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Gastrointestinal Applications

Achalasia, Gastroparesis, and Anal Fissure

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Therapeutic Uses of Botulinum Toxin
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Abstract

The origin, subtypes, physiology and pharmacology of botulinum toxin type A (BTX-A) have been discussed in other chapters. In this chapter, some of the current applications of BTX in gastroenterology are discussed. BTX has been used for a large number of gastrointestinal disorders, however, this chapter is confined to those conditions for which the best data are available (achalasia, gastroparesis, and anal fissure). Other conditions with only preliminary descriptive data are not discussed because widespread use of BTX for these disorders remains unlikely (esophageal spasm, anismus, and sphincter of Oddi dysfunction). This chapter does not address the use of BTX for the treatment of cricopharyngeal spasm because physicians specializing in ears, nose, and throat typically treat this disorder (1,2).

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References

  1. Shaw GY, Searl JP. Botulinum toxin treatment for cricopharyngeal dysfunction. Dysphagia 2001;16:161–167.

    Article  PubMed  CAS  Google Scholar 

  2. Schneider I, Thumfart WF, Pototschnig C, Eckel HE. Treatment of dysfunction of the cricopharyngeal muscle with botulinum A toxin: introduction of a new, noninvasive method. Ann Otol Rhinol Laryngol 1994;103:31–35.

    PubMed  CAS  Google Scholar 

  3. Zarate N, Mearin F, Wang XY, Hewlett B, Huizinga JD, Malagelada JR. Severe idiopathic gastroparesis due to neuronal and interstitial cells of Cajal degeneration: pathological findings and management. Gut 2003;52:966–970.

    Article  PubMed  CAS  Google Scholar 

  4. Hornbuckle K, Barnett JL. The diagnosis and work-up of patients with gastroparesis. J Clin Gastroeneterol 2000;30:2:117–124.

    Article  CAS  Google Scholar 

  5. Tougas G, Eaker EY, Abell TL, et al. Assessment of gastric emptying using a low fat meal: establishment of international control values. Am J Gastroenterol 2000;95:1456–1462.

    Article  PubMed  CAS  Google Scholar 

  6. Ezzeddine D, Jit R, Katz N, Gopalswamy N, Bhutani MS. Pyloric injection of botulinum toxin for treatment of diabetic gastroparesis. Gastrointest Endosc 2002;55:920–923.

    Article  PubMed  Google Scholar 

  7. Mearin F, Camilleri M, Malagelada JR. Pyloric dysfunction in diabetics with recurrent nausea and vomiting. Gastroenterology 1986;90:1919–1925.

    PubMed  CAS  Google Scholar 

  8. James AN, Ryan JP, Parkman HP. Inhibitory effects of botulinum toxin on pyloric and antral smooth muscle. Am J Physiol Gastrointest Liver Physiol 2003;285:291–297.

    Google Scholar 

  9. Gupta P, Rao SS. Attenuation of isolated pyloric pressure waves in gastroparesis in response to botulinum toxin injection: a case report. Gastrointest Endosc 2002;56:770–772.

    Article  PubMed  Google Scholar 

  10. Miller LS, Szych GA, Kantor SB, et al. Treatment of idiopathic gastroparesis with injection of botulinum toxin into the pyloric sphincter muscle. Am J Gastroenterol 2002;97:1653–1660.

    Article  PubMed  CAS  Google Scholar 

  11. Lacy BE, Zayat EN, Crowell MD, Schuster MM. Botulinum toxin for the treatment of gastroparesis: a preliminary report. Am J Gastroenterol 2002;97:1548–1552.

    Article  PubMed  CAS  Google Scholar 

  12. Arts J, Gool SJ, Caenepeel P, Janssens J, Tack J. Effect of intrapyloric injection of botulinum toxin on gastric emptying and meal-related symptoms in gastroparesis. Gastroenterology 2003;124:A53 (Abstract).

    Article  Google Scholar 

  13. Bromer MQ, Friedenberg F, Miller LS, Fisher RS, Swartz K, Parkman HP. Endoscopic pyloric injection of botulinum toxin a for the treatment of refractory gastroparesis. Gastrointest Endosc 2005;61:833–839.

