A prospective observational cohort study of pediatrics undergoing intrapyloric botulinum toxin injection (IPBI) for refractory nausea, vomiting, or feeding difficulties showed promising outcomes.

Although there are no prospective pediatric research, IPBI is utilized to mitigate nausea and vomiting in kids. Using endoluminal functional lumen imaging probe (EndoFLIP) as a biomarker of IPBI response, the effectiveness of IPBI was explored in children diagnosed with refractory nausea or vomiting.

Candidates filled out validated questionnaires prior to IPBI as well as 1, 2, and 3 months later. At the time of IPBI, a sample of candidates older than ten years underwent pyloric EndoFLIP. Pre- and post-IPBI symptoms were compared, and EndoFLIP measures were examined in connection to baseline traits and IPBI response. Notably, 23 of 45 patients (mean age 14.2 ± 6.0 years) who received IPBI also underwent EndoFLIP.

At the 1-month follow-up, 29 patients (64%) showed clinical improvement, including reductions in general gastrointestinal symptoms, nausea, vomiting, as well as pain during meals. Improvements in symptoms were noted to last up to three months. Despite no differences in EndoFLIP evaluations between IPBI  non-responders and responders, there was a trend towards lower pyloric distensibility in pediatrics with normal versus delayed gastric emptying (8.9 ± 6.6 mm2/mmHg in normal versus 4.5  ± 3.8 mm2/mmHg in delayed).

Most pediatric patients reacted favorably to IPBI, with notable reductions in discomfort, nauseousness, and vomiting. Although pyloric EndoFLIP did not anticipate IPBI response in this patient population, it did seem to identify baseline delays in stomach emptying.