Gastrointestinal Motility Abnormalities Research Articles

Abnormalities in gastrointestinal motility are associated with diseases of oxidative phosphorylation in children

Objective Disorders of the mitochondrial electron transport chain enzymes of oxidative phosphorylation (OXPHOS) have neurologic, musculoskeletal, ophthalmologic, cardiac, and GI manifestations. Many adult and pediatric patients with disorders of OXPHOS have abnormalities in intestinal motility. The purpose of this study was to describe pediatric patients who initially presented with signs of GI dysmotility and were later evaluated and found to have a disorder of OXPHOS. Methods Data were collected on six patients, including initial GI and neurologic symptoms, histology of skeletal muscle biopsies, mitochondrial DNA mutational analysis, OXPHOS enzyme assay, upper GI barium imaging, technetium-99M liquid gastric emptying scan, upper GI endoscopy, esophageal manometry, and antroduodenal manometry. Results All six children presented with symptoms of GI dysmotility within 2 wk of life. Patients later developed symptoms of neurologic disorders. All patients had abnormalities in OXPHOS enzyme analysis. Muscle histology showed nonspecific changes with no ragged red fibers. Sequencing of the mitochondrial DNA showed no recognized mutations. No patient had any evidence of intestinal obstruction or malrotation by upper GI barium imaging. Four patients had delayed gastric emptying. Three patients had endoscopic and histologic evidence of esophagitis. All six had demonstrable neuropathic abnormalities by antroduodenal manometry, including the following: nonpropagated antral bursts, absent migrating motor complexes, postprandial antral hypomotility, retrograde migrating motor complexes, and tonic contractions with the migrating motor complex. Conclusion Abnormalities in GI motility may be an early presenting sign of disorders of OXPHOS in children.

Role of electrogastrography in detecting motility disorders in children affected by chronic intestinal pseudo-obstruction and Crohn's disease.

Gastrointestinal motility disorders are frequently found in several pathologies. The aim of this study was to assess, by means of electrogastrography, the presence of gastrointestinal motility abnormalities in children affected by Crohn's disease (CD) or Chronic Intestinal Pseudo-Obstruction (CIPO). Patients and Methods. We studied 34 subjects; 20 control subjects (M = 15, mean age = 10 +/- 3.5 yrs), 8 patients (M = 4, mean age = 18 +/- 7 yrs) with Crohn's disease in a quiescent phase and 6 patients (M = 6, mean age = 10 +/- 3.5 yrs) with Chronic Intestinal Pseudo-Obstruction. Results. Analysis of gastric electrical activity (GEA) parameters demonstrated that in the control group physiological post-prandial changes are represented by an increase of 3 Cycles Per Minute (3 CPM) activity, Period Dominant Power (PDP) and Period Dominant Frequency (PDF) and by the reduction of bradygastria. Crohn patients showed an insignificant increase of 3 CPM and PDP; CIPO patients showed an abnormal variation of 3 CPM, PDP and post-prandial bradygastria. Moreover, CD patients showed a significant difference in post-prandial values of PDP compared to normal subjects. CIPO patients revealed a significant difference in the values of either preprandial PDF with tachygastria or the post-prandial value of 3 CPM, compared to normal subjects. Conclusions. EEG is a non-invasive method to study gut motility related to GEA alterations present in CIPO as well as in CD patients.

Long-Term Response to Subtotal Colectomy in Colonic Inertia

The purpose of this study was to determine the long-term outcome of patients who had previously undergone subtotal colectomy for severe idiopathic constipation at the University of Florida between 1983 and 1987. In addition, we aimed to determine whether preoperative motility abnormalities of the upper gastrointestinal tract are more common among those patients who have significant postoperative complications after subtotal colectomy. We evaluated 13 patients who underwent subtotal colectomy for refractory constipation between 1983 and 1987 at the University of Florida. Preoperatively, all patients exhibited a pattern consistent with colonic inertia as demonstrated by means of radiopaque markers. Each patient was asked to quantitate the pain intensity and frequency of their bowel movements before and after surgery. In seven patients an ileosigmoid anastomosis was performed, whereas in six patients an ileorectal anastomosis was used. Abdominal pain decreased after subtotal colectomy. Patients with abnormal upper gastrointestinal motility preoperatively experienced greater postoperative pain than those with normal motility regardless of the type of anastomosis. In addition, the number of postoperative surgeries was similar in those patients with abnormal upper motility compared to those with normal motility. Overall, the total number of bowel movements per week increased from 0.5 ± 0.03 preoperatively to 15 ± 4.5 ( P < 0.007) postoperatively. The results of our study suggest that patients with isolated colonic inertia have a better long-term outcome from subtotal colectomy than patients with additional upper gastrointestinal motility abnormalities associated with their colonic inertia. ( J Gastrointest Surg 2002;6:738–744)

