Botulinum Toxin A Improves Symptoms of Gastroparesis

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\xa0months. 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\xa0months. Blood samples were collected before and 1\xa0h 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\xa0month. Patients with improved GCSI total score at 1\xa0month had an improvement in most individual symptoms evaluated. For patients that improved at 1\xa0month, this improvement often extended up to 6\xa0months ( p \u2009=\u20090.04). Serum measures studied did not correlate with clinical outcomes. Conclusions BoNT/A therapy to the pylorus provided symptomatic improvement at 1\xa0month in 64% of patients. For those patients initially responding, the improvement can last out to 6\xa0months. The biochemical markers did not serve to predict the outcome of injections.