Abstract
In 11 children (mean age 44.2 months) with symptoms suggesting upper intestinal dysfunction (nonulcer dyspepsia), in nine children (mean age 27.3 months) with gastroesophageal reflux (GER) disease, and in seven controls (mean age 20.4 months) we investigated fasting [for 3 hr or until two migrating motor complexes (MMC) were observed] and fed (90 min) antroduodenal motility by means of perfused catheter system; furthermore, we measured both gastric emptying of a radiolabeled milk formula and fasting duodenogastric reflux during manometry by assessing bile salt concentration in gastric aspirates. No structural abnormalities of gastrointestinal tract and organic disorders were detected in the patients. In a high proportion of both groups of patients we found manometric abnormalities of interdigestive and fed motor patterns that were not seen in the controls: absence of antral phase III of MMC; significant decrease of antral and/or duodenal motor activity during fasting and/or fed periods; abnormal propagation or configuration of MMC phase III that was signficantly shorter than in controls; bursts of sustained fasting and/or fed phasic duodenal activity, frequently uncoordinated with adjacent gut segments. When compared to controls, the mean intragastric concentration of bile salts during all MMC phases and the mean 1-hr percent gastric activity of the radiolabeled milk were significantly higher in the two groups of patients. We conclude that in a high proportion of children with nonulcer dyspepsia and of children with GER disease, gastrointestinal manometry may reveal significant irregularities of antral and duodenal motility, which are associated with increased duodenogastric reflux and delayed gastric emptying.
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References
Lennard-Jones JE: Functional gastrointestinal disorders. N Engl J Med 308:431–435, 1983
Heatley RV, Rathbone BJ: Dyspepsia: a dilemma for doctors. Lancet 2:779–781, 1987
Thompson WG: Non-ulcer dyspepsia. Can Med Assoc J 130:565–569, 1984
Rees WDW, Miller LD, Malagelada JR: Dyspepsia, antral motor dysfunction, and gastric stasis of solids. Gastroenterology 78:360–365, 1980
Malagelada JR, Stanghellini V: Manometric evaluation of functional upper gut symptoms. Gastroenterology 88:1223–1331, 1985
Mathias JR, Finelli DS: Functional diseases of the small intestine.In Functional Disorders of the Gastrointestinal Tract. S Cohen, R Soloway (eds). New York, Churchill Livingstone, 1987, pp 39–58
Minami H, McCallum RW: The physiology and pathophysiology of gastric emptying in humans. Gastroenterology 86:1592–1610, 1984
Bolondi L, Bortolotti M, Scuti V, Coletti T, Gaiani S, Labò G: Measurement of gastric emptying time by real-time ultrasonography. Gastroenterology 89:752–759, 1985
Hyman PE, McDiarmid SV, Napolitano J, Abrams CE, Tomomasa T: Antroduodenal motility in children with chronic intestinal pseudoobstruction. J Pediatr 112:899–905, 1988
Pineiro-Carrero VM, Andres JM, Davis RH, Mathias JR: Abnormal gastroduodenal motility in children and adolescents with recurrent functional abdominal pain. J Pediatr 113:820–825, 1988
Hyman PE, Napolitano JA, Diego A, Patel S, Flores AF, Grill BB, Reddy N, Garvey TW, Tomomasa T: Antroduodenal manometry in the evaluation of chronic functional gastrointestinal symptoms. Pediatrics 86:39–44, 1990
Behar J, Ramsly G: Gastric emptying and antral motility in reflux eosphagitis. Gastroenterology 74:253–256, 1978
Fink SM, Lange RC, McCallum RW: Effect of metoclopramide on normal and delayed gastric emptying in gastroesophageal reflux patients. Dig Dis Sci 28:1057–1061, 1983
Hillemeier AC, Grill BB, McCallum RW, Gryboski JD: Esophageal and gastric motor abnormalities in gastroesophageal reflux during infancy. Gastroenterology 84:741–744, 1983
Fenton TR, Harries JT, Milla PJ: Disordered small intestinal motility: A rationale basis for toddlers' diarrhoea. Gut 24:897–903, 1983
