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Long-term clinical outcome after botulinum toxin injection in children with nonrelaxing internal anal sphincter.
Am J Gastroenterol. 2009 Apr; 104(4):976-83.AJ

Abstract

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.

Authors+Show Affiliations

Center for Motility and Functional Gastrointestinal Disorders, Children's Hospital Boston, Boston, Massachusetts 02115, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19259081

Citation

Chumpitazi, Bruno P., et al. "Long-term Clinical Outcome After Botulinum Toxin Injection in Children With Nonrelaxing Internal Anal Sphincter." The American Journal of Gastroenterology, vol. 104, no. 4, 2009, pp. 976-83.
Chumpitazi BP, Fishman SJ, Nurko S. Long-term clinical outcome after botulinum toxin injection in children with nonrelaxing internal anal sphincter. Am J Gastroenterol. 2009;104(4):976-83.
Chumpitazi, B. P., Fishman, S. J., & Nurko, S. (2009). Long-term clinical outcome after botulinum toxin injection in children with nonrelaxing internal anal sphincter. The American Journal of Gastroenterology, 104(4), 976-83. https://doi.org/10.1038/ajg.2008.110
Chumpitazi BP, Fishman SJ, Nurko S. Long-term Clinical Outcome After Botulinum Toxin Injection in Children With Nonrelaxing Internal Anal Sphincter. Am J Gastroenterol. 2009;104(4):976-83. PubMed PMID: 19259081.
* Article titles in AMA citation format should be in sentence-case
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 -