Abstract

Impairment of both autonimic & voluntary neuromuscular transmission due to C. botulinum toxin in infants is recognized. Abnormalities of gastrointestinal motility in cases of infant botulism have been identified, but not fully defined. Four infants (ages: 5-9 mos.) with documented botulism (Type A:2, Type B:2) were evaluated for disordered esophageal, rectal, & colonic motility. Esophageal manometrics documented normal lower esophageal sphincter pressures (x:24 mm Hg; N:20-35) and relaxation. Distal (smooth muscle) peristalsis was normal, but proximal (striated muscle) peristalsis was absent in all patients. In addition, upper esophageal sphincter achalasia was documented in each. The resolution of the proximal esophageal dismotility was associated with overall clinical improvement and return of skeletal muscle strength. Rectal-colonic manometrics revealed low anal pressure profiles (x:45 mm Hg; N:80-120) with normal internal sphincter relaxation; 2/4 patients exhibited delayed return of resting pressures. Colonic EMG slow waves were observed with a frequency of 3-4 cycles/minute. Colonic spike bursts were observed, but not correlated with intraluminal pressure changes during the acute stage. Significant dismotility of the proximal esophagus is present during the acute phase of infant botulism and contributes to the dysphagia observed clinically. Disordered intraluminal colonic motility may account for the frequent observation of constipation, as rectal sphincter reflexes are preserved.

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