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Vomiting and gastroesophageal motor activity in children with disorders of the central nervous system.
J Pediatr Gastroenterol Nutr. 1998 Jan; 26(1):56-63.JP

Abstract

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.

Authors+Show Affiliations

Department of Gastroenterology, Institute of Child Health, London, United Kingdom.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

9443121

Citation

Ravelli, A M., and P J. Milla. "Vomiting and Gastroesophageal Motor Activity in Children With Disorders of the Central Nervous System." Journal of Pediatric Gastroenterology and Nutrition, vol. 26, no. 1, 1998, pp. 56-63.
Ravelli AM, Milla PJ. Vomiting and gastroesophageal motor activity in children with disorders of the central nervous system. J Pediatr Gastroenterol Nutr. 1998;26(1):56-63.
Ravelli, A. M., & Milla, P. J. (1998). Vomiting and gastroesophageal motor activity in children with disorders of the central nervous system. Journal of Pediatric Gastroenterology and Nutrition, 26(1), 56-63.
Ravelli AM, Milla PJ. Vomiting and Gastroesophageal Motor Activity in Children With Disorders of the Central Nervous System. J Pediatr Gastroenterol Nutr. 1998;26(1):56-63. PubMed PMID: 9443121.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vomiting and gastroesophageal motor activity in children with disorders of the central nervous system. AU - Ravelli,A M, AU - Milla,P J, PY - 1998/1/27/pubmed PY - 1998/1/27/medline PY - 1998/1/27/entrez SP - 56 EP - 63 JF - Journal of pediatric gastroenterology and nutrition JO - J. Pediatr. Gastroenterol. Nutr. VL - 26 IS - 1 N2 - 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. SN - 0277-2116 UR - https://www.unboundmedicine.com/medline/citation/9443121/Vomiting_and_gastroesophageal_motor_activity_in_children_with_disorders_of_the_central_nervous_system_ L2 - http://dx.doi.org/10.1097/00005176-199801000-00010 DB - PRIME DP - Unbound Medicine ER -