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Long-term clinical outcome after botulinum toxin injection in children with nonrelaxing internal anal sphincter

Bruno P Chumpitazi1, Steven J Fishman, Samuel Nurko

  • 1Center for Motility and Functional Gastrointestinal Disorders, Children's Hospital Boston, Boston, Massachusetts 02115, USA.

The American Journal of Gastroenterology
|March 5, 2009
PubMed

Insights

Clostridium botulinum toxin (BoTox) injections for nonrelaxing internal anal sphincter (IAS) in children show promising long-term effectiveness and safety. Many patients experienced sustained improvement, reduced hospitalizations, and favorable outcomes, particularly those with IAS achalasia.

Area of Science:

  • Pediatric Gastroenterology
  • Colorectal Surgery
  • Pharmacology

Background:

  • Children with surgically repaired Hirschsprung's disease (HD) or internal anal sphincter (IAS) achalasia can experience obstructive symptoms due to IAS non-relaxation.
  • Clostridium botulinum toxin (BoTox) injections offer a potential reversible therapy for this condition.
  • Limited data exists on the long-term efficacy of BoTox for pediatric nonrelaxing IAS.

Purpose of the Study:

  • To evaluate the long-term clinical outcomes of BoTox therapy in children with a nonrelaxing IAS.
  • To identify prognostic factors associated with favorable outcomes after BoTox IAS injection.

Main Methods:

  • Retrospective review of pediatric patients with nonrelaxing IAS treated with anal sphincter BoTox.
  • Classification of patients into four long-term clinical outcome groups: excellent, good, fair, and poor.

Main Results:

  • 73 children (30 HD, 43 IAS achalasia) received BoTox, with a mean follow-up of 32.1 months.
  • 89% showed initial improvement; 53.4% achieved excellent/good long-term outcomes (mean 17.1 months).
  • Hospitalizations decreased; transient fecal incontinence (9.5%) and pain (1.3%) were noted. Initial improvement and IAS achalasia predicted better outcomes.

Conclusions:

  • Anal sphincter BoTox appears to be an effective and safe long-term treatment for pediatric nonrelaxing IAS.
  • The therapy demonstrates sustained benefits, including reduced hospitalizations and improved clinical outcomes.
  • Early positive response and diagnosis of IAS achalasia are favorable prognostic indicators.
Abstract

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