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DOI: 10.1055/a-1784-0061
Intra-sphincteric botulinum toxin in the management of functional biliary pain
Abstract
Background and study aims The management of functional biliary-type pain remains a clinical challenge. Intra sphincteric botulinum toxin putatively exerts an anti-spasmodic and anti-nociceptive effect. The objective of this study was to examine the clinical response to intra sphincteric botulinum toxin in patients with functional biliary-type pain.
Patients and methods This was a cross-sectional (hypothesis-generating) study of prospectively collected data from patients referred to a tertiary center from 2014 to 2019. The efficacy of ampullary botulinum toxin injection for relief of pain was recorded at post-procedure outpatient review. Opioid analgesia, neuromodulatory medication, and frequency of hospital admissions were recorded.
Results A total of 119 consecutive patients (109 women, 10 men, mean age 45 years; range 17–77) underwent 411 intra-sphincteric botulinum toxin injection procedures (mean 2 procedures; range 1–15). A total of 103 patients (87 %) had a significant improvement in pain on post-procedure review and 77 % and 76 % of patients were opioid and admission free, respectively. Of the patients, 59 % were prescribed tricyclic antidepressants (amitriptyline), 18 % duloxetine, 13 % pregabalin, and 3 % mirtazapine. Loss of response with the initial dose of botulinum toxin occurred in 56 % of patients. Pain control was reestablished in 80 % of patients in this cohort following botulinum toxin injection at a higher dose.
Conclusions These data suggest that botulinum toxin may improve outcomes in patients with functional biliary pain. Further controlled studies are needed to clarify the role of Botox and neuromodulatory agents.
Publikationsverlauf
Eingereicht: 04. August 2021
Angenommen nach Revision: 15. November 2021
Artikel online veröffentlicht:
14. April 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Farmer AD, Aziz Q. Visceral pain hypersensitivity in functional gastrointestinal disorders. Brit Med Bull 2009; 91: 123-136
- 2 Drossman DA, Hasler WL. Rome IV-functional GI disorders: Disorders of gut-brain interaction. Gastroenterology 2016; 150: 1257-1261
- 3 Afghani E, Lo SK, Covington PS. et al. Sphincter of Oddi Function and risk factors for dysfunction. Front Nutr 2017; 4: 1
- 4 Cotton PB, Elta GH, Carter R. et al. Gallbladder and sphincter of Oddi disorders. Gastroenterology 2016; 150: 1420-1429
- 5 Hogan WJ, Geenan JE. Biliary dyskinesia. Endoscopy 1988; 20: 179-183
- 6 Behar J, Corazziari E, Guelrud M. et al. Functional gallbladder and sphincter of oddi disorders. Gastroenterology 2006; 130: 1498-1509
- 7 Geenen JE, Hogan WJ, Dodds WJ. et al. The efficacy of endoscopic sphincterotomy after cholecystectomy in patients with sphincter-of-Oddi dysfunction. N Engl J Med 1989; 320: 82-87
- 8 Cotton PB, Durkalski V, Romagnuolo J. et al. Effect of endoscopic sphincterotomy for suspected sphincter of Oddi dysfunction on pain-related disability following cholecystectomy: the EPISOD randomized clinical trial. JAMA 2014; 311: 2101-2109
- 9 Baillie J. Sphincter of Oddi dysfunction: Overdue for an overhaul. Am J Gastroenterol 2005; 100: 1217-1220
- 10 Tornblom H, Drossman DA. Centrally targeted pharmacotherapy for chronic abdominal pain. Neurogastroenterol Motil 2015; 27: 455-467
- 11 Pauls Q, Durkalski-Mauldin V, Brawman-Mintzer O. et al. Duloxetine for the treatment of patients with suspected sphincter of Oddi dysfunction: A pilot study. Digest Dis Sci 2016; 61: 2704-2709
- 12 Simpson LL. The origin, structure, and pharmacological activity of botulinum toxin. Pharmacolog Rev 1981; 33: 155-188
- 13 Pasricha PJ, Ravich WJ, Kalloo AN. Botulinum toxin for achalasia. Lancet 1993; 341: 244-245
- 14 Singh J. Use of botulinum toxin in musculoskeletal pain. F1000Res 2013; 2: 1-22
- 15 Colhado OC, Boeing M, Ortega LB. Botulinum toxin in pain treatment. Revista brasileira de anestesiologia 2003; 59: 366-381
- 16 Wheeler AH, Goolkasian P. Open label assessment of botulinum toxin a for pain treatment in a private outpatient setting. Musculoskel Pain 2001; 9: 68-82
- 17 Pasricha PJ, Sostre S, Kalloo AN. Endoscopic injection of botulinum toxin for patients with suspected sphincter of Oddi dysfunction: results of a pilot trial. Gastrointest Endosc 1994; 40: 421
- 18 Austin AS, Wheeler K, Larvin M. et al. Transient response to botulinum toxin injection predicts the medium-term outcome after endoscopic sphincterotomy in type 2/3 sphincter of Oddi dysfunction. Gut 2010; 59 PTU–001
