Pyloric injection of botulinum toxin for treatment of diabetic gastroparesis.
BACKGROUND
Diabetic gastroparesis is a common clinical problem. The pathophysiology includes prolonged pyloric contractions that may cause functional resistance to gastric outflow. Botulinum toxin was injected into the pyloric sphincter in an attempt to decrease pyloric resistance and improve gastric emptying.


METHODS
Six patients with diabetic gastroparesis and an abnormal solid phase gastric emptying study underwent upper endoscopy during which 100 units of botulinum toxin were injected into the pyloric sphincter. Gastric emptying studies were obtained at 48 hours and 6 weeks after injection. Patients were questioned about symptoms of gastroparesis, and a symptom score was obtained at baseline and at 2 weeks and 6 weeks after injection.


METHODS
There was a mean improvement in the subjective symptom score at 2 weeks of 55% (range 14% to 80%). This improvement was maintained at 6 weeks. There was a 52% improvement in gastric emptying at 2 and 6 weeks.


CONCLUSIONS
Pyloric injection of botulinum toxin can improve symptoms and gastric emptying in patients with diabetic gastroparesis. Further evaluation of pyloric injection of botulinum toxin as a treatment for diabetic gastroparesis is warranted.
Ezzeddine
Dina
D
Veterans Affairs Medical Center, Wright State University School of Medicine, Dayton, Ohio, USA.
Jit
Rajkamal
R
Katz
Neil
N
Gopalswamy
Narasimh
N
Bhutani
Manoop S
MS
D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000627:therapeutic use*; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000503:physiopathology; D005260:Female; D005746:Gastric Emptying / Q000187:drug effects / Q000502:physiology; D018589:Gastroparesis / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D010865:Pilot Projects; D011446:Prospective Studies; D011708:Pylorus / Q000187:drug effects* / Q000503:physiopathology; D013997:Time Factors
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A