Published online Jul 10, 2015. doi: 10.4253/wjge.v7.i8.790
Peer-review started: January 1, 2015
First decision: January 20, 2015
Revised: January 31, 2015
Accepted: May 5, 2015
Article in press: May 8, 2015
Published online: July 10, 2015
Processing time: 195 Days and 9 Hours
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.
Core tip: Refractory gastroparesis (GP) has been identified as a chronic debilitating disease. After failure of diet and prokinetic drugs for treatment of refractory GP only surgical options are left. Because of the limited available treatment options and frequent failure of medical therapy, botulinum toxin (BT) injection in the pylorus might offer clinical value in GP. Currently available evidence is not strong enough to support the recommendation of this procedure in all patients with refractory GP; but promising results have been seen as most patients have noticed symptomatic improvement. Although BT injections were successful in some GP patients, the role of BT remains undetermined. We addressed the position of botulinum toxin in the spectrum of available treatments for refractory GP. Continuing other treatment modalities after BT may improve the results.