Initial therapy for patients with gastroparesis often centers on dietary changes and pharmacotherapy. If first-line therapy proves ineffective, we appear to lack a broad selection of treatment options for patients with refractory gastroparesis. Some small studies have explored the idea that botulinum toxin could be valuable in this situation. What are its proposed mechanisms of action, and what is the current thinking on its efficacy? Host Dr. Charles Turck evaluates the evidence with Dr. Evelyn Hermes-DeSantis, director of the Drug Information Service at Robert Wood Johnson University Hospital in New Brunswick, New Jersey, and a clinical associate professor at the Ernest Mario School of Pharmacy at Rutgers, the State University of New Jersey.