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Foregut motor function in chronic renal failure
A M Ravelli1, S E Ledermann, W M Bisset
1Medical Unit, Institute of Child Health, London.
Insights
Children with chronic renal failure (CRF) often experience anorexia and vomiting due to foregut motility disorders. These issues, including reflux and delayed gastric emptying, are linked to CRF
Area of Science:
- Pediatric Nephrology
- Gastroenterology
- Physiology
Background:
- Anorexia, nausea, and vomiting are common in children with chronic renal failure (CRF).
- The underlying mechanisms for these symptoms in pediatric CRF patients remain poorly understood.
- Foregut motility disorders are suspected contributors to these gastrointestinal issues.
Purpose of the Study:
- To investigate esophageal and gastric motor function in children with severe CRF experiencing anorexia and vomiting.
- To identify specific motility abnormalities contributing to gastrointestinal symptoms in this population.
- To explore the relationship between CRF and foregut motor function.
Main Methods:
- Studied 12 children (7 months-6.8 years) with severe CRF not on dialysis, presenting with anorexia and vomiting.
- Assessed gastro-oesophageal reflux using reflux index.
- Measured gastric emptying times (T1/2) for glucose and milk meals.
- Analyzed gastric antral electrical control activity.
- Measured fasting serum gastrin concentrations.
Main Results:
- Eight of 12 patients exhibited significant gastro-oesophageal reflux (mean reflux index 11.3%).
- Seven of 10 patients showed altered gastric half emptying times for glucose and milk.
- Gastric antral electrical control activity was abnormal in 6/11 patients, indicating gastric dysrhythmias.
- Fasting serum gastrin concentrations were elevated in 7/9 patients (mean 168 pmol/l).
- All studied CRF patients presented with at least one foregut motility disorder.
Conclusions:
- Children with chronic renal failure and persistent anorexia/vomiting exhibit significant foregut motility disorders.
- Observed abnormalities include gastro-oesophageal reflux, delayed gastric emptying, and gastric dysrhythmias.
- Elevated serum gastrin levels and the variety of motor disorders suggest that the CRF environment impacts foregut smooth muscle function.
Abstract:
In children with chronic renal failure (CRF) anorexia, nausea, and vomiting are common yet poorly understood symptoms. We studied oesophageal and gastric motor function in 12 children (age 7 months-6.8 years) with severe CRF not undergoing dialysis who had persistent anorexia and vomiting. Eight of 12 patients had significant gastro-oesophageal reflux (reflux index 5.2% to 21.9%, mean 11.3%; controls < 5%), 7/10 had altered gastric half emptying times (T1/2) for 5% glucose or milk (glucose meal--controls: 8-14 min, two CRF patients: 18-25 min; milk meal--controls: 48-72 min, five CRF patients 27, 28, 82, 83, and 110 min). Gastric antral electrical control activity was abnormal in 6/11 patients, with different types of gastric dysrhythmias whereas the remainder and controls showed a regular dominant frequency of 0.05 Hz. In 7/9 patients fasting serum gastrin concentration was raised (53 to > 400, mean 168 pmol/l, controls < 40 pmol/l). All CRF patients with anorexia and vomiting had one or more disorder of foregut motility. The nature and variety of the motor disorders and the raised concentrations of circulating gastrin suggest that the normal environment generated by CRF affects the function of the smooth muscle of the foregut.