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A prospective study of intrapyloric botulinum toxin and EndoFLIP in children with nausea and vomiting

Suzanna Hirsch1, Samuel Nurko1, Enju Liu2

  • 1Division of Gastroenterology, Hepatology & Nutrition, Aerodigestive Center, Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, Massachusetts, USA.

Neurogastroenterology and Motility
|July 11, 2022
PubMed

Insights

Intrapyloric botulinum toxin injection (IPBI) effectively improved nausea and vomiting in children. While pyloric EndoFLIP showed trends related to gastric emptying, it did not predict treatment response in this study.

Area of Science:

  • Pediatric Gastroenterology
  • Gastrointestinal Motility Disorders
  • Minimally Invasive Therapeutics

Background:

  • Intrapyloric botulinum toxin injection (IPBI) is utilized for pediatric nausea and vomiting, yet lacks prospective clinical validation.
  • Refractory nausea or vomiting in children presents a significant clinical challenge requiring effective treatment strategies.

Purpose of the Study:

  • To evaluate the efficacy of IPBI in pediatric patients experiencing refractory nausea or vomiting.
  • To determine if pyloric EndoFLIP measurements can serve as a biomarker for IPBI treatment response.

Main Methods:

  • A prospective observational cohort study involving pediatric patients undergoing IPBI for refractory gastrointestinal symptoms.
  • Validated questionnaires assessed symptoms pre- and post-IPBI (1, 2, and 3 months).
  • Pyloric EndoFLIP measurements were obtained in a subset of patients to correlate with clinical outcomes and gastric emptying.

Main Results:

  • 64% of patients (29/45) experienced symptomatic improvement at 1 month, with sustained benefits up to 3 months.
  • Significant improvements were observed in overall GI symptoms (p=0.003), nausea/vomiting (p=0.009), and eating discomfort (p=0.006).
  • A trend suggested lower pyloric distensibility in delayed gastric emptying, but EndoFLIP did not predict IPBI response (p>0.05).

Conclusions:

  • IPBI demonstrates significant efficacy in improving refractory nausea, vomiting, and discomfort in pediatric patients.
  • Pyloric EndoFLIP may offer insights into gastric emptying but does not reliably predict response to IPBI in this cohort.
Abstract

Keywords:
endoscopic functional luminal imaging probegastroparesismotility

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