Gastric Botox (Stomach Botox) has become a method of gastrointestinal treatment for a variety of disorders including gastroparesis, gastropathy, achalasia, Hirschsprung’s disease, hyperemesis gravidarum, anorexia, bulimia nervosa, and obesity, and has been evaluated for its use in the treatment of other gastrointestinal disorders including symptomatic dysphagia and chronic idiopathic pseudo-obstructions. Gastric Botox injections have been recommended for both adults and children. Many adults support its use. Despite numerous articles and research papers documenting the procedure and its results, few of them are controlled, prospective, comparative trials.

Due to the lack of high scientific evidence, various societies do not recommend it in the treatment of either adults or children, claiming a lack of information on its long-term efficacy and safety profile. The aim of this analysis is to overcome the literature shortage of papers regarding the use of local and regional anesthetics, mechanical dilatation, and scores to measure the onset, duration, and efficacy of gastric Botox injection.

Gastric Botox Injection: Mechanism and Applications

Botox is the trade name for the botulinum toxin type A and is widely known for its cosmetic application for wrinkle reduction. However, in therapeutic doses, Botox has been used to treat neuromuscular disorders and has shown an onset of action on the nervous system at molecular, cellular, and patient levels. Mechanistically, botulinum toxin exerts inhibitory action on smooth muscle activity in the gastrointestinal tract by inhibiting the release of acetylcholine, which prompts muscle relaxation. Although the effects of Botox administration are transient due to the prolonged time course of the regenerative mechanism of the acetylcholinesterase molecule, Botox administration has been described in combination with standard therapy for spastic colon, psychological diarrhea, proctalgia fugax, and problematic rumination, or refractory GERD.

Conclusively, on the basis of existing evidence, Botox injection in the human gastric antrum confers substantial utility in patients with gastroparesis, alcoholism-related gastroparesis, or overweight and obesity. Given the elevated safety profile and the absence of severe adverse effects, Botox injections may be offered even when motility studies are not available, when patients present with descriptions of chronic vomiting, and skin electromyography for either diaphragm or gastroesophageal junction demonstrates the absence of propagating gastric wavelets with integrated electrical responses. Botox injection also stands to be a good option while awaiting permanent gastric electric stimulator placement or to impose some control over substantiating entailment changes following LES Botox escalation in case the LES Botox fails to restore competent esophagus motility. The concurrent administration of Botox with medical therapy may also be constructive in reducing functional delay in gastric emptying from lessening higher esophageal sphincter flow histamine release that preliminarily reinforces transient LES relaxation or reducing the total air quantity to expand with belt traction.

Patient Suitability and Selection Criteria

It is important that the patient selection criteria are accurately established in order to obtain the most beneficial result from the treatment and avoid complications. The most important selection criterion is to exclude patients who have an underlying organic pathology and whose complaints may be due to this pathology. In the etiology, physiological and functional causes are the cause of obesity, functional dyspepsia, and functional diarrhea, with a decrease in the sensitivity of the suppressor sense of hunger and stimulation of the accelerator sense of hunger. Furthermore, certain patient groups, compared with other patients, respond better to the treatment. In patients with type II diabetes, weight loss with the suppression of appetite and gastric emptying retardation, along with positive results in hyperlipidemia, is observed. In patients with functional dyspepsia, an improvement of 57-82% is noted, and it is observed that patients become more comfortable and can return to their habitual lifestyle. As for other treatment modalities, it should be considered for morbidly obese patients after all other options have been applied and whose BMI is above 40. It can be used for patients who have complaints of frequent satiety, non-ulcer dyspepsia, functional diarrhea, gastroesophageal reflux, slow digestion, advanced gastric emptying, and recurrent peptic ulcers based on upper intestinal motility disorders. Although rare, successful results are observed in many patients who have complaints of rapid eating and never feeling satisfied after meals. Taking the patient’s lifestyle into consideration and eliminating the fundamental causes that stimulate the senses of hunger will increase the success of the treatment. After the exact cause of the increase in body weight is detected, the therapy program that will be implemented to increase the duration of hunger reduction will be successful. In patients whose complaints are caused by excessive consumption of sweet foods, the results will be better if the patient undergoes psychotherapy before and after the therapy. The application of Botox with a specific diet program in the presence of symptoms of gastritis, such as rapid satiety after eating sugar, hunger with high blood glucose, calmness with carbohydrate loading, and delayed intensified hunger after eight hours from blood glucose reduction, is reached through prolonged satiety and increased secretory activities in the stomach.

Recovery Process and Post-Procedure Care

The patient is to be monitored for any immediate side effects before leaving the endoscopy center. The patient may experience some immediate belly or back discomfort and may be gassy from the air used during the procedure. This procedure is an outpatient procedure, and therefore recovery from the sedation or anesthesia administered during the procedure is typically very fast. Most people are awake and have a very quick recovery time in the GI recovery area. It is highly advised that the patient take it easy the rest of the day. We tell patients to feel free to eat and drink what they want, but if they are feeling some discomfort, it can hurt to eat at first.

Most people eat wisely and avoid certain foods that give them stomach pain after Botox injection for up to 3 to 4 days after the injection. Patients usually return to their regular diet by day 5 should they notice some settling of their stomach pain. We advise patients to avoid salads, tough fried meats, rice, popcorn, dried fruits, skim milk, raw onion, nuts, multigrains, carbonated drinks, and spicy foods. We also advise avoiding foods that they notice result in relaxation at the gastroesophageal junction, which may have a gurgling sound in the chest from reflux or unrelieved belching. A 1 to 2-day liquid or soft diet can relieve additional early belly pain. Mashed potatoes, oatmeal, scrambled eggs, soups, and yogurt are examples of soft diet foods. The most common side effects of this procedure include, but are not limited to, temporary gassiness, mild discomfort, and bruising. Given the invasiveness of the procedure and use of sedation and/or anesthesia, there is a risk of more severe complications such as perforation, aspiration, and bleeding. Any fever, worsening belly pain, or symptoms should be reported right away; call the office. Follow-up care typically includes assessment of dietary tolerances, daily liquid volume tolerance, and fluid intake per meal.

The first weeks following the procedure can be a crucial time where patients can be going through a tough period, having come to terms with changing eating behaviors, distress about uncertainty of the outcome, and not yet seeing improvement. These following weeks, in particular, will be dominated by the caretakers’ physical and psychological symptoms of slow stomach emptying and their distress. The improvement in emotional and physical symptoms that correlate with the Botox injection treatment becomes apparent after several weeks. Typically, the earliest possible time for improvement is 4 to 6 weeks, with maximal improvement (if successful) in 8 to 12 weeks. The patient should be advised of this when discussing any intervention with Botox A. Any successful medical treatment of gastroparesis necessitates regular follow-up with your physician, generally in 4 to 8 weeks after treatment with repeat gastric emptying study. This may be more frequent initially if the patient has been hospitalized. A therapeutic trial of the progress of ability to take in an oral diet, amount and diversity of foods, as well as follow-up blood tests, should be tracked to support clinical improvement. In addition, current medications may need to be adjusted with de-escalation.