Treatment of idiopathic gastroparesis with injection of botulinum toxin into the pyloric sphincter muscle.
OBJECTIVE
We aimed to determine if botulinum toxin injection into the pyloric sphincter improves gastric emptying and reduces symptoms in patients with idiopathic gastroparesis.


METHODS
Patients with idiopathic gastroparesis not responding to prokinetic therapy underwent botulinum toxin (80-100 U, 20 U/ml) injection into the pyloric sphincter. Gastric emptying scintigraphy was performed before and 4 wk after treatment. Total symptom scores were obtained from the sum of eight upper GI symptoms graded on a scale from 0 (none) to 4 (extreme).


RESULTS
Ten patients were entered into the study. The mean percentage of solid gastric retention at 4 h improved from 27+/-6% (normal < 10%) before botulinum toxin injection into the pylorus to 14+/-4% (p = 0.038) 4 wk after treatment. The symptom score decreased from 15.3+/-1.7 at baseline to 9.0+/-1.9 (p = 0.006) at 4 wk, a 38+/-9% decrease. Improvement in symptoms tended to correlate with improved gastric emptying of solids (r = 0.565, p 0.086).


CONCLUSIONS
This initial pilot study suggests that botulinum toxin injection into the pylorus in patients with idiopathic gastroparesis improves both gastric emptying and symptoms.
Section of Gastroenterology, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA.
Larry S
LS
Miller
Gregory A
GA
Szych
Steven B
SB
Kantor
Matthew Q
MQ
Bromer
Linda C
LC
Knight
Alan H
AH
Maurer
Robert S
RS
Fisher
Henry P
HP
Parkman
D000328:Adult; D000368:Aged; D018726:Anti-Dyskinesia Agents / Q000008:administration & dosage*; D001905:Botulinum Toxins / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D005746:Gastric Emptying; D018589:Gastroparesis / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D015552:Injections, Intralesional; D009130:Muscle, Smooth; D010865:Pilot Projects; D011708:Pylorus; D013997:Time Factors
D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins