Gastroparesis(GP) is a common disease seen in gastroenterology practice particularly in western countries, and it may be underdiagnosed. The available drug therapies for this condition are quite disappointing. Botulin...Gastroparesis(GP) is a common disease seen in gastroenterology practice particularly in western countries, and it may be underdiagnosed. The available drug therapies for this condition are quite disappointing. Botulinum toxin type A(BT) has been found to be effective therapy in various spastic disorders of smooth muscle of gastrointestinal tract. However, the benefits of BT injections in GP have been unclear. Several retrospective and open label studies have shown clinical advantages of intrapyloric Botulinum toxin type A injections, while two small randomized trials did not show positive results. Therefore, the available published studies yielded conflicting results leading to fading out of botox therapy for GP. We recognize possible clinical benefit of BT injections without any disadvantages of this treatment. We are calling for revisiting the endoscopy guided botox therapy in refractory GP. In this review we discuss important features of these studies pointing out differences in results among them. Differences in patient selection, doses and method of administration of botox toxin in the prior studies may be the cause of conflicting results. The mechanism of action, indications, efficacy and side-effects of BT are reviewed. Finally, we recognize limited evidence to recommend BT in GP and calling attention for future research in this field since no advances in drug management had been made in the last two decades.展开更多
AIM:To diagnose the clinical and histologic features that may be associated with or predictive of the need for dilation and dilation related complications;examine the safety of dilation in patients with eosinophilic e...AIM:To diagnose the clinical and histologic features that may be associated with or predictive of the need for dilation and dilation related complications;examine the safety of dilation in patients with eosinophilic esophagitis(EoE).METHODS:The medical records of all patients diagnosed with EoE between January 2002 and July 2010were retrospectively reviewed.Esophageal biopsies were reexamined by an experienced pathologist to confirm the diagnosis(≥15 eos/hpf per current guidelines).Patients were divided into 2 groups:patients who did not receive dilation therapy and those who did.Demographics,clinical history,the use of pharmacologic therapy,endoscopic and pathology findings,and the number of biopsies and dilations carried out,if any,and their locations were recorded for each patient.The dilation group was further examined based on the interval between diagnosis and dilation,and whether or not a complication occurred.RESULTS:Sixty-one patients were identified with EoE and 22(36%)of them underwent esophageal dilations for stricture/narrowing.The peak eos/hpf was significantly higher in patients who received a dilation(P=0.04).Four(18%of pts.)minor complications occurred:deep mucosal tear 1,and small mucosal tears3.There were no cases of esophageal perforations.Higher peak eos/hpf counts were not associated with increased risk of complications.CONCLUSION:Esophageal dilation appears to be a safe procedure in EoE patients,carrying a low complication rate.No correlation was found between the peak of eosinophil count and complication rate.Complications can occur independently of the histologic features.The long-term outcome of EoE treatment,with or without dilation,needs to be determined.展开更多
文摘Gastroparesis(GP) is a common disease seen in gastroenterology practice particularly in western countries, and it may be underdiagnosed. The available drug therapies for this condition are quite disappointing. Botulinum toxin type A(BT) has been found to be effective therapy in various spastic disorders of smooth muscle of gastrointestinal tract. However, the benefits of BT injections in GP have been unclear. Several retrospective and open label studies have shown clinical advantages of intrapyloric Botulinum toxin type A injections, while two small randomized trials did not show positive results. Therefore, the available published studies yielded conflicting results leading to fading out of botox therapy for GP. We recognize possible clinical benefit of BT injections without any disadvantages of this treatment. We are calling for revisiting the endoscopy guided botox therapy in refractory GP. In this review we discuss important features of these studies pointing out differences in results among them. Differences in patient selection, doses and method of administration of botox toxin in the prior studies may be the cause of conflicting results. The mechanism of action, indications, efficacy and side-effects of BT are reviewed. Finally, we recognize limited evidence to recommend BT in GP and calling attention for future research in this field since no advances in drug management had been made in the last two decades.
文摘AIM:To diagnose the clinical and histologic features that may be associated with or predictive of the need for dilation and dilation related complications;examine the safety of dilation in patients with eosinophilic esophagitis(EoE).METHODS:The medical records of all patients diagnosed with EoE between January 2002 and July 2010were retrospectively reviewed.Esophageal biopsies were reexamined by an experienced pathologist to confirm the diagnosis(≥15 eos/hpf per current guidelines).Patients were divided into 2 groups:patients who did not receive dilation therapy and those who did.Demographics,clinical history,the use of pharmacologic therapy,endoscopic and pathology findings,and the number of biopsies and dilations carried out,if any,and their locations were recorded for each patient.The dilation group was further examined based on the interval between diagnosis and dilation,and whether or not a complication occurred.RESULTS:Sixty-one patients were identified with EoE and 22(36%)of them underwent esophageal dilations for stricture/narrowing.The peak eos/hpf was significantly higher in patients who received a dilation(P=0.04).Four(18%of pts.)minor complications occurred:deep mucosal tear 1,and small mucosal tears3.There were no cases of esophageal perforations.Higher peak eos/hpf counts were not associated with increased risk of complications.CONCLUSION:Esophageal dilation appears to be a safe procedure in EoE patients,carrying a low complication rate.No correlation was found between the peak of eosinophil count and complication rate.Complications can occur independently of the histologic features.The long-term outcome of EoE treatment,with or without dilation,needs to be determined.