    Article  PubMed  Google Scholar 

  14. Holloway RH, Dodds WJ, Helm JF, Hogan WJ, Dent J, Arndorfer RC. Integrity of cholinergic innervation to the lower esophageal sphincter in achalasia. Gastroenterology 1986;90:924–929.

    PubMed  CAS  Google Scholar 

  15. Mittel RK, Balaban D. The esophagogastric junction. N Engl J Med 1997;336:924–932.

    Article  Google Scholar 

  16. Mearin F, Mourelle M, Guarner F, et al. Patients with achalasia lack nitric oxide synthase in the gastro-esophageal junction. Eur J Clin Invest 1993;23:724–728.

    Article  PubMed  CAS  Google Scholar 

  17. Gaumnitz EA, Bass P, Osinski MA, Sweet MA, Singaram C. Electrophysiological and pharmacological responses of chronically denervated lower esophageal sphincter of the opossum. Gastroenterology 1995;109:789–799.

    Article  PubMed  CAS  Google Scholar 

  18. Reynolds JC, Parkman HP. Achalasia. Gastroenterol Clin North Am 1989;18:223–256.

    PubMed  CAS  Google Scholar 

  19. Pasricha PJ, Ravich WJ, Kalloo AN. Effects of intrasphincteric botulinum toxin on the lower esophageal sphincter in piglets. Gastroenterology 1993;105:1045–1049.

    PubMed  CAS  Google Scholar 

  20. Pasricha PJ, Ravich WJ, Hendrix TR, Sostre S, Jones B, Kalloo AN. Treatment of achalasia with intrasphicteric injection of botulinum toxin—a pilot trial. Ann Internal Med 1994;121:590–591.

    CAS  Google Scholar 

  21. Fishman VM, Parkman HP, Schiano TD, et al. Symptomatic improvement in achalasia after botulinum toxin injection of the lower esophageal sphincter. Am J Gastroenterol 1996;91:1724–1730.

    PubMed  CAS  Google Scholar 

  22. Neubrand M, Scheurlen C, Schepke M, Sauerbruch T. Long-term results and prognostic factors in the treatment of achalasia with botulinum toxin. Endoscopy 2002;34:519–523.

    Article  PubMed  CAS  Google Scholar 

  23. Cuilliere. C, Ducrotte. P, Zerbib F, et al. Achalasia: outcome of patients treated with intrasphincteric injection of botulinum toxin. Gut 1997;41:87–92.

    Article  PubMed  CAS  Google Scholar 

  24. Annese V, Basciani M, Borrelli O, Leandro G, Simone P, Andriulli A. Intrasphincteric injection of botulinum toxin is effective in long-term treatment of esophageal achalasia. Muscle Nerve 1998;21:1540–1542.

    Article  PubMed  CAS  Google Scholar 

  25. Greaves RR, Mulcahy HE, Patchett SE, et al. Early experience with intrasphincteric botulinum toxin in the treatment of achalasia. Aliment Pharmacol Ther 1999;13:1221–1225.

    Article  PubMed  CAS  Google Scholar 

  26. Kolbasnik J, Waterfall WE, Fachnie B, Chen Y, Tougas G. Long term efficacy of botulinum toxin in classical achalasia: a prospective study. Am J Gastroenterol 1999;94:3434–3439.

    Article  PubMed  CAS  Google Scholar 

  27. Pasricha PJ, Ravich WJ, Hendrix TR, Sostre S, Jones B, Kalloo AN. Intrasphincteric botulinum toxin for the treatment of achalasia. N Engl J Med 1995;332:774–778.

    Article  PubMed  CAS  Google Scholar 

  28. Pasricha PJ, Rai R, Ravich WJ, Hendrix TR, Kalloo AN. Botulinum toxin for achalasia: long term outcome and predictors of response. Gastroenterology 1996;110:1410–1415.

    Article  PubMed  CAS  Google Scholar 

  29. Annese V, Basciani M, Perri F, et al. Controlled trial of botulinum toxin injection versus placebo and pneumatic dilation in achalasia. Gastroenterology 1996;111:1418–1424.

    Article  PubMed  CAS  Google Scholar 

  30. Muehldorfer SM, Schneider TH, Hochberger J, Martus P, Hahn EG, Ell C. Esophageal achalasia: intrasphincteric injection of BTX versus balloon dilation. Endoscopy 1999;31:517–521.

