Degree of pyloric dysfunction may impact Botox injection in gastroparesis symptom response


November 02, 2021

1 min read


Watts LS, et al. Abstract S1383. Presented at: ACG Annual Scientific Meeting; Oct. 22-27, 2021; Las Vegas (hybrid meeting).

Watts reports no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclosures.

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LAS VEGAS — Among patients with gastroparesis, pyloric botulinum toxin may be effective among those with lesser pyloric impairments. However, those with worse pyloric dysfunction may not benefit, according to a presentation.

“Pyloric botulinum toxin injection improved nausea and vomiting and elicited trends to reduced overall gastroparesis symptoms at 6 weeks,” Lydia S. Watts, BS, of Michigan Medicine at the University of Michigan in Ann Arbor, Michigan, said during the presentation at the ACG Annual Scientific Meeting. “Exploratory EndoFLIP (Medtronic) analyses defined cutoffs for pyloric diameter and distensibility.

“Only patients with diameter greater than 15.1 mm and distensibility greater than or equal to 3.5 mm²/mmHg showed reduced overall symptoms or nausea/vomiting scores; those with lower values had no response,” she added.

Watts and colleagues identified 32 patients with gastroparesis who received 200 units of pyloric botulinum toxin. Pyloric diameter and distensibility were measured with EndoFLIP. Prior to and 6 weeks after the Botox injection, the Gastroparesis Cardinal Symptom Index (GCSI) measures of overall and individual symptoms were enumerated. Investigators used exploratory analyses to define pyloric diameter and distensibility values correlated with greater vs. less symptom reductions after Botox.

At 50 mL inflation, the baseline pyloric diameter was 16.1 mm, and the distensibility was 4.7 mm2/mmHg. Investigators noted the overall GCSI in the whole group decreased from 3.4 to 3. Over 6 weeks, the nausea/ vomiting scores decreased from 2.5 to 1.6 (P = .008).

Results showed there were no improvements in the scores for fullness/early satiety (3.8 to 3.7) or bloating/distention (4 to 3.6). However, there were significant improvements in GCSI (P = .02) and nausea/vomiting scores (P = .005) with diameter cutoffs less than 15.1 mm.
Watts noted there were no improvements in GCSI (3.2 to 2.9) and nausea/vomiting (2 to 1.3) with a pyloric diameter of 15.1 mm or less. Additionally, there were no reductions in GCSI (3.3 to 3.3) and nausea/vomiting (2 to 1.5) with distensibility less than 3.5 mm2/mmHg.

Fullness or bloating scores were not impacted by diameter and distensibility cutoffs, according to Watts. The scores were not correlated to age, BMI or gastric emptying.

Watts said the next step is confirm the findings with larger gastroparesis patient cohorts.

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