Endoscopic botox injections in therapy of refractorygastroparesis

• 作者: Alicia Alvarez. Andrew Ukleja Kanwarpreet Tandon Kinchit Shah
• 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: GASTROPARESIS Delayed gastric EMPTYING BOTOX BOTULINUM TOXIN Refractory GASTROPARESIS
• 年，卷（期）: 2015,（8）
• 页码范围: 790-798
• 页数: 9页
• 分类号: R

摘要

Gastroparesis （GP） is a common disease seen in gastroenterologypractice particularly in western countries,and it may be underdiagnosed. The available drugtherapies for this condition are quite disappointing.Botulinum toxin type A （BT） has been found to be effectivetherapy in various spastic disorders of smoothmuscle of gastrointestinal tract. However, the benefitsof BT injections in GP have been unclear. Severalretrospective and open label studies have shown clinicaladvantages of intrapyloric Botulinum toxin type Ainjections, while two small randomized trials did notshow positive results. Therefore, the available publishedstudies yielded conflicting results leading to fading outof botox therapy for GP. We recognize possible clinicalbenefit of BT injections without any disadvantages of thistreatment.We are calling for revisiting the endoscopyguided botox therapy in refractory GP. In this reviewwe discuss important features of these studies pointingout differences in results among them. Differences inpatient selection, doses and method of administrationof botox toxin in the prior studies may be the cause ofconflicting results. The mechanism of action, indications,efficacy and side-effects of BT are reviewed. Finally, werecognize limited evidence to recommend BT in GP andcalling attention for future research in this field since noadvances in drug management had been made in thelast two decades.