Gui D, Rossi S, Runfola M, Magalini S C
Department of Surgery, Catholic University, Rome, Italy.
Aliment Pharmacol Ther. 2003 Jul 1;18(1):1-16. doi: 10.1046/j.1365-2036.2003.01598.x.
Since 1980, botulinum toxin has been employed for the treatment of various voluntary muscle spastic disorders in the fields of neurology and ophthalmology. More recently, botulinum toxin has been proved to be effective in the therapy of dyskinetic smooth muscle disorders of the gastrointestinal tract. Achalasia and anal fissure are the gastrointestinal disorders in which botulinum toxin therapy has been most extensively investigated. Botulinum toxin is the best treatment option for achalasia in patients whose condition makes them unfit for pneumatic dilation or surgery. In anal fissure, botulinum toxin is highly effective and may become the treatment of choice. In the future, botulinum toxin application in the gastrointestinal tract will be extended to many other gastrointestinal disorders, such as non-achalasic motor disorders of the oesophagus, dysfunction of Oddi's sphincter, achalasia of the internal anal sphincter and others. This article describes the mechanism of action, rationale of employment, indications and side-effects of botulinum toxin application in smooth muscle disorders of the gastrointestinal tract, and compares the results of different techniques of botulinum toxin therapeutic application.
自1980年以来，肉毒杆菌毒素已被用于治疗神经病学和眼科领域的各种随意肌痉挛性疾病。最近，肉毒杆菌毒素已被证明在治疗胃肠道运动障碍性平滑肌疾病方面有效。贲门失弛缓症和肛裂是对肉毒杆菌毒素疗法研究最为广泛的胃肠道疾病。对于因身体状况不适宜进行气囊扩张术或手术的贲门失弛缓症患者，肉毒杆菌毒素是最佳治疗选择。在肛裂治疗中，肉毒杆菌毒素非常有效，可能会成为首选治疗方法。未来，肉毒杆菌毒素在胃肠道的应用将扩展到许多其他胃肠道疾病，如食管非贲门失弛缓性运动障碍、Oddi括约肌功能障碍、肛门内括约肌失弛缓症等。本文描述了肉毒杆菌毒素在胃肠道平滑肌疾病中的作用机制、应用原理、适应证和副作用，并比较了肉毒杆菌毒素不同治疗应用技术的结果。
