Drugs in focus: Botulinum toxin in the therapy of gastrointestinal disorders in children

Matjaž Homan¹, Mike Thomson², Patrick Bontems³, Marco Deganello Saccomani⁴, Jorge Amil Dias⁵, Simona Faraci⁶, Raoul Furlano⁷, Iva Hojsak⁸, Oren Ledder⁹, Mordechai Slae¹⁰, Priya Narula², Andreia Florina Nita¹¹, Lorenzo Norsa¹², Salvatore Oliva¹³, Alexandra Papadopoulou¹⁴, Claudio Romano¹⁵, Anna Rybak¹¹, Vasiliki Spyropoulou¹⁶, Renato Tambucci⁶, Christos Tzivinikos¹⁷, Michiel van Wijk¹⁸, Osvaldo Borrelli¹¹; Endoscopy SIG and Motility SIG of ESPGHAN Organisation

Affiliations

¹ Department of Gastroenterology, Hepatology, and Nutrition, University Children's Hospital, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
² Department of Paediatric Gastroenterology, Sheffield Children's Hospital NHS FT and University of Sheffield, Sheffield, UK.
³ Paediatric Gastroenterology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium.
⁴ Department of Paediatrics, Woman's and Child's University Hospital of Verona, Verona, Italy.
⁵ Department of Gastroenterology, Hospital Lusíadas, Porto, Portugal.
⁶ Gastroenterology and Nutrition Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
⁷ Department of Gastroenterology, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland.
⁸ Children's Hospital Zagreb, University of Zagreb Medical School, Zagreb, Croatia.
⁹ Juliet Keidan Institute of Pediatric Gastroenterology, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.
¹⁰ Pediatric Gastroenterology, Hepatology and Nutrition Unit, Hadassah University Hospital, Jerusalem, Israel.
¹¹ Paediatric Gastroenterology Department, Great Ormond Street Hospital, London, UK.
¹² Pediatric Department, Children's Hospital Vittore Buzzi, University of Milan, Milan, Italy.
¹³ Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza-University of Rome, Rome, Italy.
¹⁴ Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Children's Hospital Agia Sofia, Athens, Greece.
¹⁵ Claudio Romano Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Messina, Italy.
¹⁶ Division of Gastroenterology, Hepatology and Nutrition, University Children's Hospital Zurich, Zurich, Switzerland.
¹⁷ Pediatric Gastroenterology Department, Al Jalila Children's Specialty Hospital, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.
¹⁸ Emma Children's Hospital-Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.

PMID: 39315663
PMCID: PMC11615126
DOI: 10.1002/jpn3.12376

Drugs in focus: Botulinum toxin in the therapy of gastrointestinal disorders in children

Matjaž Homan et al. J Pediatr Gastroenterol Nutr. 2024 Dec.

. 2024 Dec;79(6):1096-1105.

doi: 10.1002/jpn3.12376. Epub 2024 Sep 24.

Authors

Affiliations

¹ Department of Gastroenterology, Hepatology, and Nutrition, University Children's Hospital, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
² Department of Paediatric Gastroenterology, Sheffield Children's Hospital NHS FT and University of Sheffield, Sheffield, UK.
³ Paediatric Gastroenterology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium.
⁴ Department of Paediatrics, Woman's and Child's University Hospital of Verona, Verona, Italy.
⁵ Department of Gastroenterology, Hospital Lusíadas, Porto, Portugal.
⁶ Gastroenterology and Nutrition Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
⁷ Department of Gastroenterology, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland.
⁸ Children's Hospital Zagreb, University of Zagreb Medical School, Zagreb, Croatia.
⁹ Juliet Keidan Institute of Pediatric Gastroenterology, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.
¹⁰ Pediatric Gastroenterology, Hepatology and Nutrition Unit, Hadassah University Hospital, Jerusalem, Israel.
¹¹ Paediatric Gastroenterology Department, Great Ormond Street Hospital, London, UK.
¹² Pediatric Department, Children's Hospital Vittore Buzzi, University of Milan, Milan, Italy.
¹³ Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza-University of Rome, Rome, Italy.
¹⁴ Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Children's Hospital Agia Sofia, Athens, Greece.
¹⁵ Claudio Romano Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Messina, Italy.
¹⁶ Division of Gastroenterology, Hepatology and Nutrition, University Children's Hospital Zurich, Zurich, Switzerland.
¹⁷ Pediatric Gastroenterology Department, Al Jalila Children's Specialty Hospital, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.
¹⁸ Emma Children's Hospital-Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.

PMID: 39315663
PMCID: PMC11615126
DOI: 10.1002/jpn3.12376

Abstract

What is Known:

Botulinum toxin (BoNT) causes muscle relaxation by inhibiting acetylcholine release from presynaptic motor neurons at the neuromuscular junction.

What is New:

In children with achalasia, BoNT can be considered only in patients in whom rapid weight gain is important to improve surgical outcomes.
BoNT has been suggested for treating cricopharyngeal achalasia and delayed gastric emptying.
Anal achalasia and constipation after Hirschsprung disease corrective surgery are very promising indications for BoNT use.
In selected children with resistant type of functional constipation and chronic anal fissure, BoNT is a viable option for treating.

Keywords: constipation; oesophagus; weight loss.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**
Mean duration of botulinum toxin effect in achalasia. *Source*: From Hurwitz et al. with permission.

**Figure 2**
(A) Present RAIR: anal relaxation (red arrow) responding to rectal balloon distension (grey arrows). (B) Absent RAIR: anal sphincter pressure does not decrease upon rectal balloon insufflation (grey arrows). RAIR is absent in both Hirschsprung disease and internal anal sphincter achalasia (with the courtesy of Renato Tambucci). RAIR, recto‐anal inhibitory reflex.

**Figure 3**
Anal sphincter botulinum toxin procedure (with the courtesy of Renato Tambucci).

See this image and copyright information in PMC

References

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1. Lew MF. Review of the FDA‐approved uses of botulinum toxins, including data suggesting efficacy in pain reduction. Clin J Pain. 2002;18(6 suppl):S142‐S146. - PubMed
1. Thomas A, de Souza Ribeiro B, Malespin M, de Melo SW Jr.. Botulinum toxin as a treatment for refractory gastroparesis: a literature review. Curr Treat Options Gastroenterol. 2018;16(4):479‐488. - PubMed
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Drugs in focus: Botulinum toxin in the therapy of gastrointestinal disorders in children

Affiliations

Drugs in focus: Botulinum toxin in the therapy of gastrointestinal disorders in children

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources