Background A potential approach to the treatment of morbid obesity is reduction of gastric emptying to achieve satiety. Botulinum toxin A (Btx-A) is a long-acting inhibitor of acetylcholine-mediated peristalsis, which is mainly responsible for gastric motility.

Aim To investigate whether botulinum toxin A, injected in the antrum of obese patients, delays gastric emptying.

Methods In a double_blind study, 18 healthy obese subjects (body mass index >30) were randomized into three groups (BTX133, BTX200 and Saline); they received Btx-A133U, Btx-A200U, or saline under endoscopic control. Gastric emptying was tested by scintigraphy before and 10 days after treatment. Body weight variations and appetite sensation were recorded after 5 weeks.

Results Fourteen patients completed the study. The botulinum toxin A-treated groups showed weight reduction, which was not statistically significant. The effects on gastric emptying were variable. Most of the botulinum toxin A treated patients reported a reduced appetite.

Conclusion This pilot clinical trial suggests potential activity of botulinum toxin A for the manipulation of appetite.

References

1 Pappas TN. Physiological satiety implications of gastro-intestinal anti-obesity surgery. Am J Clin Nutr 1992; 55: 571S–2S.
10.1093/ajcn/55.2.571s
CAS PubMed Web of Science® Google Scholar
2 Cullen JJ, Kelly KA. Motility disorders of the gastro-intestinal tract: Gastric motor physiology and pathophysiology. Surg Clin North Am 1993; 73: 1145–1160.
10.1016/S0039-6109(16)46184-0
CAS PubMed Web of Science® Google Scholar
3 Schiavo G, Rossetto O, Benfenati F, Poulain B, Montecucco C. Tetanus and botulinum neurotoxins are zinc proteases specific for components of the neuroexocytosis apparatus. Ann N Y Acad Sci 1994; 710: 65–75.
10.1111/j.1749-6632.1994.tb26614.x
CAS PubMed Web of Science® Google Scholar
4 Pasricha PJ, Ravich WJ, Hendix RT, Sostre S, Jones B, Kalloo AN. Treatment of achalasia with intrasphincteric injection of botulinum toxin: a pilot trial. Ann Intern Med 1994; 121: 590–1.
10.7326/0003-4819-121-8-199410150-00006
CAS PubMed Web of Science® Google Scholar
5 Gui D, Cassetta E, Anastasio G, Bentivoglio AM, Maria G, Albanese A. Botulinum toxin for chronic anal fissure. Lancet 1994; 344: 1127–8.
10.1016/S0140-6736(94)90633-5
CAS PubMed Web of Science® Google Scholar
6 Maria G, Cassetta E, Gui D, Brisinda G, Bentivoglio AR, Albanese A. A comparison of botulinum toxin and saline for the treatment of chronic anal fissure. N Engl J Med 1998; 338: 217–20.
10.1056/NEJM199801223380402
CAS PubMed Web of Science® Google Scholar
7 Godevenos D, Pikoulis E, Pavlakis E, et al. The treatment of chronic anal fissure with botulinum toxin. Acta Chir Belg 2004; 104: 577–80.
CAS PubMed Web of Science® Google Scholar
8 Gui D, Rossi S, Runfola M, Magalini SC. Review article: botulinum toxin in the therapy of gastrointestinal motility disorders. Aliment Pharmacol Ther 2003; 18: 1–16.
10.1046/j.1365-2036.2003.01598.x
CAS Google Scholar
9 Gui D, De Gaetano A, Spada PL, Viggiano A, Cassetta E, Albanese A. Botulinum Toxin injected in gastric wall reduces body weight and food intake in rats. Aliment pharmacol Ther 2000; 14: 829–34.
10.1046/j.1365-2036.2000.00765.x
CAS PubMed Web of Science® Google Scholar
10 Rogers PJ. The experimental investigation of human eating behaviour. In: I Hindmarch, PD Stonier, eds. Human Psychopharmacology, Measures and Methods. Chichester: John Wiley and Sons Ltd, 1993: 123–42.
Web of Science® Google Scholar
11 Siegel JA, Wu RK, Knight LC, Zelac RE, Stern HS, Malmud LS. Radiation dose estimates for oral agents used in upper gastrointestinal disease. J Nucl Med 1983; 24: 835–8.
