Botulinum toxin for the treatment of gastroparesis: a preliminary report.
Gastroparesis is a disorder of gastric motility that results in delayed gastric emptying. Common symptoms include early satiety, postprandial fullness, epigastric pain, nausea, vomiting, and weight loss. The underlying etiologies of gastroparesis are many and include diabetes, prior gastric surgery, collagen vascular disorders, and a previous viral illness. Up to one third of cases are classified as idiopathic. Treatment typically consists of a change in diet to small volume, frequent meals and the use of the prokinetic agents metoclopramide, cisapride, erythromycin, or domperidone. Botulinum toxin has recently been shown to be effective in treating disorders of smooth muscle hypertonicity in the GI tract. This case report describes three patients with severe gastroparesis whose symptoms persisted despite dietary changes and the use of high dose prokinetic agents. All three were treated with intrasphincteric injection of the pylorus with botulinum toxin and all had significant symptomatic improvement afterwards. Possible mechanisms of action of botulinum toxin on the pylorus and its effects in patients with gastroparesis are discussed.
Lacy
Brian E
BE
The Division of Digestive Disease and the Marvin M. Schuster Center for Digestive and Motility Disorders, John Hopkins Bayview Medical Center, Baltimore, Maryland 21224, USA.
Zayat
Estephan N
EN
Crowell
Michael D
MD
Schuster
Marvin M
MM
D000293:Adolescent; D000328:Adult; D018726:Anti-Dyskinesia Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001905:Botulinum Toxins / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D018589:Gastroparesis / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007267:Injections; D011708:Pylorus; D012720:Severity of Illness Index; D016896:Treatment Outcome
D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins