[Using botulinum toxin type A in the gastrointestinal tract]

Botulinum toxin (BTX) is an extremely potent poison which interacts selectively with cholinergic neurons to inhibit the release of neurotransmitters. Local intrasphincteric injection of BTX has been suggested as possible therapy for several spastic disorders of the gastrointestinal tract.

There is good evidence for the clinical benefit of BTX injection as an alternative treatment for achalasia and chronic anal fissures. Other possible indications for BTX injection such as sphincter of Oddi dyskinesia or cervical achalasia remain to be further established. BTX injection showed no severe side effects when compared to other interventional or operative treatment alternatives. However, the effect of BTX injection lasts only for several months and is fully reversible. The time-limited effect of BTX is a disadvantage in the treatment of achalasia. By contrast, the limited effect is advantageous in the treatment of chronic anal fissures as the normal function is restored after the lesion has healed and the BTX effect disappeared. The use of BTX has added a new therapeutic concept with few side effects to our interventional methods. When applied critically, this method can be used with benefit for the treatment of our patients.