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Vomiting and gastroesophageal motor activity in children with disorders of the central nervous system
1Department of Gastroenterology, Institute of Child Health, London, United Kingdom.
Insights
Children with central nervous system (CNS) disorders often experience vomiting due to abnormal gastric motility, not just gastroesophageal reflux (GER). Fundoplication may unmask these underlying gastric dysrhythmias, suggesting broader foregut dysmotility in these patients.
Area of Science:
- Pediatric Gastroenterology
- Neurogastroenterology
- Pediatric Neurology
Background:
- Vomiting is a frequent symptom in children with central nervous system (CNS) disorders.
- Gastroesophageal reflux (GER) is often cited as the cause, but foregut dysmotility may be more prevalent.
- Understanding the pathophysiology of vomiting in this population is crucial.
Purpose of the Study:
- To investigate the prevalence of gastroesophageal reflux (GER) and gastric dysrhythmias in children with CNS disorders presenting with vomiting.
- To assess the impact of fundoplication on vomiting symptoms and gastric motility.
- To explore the relationship between central nervous system disorders, foregut dysmotility, and vomiting.
Main Methods:
- Studied 55 children with CNS disorders, focusing on 50 with vomiting or retching.
- Assessed GER using 24-hour pH monitoring and endoscopy.
- Evaluated gastric electrical activity with electrogastrography and gastric emptying time (T1/2) using electrical impedance tomography.
Main Results:
- Of 50 vomiting patients, 29 had GER and 31 had gastric dysrhythmias.
- Sixteen patients exhibited both GER and gastric dysrhythmias.
- Delayed gastric emptying was observed in most patients with gastric dysrhythmias, particularly those with concurrent GER.
Conclusions:
- Abnormal gastric motility is as common as GER in children with CNS disorders who vomit.
- Gastric dysrhythmias may persist or become apparent after fundoplication, contributing to ongoing symptoms.
- Foregut dysmotility in these children may stem from CNS modulation of the enteric nervous system or shared pathological processes.
Background:
Vomiting is common in children with disorders of the central nervous system (CNS) and is usually ascribed to gastroesophageal reflux (GER). However, recent acquisitions on the pathophysiology of vomiting suggest that the dysmotility of the foregut may be more widespread.
Methods:
Fifty-five children with CNS disorders, 50 of whom suffered from retching and/or vomiting (18 following fundoplication) were studied. We assessed GER by 24 hour pH monitoring and endoscopy, gastric electrical activity by electrogastrography, and gastric half-emptying time (T1/2) of a milk meal be electrical impedance tomography.
Results:
Of the 50 vomiting patients, 29 had GER (reflux index of 5.7%-87.4%; controls: < 5%), and 31 had gastric dysrhythmias (12 tachyarrhythmia at 5.5-11.2 cpm, 4 bradyarrhythmia at 1.7-1.9 cpm, 15 unstable electrical activity; controls; 2.2-4.0 cpm). Sixteen patients had GER and gastric dysrhythmias. Eleven of 18 patients with fundoplication had gastric dysrhythmias. Gastric T1/2 was delayed in 12 of 13 patients with gastric dysrhythmia (6 with GER), versus 2 of 5 with GER alone. No abnormalities were detected in the 5 patients who did not suffer from vomiting.
Conclusions:
Children with CNS disorders who vomit have abnormal gastric motility as often as GER. Following fundoplication, many patients continue to have symptoms possibly related to gastric dysrhythmias, the effects of which may be unmasked by fundoplication. Foregut dysmotility may be related to abnormal modulation of the enteric nervous system by the CNS or to involvement of the enteric nervous system by the same process affecting the brain.