Treatment with a poison lets woman eat again

February 02, 1993|By Jonathan Bor | Jonathan Bor,Staff Writer

Luretta Purse never imagined the answer to a throat condition that caused her to shed 52 pounds and constantly pine for food would be one of the world's most potent toxins -- the kind associated with botulism poisoning.

Nor, given the life-altering benefits of the treatments, does she care. "It's been a miracle -- I can eat!" Mrs. Purse, of Seaford, Del., said yesterday at the Johns Hopkins Hospital.

Mrs. Purse wasn't about to temper her enthusiasm for the treatment that relieved a rare swallowing disorder called acalasia, which caused food to back up in her esophagus rather than drop into her stomach.

Last June, gastroenterologist Pankaj J. Pasricha passed a tube down her throat and injected botulinum toxin into a ringlike muscle at the base of her esophagus. Since then, she has regained 35 poundsand rediscovered what she unabashedly calls her love of eating.

"She was a mere shell of what you see today," said Dr. Pasricha, who appeared with Mrs. Purse to announce the results of a trial involving seven patients -- all of whom improved dramatically.

Acalasia is caused by the abnormal tightening of the muscle, known as the lower esophageal sphincter, which functions as a gateway to the stomach.

Normally, this muscle relaxes to allow food to enter. When it remains constricted, food has nowhere to go but up.

The disorder, which is not hereditary, afflicts one in 10,000 people.

So sick was Mrs. Purse, 72, that she could hardly eat anything without vomiting, and got used to sleeping with a trash basket beside her bed.

She lived with the condition for over two years, dropping from 150 to 98 pounds and suffering from a constant hunger. A doctor in Salisbury tried the conventional approach of stretching the muscle with an inflatable balloon, but that did no good.

Last June, he referred her to Hopkins, where Dr. Pasricha was giving experimental injections of the botulinum toxin. The toxin is produced by bacteria that grows in improperly canned or preserved food, and causes death in about 70 percent of food poisonings that go untreated.

In recent years, the toxin has shed its all-bad image as physicians have found it can relieve a variety of conditions that have one thing in common: abnormal muscle constrictions known as spasms.

Just as heavy doses of botulinum can cause fatal paralysis of the respiratory muscles, low doses can safely relieve spasms of the shoulders, eyelids and facial muscles, doctors have discovered. In one particularly impressive treatment, the toxin has been used to relax the vocal cords -- ending spasms that can make it impossible to speak.

But Dr. Pasricha's treatment represents the first use of botulinum on "smooth" or involuntary muscles. Previous treatments have targeted the voluntary muscles -- those that do their work with some conscious thought on the person's part.

Following treatment, he said, all seven patients were able to eat again -- although one needed two injections to bring about a complete recovery.

"All our patients have shown a clinical improvement and been able to go back to their normal diet," Dr. Pasricha said.

There were no side effects, he added, because the doses were lower than the levels that cause poisonings. Results were published in the current issue of Lancet, a British medical journal.

The injections are given internally, by passing a tube known as an endoscope into the esophagus. The instrument contains a fiber-optic device that allows doctors to see what they are doing, and a long needle which delivers the injection.

Dr. Pasricha said it is too soon to tell whether patients will need a repeat injection of the toxin.

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