食道弛緩不能（achalasia）是一種少見的食道無蠕動或下食道括約肌（lower esophageal sphincter, LES）無法放鬆的疾病。發生率約為十萬分之一，常見於20至40歲成年人。臨床上常見的治療方式包括給予平滑肌鬆弛劑、內視鏡下注射投予肉毒桿菌毒素（botulinum toxin）等藥物治療，或進行下食道括約肌、充氣擴張術（pneumatic dilation）或採外科手術治療。本案例為一名55歲男性，因急性且嚴重的吞嚥困難，伴有胃酸逆流等症狀而住院求診。住院後食道內視鏡及壓力測量證實為食道弛緩不能，以內視鏡注射肉毒桿菌毒素 （Botox, botulinum toxin type A）至下食道括約肌緩解症狀。病人於出院後八個月，再次因吞嚥困難求診並接受充氣擴張術治療。藉由文獻回顧探討注射肉毒桿菌毒素之藥物治療方式，與其他治療方式對食道弛緩不能的改善效果之比較。結果顯示：與充氣擴張術或外科手術相較，注射肉毒桿菌毒素對症狀初期緩解的效果相當，症狀緩解時間較短，但注射肉毒桿菌毒素比其他兩種療法安全性為高。

Achalasia is a rare swallowing disorder with a loss of peristalsis in the esophagus and a failure of relaxation of the lower esophageal sphincter (LES). The annual incidence of achalasia approximately 1 case per 100,000 and this disease is usually diagnosed in patients who are between the ages of 20 to 40 years. The treatments of achalasia contain smooth muscle relaxants, botulinum toxin which injected by endoscopy, pneumatic dilation, and surgery. A 55-year-old male suffered acute severe dysphagia (including solid and liquid) with symptoms of acid regurgitation. Esophageal endoscopy and namomatry revealed achalasia. Botulinum toxin was injected to LES by endoscopy and then his dysphagia improved. Eight months after discharge, he suffered dysphagia again and confirmed as achalasia again. Then he accepted balloon dilatation as treatment to relief symptoms. In this report, we evaluated the botulinum toxin’s effect with other medical treatments. Compared with pneumatic dilation and surgery, botulinum toxin injection had similar effect for relief symptoms and shorter relief duration. In addition, botulinum toxin injection might be safer than pneumatic dilation and surgery.