Botox may relieve diabetic GI complication

An injection of botulinum toxin (Botox) into the stomach is a safe method of relieving the nausea, vomiting, and abdominal pain that occurs with diabetic gastroparesis, findings from a small study suggest.

Diabetic gastroparesis is when the stomach becomes dilated and gastric secretions are retained, causing pain, nausea and vomiting.

A previous study has shown that pressure in the lower portion of the stomach is elevated in patients with diabetic gastroparesis, lead author Dr. Brian E. Lacy, from Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, told Reuters Health. "So, we were interested in testing Botox as a way to bring down these pressures and, hopefully, improve gastric emptying."

The study, which is reported in Diabetes Care, involved eight patients with type 1 diabetes and gastroparesis that had not responded to standard therapy, and eight healthy matched controls, who received a Botox injection to the stomach. Seven of the patients completed the 12-week follow-up period.

Treatment with Botox was associated with a significant drop in average symptom scores and with an improvement in physical functioning. Gastric emptying times improved in four patients and six patients were able to gain weight.

Perhaps as a result of increased ability to eat (due to reduced nausea and vomiting), four patients needed higher levels of insulin.

No complications related to the procedure were observed.

Botox injection to the stomach is "probably more of a stop-gap measure for treating severe diabetic gastroparesis," Dr. Lacy said. For example, "it could be used to let a really sick patient with intractable nausea and vomiting get out of the hospital. It's not a permanent solution."

The next step is to conduct a study that compares the effect of Botox injections with saline injections, he added.

SOURCE: Diabetes Care, October 2004.