Botulinum toxin eases swallowing problems

NEW YORK (Reuters Health) - Swallowing difficulties experienced by some people with nerve damage resulting from diabetes can be relieved by injections of botulinum toxin, better known as Botox, Italian doctors report.

"We believe that botulinum toxin may be a first-line intervention" in such cases, Dr. Damiano Gullo told Reuters Health.

Gullo, from the Garibaldi Hospital in Catania, and his colleagues assessed the safety and efficacy of botulinum toxin injected into the upper sphincter of the esophagus in 12 people with type 2 diabetes who had severe swallowing impairment.

A single injection completely resolved the problem for 10 patients while the other two were significantly improved, the team reports in the medical journal Diabetes Care.

The beneficial effect of the injection appeared within a week in all patients and lasted up to 12 weeks, the results indicate.

By 24 weeks, all the patients had a return of swallowing problems, but with a repeat injection they all had another good improvement. Treatments thereafter were given every 3 to 4 months, depending on the response of each patient.

The report indicates that the treatment was well tolerated, with no relevant side effects.

Botulinum toxin injections "can be performed in an outpatient clinic, needing neither hospitalization nor anesthesia," the investigators point out. "It can be repeated when the symptoms reappear, retains the same efficacy, and requires no specific follow-up."

The team has found the treatment helpful for people with swallowing problems related to other disorders, Dr. Gullo said. "We intend to further investigate the use of botulinum toxin for (swallowing problems) associated with other neurological disorders such as stroke and multiple sclerosis."

SOURCE: Diabetes Care, December 2006.