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Pyloric Injection of Botulinum Toxin for the Treatment of Refractory GERD Accompanied with Gastroparesis: A Preliminary Report

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Abstract

Gastroesophageal reflux disease (GERD) refractory to conventional medical treatment is frequently associated with gastroparesis, a complex condition with no definitive treatment to date. We first developed a scoring system to assess the severity and frequency of both reflux- and gastroparesis-related symptoms. We then tested, for the first time, the hypothesis that endoscopic pyloric botulinum toxin injection alleviates both of these symptom types. Eleven patients (four males) with GERD (confirmed by esophageal pH monitoring) plus gastroparesis (confirmed by gastric emptying study) underwent toxin injection. Patients had no concomitant disease and were not allowed to use prokinetics before or after treatment. Injection significantly improved both gastroparesis- and reflux-related symptoms in the majority of patients but the duration of symptom relief was relatively short. Responders to treatment had significantly higher total reflux symptom scores (before injection) than nonresponders. All but one of the patients in whom gastroparesis symptoms improved also showed response in reflux symptoms, which supports our hypothesis. We believe that response to toxin injection is a reliable predictor of response to subsequent surgery following the recurrence of symptoms.

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References

  1. Vaezi MF (2004) Refractory GERD: acid, nonacid, or not GERD? Am J Gastroenterol 99:989–990

    Article  PubMed  Google Scholar 

  2. Cunningham KM, Horowitz M, Riddell PS, Maddern GJ, Myers JC, Holloway RH, Wishart JM, Jamieson GG (1991) Relations among autonomic nerve dysfunction, oesophageal motility, and gastric emptying in gastro-oesophageal reflux disease. Gut 32:1436–1440

    Article  PubMed  CAS  Google Scholar 

  3. McCallum RW, Berkowitz DM, Lerner E (1981) Gastric emptying in patients with gastroesophageal reflux. Gastroenterology 80:285–291

    PubMed  CAS  Google Scholar 

  4. Horowitz M, Fraser RJ (1995) Gastroparesis: diagnosis and management. Scand J Gastroenterol 213(Suppl):7–16

    CAS  Google Scholar 

  5. Soykan I, Sivri B, Sarosiek I, Kiernan B, McCallum RW (1998) Demography, clinical characteristics, psychological and abuse profiles, treatment, and long-term follow-up of patients with gastroparesis. Dig Dis Sci 43:2398–2404

    Article  PubMed  CAS  Google Scholar 

  6. Waring JP, Baron TH, Hirota WK, Goldstein JL, Jacobson BC, Leighton JA, Mallery JS, Faigel DO (2003) American Society for Gastrointestinal Endoscopy, Standards of Practice Committee. Guidelines for conscious sedation and monitoring during gastrointestinal endoscopy. Gastrointest Endosc 58:317–322

    Article  PubMed  Google Scholar 

  7. Armstrong D, Bennett JR, Blum AL, Dent J, De Dombal FT, Galmiche JP, Lundell L, Margulies M, Richter JE, Spechler SJ, Tytgat GN, Wallin L (1996) The endoscopic assessment of esophagitis: a progress report on observer agreement. Gastroenterology 111:85–92

    Article  PubMed  CAS  Google Scholar 

  8. Camilleri M, Hasler WL, Parkman HP, Quigley EM, Soffer E (1998) Measurement of gastrointestinal motility in the GI laboratory. Gastroenterology 115:747–762

    Article  PubMed  CAS  Google Scholar 

  9. Ziessman HA, Fahey FH, Atkins FB, Tall J (2004) Standardization and quantification of radionuclide solid gastric-emptying studies. J Nucl Med 45:760–764

    PubMed  CAS  Google Scholar 

  10. Guo JP, Maurer AH, Fisher RS, Parkman HP (2001) Extending gastric emptying scintigraphy from two to four hours detects more patients with gastroparesis. Dig Dis Sci 46:24–29

    Article  PubMed  CAS  Google Scholar 

  11. Cuomo R, Koek G, Sifrim D, Janssens J, Tack J (2000) Analysis of ambulatory duodenogastroesophageal reflux monitoring. Dig Dis Sci 45:2463–2469

    Article  PubMed  CAS  Google Scholar 

  12. Johnson LF, Demeester TR (1974) Twenty-four-hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux. Am J Gastroenterol 62:325–332

    PubMed  CAS  Google Scholar 

  13. Bromer MQ, Friedenberg F, Miller LS, Fisher RS, Swartz K, Parkman HP (2005) Endoscopic pyloric injection of botulinum toxin A for the treatment of refractory gastroparesis. Gastrointest Endosc 61:833–839

