Arbizu Ricardo A, Rodriguez Leonel
Ricardo A Arbizu, Leonel Rodriguez, Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, United States.
World J Gastrointest Endosc. 2015 May 16;7(5):433-7. doi: 10.4253/wjge.v7.i5.433.
More than a century has elapsed since the identification of Clostridia neurotoxins as the cause of paralytic diseases. Clostridium botulinum is a heterogeneous group of Gram-positive, rod-shaped, spore-forming, obligate anaerobic bacteria that produce a potent neurotoxin. Eight different Clostridium botulinum neurotoxins have been described (A-H) and 5 of those cause disease in humans. These toxins cause paralysis by blocking the presynaptic release of acetylcholine at the neuromuscular junction. Advantage can be taken of this blockade to alleviate muscle spams due to excessive neural activity of central origin or to weaken a muscle for treatment purposes. In therapeutic applications, minute quantities of botulinum neurotoxin type A are injected directly into selected muscles. The Food and Drug Administration first approved botulinum toxin (BT) type A in 1989 for the treatment of strabismus and blepharospasm associated with dystonia in patients 12 years of age or older. Ever since, therapeutic applications of BT have expanded to other systems, including the gastrointestinal tract. Although only a single fatality has been reported to our knowledge with use of BT for gastroenterological conditions, there are significant complications ranging from minor pain, rash and allergic reactions to pneumothorax, bowel perforation and significant paralysis of tissues surrounding the injection (including vocal cord paralysis and dysphagia). This editorial describes the clinical experience and evidence for the use BT in gastrointestinal motility disorders in children.
自梭菌神经毒素被确认为麻痹性疾病的病因以来，已经过去了一个多世纪。肉毒杆菌是一组革兰氏阳性、杆状、产芽孢的专性厌氧菌，它们会产生一种强效神经毒素。已经描述了八种不同的肉毒杆菌神经毒素（A - H），其中五种会导致人类发病。这些毒素通过阻断神经肌肉接头处乙酰胆碱的突触前释放而导致麻痹。可以利用这种阻断作用来缓解由于中枢起源的过度神经活动引起的肌肉痉挛，或者为了治疗目的而使肌肉松弛。在治疗应用中，将微量的A型肉毒杆菌神经毒素直接注射到选定的肌肉中。美国食品药品监督管理局于1989年首次批准A型肉毒杆菌毒素（BT）用于治疗12岁及以上患者与肌张力障碍相关的斜视和眼睑痉挛。从那时起，BT的治疗应用已扩展到其他系统，包括胃肠道。尽管据我们所知，使用BT治疗胃肠疾病仅报告了一例死亡病例，但仍存在严重的并发症，从轻微疼痛、皮疹和过敏反应到气胸、肠穿孔以及注射周围组织的严重麻痹（包括声带麻痹和吞咽困难）。这篇社论描述了在儿童胃肠动力障碍中使用BT的临床经验和证据。
