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Updated: Feb 16, 2026
Gastrointestinal Motility Monitor GIMM
Published on: December 1, 2010
Application of Pyridostigmine in Pediatric Gastrointestinal Motility Disorders: A Case Series
Mhd Louai Manini1, Michael Camilleri2, Rayna Grothe3
1Division of Pediatric Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. manini.mhd@mayo.edu.
Insights
Pyridostigmine is a safe and effective treatment for pediatric gastrointestinal (GI) motility disorders, improving symptoms like abdominal distention and feeding tolerance. This acetylcholinesterase inhibitor offers a new therapeutic option for children with GI dysmotility when other treatments fail.
Area of Science:
- Pediatric Gastroenterology
- Pharmacology
- Neurogastroenterology
Background:
- Gastrointestinal (GI) motility disorders present significant challenges in pediatric care.
- Limited effective medical and surgical interventions exist for these conditions.
- Pyridostigmine, an acetylcholinesterase inhibitor, enhances cholinergic neurotransmission, potentially improving GI motility.
Observation:
- A case series evaluated oral pyridostigmine in pediatric patients diagnosed with various GI dysmotilities.
- Conditions included chronic intestinal pseudo-obstruction, gastroparesis, chronic constipation with failure to thrive, and post-surgical ileus.
- Patients received pyridostigmine at doses ranging from 0.25-2.0 mg/kg/day.
Findings:
- Pyridostigmine demonstrated efficacy and safety across all treated pediatric cases.
- Observed benefits included reduced abdominal distention, increased bowel movement frequency, and enhanced enteral feeding tolerance.
- One patient experienced transient abdominal cramping, which resolved upon discontinuation of the medication.
Implications:
- Oral pyridostigmine presents a viable therapeutic option for pediatric GI motility disorders.
- This treatment should be considered for children unresponsive to conventional therapies.
- Further research into pyridostigmine's role and optimal dosing in pediatric populations is warranted.
Background:
Gastrointestinal (GI) motility disorders are common in children. Treatment is challenging with limited medical and surgical options. Pyridostigmine, an acetyl cholinesterase inhibitor, increases acetylcholine at the neuromuscular junction promoting intestinal contractions. Little is known about the role and dosing of pyridostigmine in pediatric GI motility disorders.
Methods:
We present a case series of children with GI dysmotility managed with oral pyridostigmine. Patients' diagnoses include chronic intestinal pseudo-obstruction, gastroparesis with delayed small bowel transit, chronic constipation with failure to thrive, and prolonged ileus after pelvic surgery with chronic opioid use.
Results:
Pyridostigmine was effective and safe in all cases. Pyridostigmine decreased abdominal distention, increased bowel movement frequency, and improved enteral feeding tolerance. Effective dosing ranged between 0.25-2.0 mg/kg/day. One patient experienced cramping abdominal pain while on pyridostigmine, but pain resolved after medication was discontinued.
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.
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