    Article  PubMed  Google Scholar 

  14. Ezzeddine D, Jit R, Katz N, Gopalswamy N, Bhutani MS (2002) Pyloric injection of botulinum toxin for treatment of diabetic gastroparesis. Gastrointest Endosc 55:920–923

    Article  PubMed  Google Scholar 

  15. Lacy BE, Zayat EN, Crowell MD, Schuster MM (2002) Botulinum toxin for the treatment of gastroparesis: a preliminary report. Am J Gastroenterol 97:1548–1552

    Article  PubMed  CAS  Google Scholar 

  16. Gupta P, Rao SS (2002) Attenuation of isolated pyloric pressure waves in gastroparesis in response to botulinum toxin injection: a case report. Gastrointest Endosc 56:770–772

    Article  PubMed  Google Scholar 

  17. Revicki DA, Rentz AM, Dubois D, Kahrilas P, Stanghellini V, Talley NJ, Tack J (2003) Development and validation of a patient-assessed gastroparesis symptom severity measure: the Gastroparesis Cardinal Symptom Index. Aliment Pharmacol Ther 18:141–150

    Article  PubMed  CAS  Google Scholar 

  18. Revicki DA, Rentz AM, Dubois D, Kahrilas P, Stanghellini V, Talley NJ, Tack J (2004) Gastroparesis Cardinal Symptom Index (GCSI): development and validation of a patient reported assessment of severity of gastroparesis symptoms. Qual Life Res 13:833–844

    Article  PubMed  Google Scholar 

  19. Velanovich V, Vallance SR, Gusz JR, Tapia FV, Harkabus MA (1996) Quality of life scale for gastroesophageal reflux disease. J Am Coll Surg 183:217–224

    PubMed  CAS  Google Scholar 

  20. Velanovich V, Karmy-Jones R (1998) Measuring gastroesophageal reflux disease: relationship between the Health-Related Quality of Life score and physiologic parameters. Am Surg 64:649–653

    PubMed  CAS  Google Scholar 

  21. Lin Z, Forster J, Sarosiek I, McCallum RW (2004) Treatment of diabetic gastroparesis by high-frequency gastric electrical stimulation. Diabetes Care 27:1071–1076

    Article  PubMed  Google Scholar 

  22. Nouraie M, Radmard AR, Zaer-Rezaii H, Razjouyan H, Nasseri-Moghaddam S, Malekzadeh R (2007) Hygiene could affect GERD prevalence independently: a population-based study in Tehran. Am J Gastroenterol 102:1353–1360

    Article  PubMed  Google Scholar 

  23. Jackson PG, Gleiber MA, Askari R, Evans SR (2001) Predictors of outcome in 100 consecutive laparoscopic antireflux procedures. Am J Surg 181:231–235

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The personnel of the Oil Company Hospital are thanked for their collaboration. The authors would also like to thank the Red Crescent Society of Iran for providing Dysport agents. The authors wish to acknowledge the reviewers for their helpful comments on the original manuscript.

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Authors and Affiliations

  1. Amir-Alam Hospital, Medical Sciences/University of Tehran, Tehran, Iran

    Seyed Amir Mirbagheri & Mehdi Abouzari

  2. Medical Sciences/University of Tehran, Tehran, Iran

    Amir Sadeghi & Armin Rashidi

  3. Shohada Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran

    Mahasti Amouie

  4. Oil Company Hospital, Tehran, Iran

    Siavash Mansouri

  5. Taleghani Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran

    Mojgan Forootan

  6. No. 17, Alaei Alley, Ard-e-Iran Street, Shahr-e-Rey, Tehran, Iran

    Mehdi Abouzari

Authors
  1. Seyed Amir Mirbagheri
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  2. Amir Sadeghi
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  3. Mahasti Amouie
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  4. Siavash Mansouri
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  5. Mojgan Forootan
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  6. Armin Rashidi
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  7. Mehdi Abouzari
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Correspondence to Mehdi Abouzari.

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Mirbagheri, S.A., Sadeghi, A., Amouie, M. et al. Pyloric Injection of Botulinum Toxin for the Treatment of Refractory GERD Accompanied with Gastroparesis: A Preliminary Report. Dig Dis Sci 53, 2621–2626 (2008). https://doi.org/10.1007/s10620-007-0187-5

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  • DOI: https://doi.org/10.1007/s10620-007-0187-5

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