- 19 Wehrmann T, Seifert H, Seipp M. et al. Endoscopic injection of botulinum toxin for biliary sphincter of Oddi dysfunction. Endoscopy 1998; 30: 702-707
- 20 Wheeler K, Salmon CA, Austin AS. Response to peri-ampullary botox injection and subsequent long term response to endoscopic sphincterotomy in type 2/3 sphincter of Oddi dysfunction. Gut 2014; 63 PTH–012
- 21 Murray W, Kong S. Botulinum toxin may predict the outcome of endoscopic sphincterotomy in episodic functional post-cholecystectomy biliary pain. Scand J Gastroenterol 2010; 45: 623-627
- 22 Macdougall L, Nayar M, McArdle F. et al. Use of botulinum toxin to predict manometry results in type iii sphincter of Oddi dysfunction; a retrospective single centre review. Gut 2014; 63 OC–073
- 23 Menon S, Kurien R, Mathew R. The role of intrasphincteric botulinum toxin injection in the management of functional biliary pain: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2020; 32: 984-989
- 24 Menon S, Mathew R. PTH-122 Is there a role for intra-sphincteric botulinum toxin injection in the management of type iii sphincter of oddi dysfunction?. Gut 2017; 66
- 25 British Pain Society. Outcome Measures. Churchill House, 35 Red Lion Square, London WC1R 4SG: The Faculty of Pain Medicine of the Royal College of Anaesthetists; 2019 https://www.britishpainsociety.org/static/uploads/resources/files/Outcome_Measures_January_2019.pdf
- 26 Kurucsai G, Joó I, Fejes R. et al. Somatosensory hypersensitivity in the referred pain area in patients with chronic biliary pain and a sphincter of Oddi dysfunction: new aspects of an almost forgotten pathogenetic mechanism. Am J Gastroenterol 2008; 103: 2717-2725
- 27 Thune A, Saccone GT, Scicchitano JP. et al. Distension of the gall bladder inhibits sphincter of Oddi motility in humans. Gut 1991; 32: 690-693
- 28 Tanaka M, Ikeda S, Nakayama F. Change in bile duct pressure responses after cholecystectomy: loss of gallbladder as a pressure reservoir. Gastroenterology 1984; 87: 1154-1159
- 29 Rolny P, Funch-Jensen P, Kruse A. et al. Effect of cholecystectomy on the relationship between hydrostatic common bile duct pressure and sphincter of Oddi motility. Endoscopy 1991; 23: 111-113
- 30 Pasricha PJ. Unraveling the mystery of pain in chronic pancreatitis. Nature Rev Gastroenterol Hepatol 2012; 24: 140-151
- 31 Li C, Zhu Y, Shenoy M. et al. Anatomical and functional characterization of a duodeno-pancreatic neural reflex that can induce acute pancreatitis. Am J Physiol Gastrointest Liver Physiol 2013; 304: G490-500
- 32 Desautels SG, Slivka A, Hutson WR. et al. Postcholecystectomy pain syndrome: pathophysiology of abdominal pain in sphincter of Oddi type III. Gastroenterol 1999; 116: 900-905
- 33 Pasricha PJ, Miskovsky EP, Kalloo AN. Intrasphincteric injection of botulinum toxin for suspected sphincter of Oddi dysfunction. Gut 1994; 35: 1319-1321
- 34 Sand J, Nordback I, Arvola P. et al. Effects of botulinum toxin A on the sphincter of Oddi: an in vivo and in vitro study. Gut 1998; 47: 507-510
- 35 Macdougall L, Nayar M, McArdle F. et al. OC-073 Use of botulinum toxin to predict manometry results in type iii sphincter of Oddi dysfunction; a retrospective single centre review. Gut 2014; 63: A36-37
- 36 Austin AS, Wheeler K, Larvin M. et al. PTU-001 Transient response to botulinum toxin injection predicts the medium-term outcome after endoscopic sphincterotomy in type 2/3 sphincter of Oddi dysfunction. Gut 2010; 59: A48
- 37 Lacy BE, Weiser K, Kennedy A. Botulinum toxin and gastrointestinal tract disorders: panacea, placebo, or pathway to the future?. Gastroenterol Hepatol 2008; 4: 283-295
- 38 Richardson WS, Willis GW, Smith JW. Evaluation of scar formation after botulinum toxin injection or forced balloon dilation to the lower esophageal sphincter. Surg Endosc 2003; 17: 696-698
- 39 Bloomston M, Fraiji E, Boyce Jr HW. et al. Preoperative intervention does not affect esophageal muscle histology or patient outcomes in patients undergoing laparoscopic Heller myotomy. J Gastrointest Surg 2003; 7: 181-188 ; discussion 188–190
- 40 Cowgill SM, Villadolid DV, Al-Saadi S. et al. Difficult myotomy is not determined by preoperative therapy and does not impact outcome. JSLS 2007; 11: 336-343
- 41 Musial F, Klosterhalfen S, Enck P. Placebo responses in patients with gastrointestinal disorders. World J Gastroenterol 2007; 13: 3425-3429
- 42 Enck P, Klosterhalfen S. The placebo response in functional bowel disorders: perspectives and putative mechanisms. Neurogastroenterol Motility 2005; 17: 325-331