Metabolic Consequences and Bowel Dysfunction in Continent Urinary Diversion

Different segments of the gastrointestinal (GI) tract are commonly used in urologic surgery as a conduit or as a reservoir to replace the bladder. Evidence shows, however, that even after many years, the redeployed bowel segment still retains its secretory and absorptive functions. Therefore, when the bowel is placed in contact with the urine, it may result in numerous metabolic abnormalities. Metabolic complications include (1 electrolyte abnormalities, (2) altered sensorium, (3) abnormal drug metabolism, (4) bone disease, (5) growth retardation, (6) persistent and recurrent infections, and (7) formation of renal and reservoir calculi. Removal of a portion of the GI tract for urologic reconstruction may also interfere with normal GI function. This includes GI motility abnormalities and GI malabsorptive complications. Finally, there is evidence that juxtaposition of GI and genitourinary (GU) tissue in the presence of urine increases the risk of urothelial/intestinal malignancies.

Abnormalities in gastrointestinal motility as a presentation of diseases of oxidative phosphorylation in children

Abnormalities in gastrointestinal motility as a presentation of diseases of oxidative phosphorylation in children

Abnormalities in gastrointestinal motility as a presentation of diseases of oxidative phosphorylation in children

Abnormalities in gastrointestinal motility as a presentation of diseases of oxidative phosphorylation in children

Gastric Myoelectric Activity in Patients with End-Stage Liver Disease

Background: Abnormalities of gastrointestinal motility and transit time have been reported in association with end-stage liver disease. Motility abnormalities could be routinely studied if a simple noninvasive test were available. The electrogastrogram is a cutaneous measure of gastric myoelectric activity and correlates well with serosal recordings of gastric myoelectric activity. The aim of this study was to evaluate gastric myoelectric activity in patients with end-stage liver disease. Methods: Fourteen patients with end-stage liver disease had gastric myoelectric activity measured with the electrogastrogram. An electrogastrogram was considered abnormal when normal gastric slow waves were seen less than 70% of the time or there was no increase in the electrogastrogram amplitude after a meal. Results: Abnormal electrogastrograms were present in 8 of 14 (57%) end-stage liver disease patients. Conclusions: Abnormal gastric myoelectric activity is common in end-stage liver disease.

Advances in the diagnosis and treatment of gastroesophageal reflux disease.

Pathophysiology and treatment of gastroesophageal reflux (GER) in children have often been extrapolated from studies in adult patients. Fortunately, many groups are now addressing GER specifically in relation to children. Abnormalities in gastrointestinal motility are described in gastroesophageal reflux GER, and there are several new studies looking at this issue in infantile GER. An international working group has put together recommendations for management of infantile GER. The results of a large pediatric study using omeprazole and a review of the use of the prokinetic cisapride in pediatrics are summarized. Several papers review recent experiences with laparoscopic fundoplication. New diagnostic modalities used to investigate GER in infants and children are discussed. These studies aid in both our understanding of possible pathogenesis of GER as well as treatment of the young patient with GER.

Gastric myoelectrical activity and gastrointestinal motility in patients with functional dyspepsia.

The aim of our study was to examine the prevalence of gastric myoelectrical disturbances in relation to gastrointestinal motility abnormalities in patients with functional dyspepsia, using simultaneous electrogastrography and antroduodenojejunal manometry. We carried out electrogastrography in 20 patients with functional dyspepsia and in 20 healthy volunteers. In 10 of these patients and in 10 of the volunteers antroduodenojejunal manometry was performed simultaneously. Apart from a higher postprandial power content of the 3 cycles per minute (cpm) component in the patients (1263 +/- 317 and 393 +/- 101 microV2, respectively; P = 0.016), no differences in the electrogastrographic variables were found between the groups. In the manometric part of the study, postprandial antral hypoactivity was not a prominent finding. Instead, small intestinal hyperactivity was found in the dyspeptic patients, with both a higher frequency and amplitude of the contractions (P < 0.05). This hyperactivity often consisted of bursts, which were significantly more frequent in patients than in control subjects (total duration of burst activity 25.6 +/- 6.4 and 6.0 +/- 1.7 min, respectively; P = 0.013). A positive correlation was found between the frequency of the gastric electrical control activity and the antral contraction frequency (P = 0.006), between the power content of the electrographic signal and the antral contraction amplitude (P = 0.025), and between the postprandial/fasting electrographic power ratio and the antral motility index (P = 0.007). In conclusion, gastric myoelectrical activity is minimally disturbed in patients with functional dyspepsia. Motor abnormalities, especially small intestinal hyperactivity, are more likely to play a prominent role in the genesis of dyspeptic symptoms.

