Treatment of idiopathic gastroparesis with injection of botulinum toxin into the pyloric sphincter muscle

Am J Gastroenterol. 2002 Jul;97(7):1653-60. doi: 10.1111/j.1572-0241.2002.05823.x.


Objectives: We aimed to determine if botulinum toxin injection into the pyloric sphincter improves gastric emptying and reduces symptoms in patients with idiopathic gastroparesis.

Methods: Patients with idiopathic gastroparesis not responding to prokinetic therapy underwent botulinum toxin (80-100 U, 20 U/ml) injection into the pyloric sphincter. Gastric emptying scintigraphy was performed before and 4 wk after treatment. Total symptom scores were obtained from the sum of eight upper GI symptoms graded on a scale from 0 (none) to 4 (extreme).

Results: Ten patients were entered into the study. The mean percentage of solid gastric retention at 4 h improved from 27+/-6% (normal < 10%) before botulinum toxin injection into the pylorus to 14+/-4% (p = 0.038) 4 wk after treatment. The symptom score decreased from 15.3+/-1.7 at baseline to 9.0+/-1.9 (p = 0.006) at 4 wk, a 38+/-9% decrease. Improvement in symptoms tended to correlate with improved gastric emptying of solids (r = 0.565, p 0.086).

Conclusions: This initial pilot study suggests that botulinum toxin injection into the pylorus in patients with idiopathic gastroparesis improves both gastric emptying and symptoms.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Anti-Dyskinesia Agents / administration & dosage*
  • Botulinum Toxins / administration & dosage*
  • Female
  • Follow-Up Studies
  • Gastric Emptying
  • Gastroparesis / diagnosis
  • Gastroparesis / drug therapy*
  • Gastroparesis / physiopathology
  • Humans
  • Injections, Intralesional
  • Muscle, Smooth
  • Pilot Projects
  • Pylorus
  • Time Factors


  • Anti-Dyskinesia Agents
  • Botulinum Toxins