CAS PubMed Web of Science® Google Scholar
12 Rowe B. Quantitative gastric emptying half–time clearance using dynamic and static images. J Nucl Med Technol 1991; 19: 136.
Google Scholar
13 Siegel JA, Wu RK, Knight LC, Zelac RE, Stern HS, Malmud LS. Radiation dose estimates for oral agents used in upper gastrointestinal disease. J Nucl Med 1983; 24: 835–7.
CAS PubMed Web of Science® Google Scholar
14 Chatterton BE. Nuclear Medicine in Clinical Diagnosis and Treatment, Vol. 1. Edinburgh: Churchill Livingstone, 1994: 393–405.
Google Scholar
15 Sheskin DJ. Handbook of Parametric and non Parametric Statistical Procedures, 2nd edn. Boca Raton, Fl: Chapman & Hall/CRC, 2000.
Google Scholar
16 Tokunaga T, Nishimura R, Akagi M. Muscarinic cholinergic receptors in human gastric mucosa. Jpn J Surg 1984; 14: 122–6.
10.1007/BF02469802
CAS PubMed Web of Science® Google Scholar
17 Schemann M, Schaaf C, Mader M. Neurochemical coding of enteric neurons in the guinea pig stomach. J Comp Neurol 1995; 353: 161–78.
10.1002/cne.903530202
CAS PubMed Web of Science® Google Scholar
18 Bigalke H, Habermann E. Blockade by tetanus and botulinum A toxin of postganglionic cholinergic nerve endings in the myenteric plexus. Naunyn Schmiedebergs Arch Pharmacol 1980; 312: 255–63.
10.1007/BF00499155
CAS PubMed Web of Science® Google Scholar
19 Jones OM, Brading AF, Mortensen NJ. Mechanism of action of botulinum toxin on the internal anal sphincter. Br J Surg 2004; 9: 224–8.
10.1002/bjs.4394
Web of Science® Google Scholar
20 James AN, Ryan JP, Parkman HP. Inhibitory effects of botulinum toxin on pyloric and antral smooth muscle. Am J Physiol Gastrointest Liver Physiol 2003; 285: G291–7.
10.1152/ajpgi.00296.2002
CAS PubMed Web of Science® Google Scholar
21 Rollnik JD, Meier PN, Manns MP, Göke M. Antral Injections of Botulinum A Toxin for the Treatment of Obesity. Ann Intern Med 2003; 138: 359–60.
10.7326/0003-4819-138-4-200302180-00026
PubMed Web of Science® Google Scholar
22 Caballero-Plasencia AM, Valenzuela-Barranco M, Martin-Ruiz JL, Herrerias-Gutierrez JM, Esteban-Carretero JM. Are there changes in gastric emptying during the menstrual cycle? Scand J Gastroenterol 1999; 34: 772–6.
10.1080/003655299750025697
CAS PubMed Web of Science® Google Scholar
23 Gill RC, Murphy PD, Hooper HR, Bowes KL, Kingma YJ. Effect of the menstrual cycle on gastric emptying. Digestion 1987; 36: 168–74.
10.1159/000199414
CAS PubMed Web of Science® Google Scholar
24 Bromer MQ, Friedenberg F, Miller LS, Fisher RS, Swartz K, Parkman HP. Endoscopic pyloric injection of botulinum toxin A for the treatment of refractory gastroparesis. Gastrointest Endosc 2005; 61: 833–9.
10.1016/S0016-5107(05)00328-7
PubMed Web of Science® Google Scholar
25 Black JD, Dolly JO. Selective location of acceptors for botulinum neurotoxin A in the central and peripheral nervous system. Neuroscience 1987; 23: 767–79.
10.1016/0306-4522(87)90094-7
CAS PubMed Web of Science® Google Scholar
26 Torbey CF, Singaram C, Bass P, Gaumnitz EA. Action of botulinum toxin on gut smooth muscle involves cholinergic and non-cholinergic neural pathways. Gastroenterology 1997; 112: A840.
Web of Science® Google Scholar

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Volume23, Issue5

March 2006

Pages 675-680

Effect of botulinum toxin antral injection on gastric emptying and weight reduction in obese patients: a pilot study

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Effect of botulinum toxin antral injection on gastric emptying and weight reduction in obese patients: a pilot study

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