TY - JOUR T1 - Long-term clinical outcome after botulinum toxin injection in children with nonrelaxing internal anal sphincter. AU - Chumpitazi,Bruno P, AU - Fishman,Steven J, AU - Nurko,Samuel, Y1 - 2009/03/03/ PY - 2009/3/5/entrez PY - 2009/3/5/pubmed PY - 2009/4/22/medline SP - 976 EP - 83 JF - The American journal of gastroenterology JO - Am J Gastroenterol VL - 104 IS - 4 N2 - OBJECTIVES: Children with surgically repaired Hirschsprung's disease (HD) and those with internal anal sphincter (IAS) achalasia may develop obstructive gastrointestinal symptoms and/or enterocolitis due to a functional obstruction caused by an inability of the IAS to relax. Anal sphincter Clostridium botulinum toxin (BoTox) injections may provide a reversible therapy. However, there is limited information regarding the long-term outcomes of children receiving this therapy. The primary aim of this study was to determine the long-term clinical outcomes of BoTox therapy in children with a nonrelaxing IAS. The secondary aim of this study was to determine prognostic factors predicting a favorable outcome following BoTox IAS injection. METHODS: We conducted a retrospective review of children with nonrelaxing IAS who received anal sphincter BoTox at a tertiary medical center. Children were classified into one of four long-term clinical outcome groups (excellent, good, fair, poor). RESULTS: A total of 73 children (30 HD, 43 IAS achalasia) received anal sphincter BoTox injections and had a mean follow-up of 32.1+/-2.9 (s.e.) months. A mean of 2.7+/-0.2 injections were given to each child, with 56 (76.7%) children receiving multiple injections. An initial clinical improvement was seen in 65 of 73 (89%) children after the first injection. A total of 39 (53.4%) children had an excellent or good long-term outcome that was maintained for a mean of 17.1+/-3.1 months from the time of the last BoTox injection. Hospitalization rates significantly decreased in those previously hospitalized before initial BoTox injection. Seven (9.5%) patients developed transient fecal incontinence, and one (1.3%) developed significant pain after an injection. Factors predicting a favorable long-term clinical outcome were initial short-term improvement after the first BoTox injection and having IAS achalasia rather than HD. CONCLUSIONS: Anal sphincter BoTox may be an effective and safe long-term therapy for children with nonrelaxing IAS. SN - 1572-0241 UR - https://www.unboundmedicine.com/medline/citation/19259081/Long_term_clinical_outcome_after_botulinum_toxin_injection_in_children_with_nonrelaxing_internal_anal_sphincter_ L2 - https://Insights.ovid.com/pubmed?pmid=19259081 DB - PRIME DP - Unbound Medicine ER -