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Chronic intestinal pseudoobstruction associated with fetal alcohol syndrome
A Uc1, E Vasiliauskas, D A Piccoli
1Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City 52242, USA.
Insights
Fetal alcohol syndrome (FAS) may cause gastrointestinal neuropathy, leading to chronic intestinal pseudoobstruction in infants. This study identified abnormal gut motility in children with FAS, suggesting a link between prenatal alcohol exposure and enteric nervous system dysfunction.
Area of Science:
- Neuroscience
- Gastroenterology
- Teratology
Background:
- Alcohol is a known teratogen causing developmental issues in fetuses.
- Central nervous system dysfunction is a recognized effect of prenatal alcohol exposure.
- Gastrointestinal neuropathy has not been previously described in fetal alcohol syndrome (FAS).
Purpose of the Study:
- To investigate gastrointestinal motility in infants with FAS presenting with symptoms of chronic intestinal pseudoobstruction.
- To determine if enteric neuropathy is associated with FAS.
Main Methods:
- Antroduodenal manometry was performed on five infants diagnosed with FAS.
- Clinical presentation and feeding difficulties were assessed.
Main Results:
- All five patients exhibited abnormal propagating phase III-like episodes during fasting.
- Retrograde propagation occurred in four patients, and simultaneous propagation in two.
- Two patients displayed persistent clusters of stationary contractions.
Conclusions:
- Prenatal alcohol exposure may cause enteric neuropathy, not just central nervous system toxicity.
- This enteric neuropathy can manifest in infancy as chronic intestinal pseudoobstruction.
- Abnormal gut motility is a key feature in infants with FAS and gastrointestinal symptoms.
Abstract:
Alcohol acts as a teratogen in the fetus, resulting in prenatal or postnatal growth failure, characteristic facial dysmorphic features, and central nervous system dysfunction. The toxic effects of alcohol on the developing brain are well recognized, but gastrointestinal neuropathy has not been described in fetal alcohol syndrome (FAS). Five children with FAS presented in infancy with signs and symptoms suggestive of chronic intestinal pseudoobstruction. They were not able to sustain adequate caloric intake by mouth, and all required prolonged special methods of alimentation. We performed antroduodenal manometry in these children to determine whether their symptoms were associated with a gastrointestinal motility disorder. All patients had abnormally propagating phase III-like episodes during fasting (retrograde in four, simultaneous in two). Persistent clusters of stationary contractions were a prominent feature in two patients. In utero neurotoxicity of alcohol may not be limited to the central nervous system, but may also cause an enteric neuropathy presenting in infancy as chronic intestinal pseudoobstruction.