Abnormalities of gastrointestinal motility in children with nonulcer dyspepsia and in children with gastroesophageal reflux disease

In 11 children (mean age 44.2 months) with symptoms suggesting upper intestinal dysfunction (nonulcer dyspepsia), in nine children (mean age 27.3 months) with gastroesophageal reflux (GER) disease, and in seven controls (mean age 20.4 months) we investigated fasting [for 3 hr or until two migrating motor complexes (MMC) were observed] and fed (90 min) antroduodenal motility by means of perfused catheter system; furthermore, we measured both gastric emptying of a radiolabeled milk formula and fasting duodenogastric reflux during manometry by assessing bile salt concentration in gastric aspirates. No structural abnormalities of gastrointestinal tract and organic disorders were detected in the patients. In a high proportion of both groups of patients we found manometric abnormalities of interdigestive and fed motor patterns that were not seen in the controls: absence of antral phase III of MMC; significant decrease of antral and/or duodenal motor activity during fasting and/or fed periods; abnormal propagation or configuration of MMC phase III that was significantly shorter than in controls; bursts of sustained fasting and/or fed phasic duodenal activity, frequently uncoordinated with adjacent gut segments. When compared to controls, the mean intragastric concentration of bile salts during all MMC phases and the mean 1-hr percent gastric activity of the radiolabeled milk were significantly higher in the two groups of patients. We conclude that in a high proportion of children with nonulcer dyspepsia and of children with GER disease, gastrointestinal manometry may reveal significant irregularities of antral and duodenal motility, which are associated with increased duodenogastric reflux and delayed gastric emptying.

Pupillary and Electroretinographic Abnormalities in a Family With Neuronal Intranuclear Hyaline Inclusion Disease

Abnormal pupillary function and a severely depressed electroretinogram were found in four members of a family with neuronal intranuclear hyaline inclusion disease, an idiopathic degenerative disorder that involves the central and peripheral nervous systems. Symptoms were limited to the gastrointestinal system and consisted principally of abdominal pain, constipation, and severe weight loss. The discovery of light-fixed pupils in the propositus led to the first antemortem diagnosis by rectal biopsy in two generations of this family. Abnormalities of gastrointestinal motility and pupillary reactions constituted the only objective evidence of autonomic dysfunction; the abnormal electroretinogram was the only evidence of central nervous system dysfunction.

DISORDERED ESOPHAGEAL, COLONIC, AND RECTAL MOTILITY IN INFANT BOTULISM

Impairment of both autonimic & voluntary neuromuscular transmission due to C. botulinum toxin in infants is recognized. Abnormalities of gastrointestinal motility in cases of infant botulism have been identified, but not fully defined. Four infants (ages: 5-9 mos.) with documented botulism (Type A:2, Type B:2) were evaluated for disordered esophageal, rectal, & colonic motility. Esophageal manometrics documented normal lower esophageal sphincter pressures (x:24 mm Hg; N:20-35) and relaxation. Distal (smooth muscle) peristalsis was normal, but proximal (striated muscle) peristalsis was absent in all patients. In addition, upper esophageal sphincter achalasia was documented in each. The resolution of the proximal esophageal dismotility was associated with overall clinical improvement and return of skeletal muscle strength. Rectal-colonic manometrics revealed low anal pressure profiles (x:45 mm Hg; N:80-120) with normal internal sphincter relaxation; 2/4 patients exhibited delayed return of resting pressures. Colonic EMG slow waves were observed with a frequency of 3-4 cycles/minute. Colonic spike bursts were observed, but not correlated with intraluminal pressure changes during the acute stage. Significant dismotility of the proximal esophagus is present during the acute phase of infant botulism and contributes to the dysphagia observed clinically. Disordered intraluminal colonic motility may account for the frequent observation of constipation, as rectal sphincter reflexes are preserved.

Laubry-Soulle Syndrome

To the Editor.— The Laubry-Soulle syndrome, a syndrome of abnormal collections of gas in the colon and stomach following acute myocardial infarction, was discussed by Palmer (230:1575, 1974). He pointed out that an explanation of this phenomenon had not been offered. Abnormal collections of gas within the gastrointestinal tract are well recognized to be associated with abnormalities of gastrointestinal motility. Stasis of gas and other intraluminal contents is generally considered to occur more commonly in gastrointestinal hypomotility rather than in hypermotility, disorders with generalized or localized ileus being the classic example. Recent investigations have shown that many of the gastrointestinal-released hormones affect gastrointestinal motility and may play a physiologic role in the regulation of gastrointestinal motility. 1,2 The question then arises as to the possible role of these hormones in the pathogenesis of this syndrome. With this in mind, it is of interest to note the recent report of Willerson