Drugs in focus: Botulinum toxin in the therapy of gastrointestinal disorders in children

Matjaž Homan; Mike Thomson; Patrick Bontems; Marco Deganello Saccomani; Jorge Amil Dias; Simona Faraci; Raoul Furlano; Iva Hojsak; Oren Ledder; Mordechai Slae; Priya Narula; Andreia Florina Nita; Lorenzo Norsa; Salvatore Oliva; Alexandra Papadopoulou; Claudio Romano; Anna Rybak; Vasiliki Spyropoulou; Renato Tambucci; Christos Tzivinikos; Michiel van Wijk; Osvaldo Borrelli; Endoscopy SIG and Motility SIG of ESPGHAN Organisation

doi:10.1002/jpn3.12376

Drugs in focus: Botulinum toxin in the therapy of gastrointestinal disorders in children

J Pediatr Gastroenterol Nutr. 2024 Dec;79(6):1096-1105. doi: 10.1002/jpn3.12376. Epub 2024 Sep 24.

Authors

Matjaž Homan¹, Mike Thomson², Patrick Bontems³, Marco Deganello Saccomani⁴, Jorge Amil Dias⁵, Simona Faraci⁶, Raoul Furlano⁷, Iva Hojsak⁸, Oren Ledder⁹, Mordechai Slae¹⁰, Priya Narula², Andreia Florina Nita¹¹, Lorenzo Norsa¹², Salvatore Oliva¹³, Alexandra Papadopoulou¹⁴, Claudio Romano¹⁵, Anna Rybak¹¹, Vasiliki Spyropoulou¹⁶, Renato Tambucci⁶, Christos Tzivinikos¹⁷, Michiel van Wijk¹⁸, Osvaldo Borrelli¹¹; Endoscopy SIG and Motility SIG of ESPGHAN Organisation

Affiliations

¹ Department of Gastroenterology, Hepatology, and Nutrition, University Children's Hospital, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
² Department of Paediatric Gastroenterology, Sheffield Children's Hospital NHS FT and University of Sheffield, Sheffield, UK.
³ Paediatric Gastroenterology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium.
⁴ Department of Paediatrics, Woman's and Child's University Hospital of Verona, Verona, Italy.
⁵ Department of Gastroenterology, Hospital Lusíadas, Porto, Portugal.
⁶ Gastroenterology and Nutrition Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
⁷ Department of Gastroenterology, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland.
⁸ Children's Hospital Zagreb, University of Zagreb Medical School, Zagreb, Croatia.
⁹ Juliet Keidan Institute of Pediatric Gastroenterology, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.
¹⁰ Pediatric Gastroenterology, Hepatology and Nutrition Unit, Hadassah University Hospital, Jerusalem, Israel.
¹¹ Paediatric Gastroenterology Department, Great Ormond Street Hospital, London, UK.
¹² Pediatric Department, Children's Hospital Vittore Buzzi, University of Milan, Milan, Italy.
¹³ Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza-University of Rome, Rome, Italy.
¹⁴ Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Children's Hospital Agia Sofia, Athens, Greece.
¹⁵ Claudio Romano Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Messina, Italy.
¹⁶ Division of Gastroenterology, Hepatology and Nutrition, University Children's Hospital Zurich, Zurich, Switzerland.
¹⁷ Pediatric Gastroenterology Department, Al Jalila Children's Specialty Hospital, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.
¹⁸ Emma Children's Hospital-Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.

Abstract

What is Known:

Botulinum toxin (BoNT) causes muscle relaxation by inhibiting acetylcholine release from presynaptic motor neurons at the neuromuscular junction.

What is New:

In children with achalasia, BoNT can be considered only in patients in whom rapid weight gain is important to improve surgical outcomes.
BoNT has been suggested for treating cricopharyngeal achalasia and delayed gastric emptying.
Anal achalasia and constipation after Hirschsprung disease corrective surgery are very promising indications for BoNT use.
In selected children with resistant type of functional constipation and chronic anal fissure, BoNT is a viable option for treating.

Keywords: constipation; oesophagus; weight loss.