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Overinterpretation of gastroduodenal motility studies: two cases involving Munchausen syndrome by proxy
H I Baron1, D C Beck, J H Vargas
1Department of Pediatrics, University of California at Los Angeles Center for the Health Sciences.
Abstract:
Two children were thought to have an atypical gastroduodenal motility disorder because of the history and clinical course; both had received parenteral alimentation because of claims of inability to tolerate enteral feedings, and both continued to have unusual medical problems during parenteral alimentation. Both children had motility studies that were interpreted by a pediatric gastroenterologist to be "abnormal" and "diagnostic" of a motility disorder, but each was eventually shown to have a behavioral abnormality related to Munchausen syndrome by proxy.
Insights
Children initially suspected of having gastroduodenal motility disorders were diagnosed with behavioral issues. Munchausen syndrome by proxy can mimic serious gastrointestinal conditions, highlighting the need for careful differential diagnosis.
Area of Science:
- Pediatric Gastroenterology
- Child Psychology
Background:
- Gastroduodenal motility disorders can present with complex symptoms, leading to prolonged investigations.
- Parenteral alimentation is often employed when enteral feeding is perceived as impossible due to suspected motility issues.
Observation:
- Two children presented with symptoms suggestive of atypical gastroduodenal motility disorders.
- Both children had undergone motility studies interpreted as abnormal, supporting the initial diagnosis.
Findings:
- The children's persistent medical problems during parenteral alimentation prompted further evaluation.
- Both cases were ultimately attributed to behavioral abnormalities consistent with Munchausen syndrome by proxy.
Implications:
- This highlights the critical importance of considering non-organic causes, such as factitious disorder imposed on another, in pediatric unexplained symptoms.
- Accurate diagnosis requires a multidisciplinary approach, integrating gastroenterological findings with psychological and social assessments.
- Munchausen syndrome by proxy can present with severe medical manifestations, necessitating vigilance among healthcare providers.