Botulinum toxin treatment in gastrointestinal disorders

Botulinum toxin is used extensively for the management of gastrointestinal smooth muscle disorders. This chapter is a summary of the current status of this therapy. Botulinum toxin appears to be beneficial for achalasia, hypertensive esophageal disorders, and anal fissure and unclear utility in gastroparesis, upper esophageal sphincter dysfunction, and sphincter of Oddi dysfunction. Very few placebo-controlled trials have been performed despite widespread use of toxin for the past 25 years. Botulinum toxin appears to be safe and side effects are uncommon. Despite uncontrolled data, botulinum toxin is now used for a variety of spastic disorders of GI smooth muscle. In some instances, this therapy may preclude the need for more invasive treatments. Controlled trials are needed.