The treatment of internal anal sphincter achalasia with botulinum toxin

Messineo, Antonio; Codrich, Daniela; Monai, Margherita; Martellossi, Stefano; Ventura, Alessandro

doi:10.1007/s003830100583

Cited by 34 publications

(10 citation statements)

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“…By interfering with acetylcholine release at the neuromuscular junction [8] and inhibiting sympathetic stimulation to the IAS [9], intrasphincteric injection of botox produces a local and transient chemical denervation of the sphincter. In the gastrointestinal tract, botox has been used for the treatment of esophageal achalasia [10], chronic anal fissure [11], IAS achalasia [2,4], obstructed defecation [12], post-hemorrhoidectomy pain [13], and chronic idiopathic constipation [14].…”

Section: Introductionmentioning

confidence: 99%

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Botulinum toxin for the treatment of chronic constipation in children with internal anal sphincter dysfunction

et al. 2008

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Internal anal sphincter (IAS) dysfunction is a cause of refractory constipation in children. The goal of this study was to determine whether intrasphincteric injection of botulinum toxin is effective in the treatment of constipation in pediatric patients with IAS dysfunction. A retrospective review was performed of 24 pediatric patients with intractable constipation. All patients had abnormal anorectal manometry, with either elevated IAS resting pressure (> or =100 mm Hg) or an absent or diminished rectoanal inhibitory reflex. Patients with Hirschsprung's disease were excluded. All patients underwent botox injection into the IAS and were followed for a minimum of 6 months. Of 24 patients, 22 experienced significant improvement in their constipation lasting greater than 2 weeks. The duration of effect was variable, with 12 patients demonstrating benefit lasting at least 6 months. Transient postoperative incontinence occurred in five patients. Intrasphincteric injection of botox is a safe and effective treatment for intractable constipation in children with IAS dysfunction.

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Section: Introductionmentioning

confidence: 99%

“…Anal achalasia, defined as absence of the RAIR [1,2], is associated with Hirschsprung's disease and can contribute to persistent obstructive symptoms following pull-through surgery [3]. Anal achalasia can also occur in otherwise healthy children [4] and has been identified in up to 4.5% of children with chronic constipation [1].…”

Section: Introductionmentioning

confidence: 99%

Botulinum toxin for the treatment of chronic constipation in children with internal anal sphincter dysfunction

et al. 2008

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“…It usually presents beyond the newborn period and may be found in a subgroup of children with refractory constipation [3]. Children with IAS achalasia typically have a history of no fecal-soiling or stoolwithholding behavior, differentiating them from children who suffer from functional constipation.…”

Section: Enteric Neuromuscular Disordersmentioning

confidence: 99%

“…During this test, it is essential to inflate the rectal balloon enough to distend the rectal wall to the point of causing the child to feel the urge to defecate. The exact pathogenesis and pathophysiology of IAS achalasia is not fully understood, but intramuscular innervation abnormalities, as well as defective innervation of the neuromuscular junction, are believed to be responsible for the anal motor dysfunction [3].…”

Section: Enteric Neuromuscular Disordersmentioning

confidence: 99%

Treatment options for refractory childhood constipation

Youssef

Lorenzo

2002

Curr Treat Options Gastro

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Constipation in children is very common. Childhood constipation responds successfully to medical therapies, behavioral modifications, or a combination of both in approximately 70% of children within 2 years of diagnosis. Persistence of constipation is associated with fecal incontinence, recurrent fecal impactions, and significant emotional problems. Refractory constipation that interferes with both the child's function and the family's life requires extensive evaluations in order to uncover its cause and devise appropriate therapeutic strategies. Children with persistent constipation can be divided into three broad categories: 1) those who have functional constipation, 2) those affected by enteric neuromuscular disorders, and 3) those whose constipation is associated with neurologic handicaps. Treatment options vary widely. The majority of patients require more aggressive medical and more intense behavioral interventions. Others benefit from novel approaches, including surgical intervention.

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“…is amenable to primary injection therapy [39]. The second and most common indication is persistent internal anal sphincter hypertonicity following surgical repair for typical HSCR [24,25].…”

Section: Pharmacologic Treatmentmentioning

confidence: 99%

Hirschsprung’s disease

Belknap

2003

Curr Treat Options Gastro

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Hirschsprung's disease (HSCR) is the most common congenital malformation of the enteric nervous system and requires early diagnosis and surgical repair for the best comprehensive outcome. The early diagnosis of this disorder permits the use of primary endorectal pull-through (PERPT), which is now the definitive surgical therapy for HSCR. PERPT has become the preferred method of treatment for HSCR, and large numbers of successfully treated patients have been described in the recent medical literature. The rate of postoperative complications is generally similar to that following a two-stage surgical repair, but PERPT patients may be at a slightly higher risk for Hirschsprung's-associated enterocolitis. Despite recent surgical advances in the treatment of HSCR, a two-stage surgical repair involving a temporary diverting colostomy may still be necessary in up to one third of patients. Candidates for a staged repair include those HSCR patients with long-segment or total colonic disease or when there has been a delay in diagnosis that results in a markedly dilated proximal colon or patient clinical instability. Internal anal sphincter hypertonicity, occurring either as isolated primary anal achalasia or as a postoperative complication, can be successfully managed by either botulinum toxin injections or anal myectomy. The measurement of colonic motility in surgically repaired patients with a long-standing postoperative abnormality of bowel function can identify several distinct motility disorders that are amenable to separate and individualized therapies. The single most important element in the management of HSCR remains the clinical judgement of the surgeon of record, who utilizes all discernible clinical data to elect the manner of surgical repair in a given patient.

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The treatment of internal anal sphincter achalasia with botulinum toxin

Cited by 34 publications

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Botulinum toxin for the treatment of chronic constipation in children with internal anal sphincter dysfunction

Botulinum toxin for the treatment of chronic constipation in children with internal anal sphincter dysfunction

Treatment options for refractory childhood constipation

Hirschsprung’s disease

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