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Gastrointestinal myoelectric activity in an infant with congenital idiopathic motility disorder
E L Blank1, M Karaus, M Glicklich
1Department of Pediatrics, Medical College of Wisconsin, Milwaukee.
Insights
This study explored myoelectric activity in an infant with severe gastrointestinal issues. Despite clinical dysfunction, some normal myoelectric patterns were observed, alongside specific abnormalities like short migrating myoelectric complex periods.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Physiology
Background:
- Investigated myoelectric activity in an 8-month-old male with perinatal bowel obstruction, duodenal band, congenital short small intestine, and feeding intolerance.
- Surgical implantation of serosal electrodes on the stomach, duodenum, and jejunum was performed during Nissen fundoplication and ileostomy.
Observation:
- Spontaneous migrating myoelectric complexes (MMC) were present in the stomach and small intestine.
- Bethanechol increased electrical response activity (ERA) in the stomach and duodenum; morphine induced intense ERA and phase III activity.
- Pentagastrin infusion did not disrupt MMC cycling, while feeding disrupted it 30-40 minutes post-meal. Metoclopramide delayed this disruption.
Findings:
- In vitro studies of ileal muscle strips showed spontaneous contractions and electrical control activity (ECA).
- Bethanechol, McNeil A-343, motilin, and cholecystokinin induced contractions in vitro; pentagastrin had no effect.
- Abnormalities identified include a short MMC period, lack of pentagastrin-induced MMC disruption, and intermittent gastric arrhythmias postoperatively.
Implications:
- Despite significant clinical motility dysfunction, some normal physiological responses were observed.
- The study highlights specific myoelectric abnormalities in infants with complex gastrointestinal motility disorders.
- Findings contribute to understanding the complex interplay of factors affecting gastrointestinal motility in infants.
Abstract:
We investigated myoelectric activity in an 8-month-old male who presented with a perinatal bowel obstruction, duodenal band, congenital short small intestine, and persistent feeding intolerance. Serosal electrodes were surgically implanted on stomach, duodenum, and jejunum during Nissen fundoplication and ileostomy. A 5-cm ileal specimen was taken for in vitro studies. Spontaneous migrating myoelectric complexes (MMC) were present in stomach and small intestine. Bethanechol increased electrical response activity (ERA) in stomach and duodenum. Morphine induced intense ERA and distinct phase III activity. Pentagastrin infusion did not disrupt MMC cycling. Feeding disrupted MMC complex cycling 30-40 min after the meal. Metoclopramide before feeding delayed disruption of the MMC cycling after the feeding. Intermittent gastric arrhythmias were present after the fifth postoperative day. In vitro muscle strips showed spontaneous contractions and electrical control activity (ECA). Bethanechol, McNeil A-343, motilin, and cholecystokinin induced contractions, but pentagastrin had no effect. We conclude that in spite of a major clinical motility dysfunction, several of our findings were normal. The abnormalities include short MMC period, absence of disruption of MMC by pentagastrin, and gastric arrhythmias.