Tomomasa T, Itoh Z, Koizumi T, Kuroume T: Nonmigrating rhythmic activity in the stomach and duodenum of neonates. Biol Neonate 48:1–9, 1985
Morriss FH, Moore M, Weisbrodt MW, West SM: Ontogenic development of gastrointestinal motility: Duodenal contractions in preterm infants. Pediatrics 78:1106–1113, 1986
Fausa O, Skalhegg BA: Quantitative determination of bile acids and their conjugates using thin-layer chromatography and a purified 3-hydroxysteroid dehydrogenase. Scand J Gastroenterol 9:249–254, 1974
Kelly KA: Gastric emptying of liquids and solids. Roles of proximal and distal stomach. Am J Physiol 239:G471-G476, 1980
Read NW, Houghton LA: Physiology of gastric emptying and pathophysiology of gastroparesis. Gastroenterol Clin North Am 18:359–373, 1989
Weisbrodt NW, Wiley JN, Overholt BF, Bass P: A relation between gastroduodenal muscle contractions and gastric emptying. Gut 10:543–548, 1969
Miller J, Kauffman G, Elashoff, J, Ohashi H, Carter D, Meyer JH: Search for resistances controlling gastric emptying of liquid meals. Am J Physiol 241:G403-G425, 1981
Camilleri M, Brown ML, Malagelada JR: Relationship between impaired gastric emptying and abnormal gastrointestinal motility. Gastroenterology 91:94–99, 1986
Itoh Z: Hormones, peptides, opoids and prostaglandins in normal gastric contractions.In Gastric and Gastroduodenal Motility. LMA Akkermans, AG Johnson, NW Read (eds). New York, Praeger, 1984, pp 41–59
Niemela S: Duodenogastric reflux in patients with upper abdominal complaints or gastric ulcer with particular reference to reflux associated gastritis. Scand J Gastroenterol 20(suppl):13–56, 1985
McCallum RW: Role of motility in gastric emptying and gastroduodenal reflux.In Progress in the Treatment of Gastrointestinal Motility Disorders: The Role of Cisapride. AG Johnson, G Lux (eds). Amsterdam, Excerpta Medica, Elsevier Science Publishers, 1988, pp 99–112
Kellow JE, Phillips SF: Altered small bowel motility in irritable bowel syndrome is correlated with symptoms. Gastroenterology 92:1885–1893, 1987
Stern MR, Koch KL, Stewart WR, Lindbled IM: Spectral analysis of tachygastria recorded during motion sickness. Gastroenterology 92:92–97, 1987
Holloway RH, Hongo M, Berger K, McCallum RW: Gastric distension: a mechanism for postprandial gastroesophageal reflux. Gastroenterology 89:779–784, 1985
Keane FB, Di Magno EP, Malagelada JR: Duodenogastric reflux in humans: Its relationship to fasting antroduodenal motility and gastric, pancreatic and biliary secretions. Gastroenterology 81:726–731, 1981
Heading RC: Duodenogastric reflux. Gut 24:507–509, 1983
Miranda M, Defilippi C, Valenzuela JE: Abnormalities of interdigestive motility complex and increased duodenogastric reflux in gastric ulcer patients. Dig Dis Sci 30:16–21, 1985
Muller-Lissner SA, Schattwenmann G, Scheuker G, Sonnenberg A, Hollinger A, Siewert JR, Blum AL: Duodenogastric reflux in the fasting dog: Role of the pylorus and duodenal motility. Am J Physiol 241:G159-G162, 1981
Camilleri M, Malagelada JR, Stanghellini V, Fealy RD, Sheps SG: Gastrointestinal motility disturbances in patients with orthostatic hypotension. Gastroenterology 88:1852–1859, 1985
Stanghellini V, Camilleri M, Malagelada JR: Chronic idiopathic intestinal pseudo-obstruction: Clinical and intestinal manometric findings. Gut 28:5–12, 1987
Read NW: Functional gastroenterological disorders: The name's the thing. Gut 28:1–4, 1987
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Cucchiara, S., Bortolotti, M., Colombo, C. et al. Abnormalities of gastrointestinal motility in children with nonulcer dyspepsia and in children with gastroesophageal reflux disease. Digest Dis Sci 36, 1066–1073 (1991). https://doi.org/10.1007/BF01297448
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DOI: https://doi.org/10.1007/BF01297448