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"Antral dysmotility". An unrecognized cause of chronic vomiting during infancy
Insights
Infants with chronic vomiting may have a motility disorder causing delayed gastric emptying, not just reflux. Treatment involves feeding changes, therapy, or pyloroplasty for symptom relief.
Area of Science:
- Pediatric Gastroenterology
- Motility Disorders
Background:
- Chronic nonbilious vomiting in infants is a common clinical presentation.
- Gastroesophageal reflux is often suspected, but other causes need consideration.
Purpose of the Study:
- To evaluate infants with chronic nonbilious vomiting for underlying causes beyond simple gastroesophageal reflux.
- To identify a potential motility disorder affecting gastric emptying.
Main Methods:
- Evaluated ten infants (<9 months) with chronic nonbilious vomiting.
- Utilized upper gastrointestinal series, manometric studies, and esophageal pH monitoring.
- Assessed response to medical management and surgical intervention (pyloroplasty).
Main Results:
- All infants showed delayed gastric emptying, funnel-shaped antrum, and absent antral peristalsis.
- Lower esophageal sphincter pressures were normal or elevated; pH probes were mostly negative.
- Medical management succeeded in 6/10 infants; 4 required pyloroplasty.
Conclusions:
- Delayed gastric emptying in these infants likely stems from a primary antral motility disorder.
- Distinguishing this from gastroesophageal reflux prevents misdiagnosis and inappropriate surgery.
- Pyloroplasty is effective for refractory cases, leading to symptom resolution and weight gain.
Abstract:
Ten infants who were less than nine months of age and had chronic nonbilious vomiting were evaluated for gastroesophageal reflux. Upper gastrointestinal series in all showed delayed gastric emptying, a funnel-shaped antrum, absent antral peristalsis, and gastroesophageal reflux. None had evidence of anatomic obstruction in the stomach or duodenum. Manometric studies of the esophagus revealed either normal (4 patients) or elevated (6 patients) lower esophageal sphincter pressures. One-hour esophageal pH probe tests were negative in seven of the ten infants. This obstruction to gastric emptying appears to represent a disorder of antral motility. Medical management, which consisted of small frequent feedings and postural therapy, was successful in six of the infants. The remaining four patients required pyloroplasty. All of the infants are now asymptomatic and gaining weight at either a normal or accelerated rate for their ages. Familiarity with this previously undescribed disorder should prevent the incorrect diagnosis of gastroesophageal reflux secondary to lower esophageal sphincter incompetence and the resulting inappropriate surgical reconstruction.