The following is a summary of “Intrapyloric Botulinum Toxin Injection for Refractory Nausea and Vomiting in Pediatric Patients,” published in the December 2023 issue of Pediatrics by Osgood, et al.

For a study, researchers sought to investigate the efficacy of intrapyloric botulinum toxin injection (IPBI) in alleviating chronic nausea and vomiting in pediatric patients, irrespective of gastroparesis. Additionally, the research sought to identify patterns of gastric emptying (GE) and antroduodenal manometry (ADM) associated with responders and nonresponders to IPBI.

A retrospective review of electronic records included 25 pediatric patients who underwent IPBI for refractory nausea, vomiting, or both. The study assessed post-IPBI symptom improvement and compared symptoms, GE, and ADM findings between IPBI responders and nonresponders.

Post-IPBI, at least one major symptom improved in 76% of patients (19 out of 25). Among 22 patients who underwent GE studies, 14 exhibited delayed GE, with no significant difference between responders and nonresponders. Of the 22 patients who underwent ADM, 18 had normal fasting peristalsis, 5 displayed postprandial antral hypomotility, 4 exhibited neuropathic findings, and 19 had pylorospasm. Responders to IPBI, in comparison to nonresponders, demonstrated higher antral pressures during feeding (P < 0.0001) and a shorter duration of pylorospasm (P = 0.0036). Antral pressures did not significantly differ during fasting or following motilin agonists.

The study suggested that IPBI may be therapeutically beneficial for chronic nausea and/or vomiting in pediatric patients, regardless of gastroparesis. ADM findings indicating intact antral peristalsis and elevated antral pressures, along with the effectiveness of IPBI, support the hypothesis that pyloric non-relaxation could contribute to nausea and/or vomiting in the pediatric population.

Source: journals.lww.com/jpgn/abstract/2023/12000/intrapyloric_botulinum_toxin_injection_for.11.aspx