title: Endoscopic pyloric injection of botulinum toxin A for the treatment of refractory gastroparesis.
abstract: BACKGROUND
  Botulinum toxin A injected into the pyloric sphincter has been reported in small case series to treat gastroparesis. This study reviews the use of this treatment in a large number of patients with gastroparesis.
  
  
  METHODS
  Patients who underwent pyloric botulinum injection for treatment of gastroparesis were identified. Response was defined as improvement or resolution of the patient's major symptom and/or two minor symptoms for 4 weeks.
  
  
  RESULTS
  Of 115 patients treated, 63 patients met the study criteria. There were 53 women, 10 men, mean age 42 years. Most patients (56%) had idiopathic gastroparesis. Twenty-seven of 63 (43%) patients experienced a symptomatic response to treatment. By stepwise logistic regression, male gender was associated with response to treatment (OR 3.27: 95% CI[1.31, 8.13], p = 0.01). Vomiting as a major symptom was associated with a lack of response (OR 0.16: 95% CI[0.04, 0.67], p = 0.01). Despite the association of male gender with response, the mean duration of response for those patients responding, with a minimum of 3 months' follow-up was 4.9 months (+/-2.7 months) for women and 3.5 months (+/-0.71 months) for men (p = 0.59). The corresponding medians and interquartile ranges (IQR) were 5 (IQR 3-6) for females and 3.5 (IQR 3-4) for males.
  
  
  CONCLUSIONS
  Of the patients, 43% had a response to botulinum toxin treatment that lasted a mean of approximately 5 months. Male gender was associated with a response to this therapy; however, durability of response was unrelated to gender. Vomiting as a major symptom predicted no response.
authors.affiliation: Section of Gastroenterology, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Matthew Q
authors.initials: MQ
authors.lastname: Bromer
authors.forename: Frank
authors.initials: F
authors.lastname: Friedenberg
authors.forename: Larry S
authors.initials: LS
authors.lastname: Miller
authors.forename: Robert S
authors.initials: RS
authors.lastname: Fisher
authors.forename: Kenneth
authors.initials: K
authors.lastname: Swartz
authors.forename: Henry P
authors.initials: HP
authors.lastname: Parkman
mesh_terms: D015746:Abdominal Pain / Q000188:drug therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D016145:Endoscopy, Digestive System; D005260:Female; D005500:Follow-Up Studies; D005746:Gastric Emptying / Q000187:drug effects; D018589:Gastroparesis / Q000188:drug therapy*; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000188:drug therapy; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D011708:Pylorus / Q000473:pathology*; D012074:Remission Induction; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014839:Vomiting / Q000188:drug therapy
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A