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Digestive Diseases and Sciences

, Volume 54, Issue 12, pp 2634–2642 | Cite as

Factors Associated with Symptom Response to Pyloric Injection of Botulinum Toxin in a Large Series of Gastroparesis Patients

  • Radoslav Coleski
  • Michelle A. Anderson
  • William L. HaslerEmail author
Original Article

Abstract

Case series report symptom reductions after pyloric botulinum toxin injection in gastroparesis, but small controlled trials show no benefit. Factors that enhance response to therapy are undefined. A retrospective analysis of 179 gastroparetics undergoing pyloric botulinum toxin injection from 2001 to 2007 assessed responses relating to drug dosing, demographic factors, comorbidities, and gastric function. Overall, there was a decrease in gastroparetic symptoms 1–4 months after pyloric botulinum toxin injection in 92 patients (51.4%). Increasing the botulinum toxin dose significantly improved clinical responses of patients who provided information on symptoms after therapy (100 units: 54.2%; 200 units: 76.7%; P = 0.02). Other factors that improved response to botulinum toxin included female gender, age <50 years, and nondiabetic nonpostsurgical etiology (all P < 0.05). Eighty-seven patients received 307 follow-up injections. A clinical response to a second injection was observed in 73.4% of evaluable patients. In conclusion, responses to pyloric botulinum toxin depended on dose and were maintained on repeat injection. Subgroup analyses defined subgroups likely to benefit. These findings provide the foundation for large, controlled trials of high-dose botulinum toxin in selected gastroparesis subsets.

Keywords

Gastroparesis Gastric emptying Botulinum toxin Diabetes mellitus Nausea and vomiting 

Notes

Acknowledgments

Dr. Hasler receives grant funding from the NIH (1 U01 DK073985-01) to support his research in gastroparesis.

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Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Radoslav Coleski
    • 1
  • Michelle A. Anderson
    • 1
  • William L. Hasler
    • 1
    Email author
  1. 1.Division of Gastroenterology, Department of Internal MedicineUniversity of Michigan Health SystemAnn ArborUSA

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