Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. May 16, 2015; 7(5): 433-437
Published online May 16, 2015. doi: 10.4253/wjge.v7.i5.433
Use of Clostridium botulinum toxin in gastrointestinal motility disorders in children
Ricardo A Arbizu, Leonel Rodriguez
Ricardo A Arbizu, Leonel Rodriguez, Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, United States
Author contributions: Arbizu RA and Rodriguez L both contributed to this paper.
Conflict-of-interest: No conflicts.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Leonel Rodriguez, MD, MS, Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, United States. leonel.rodriguez@childrens.harvard.edu
Telephone: +1-617-3556055 Fax: +1-617-7300043
Received: September 29, 2014
Peer-review started: October 11, 2014
First decision: November 14, 2014
Revised: December 6, 2014
Accepted: February 9, 2015
Article in press: February 11, 2015
Published online: May 16, 2015
Processing time: 230 Days and 11.3 Hours
Abstract

More than a century has elapsed since the identification of Clostridia neurotoxins as the cause of paralytic diseases. Clostridium botulinum is a heterogeneous group of Gram-positive, rod-shaped, spore-forming, obligate anaerobic bacteria that produce a potent neurotoxin. Eight different Clostridium botulinum neurotoxins have been described (A-H) and 5 of those cause disease in humans. These toxins cause paralysis by blocking the presynaptic release of acetylcholine at the neuromuscular junction. Advantage can be taken of this blockade to alleviate muscle spams due to excessive neural activity of central origin or to weaken a muscle for treatment purposes. In therapeutic applications, minute quantities of botulinum neurotoxin type A are injected directly into selected muscles. The Food and Drug Administration first approved botulinum toxin (BT) type A in 1989 for the treatment of strabismus and blepharospasm associated with dystonia in patients 12 years of age or older. Ever since, therapeutic applications of BT have expanded to other systems, including the gastrointestinal tract. Although only a single fatality has been reported to our knowledge with use of BT for gastroenterological conditions, there are significant complications ranging from minor pain, rash and allergic reactions to pneumothorax, bowel perforation and significant paralysis of tissues surrounding the injection (including vocal cord paralysis and dysphagia). This editorial describes the clinical experience and evidence for the use BT in gastrointestinal motility disorders in children.

Keywords: Botulinum toxin; Gastrointestinal motility disorders; Children; Swallowing disorders; Gastroparesis; Defecation disorders

Core tip:Clostridium botulinum toxin has been used to alleviate symptoms associated to muscle spams due to excessive neural activity of central origin or to weaken a muscle for treatment purposes. In therapeutic applications, minute quantities of botulinum neurotoxin type A are injected directly into selected muscles. Ever since, therapeutic applications of botulinum toxin have expanded to other systems, including the gastrointestinal tract. This editorial presents the current evidence and evaluates the clinical experience for the use of botulinum toxin in gastrointestinal motility disorders in children.