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內镜下幽门内注射A型肉毒杆菌素治疗小儿胃轻瘫:一项回顾性开放标签研究

发布日期:2014-1-29 12:40:26 文章来源:GIE 作者次数:1076
     

    內镜下幽门内注射A型肉毒杆菌素治疗小儿胃轻瘫:一项回顾性开放标签研究

    背景

    A型肉毒毒素一直以来用于治疗儿童痉挛性疾病,近来也用于治疗胃肠道疾病。治疗成人胃轻瘫的开放标签研究已报道过內镜下幽门内注射肉毒杆菌素IPBIs后,胃轻瘫症状和胃排空情况都有所改善,然而安慰剂对照试验所得出的结果与之相冲突。目前只发现一份关于內镜下幽门内注射肉毒杆菌素(IPBIs)治疗小儿胃轻瘫的报告。

    目的

    确定那些药物难以治疗的小儿胃轻瘫IPBI的反应的长期临床疗效和预测性因素。

    设计

    回顾性分析。

    环境

    单一三级医疗中心。

    患者

    接受IPBIs的难治性小儿胃轻瘫

    干预

    IPBIs

    主要测量指标

    注射后药物反应的临床改善状况与预测性因素。

    结果

    本研究对47例患者行70次注射,患者平均年龄为9.98±6.5岁,23例女性,而且对45例进行了随访。对15例患者行IPBI失败,30例患者成功。第一次IPBIs反应中位数为3个月(95%置信区间为1.2-4.8)。共29例患者只接受了一次IPBI18例患者接受了多次IPBIs。年龄较大和呕吐这些因素可预测出初次IPBIs反应,男性预示着重复IPBI。据报道仅有一例患者行IPBI后一周内呕吐加剧。

    局限性

    这项研究的开放标签和追溯性。

    IPBI是安全的,而且它也可能有效地治疗有小儿胃轻瘫综合症。对第一次IPBI有反应的人群包括老年患者和有呕吐症状的患者,而男性患者对重复IPBIs治疗效果更好。

    缩写词:GES,胃排空研究;IPBI,幽门内注射肉毒杆菌素;PPAHM,餐后胃窦动力低下。

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    Endoscopic intrapyloric injection of botulinum toxin A in the treatment of children with gastroparesis: a retrospective, open-label study

    Background

    Botulinum toxin A has been used in children to treat spastic disorders and recently for GI conditions. Open-label studies in adults with gastroparesis have reported an improvement in symptoms and gastric emptying after endoscopic intrapyloric botulinum injections (IPBIs), although placebo-controlled trials have shown conflicting results. Only a single case report of IPBI is available in children.

    Objective

    To determine the long-term clinical outcomes and predictive factors for IPBI response in children with gastroparesis refractory to medical therapy.

    Design

    Retrospective review.

    Setting

    Single tertiary care center.

    Patients

    Children with refractory gastroparesis symptoms undergoing IPBIs.

    Interventions

    IPBIs.

    Main Outcome Measurements

    Clinical improvement and predictive factors for response.

    Results

    A total of 70 injections were given to 47 patients (mean age 9.98 ± 6.5 years; 23 female patients) with follow-up in 45 patients. IPBI failed in 15 patients and was successful in 30 patients. The median duration of response to the first IPBI was 3.0 months (95% CI, 1.2-4.8). A total of 29 patients received a single IPBI, and 18 received multiple IPBIs. Older age and vomiting predicted response to initial IPBI, and male sex predicted response to repeat IPBI. Only 1 patient reported exacerbation of vomiting after IPBI resolving within a week.

    Limitations

    The open-label and retrospective nature of the study.

    Conclusion

    IPBI is safe and may be effective in the management of children with symptoms of gastroparesis. Subgroups identifying who responded to the first IPBI include older patients and those presenting with vomiting, whereas male patients responded better to repeat IPBIs.

    Abbreviations:  GES, gastric emptying study, IPBI, intrapyloric botulinum injection, PPAHM, postprandial antral hypomotility

     

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