    Article  PubMed  CAS  Google Scholar 

  31. Vaezi MF, Richter JE, Wilcox CM, et al. Botulinum toxin injection versus pneumatic dilation in the treatment of achalasia: a randomised trial. Gut 1999;44:231–239.

    Article  PubMed  CAS  Google Scholar 

  32. Mikaeli J, Fazel A, Montazeri G, Yaghoobi M, Malekzadeh R. Randomized controlled trial comparing botulinum toxin injection to pneumatic dilatation for the treatment of achalasia. Aliment Pharmacol Ther 2001;15:1389–1396.

    Article  PubMed  CAS  Google Scholar 

  33. Ghoshal UC, Chaudhuri S, Pal BB, Dhar K, Ray G, Banerjee PK. Randomized controlled trial of intrasphincteric BTX injection versus balloon dilatation in treatment of achalasia cardia. Dis Esophagus 2001; 14:227–231.

    Article  PubMed  CAS  Google Scholar 

  34. Wehrmann T, Kokabpick H, Jacobi V, Scifert H, Lembcke B, Caspary WF. Long term results of endoscopic injection of botulinum toxin in elderly achalasia patients with tortuous megaesophagus or epiphrenic diverticulum. Endoscopy 1999;31:352–358.

    Article  PubMed  CAS  Google Scholar 

  35. Katzka DA, Castell DO. Use of BTXs a diagnostic/therapeutic trial to help clarify an indication for definitve therapy in patients with achalasia. Am J Gastroenterol 1999;94:637–642.

    Article  PubMed  CAS  Google Scholar 

  36. Hoffman BJ, Knapple WL, Bhutani MS, Verne GN, Hawes RH. Treatment of achalasia by injection of botulinum toxin under endoscopic ultrasound guidance. Gastrointest Endosc 1997;45:77–79.

    Article  PubMed  CAS  Google Scholar 

  37. Annese V, Bassotti G, Coccia G, et al. A multicentre randomised study of intrasphincteric botulinum toxin in patients with oesophageal achalasia. Gut 2000;46:597–600.

    Article  PubMed  CAS  Google Scholar 

  38. Forouzesh A, White KT, Mullin GE. The development of pneumoperitoneum as a result of botox injection for treatment of achalasia. Am J Gastroenterol 2003; 98(Suppl 1):5–183.

    Google Scholar 

  39. Eaker EY, Gordon JM, Vogel SB. Untoward effects of esophageal botulinum toxin injection in the treatment of achalasia. Dig Dis Sci 1997;42:724–727.

    Article  PubMed  CAS  Google Scholar 

  40. Patti MG, Feo CV, Arcerito M, et al. Effects of previous treatment on results of laparascopic heller myotomy for achalasia. Dig Dis Sci 1999;44:2270–2276.

    Article  PubMed  CAS  Google Scholar 

  41. Hannel N, Gordon PH. Re-examination of clinical manifestations and response to therapy of fissure-in-ano. Dis Colon Rectum 1997;40:229–233.

    Article  Google Scholar 

  42. Kennedy ML, Sowter S, Nguyen H, Lubowski DZ. Glyceryl trinitrate ointment for the treatment of chronic anal fissure: results of a placebo-controlled trial and long-term follow-up. Dis Colon Rectum 1999;42:1000–1006.

    Article  PubMed  CAS  Google Scholar 

  43. Jost WH. One hundred cases of anal fissure treated with botulinum toxin: early and long-term results. Dis Colon Rectum 1997;40:1029–1032.

    Article  PubMed  CAS  Google Scholar 

  44. Oettle GJ. Glyceryl trinitrate vs. sphincterotomy for treatment of chronic fissure-in-ano. Dis Colon Rectum 1997;10:1318–1320.

    Article  Google Scholar 

  45. Evans J, Luck A, Hewett P. Glyceryl trinitrate vs. lateral sphincterotomy for chronic anal fissure: prospective randomized trial. Dis Colon Rectum 2001;44:93–97.

