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Botulinum Toxin as a Treatment for Refractory Gastroparesis: a Literature Review

  • Motility (H Parkman and R Schey, Section Editors)
  • Published:
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Abstract

Purpose of review

Gastroparesis (GP) is a disorder of gastrointestinal motility which leads to delayed gastric emptying in the absence of mechanical obstruction. Treatment is limited as many patients are refractory to dietary modification and the use prokinetic medications carry significant adverse risks. These limitations necessitate more research into experimental therapies. The purpose of this article is to summarize the known information and guidelines on the diagnosis and management of GP and to review the latest literature on experimental treatments.

Recent findings

Based on the current available literature, there is conflicting data regarding the efficacy of intra-pyloric botulinum injections (IPBIs) for refractory gastroparesis. There have been many open-label trials showing good clinical response, but the only two randomized controlled trials on the matter showed no objective improvement gastric emptying studies. However, both studies were likely underpowered and changes in gastric emptying may not correlate with symptom improvement. As such, these discouraging findings should not be used to exclude botox from the armamentarium of therapies for refractory GP.

Summary

More large-scale, double-blinded, multicenter randomized control trials are needed to further validate the long-term efficacy and safety of IPBI, as well as gastric peroral endoscopic myotomy (G-POEM), as compared to gastric electrical stimulation (GES) or surgical intervention (i.e., laparoscopic pylorotomy) for refractory gastroparesis.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

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Author information

Authors and Affiliations

  1. Department of Internal Medicine, University of Florida College of Medicine, Jacksonville, FL, USA

    Ashley Thomas MD

  2. Division of Gastroenterology, University of Florida College of Medicine, 4555 Emerson Street, Suite 300, Jacksonville, FL, 32207, USA

    Bruno de Souza Ribeiro MD & Miguel Malespin MD

  3. Division of Gastroenterology, Oregon Health & Science University, 3303 SW Bond Avenue, Portland, OR, 97239, USA

    Silvio W. de Melo Jr MD, FACG, AGAF

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  1. Ashley Thomas MD
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  2. Bruno de Souza Ribeiro MD
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  3. Miguel Malespin MD
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  4. Silvio W. de Melo Jr MD, FACG, AGAF
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Correspondence to Silvio W. de Melo Jr MD, FACG, AGAF.

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Conflict of interest

Miguel Malespin reports research grants and support from AbbVie, Gilead, and Intercept and fees as a consultant for Gilead.

Ashley Thomas declares that she has no conflict of interest.

Silvio de Melo Jr. declares that he has no conflict of interest.

Bruno Ribeiro declares that he has no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Thomas, A., de Souza Ribeiro, B., Malespin, M. et al. Botulinum Toxin as a Treatment for Refractory Gastroparesis: a Literature Review. Curr Treat Options Gastro 16, 479–488 (2018). https://doi.org/10.1007/s11938-018-0187-x

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