Assuntos
Doenças Funcionais do Colo , Antidepressivos Tricíclicos/uso terapêutico , Antidiarreicos/uso terapêutico , Terapia Comportamental , Carbolinas/uso terapêutico , Catárticos/uso terapêutico , Doenças Funcionais do Colo/diagnóstico , Doenças Funcionais do Colo/tratamento farmacológico , Doenças Funcionais do Colo/epidemiologia , Doenças Funcionais do Colo/terapia , Diagnóstico Diferencial , Humanos , Indóis/uso terapêutico , Loperamida/uso terapêutico , América do Norte , Parassimpatolíticos/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Projetos de Pesquisa , Antagonistas da Serotonina/uso terapêutico , Agonistas do Receptor de Serotonina/uso terapêutico , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Gastroparesis is a disorder of gastric motility that results in delayed gastric emptying. Common symptoms include early satiety, postprandial fullness, epigastric pain, nausea, vomiting, and weight loss. The underlying etiologies of gastroparesis are many and include diabetes, prior gastric surgery, collagen vascular disorders, and a previous viral illness. Up to one third of cases are classified as idiopathic. Treatment typically consists of a change in diet to small volume, frequent meals and the use of the prokinetic agents metoclopramide, cisapride, erythromycin, or domperidone. Botulinum toxin has recently been shown to be effective in treating disorders of smooth muscle hypertonicity in the GI tract. This case report describes three patients with severe gastroparesis whose symptoms persisted despite dietary changes and the use of high dose prokinetic agents. All three were treated with intrasphincteric injection of the pylorus with botulinum toxin and all had significant symptomatic improvement afterwards. Possible mechanisms of action of botulinum toxin on the pylorus and its effects in patients with gastroparesis are discussed.