    Article  PubMed  CAS  Google Scholar 

  46. Brisinda G, Maria G, Bentivoglio AR, Cassetta E, Gui D, Albanese A. A comparision of injections of BTXnd topical nitroglycerin ointment for the treatment of chronic anal fissure. N Engl J Med 1999;34:65–69.

    Article  Google Scholar 

  47. Jost WH, Schimrigk K. Therapy of anal fissure using botulin toxin. Dis Colon Rectum 1994; 37:1340.

    Article  PubMed  CAS  Google Scholar 

  48. Gui D, Cassetta E, Anastasio G, Bentivoglio AR, Maria G, Albanese A. Botulinum toxin for chronic anal fissure. Lancet 1994:344:1127–1128.

    Article  PubMed  CAS  Google Scholar 

  49. Mason PF, Watkins MJ, Hall HS, Hall AW. The management of chronic fissure in-ano with botulinum toxin. J R Coll Surg Edinb 1996;41:235–238.

    PubMed  CAS  Google Scholar 

  50. Jost WH, Schrank B. Repeat botulinum toxin injections in anal fissure in patients with relapse after insufficient effect of first treatment. Dig Dis Sci 1999;44:1588–1589.

    Article  PubMed  CAS  Google Scholar 

  51. Minguez M, Melo F, Espi A, et al. Therapeutic effects of different doses of botulinum toxin in chronic anal fissure. Dis Colon Rectum 1999;42:1016–1021.

    Article  PubMed  CAS  Google Scholar 

  52. Maria G, Brisinda G, Bentivoglio AR, Cassetta E, Gui D, Albanese A. Influence of botulinum toxin site of injections on healing rate in patients with chronic anal fissure. Am J Surg 2000; 179:46–50.

    Article  PubMed  CAS  Google Scholar 

  53. Brisinda G, Maria G, Sganga G, Bentivoglio AR, Albanese A, Castagneto M. Effectiveness of higher doses of botulinum toxin to induce healing in patients with chronic anal fissures. Surgery 2002;131:179–184.

    Article  PubMed  Google Scholar 

  54. Maria G, Cassetta E, Gui D, Brisinda G, Bentivoglio AR, Albanese A. A comparison of BTX and saline for the treatment of chronic anal fissure. N Engl J Med 1998;338:217–220.

    Article  PubMed  CAS  Google Scholar 

  55. Mentes BB, Irkorucu O, Akin M, Leventoglu S, Tatlicioglu E. Comparision of botulinum toxin injection and lateral internal sphincterotomy for the treatment of chronic anal fissure. Dis Colon Rectum 2003;46:232–237.

    Article  PubMed  Google Scholar 

  56. Lindsey I, Jones OM, Cunningham C, George BD, Mortensen NJ. Botulinum toxin as secondline therapy for chronic anal fissure failing 0.2 percent glyceryl trinitrate. Dis Colon Rectum 2003;46:361–366.

    Article  PubMed  Google Scholar 

  57. Lysy J, Israelit-Yatzkan Y, Sestiery-Ittah M, Weksler-Zangen S, Keret D, Goldin E. Topical nitrates potentiate the effect of botulinum toxin in the treatment of patients with refractory anal fissure. Gut 2001;48;221-224.

    Google Scholar 

  58. Cassidy TD, Pruitt A, Perry WB. Permanent fecal incontinence following botulinum toxin injection therapy for chronic anal fissure. Am J Gastroenterol 2003; 98:page range.

    Google Scholar 

  59. Madalinski MH, Slawek J, Duzynski W, et al. Side effects of botulinum toxin injection for benign anal disorders. Eur J Gastroenterol Hepatol 2002;14:853–856.

    Article  PubMed  CAS  Google Scholar 

  60. Langer JC, Birnbaum EE, Schmidt RE. Histology and function of the internal anal sphincter after injection of botulinum toxin. J Surg Res 1997;73:113–116.

    Article  PubMed  CAS  Google Scholar 

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Irani, S., Friedenberg, F.K. (2007). Gastrointestinal Applications. In: Cooper, G. (eds) Therapeutic Uses of Botulinum Toxin. Humana Press. https://doi.org/10.1007/978-1-59745-247-2_13

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  • DOI: https://doi.org/10.1007/978-1-59745-247-2_13

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-914-7

  • Online ISBN: 978-1-59745-247-2

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