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Internal anal sphincter achalasia in children: clinical characteristics and treatment with Clostridium botulinum toxin.
J Pediatr Gastroenterol Nutr. 2003 Sep; 37(3):315-9.JP

Abstract

OBJECTIVES

To describe the clinical characteristics of children with internal anal sphincter (IAS) achalasia and to evaluate the benefit of intrasphincteric injection of Clostridium botulinum toxin.

METHODS

Retrospective review of the medical records of 20 patients (8 male, mean 5.8 +/- 4.2 years) with severe chronic constipation and IAS achalasia. Each patient received four-quadrant, intrasphincteric injections of botulinum toxin at a dose of 15-25U per quadrant. Patients were reassessed 4 weeks-18 months after injection. We compared the clinical characteristics of these patients to 20 consecutive children (14 male, mean age 8.1 + 4.6 y) with functional constipation (control group).

RESULTS

The children with IAS achalasia had earlier onset of symptoms, less fecal soiling, and less withholding behavior than the control children. Response to botulinum injection was rated excellent by the parents in 60% and by the physician in 35% of children. There was wide individual variability in the frequency of defecation after therapy. Duration of response ranged from 1 week to 18 months.

CONCLUSIONS

Children with IAS achalasia have clinical characteristics differentiating them from children with functional constipation. Intra-anal injection of botulinum toxin is a safe and effective short-term treatment for these children.

Authors+Show Affiliations

Department of Pediatric Gastroenterology and Surgery, Children's Hospital of Pittsburgh, 3705 Fifth Avenue at De Soto Street, Pittsburgh, PA 15213, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12960655

Citation

Ciamarra, Paola, et al. "Internal Anal Sphincter Achalasia in Children: Clinical Characteristics and Treatment With Clostridium Botulinum Toxin." Journal of Pediatric Gastroenterology and Nutrition, vol. 37, no. 3, 2003, pp. 315-9.
Ciamarra P, Nurko S, Barksdale E, et al. Internal anal sphincter achalasia in children: clinical characteristics and treatment with Clostridium botulinum toxin. J Pediatr Gastroenterol Nutr. 2003;37(3):315-9.
Ciamarra, P., Nurko, S., Barksdale, E., Fishman, S., & Di Lorenzo, C. (2003). Internal anal sphincter achalasia in children: clinical characteristics and treatment with Clostridium botulinum toxin. Journal of Pediatric Gastroenterology and Nutrition, 37(3), 315-9.
Ciamarra P, et al. Internal Anal Sphincter Achalasia in Children: Clinical Characteristics and Treatment With Clostridium Botulinum Toxin. J Pediatr Gastroenterol Nutr. 2003;37(3):315-9. PubMed PMID: 12960655.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Internal anal sphincter achalasia in children: clinical characteristics and treatment with Clostridium botulinum toxin. AU - Ciamarra,Paola, AU - Nurko,Samuel, AU - Barksdale,Edward, AU - Fishman,Steven, AU - Di Lorenzo,Carlo, PY - 2003/9/10/pubmed PY - 2004/2/28/medline PY - 2003/9/10/entrez SP - 315 EP - 9 JF - Journal of pediatric gastroenterology and nutrition JO - J Pediatr Gastroenterol Nutr VL - 37 IS - 3 N2 - OBJECTIVES: To describe the clinical characteristics of children with internal anal sphincter (IAS) achalasia and to evaluate the benefit of intrasphincteric injection of Clostridium botulinum toxin. METHODS: Retrospective review of the medical records of 20 patients (8 male, mean 5.8 +/- 4.2 years) with severe chronic constipation and IAS achalasia. Each patient received four-quadrant, intrasphincteric injections of botulinum toxin at a dose of 15-25U per quadrant. Patients were reassessed 4 weeks-18 months after injection. We compared the clinical characteristics of these patients to 20 consecutive children (14 male, mean age 8.1 + 4.6 y) with functional constipation (control group). RESULTS: The children with IAS achalasia had earlier onset of symptoms, less fecal soiling, and less withholding behavior than the control children. Response to botulinum injection was rated excellent by the parents in 60% and by the physician in 35% of children. There was wide individual variability in the frequency of defecation after therapy. Duration of response ranged from 1 week to 18 months. CONCLUSIONS: Children with IAS achalasia have clinical characteristics differentiating them from children with functional constipation. Intra-anal injection of botulinum toxin is a safe and effective short-term treatment for these children. SN - 0277-2116 UR - https://www.unboundmedicine.com/medline/citation/12960655/Internal_anal_sphincter_achalasia_in_children:_clinical_characteristics_and_treatment_with_Clostridium_botulinum_toxin_ L2 - https://doi.org/10.1097/00005176-200309000-00020 DB - PRIME DP - Unbound Medicine ER -