Medical Center, Creighton University School of Medicine, Phoenix, AZ; ²Creighton University/St. Joseph's Medical Center, Phoenix, AZ

Introduction: Myobloc is a form of botulinum toxin used in the treatment of pain and dystonia. Serious adverse effects of this treatment are fairly rare. Herein, we present a case of aperistalsis of the esophagus secondary to Myobloc injection.

Case Description/Methods: A 55-year-old female with a history of migraines presented to our hospital due to a one week history of dysphagia. She had been receiving protein B Myobloc injections for migraine therapy and after the most recent injection one week prior began having increased dry mouth, eye irritation, and inability to swallow food. She endorsed dysphagia to both solids and liquids and felt as though food got stuck in the middle of her throat. On presentation, she was afebrile and hemodynamically stable. Physical examination was unremarkable. MBS study showed an abnormal delay in the oral phase of swallowing and the patient was scheduled for EGD to further evaluate, which showed UES resistance. The UES was successfully dilated during the procedure. Following the EGD, the patient continued to endorse difficulty swallowing food and medication. The patient subsequently underwent XR esophagram with Gastrografin, which showed no leak of contrast and no passage of contrast from the esophagus into the stomach. Further work-up with esophageal manometry showed a hypotensive LES with adequate relaxation and a median IRP of 10 mmHg. The aperistalsis was presumed to be secondary to myobloc injection. She was continued on PPI and a PEG tube was placed for supplemental nutrition until resolution of her symptoms. At a clinic visit 5 weeks later, the patient reported improvement in her dysphagia and had no new complaints.

Discussion: There are numerous disorders of the esophagus that result in motility abnormalities. Patients may present with chest pain or dysphagia, prompting further workup to determine the etiology of their symptoms. Diagnostic evaluation includes radiography with barium swallow study, endoscopy and high-resolution manometry. Ineffective esophageal motility or aperistalsis are most frequently seen in systemic disorders such as connective tissue disease. This case illustrates a rare side effect of Myobloc, a serotype of botulinum neurotoxin, used for the treatment of migraines. Our patient’s injection resulted in aperistalsis of the esophagus and feeding tube placement. Treatment consisted of symptomatic management, dietary changes, and endoscopic interventions while waiting for the effect of the toxin to dissipate.


Disclosures:
Bianca Varda indicated no relevant financial relationships.
Brett Hughes indicated no relevant financial relationships.
Ashish Sadolikar indicated no relevant financial relationships.
Layth Al-Jashaami indicated no relevant financial relationships.
Shifat Ahmed indicated no relevant financial relationships.


Bianca Varda, MD¹, Brett Hughes, MD², Ashish Sadolikar, MD¹, Layth Al-Jashaami, MD¹, Shifat Ahmed, MD¹. P1393 - A Unique Presentation of Aperistalsis of the Esophagus Secondary to Myobloc Injection, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.