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Botulinum Toxin A Improves Symptoms of Gastroparesis

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Abstract

Background and Aims

Pyloric injections of botulinum toxin A (BoNT/A) have shown benefit in open-label studies for patients with gastroparesis but not in randomized trials. We sought to examine the effectiveness of BoNT/A injections in a prospective open-label trial of patients with gastroparesis to assess specific symptom improvements over the course of 6 months. We also wanted to determine if specific biochemical measures including creatinine kinase, lactate dehydrogenase, aldolase, and C-reactive protein suggesting muscular injection could be used to predict successful response to pyloric injections of BoNT/A.

Methods

Patients with gastroparesis undergoing pyloric BoNT/A injections for the treatment of symptomatic gastroparesis were enrolled. The patients completed the Gastroparesis Cardinal Symptom Index (GCSI) at the initial encounter and at 1, 3, and 6 months. Blood samples were collected before and 1 h after BoNT/A therapy.

Results

We enrolled 34 patients for serum analysis of which 25 patients were available for symptom follow-up. Sixty-four percent of patients had an improvement in symptoms at 1 month. Patients with improved GCSI total score at 1 month had an improvement in most individual symptoms evaluated. For patients that improved at 1 month, this improvement often extended up to 6 months (p = 0.04). Serum measures studied did not correlate with clinical outcomes.

Conclusions

BoNT/A therapy to the pylorus provided symptomatic improvement at 1 month in 64% of patients. For those patients initially responding, the improvement can last out to 6 months. The biochemical markers did not serve to predict the outcome of injections.

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Authors and Affiliations

  1. Department of Gastroenterology, Temple University Hospital, 3401 N. Broad Street, Ambulatory Care Center, 3rd Floor, Philadelphia, PA, 19140, USA

    Zachary Wilmer Reichenbach, Steven Stanek, Shyam Patel, Zubair Malik, Henry P. Parkman & Ron Schey

  2. Center for Substance Abuse Research (CSAR), Lewis Katz School of Medicine, Temple University, 3500 N. Broad Street, Medical Education and Research Bldg., 8th Floor, Philadelphia, PA, 19140, USA

    Zachary Wilmer Reichenbach & Sara Jane Ward

Authors
  1. Zachary Wilmer Reichenbach
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  2. Steven Stanek
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  3. Shyam Patel
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  4. Sara Jane Ward
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  5. Zubair Malik
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  6. Henry P. Parkman
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  7. Ron Schey
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Correspondence to Zachary Wilmer Reichenbach.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Reichenbach, Z.W., Stanek, S., Patel, S. et al. Botulinum Toxin A Improves Symptoms of Gastroparesis. Dig Dis Sci 65, 1396–1404 (2020). https://doi.org/10.1007/s10620-019-05885-z

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  • DOI: https://doi.org/10.1007/s10620-019-05885-z

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