The Role of Pyridostigmine in Pediatric Motility Disorders

Abstract

Background: Gastrointestinal (GI) motility disorders are common in children. Treatment is challenging with limited medical and surgical options. Pyridostigmine, acetyl cholinesterase inhibitor, increases acetylcholine at the neuromuscular junction promoting intestinal contractions. Little is known about pyridostigmine role and dosing in pediatric GI motility disorders. Methods: Case series of children with GI dysmotility managed with oral Pyridostigmine. Patients' diagnoses include chronic intestinal pseudo-obstruction, gastroparesis with delayed small intestinal transit, chronic constipation with failure to thrive, and prolonged ileus after pelvic surgery with chronic opioid use (note attached table for details). Results: Pyridostigmine was effective and safe in all cases. Pyridostigmine decreased abdominal distention, increased bowel movements frequency, and improved enteral feeding tolerance. Effective dosing ranged between 0.25-2.0 mg/kg/day. Conclusion: We found oral pyridostigmine to be helpful in children with different GI motility problems. Pyridostigmine should be considered in such patients when other treatment interventions have not been beneficial.Figure: Upright film in 11 yo with pelvic sarcoma. Air fluid levels suggestive of ileus or partial obstruction.Figure: ADM in 18 years old with CIPO. MMC activity with low amplitude retrograde contractions.Figure: Significant abdominal distention on coronal CT image in a 7 year old patient with failure to thrive, abdominal distention, and constipation.Table: Table. Summary of cases treated with pyridostigmine