Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 48 2 2010 04 15 107 110 Alireza Bakhshipour Department of Gastroenterology, Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Romina Rabbani Department of Gastroenterology, Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Shapoor Shirani Department of Radiology, Tehran Heart Center, Tehran University of Medical Science, Tehran, Iran. Hosein ASL Soleimani Department of Gastroenterology, Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Javad Mikaeli Department of Gastroenterology, Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2015 09 28 Among the therapeutic options for achalasia are pneumatic dilatation (PD), an appropriate longterm therapy, and botulinum toxin injection (BT) that is a relatively short-term therapy. This study aimed to compare therapeutic effect of repetitive pneumatic dilation with a combined method (botulinum toxin injection and pneumatic dilation) in a group of achalasia patients who are low responder to two initial pneumatic dilations. Thirty- four patients with documented primary achalasia that had low response to two times PD (<50% decrease in symptom score and barium height at 5 minute in timed esophagogram after 3month of late PD) were randomized to receive pneumatic dilation (n=18) or botulinum toxin injection and pneumatic dilation by four weeks interval (n=16), PD and BT+PD groups respectively. Symptom scores were evaluated before and at 1, 6 and 12 months after treatment. Clinical remission was defined as a decrease in symptom score ≥ 50% of baseline. There were no significant differences between the two groups in gender, age and achalasia type. Remission rate of patients in BT-PD group in comparison with PD group were 87.5% vs. 67.1% (P = 0.7), 87.5% vs. 61.1% (P = 0.59) and 87.5% vs. 55.5% (P = 0.53) at 1, 6 and 12 months respectively .There were no major complications in either group. The mean symptom score decreased by 62.71% in the BT-PD group (P < 0.002) and 50.77% in the PD group (P < 0.01) at the end of the first year. Despite a better response rate in BT+PD group, a difference was not statistically significant. A difference may be meaningful if a large numbers of patients are included in the study. https://acta.tums.ac.ir/index.php/acta/article/view/3659 https://acta.tums.ac.ir/index.php/acta/article/download/3659/3634