Use of Clostridium botulinum toxin in gastrointestinalmotility disorders in children

• 作者: Leonel Rodriguez. Ricardo A Arbizu
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: BOTULINUM toxin Gastrointestinal motilitydisorders CHILDREN SWALLOWING DISORDERS GASTROPARESIS DEFECATION DISORDERS
• 年，卷（期）: 2015,（5）
• 页码范围: 433-437
• 页数: 5页
• 分类号: R

摘要

More than a century has elapsed since the identificationof Clostridia neurotoxins as the cause of paralyticdiseases. Clostridium botulinum is a heterogeneousgroup of Gram-positive, rod-shaped, spore-forming,obligate anaerobic bacteria that produce a potentneurotoxin. Eight different Clostridium botulinumneurotoxins have been described （A-H） and 5 of thosecause disease in humans. These toxins cause paralysisby blocking the presynaptic release of acetylcholine atthe neuromuscular junction. Advantage can be taken ofthis blockade to alleviate muscle spams due to excessiveneural activity of central origin or to weaken a musclefor treatment purposes. In therapeutic applications,minute quantities of botulinum neurotoxin type A areinjected directly into selected muscles. The Food andDrug Administration first approved botulinum toxin （BT）type A in 1989 for the treatment of strabismus andblepharospasm associated with dystonia in patients 12years of age or older. Ever since, therapeutic applicationsof BT have expanded to other systems, including thegastrointestinal tract. Although only a single fatalityhas been reported to our knowledge with use of BTfor gastroenterological conditions, there are significantcomplications ranging from minor pain, rash and allergicreactions to pneumothorax, bowel perforation andsignificant paralysis of tissues surrounding the injection（including vocal cord paralysis and dysphagia）. Thiseditorial describes the clinical experience and evidencefor the use BT in gastrointestinal motility disorders inchildren.