Related Experiment Videos
Antroduodenal manometry in children and adults with severe non-ulcer dyspepsia
C Di Lorenzo1, P E Hyman, A F Flores
1Dept. of Pediatrics, Harbor-UCLA Medical Center.
Insights
Childhood nonulcer dyspepsia shares similar signs, symptoms, and manometric abnormalities with adult cases. These findings suggest a spectrum of enteric neuromuscular diseases, including chronic intestinal pseudo-obstruction.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Motility Disorders
- Neuromuscular Diseases of the Gut
Background:
- Nonulcer dyspepsia is a prevalent condition in adults, with recent recognition in pediatric populations.
- Understanding childhood nonulcer dyspepsia is crucial due to its increasing diagnosis.
Purpose of the Study:
- To compare the clinical presentation and gastrointestinal motility in children and adults with severe nonulcer dyspepsia.
- To investigate potential underlying enteric neuromuscular abnormalities in pediatric nonulcer dyspepsia.
Main Methods:
- A comparative study involving 34 children and 35 adults diagnosed with severe nonulcer dyspepsia.
- Assessment included clinical signs and symptoms, esophageal manometry, and antroduodenal manometry to evaluate gut motility.
- Specific focus on the presence of neuropathy, myopathy, and the migrating motor complex (MMC).
Main Results:
- Similarities observed in signs and symptoms between pediatric and adult cohorts.
- A significantly higher proportion of children (29%) required tube feedings compared to adults (3%).
- Antroduodenal manometry revealed abnormalities suggestive of neuropathy in both groups, with reduced phase 3 of the migrating motor complex noted more frequently in adults.
Conclusions:
- Childhood nonulcer dyspepsia exhibits comparable clinical and manometric features to adult nonulcer dyspepsia.
- Manometric findings align with those seen in chronic intestinal pseudo-obstruction, indicating a potential continuum of enteric neuromuscular diseases.
- These results highlight the importance of investigating neuromuscular function in pediatric nonulcer dyspepsia.
Background:
Nonulcer dyspepsia is common in adults but has been recognized only recently in children.
Methods:
We compared signs, symptoms, and antroduodenal motility findings in 34 children and 35 adults with severe nonulcer dyspepsia.
Results:
Symptoms and signs were similar in the two groups. Ten children (29%) and one adult (3%) required tube feedings (p = 0.01). Abdominal surgery had been performed on 6 of 34 (18%) children and 18 of 35 adults (51%) (p < 0.01), without relief of symptoms. Esophageal manometry was abnormal in 5 of 23 (22%) children and 6 of 31 (19%) adults. Antroduodenal manometry was suggestive of neuropathy in 25 children and 26 adults and of myopathy in 3 children and 2 adults. Absence of phase 3 of the migrating motor complex was found in 4 children and 17 adults (p = 0.01). Antroduodenal manometry was normal in six children and seven adults.
Conclusion:
Signs, symptoms, and discrete manometric abnormalities of childhood nonulcer dyspepsia resembled those of adult nonulcer dyspepsia. Manometric findings in nonulcer dyspepsia resembled those reported in chronic intestinal pseudo-obstruction, suggesting that these conditions are on a continuum of enteric neuromuscular diseases.