Influence of intrapyloric botulinum toxin injection on gastric emptying and meal-related symptoms in gastroparesis patients.
BACKGROUND
Recent observations in limited numbers of patients suggest a potential benefit of intrapyloric injection of botulinum toxin in the treatment of gastroparesis.


OBJECTIVE
To characterize the effect of botulinum toxin on solid and liquid gastric emptying and on meal-related symptoms.


METHODS
In 20 gastroparesis patients (17 women, mean age 37 +/- 3 years, three diabetic and 17 idiopathic), gastric emptying for solids and liquids was measured before and one month after intrapyloric botulinum toxin 4 x 25 units. Before the meal and at 15-min intervals up to 240 min postprandially, the patient graded the intensity of six gastroparesis symptoms, and a meal-related severity score was obtained by adding all intensities. Data (mean +/- S.E.M.) were compared using paired Student's t-test.


RESULTS
Treatment with botulinum toxin significantly enhanced solid (t(1/2) 132 +/- 16 vs. 204 +/- 35 min, P < 0.05) but not liquid (92 +/- 10 vs. 104 +/- 11 min, N.S.) emptying. This was accompanied by a significant decrease in cumulative meal-related symptom score (73.5 +/- 16.3 vs. 103 +/- 17.1 baseline, P = 0.01) as well as individual severity scores for postprandial fullness, bloating, nausea and belching (all P < 0.001, two-way anova).


CONCLUSIONS
Botulinum toxin improves solid but not liquid gastric emptying in gastroparesis, and this is accompanied by significant improvement of several meal-related symptoms.
Arts
J
J
Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium.
van Gool
S
S
Caenepeel
P
P
Verbeke
K
K
Janssens
J
J
Tack
J
J
D000328:Adult; D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use*; D001905:Botulinum Toxins / Q000627:therapeutic use*; D005260:Female; D005746:Gastric Emptying / Q000187:drug effects; D018589:Gastroparesis / Q000188:drug therapy*; D006801:Humans; D008297:Male; D019518:Postprandial Period / Q000502:physiology; D016896:Treatment Outcome
D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins