摘要
Gastroparesis(GP) is a common disease seen in gastroenterology practice particularly in western countries, and it may be underdiagnosed. The available drug therapies for this condition are quite disappointing. Botulinum toxin type A(BT) has been found to be effective therapy in various spastic disorders of smooth muscle of gastrointestinal tract. However, the benefits of BT injections in GP have been unclear. Several retrospective and open label studies have shown clinical advantages of intrapyloric Botulinum toxin type A injections, while two small randomized trials did not show positive results. Therefore, the available published studies yielded conflicting results leading to fading out of botox therapy for GP. We recognize possible clinical benefit of BT injections without any disadvantages of this treatment. We are calling for revisiting the endoscopy guided botox therapy in refractory GP. In this review we discuss important features of these studies pointing out differences in results among them. Differences in patient selection, doses and method of administration of botox toxin in the prior studies may be the cause of conflicting results. The mechanism of action, indications, efficacy and side-effects of BT are reviewed. Finally, we recognize limited evidence to recommend BT in GP and calling attention for future research in this field since no advances in drug management had been made in the last two decades.
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.
