24 GASTROINTESTINAL (GI) MOTILITY, DUODENOGASTRIC REFLUX (DGR) AND GASTRIC EMPTYING (GE) IN CHILDREN WITH CHRONIC VOMITING

Abstract

We evaluated GI motility by means of a perfused catheter system, DGR, as assessed by Bile Salts (BS) output in gastric aspirates, and GE of a milk labeled formula (% of emptying at 1 hr) in 11 patients (pts) with unexplained chronic vomiting. (Apts), in 8 pts with protracted gastroesophageal reflux (GER) disease (Bpts) and in 7 symptomatic controls (Cpts). Mean ± SD age (months) was respectively 44.2±37.7, 18.1±11.2, 20.4±14.4. In 9 Apts and 5 Bpts we found GI manometric abnormalities none of which were seen in Cpts: a) fasting and/or fed antral (and/or duodenal) hypomotility; b) abnormal propagation or configuration of interdigestive motor complexes (IMC); c) bursts of non propagated duodenal or jejunal motility; d) sustained fasting and/or fed phasic activity incoordinated with adjacent gut segments. Both A and B pts had BS fasting recovery significantly higher than Cpts during the various phases of IMC (mean group values (mg/ml): 1.52 (A), 1.12 (B), 0.36 (C), p < 0.05) and a significant delay of GE (A: 32.8±8.9%; B: 34.4±9.8%) as compared to Cpts (64.5±5.3%, p< 0.05, mean±SD). Highest degrees of gastric BS output and of delayed GE were associated with the most marked GI motility dysfunctions in both A and B pts. Conclusions: 1) children with chronic unexplained vomiting may exhibit, at GI manometry, disordered gut motility patterns; 2) the latter seem to be associated with increased DGR and delayed GE; 3) severe GER disease shows diffuse dysmotllity of upper GI tract.