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Antroduodenal motility in children with chronic intestinal pseudo-obstruction
P E Hyman1, S V McDiarmid, J Napolitano
1Department of Pediatrics, Harbor-UCLA Medical Center, Torrance 90509.
Insights
This study shows that antroduodenal manometry effectively diagnoses chronic intestinal pseudo-obstruction in children. The prokinetic drug cisapride was found to stimulate duodenal contractions, offering potential treatment for this condition.
Area of Science:
- Gastroenterology
- Pediatric Motility Disorders
- Pharmacology
Background:
- Chronic intestinal pseudo-obstruction (CIPO) presents as intestinal obstruction without mechanical blockage.
- CIPO is a complex condition affecting children, necessitating accurate diagnostic methods.
- Understanding antroduodenal motility is crucial for diagnosing and managing CIPO.
Purpose of the Study:
- To characterize antroduodenal motility patterns in children diagnosed with CIPO.
- To evaluate the efficacy of cisapride in stimulating postprandial duodenal contractions in these patients.
Main Methods:
- Antroduodenal manometry was performed on 13 children with CIPO.
- Diagnosis was confirmed via radiography, surgery, and pathological findings.
- The effect of cisapride on proximal duodenal contractions was assessed postprandially.
Main Results:
- All 13 children exhibited abnormal antroduodenal motility.
- Distinct motility patterns were identified, including hypomotility, absent migrating motor complexes, and myopathic or neuropathic varieties.
- Cisapride stimulated postprandial duodenal contractions in 9 out of 10 tested patients.
Conclusions:
- Antroduodenal manometry is a valuable tool for characterizing CIPO in children.
- Cisapride demonstrates potential as a prokinetic agent, stimulating duodenal contractions in CIPO patients.
Abstract:
Chronic intestinal pseudo-obstruction describes a heterogeneous group of disorders characterized by signs and symptoms of intestinal obstruction in the absence of a mechanical lesion. We studied antroduodenal motility in 13 children with pseudo-obstruction. The diagnosis was based on radiographic evidence in all, surgery in 11, and specific pathologic features in four. Antroduodenal motility was abnormal in all 13. Qualitative abnormalities in the patterns of antroduodenal contractions permitted separation into groups: (1) postprandial hypomotility (n = 3), (2) absent migrating motor complexes, with phase 3-like activity at the start of meals (neuropathic variety) (n = 5) (3) very low amplitude or absent contractions (myopathic variety) (n = 2); the remaining patients (n = 3) had other distinctive abnormalities. Cisapride, a new gastrointestinal prokinetic drug, stimulated proximal duodenal contractions in the 30 minutes after a meal in nine of 10 patients tested. These studies indicate that antroduodenal manometry is useful for characterizing intestinal pseudo-obstruction, and cisapride stimulates postprandial duodenal contractions in patients with pseudo-obstruction.