Botulinum toxin, one of the most powerfull biological toxins known, is not only a poison but also a therapeutic agent. Previously known as the cause of botulism - a serious and often fatal form of paralysis acquired through ingestion of contaminated food - the toxin has been found to be of value in the treatment of a variety of neurological and ophthalmological disorders associated with inappropriate muscular contractions or spasms [1]. Strabismus was the first syndrome for which therapy using local injection of botulinum toxin was introduced as an alternative to surgery [2]. Since then, botulinum toxin has also been used successfully for the treatment of other diseases involving involuntary muscle movements. These include blepharospasm, hemifacial spasm, spasmodic torticollis, oromandibular or lingual dystonia, focal dystonias of the hand, neurogenic bladder, and limb spasticity [1]. These disorders are all characterized by extensive efferent activity in cholinergic nerves.
In the past few years, botulinum toxin has been tested or used as therapeutic agent in a variety of gastroenterological disorders. The present article reviews the underlying rationale and the current indications for the use of botulinum toxin in gastroenterology.
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