Bromer Matthew Q, Friedenberg Frank, Miller Larry S, Fisher Robert S, Swartz Kenneth, Parkman Henry P
Section of Gastroenterology, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.
Gastrointest Endosc. 2005 Jun;61(7):833-9. doi: 10.1016/s0016-5107(05)00328-7.
Botulinum toxin A injected into the pyloric sphincter has been reported in small case series to treat gastroparesis. This study reviews the use of this treatment in a large number of patients with gastroparesis.
Patients who underwent pyloric botulinum injection for treatment of gastroparesis were identified. Response was defined as improvement or resolution of the patient's major symptom and/or two minor symptoms for 4 weeks.
Of 115 patients treated, 63 patients met the study criteria. There were 53 women, 10 men, mean age 42 years. Most patients (56%) had idiopathic gastroparesis. Twenty-seven of 63 (43%) patients experienced a symptomatic response to treatment. By stepwise logistic regression, male gender was associated with response to treatment (OR 3.27: 95% CI[1.31, 8.13], p = 0.01). Vomiting as a major symptom was associated with a lack of response (OR 0.16: 95% CI[0.04, 0.67], p = 0.01). Despite the association of male gender with response, the mean duration of response for those patients responding, with a minimum of 3 months' follow-up was 4.9 months (+/-2.7 months) for women and 3.5 months (+/-0.71 months) for men (p = 0.59). The corresponding medians and interquartile ranges (IQR) were 5 (IQR 3-6) for females and 3.5 (IQR 3-4) for males.
Of the patients, 43% had a response to botulinum toxin treatment that lasted a mean of approximately 5 months. Male gender was associated with a response to this therapy; however, durability of response was unrelated to gender. Vomiting as a major symptom predicted no response.
在一些小病例系列中报告了向幽门括约肌注射A型肉毒杆菌毒素治疗胃轻瘫的情况。本研究回顾了大量胃轻瘫患者使用这种治疗方法的情况。
确定接受幽门肉毒杆菌注射治疗胃轻瘫的患者。反应定义为患者的主要症状和/或两个次要症状改善或缓解达4周。
在接受治疗的115例患者中，63例符合研究标准。其中53例女性，10例男性，平均年龄42岁。大多数患者（56%）患有特发性胃轻瘫。63例患者中有27例（43%）对治疗有症状性反应。通过逐步逻辑回归分析，男性与治疗反应相关（比值比3.27：95%置信区间[1.31, 8.13]，p = 0.01）。以呕吐为主要症状与无反应相关（比值比0.16：95%置信区间[0.04, 0.67]，p = 0.01）。尽管男性与反应相关，但在至少随访3个月的有反应患者中，女性的平均反应持续时间为4.9个月（±2.7个月），男性为3.5个月（±0.71个月）（p = 0.59）。女性相应的中位数和四分位间距（IQR）为5（IQR 3 - 6），男性为3.5（IQR 3 - 4）。
在这些患者中，43%对肉毒杆菌毒素治疗有反应，反应平均持续约5个月。男性与这种治疗的反应相关；然而，反应的持久性与性别无关。以呕吐为主要症状预示无反应。
