NON-INVASIVE ASSESSMENT OF GASTRIC MOTILITY AND GASTRIC EMPTYING IN VOMITING CHILDREN WITH DISORDERS OF THE CENTRAL NERVOUS SYSTEM.

Abstract

Vomiting and feeding problems are common in children with disorders of the central nervous system (CNS) and may be related to a disordered motility of the foregut. The conventional tools for assessing foregut motility are either invasive (e.g. pH monitoring and manometry) or very expensive and time-consuming (e.g. scintigraphy) and therefore they are not ideal for general use in neurologically handicapped infants and children. We studied gastroesophageal motor function in 50 vomiting patients with CNS disorders, 25 boys and 25 girls (age range: 4 months - 15.5 years), 38 with neurodevelopmental delay and 12 with spastic cerebral palsy. The novel non-invasive techniques of electrogastrography (EGG) and electrical impedance tomography (EIT) were used to investigate respectively the fasting and postprandial gastric antral electrical control activity that underlies antral contractions and the gastric emptying of a standard milk meal. In most cases, EGG and EIT were carried out simultaneously after an overnight fast at the bedside or while the patients were sitting in their wheelchairs. All tests were very well tolerated, and in some patients the tests were repeated after medical or surgical treatment. In 31 of 50 vomiting patients EGG detected abnormalities of gastric antral electrical control activity, with different dysrrhythmias: tachyarrhythmia at >5 cpm, bradyarrhythmia at <2 cpm, or unstable electrical activity where no dominant frequency could be detected (controls: 2.2 to 4.0 cpm). EIT showed that the gastric half-emptying time (T½) of a milk meal was delayed in 14 of 18 patients, 13 of whom also had a gastric dysrhythmia and 8 of whom also had gastroesophageal reflux. Gastric dysrryhtmias and/or delayed gastric emptying were also demonstrated in the majority (72%) of patients who had retching and postprandial discomfort following anti-reflux surgery. Furthermore, EIT showed evidence of gastroesophageal reflux in 12 of 13 patients who had reflux on pH monitoring. Being non-invasive, relatively cheap, portable and easy to use, EGG and EIT can be used for the routine assessment of gastrointestinal motility in infants and children with neurodevelopmental handicap. The informations they provide can help the carers to devise better nutritional and pharmacological strategies for the management of vomiting and feeding problems which are frequently encountered in these patients.