Abnormalities of gastrointestinal motility in children with nonulcer dyspepsia and in children with gastroesophageal reflux disease (original) (raw)
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Functional dyspepsia, upper gastrointestinal symptoms, and transit in children
The Journal of Pediatrics, 2003
Objective To assess the prevalence of abnormal gastric emptying and small bowel transit in children with functional dyspepsia at a tertiary care center, and the relationship between abnormal gastric and small bowel transit and symptoms in pediatric patients with functional gastrointestinal disorders.
Gut, 1998
Background-Previous studies have failed to identify manometric patterns of gastrointestinal motor activity that can distinguish dyspepsia from health. Aims-To test the hypothesis that the combined use of prolonged, ambulatory, antrojejunal manometry and computer aided analysis in patients selected for the severity of their symptoms could reveal new insights into gastrointestinal motor activity in patients with severe motilitylike dyspesia Methods-Twenty four hour antrojejunal ambulatory manometry was performed in 14 patients and 10 healthy volunteers. Parameters characterising digestive and fasted motility were obtained by a validated computer program and visual analysis. Scoring systems quantified the degree of dysmotility as well as the severity of symptoms. Gastric emptying times were measured in each patient. Results-There was a high prevalence of antral and jejunal dysmotility both during the interdigestive period (71% of patients) and in the postprandial period (78%). During the interdigestive period there was a reduced incidence of antral and jejunal phases, a larger contribution of phase 2 during migrating motor complex cycles, and aberrant configuration of jejunal phase 3 in 29% of patients. Postprandially, the most frequent finding was antral (29% of patients) or jejunal (29%) hypomotility or hypermotility. Minute rhythm was present both during the postprandial (29% of patients) and the interdigestive period (21%). There was no positive correlation between symptom scores, gastric half emptying times, or motility scores. Conclusion-Even with the use of prolonged recordings and advanced computer aided analysis, it is not possible to identify a specific motor pattern which can discriminate patients with severe motility-like dyspepsia from those with other diseases or even healthy individuals. Clinical symptoms or gastric half emptying times are poor predictors of gastrointestinal dysmotility in patients with functional dyspepsia. (Gut 1998;42:235-242)
Gastric emptying and myoelectrical activity in children with nonulcer dyspepsia
Digestive Diseases and Sciences, 1995
We examined the effect of oral cisapride on gastric emptying time and myoelectrical activity using real-time ultrasonography and cutaneous electrogastrography in 10 children with nonulcer dyspepsia. A clear dominant frequency close to 3 cpm was present both at baseline and after eight weeks of cisapride. After cisapride, nine children had an increase in the normal slow wave percentage and the mean percentage of normal slow wave was significantly different (71.90 _+ 5.19% vs 79.16 _+ 5.54%; P < 0.01). Moreover, an increased stability of the dominant frequency, determined by computing the coefficient of variation before and after cisapride, was found (28.12 _+ 1.72% vs 23.61 _+ 3.47%; P < 0.01). At baseline the gastric emptying time, expressed as T1/2, was 139.76 _+ 40.04 min and at eight weeks 119.76 + 30.04 rain (P = 0.06). As regards the relationship between EGG and gastric emptying, the proportion of children with improved normal slow wave percentage was similar to that with improved T1/2 emptying (z = 0.57, P = 0.57). Thus, gastric electrical activity seems to be an important factor in the pathophysiology of nonulcer dyspepsia in children.
Esophageal motor abnormalities in children with gastroesophageal reflux and peptic esophagitis
The Journal of Pediatrics, 1986
Esophageal motility was studied in 26 children with gastroesophageal reflux. In 11 patients (group A), esophagitis was severe; in the remaining 15 (group B), either mild or no microscopic changes were found. Lower esophageal sphincter pressure and amplitude, as well as velocity and duration of esophageal pressure waves, were manometrlcally measured. All patients underwent a 12-week intensive antacid course. Manometric tracings, blindly read, were compared with those of 16 age-matched children with emesls without proven reflux (group C). Among the variables analyzed, amplitude of the motor waves was significantly lower in patients with severe esophagitis than in group B and C patients (P <0.01). Nonspecific motor defects (simultaneous, broad-based, double-peaked waves) were more commonly present in group A. At the end of therapy, symptoms had either disappeared or significantly improved. Endoscopic and histologic studies showed disappearance of the severe inflammatory changes. Manometry, repeated in patients with cured severe esophagitis, showed normalization of the amplitude and significant decrease of the nonspecific motility abnormalities. We conclude that severe gastroesophageal reflux disease In children causes esophageal motor dysfunction, resulting from esophageal inflammation. The occurrence of esophageal motility disorders only In patients wlth severe esophagitis and its disappearance after therapy may account for the favorable course of reflux disease in infancy. (J
From Newborn to Teenage; Gastroesophagıal Reflux
Journal of Academic Research in Medicine, 2015
Gastroesophageal reflux (GER) is characterized by the involuntary passage of gastric contents into the esophagus. GER disease is defined as a persistent or intermittent passage of gastric contents into the esophagus, which often results in overt clinical signs and symptoms and affects the quality of life. GER is a common disorder in childhood and has a good prognosis. GER in infancy begins within the first month of life, peaks at the 4 th month, and after the first year, it steadily decreases and finally resolves at the age of 2 years. GER physiologically occurs due to the relaxation of the lower esophageal sphincter, independent of swallowing. The mechanisms against GER include the following; 1. Lower esophageal sphincter dysfunction, 2. Clearance effect of esophagus, 3. Esophageal mucosal integrity, and 4. Gastric emptying, which prevent the development of GER disease. Although the physiopathology of GER is still not clearly established, proposed factors are genetic, environmental, anatomic, hormonal, and neurogenic. The most responsible factor is lower esophageal sphincter relaxations. The clinical signs of GER varies with age but commonly appear with gastrointestinal and respiratory symptoms. The diagnosis of GER disease is based on history, physical examination, esophageal pH monitoring, multichannel intraluminal impedance and esophageal manometry, motility examinations, endoscopy, biopsy, examinations with barium, and nuclear scintigraphy. Treatment of GER includes non-pharmacological and pharmacological therapies, such as prokinetic agents and acid suppressors. Surgical treatment indications are relatively limited.
Regional Gastrointestinal Motility in Healthy Children
Journal of Pediatric Gastroenterology and Nutrition, 2021
VS is co-owner of Motilis Medica SA. VS contributed with technical information for the protocols for the Danish Ethics Committee and the Danish Medicines Agency. During the study he was solely involved when technical issues arose with the equipment. All other authors have no conflicts of interest to disclose.