Diabetes Swallowing Difficulties (Dysphagia) With Neurological Disorders Might be Treated by Botulinum Toxin
The swallowing tract extends from the mouth to the stomach. The act of swallowing is divided into three phases:
- The oral or mouth phase -- moving food or liquid into the throat.
- The pharyngeal or throat phase -- squeezing food down the throat and closing the airway to prevent choking.
- The esophageal phase -- relaxing and tightening the openings at the top and bottom of the esophagus and squeezing food through the esophagus into the stomach.
Swallowing problems (dysphagia) can be grouped into two categories:
Oropharyngeal dysphagia - These swallowing problems happen before food reaches the esophagus and may result from neuromuscular disease or obstructions. Patients experience difficulty starting a swallow; food goes down the wrong pipe; or there is choking and coughing.
Esophageal dysphagia - These swallowing problems originate in the esophagus. Food or liquids "stick" in the chest or throat and sometimes come back up.
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."
It is noted that botulism-causing Clostridium botulinum bacteria and their spores are everywhere. Prevalent in soil and marine sediments worldwide, their spores are often found on the surfaces of fruits and vegetables, and in seafood. The bacteria and spores themselves are harmless; the dangerous substance is the toxin produced by the bacteria when they grow. There are seven varieties of botulinum toxin.
Once in the body, the toxin binds to nerve endings at the point where the nerves join muscles. This prevents the nerves from signaling the muscles to contract. The result is weakness and paralysis that descends from the cranium down, affecting, among other things, the muscles that regulate breathing.This bacterial toxin that can paralyze and kill if consumed in contaminated food is now safely used, in a purified form, as a medicine to control certain conditions marked by involuntary muscle contractions.