Cariati Maria, Chiarello Maria Michela, Cannistra' Marco, Lerose Maria Antonietta, Brisinda Giuseppe
Department of Surgery, "San Giovanni di Dio" Hospital, Crotone, Italy.
Department of Surgery, "Agostino Gemelli" Hospital, Catholic School of Medicine, Rome, Italy.
Handb Exp Pharmacol. 2021;263:185-226. doi: 10.1007/164_2019_326.
Botulinum toxin (BT), one of the most powerful inhibitors that prevents the release of acetylcholine from nerve endings, represents an alternative therapeutic approach for "spastic" disorders of the gastrointestinal tract such as achalasia, gastroparesis, sphincter of Oddi dysfunction, chronic anal fissures, and pelvic floor dyssynergia.BT has proven to be safe and this allows it to be a valid alternative in patients at high risk of invasive procedures but long-term efficacy in many disorders has not been observed, primarily due to its relatively short duration of action. Administration of BT has a low rate of adverse reactions and complications. However, not all patients respond to BT therapy, and large randomized controlled trials are lacking for many conditions commonly treated with BT.The local injection of BT in some conditions becomes a useful tool to decide to switch to more invasive therapies. Since 1980, the toxin has rapidly transformed from lethal poison to a safe therapeutic agent, with a significant impact on the quality of life.
肉毒杆菌毒素（BT）是最强大的抑制剂之一，可阻止神经末梢释放乙酰胆碱，是治疗胃肠道“痉挛性”疾病（如贲门失弛缓症、胃轻瘫、Oddi括约肌功能障碍、慢性肛裂和盆底协同失调）的一种替代治疗方法。事实证明，BT是安全的，这使其成为有创手术高风险患者的有效替代方法，但在许多疾病中尚未观察到其长期疗效，主要是由于其作用持续时间相对较短。BT的不良反应和并发症发生率较低。然而，并非所有患者都对BT治疗有反应，而且对于许多常用BT治疗的病症，缺乏大型随机对照试验。在某些情况下，局部注射BT成为决定转向更具侵入性治疗的有用工具。自1980年以来，这种毒素已迅速从致命毒药转变为安全的治疗剂，对生活质量产生了重大影响。
