Gastric Myoelectrical and Motor Abnormalities in Children
Gastric Myoelectrical and Motor Abnormalities in Children
Background and Aims: Recurrent abdominal pain is common among children and adolescents. The majority of the affected patients have no apparent cause for their symptoms. This study evaluated gastric myoelectrical activity and motility abnormalities in children and adolescents with functional recurrent abdominal pain.
Methods: Forty-two children with functional recurrent abdominal pain [19 (45.2%) males, mean 8 years, SD 3 years, 19 functional abdominal pain, 9 irritable bowel syndrome, 9 functional dyspepsia, 1 abdominal migraine, 1 aerophagia and 3 non-specific abdominal pain according to Rome III criteria] and 20 healthy children [10 (50%) males, mean 9 years, SD 2.7 years] from the same geographical area underwent electrogastrography (EGG), and ultrasonographic assessment of gastric emptying rate and antral motility.
Results: Average gastric emptying rate, amplitude of antral contractions and antral motility index were lower in patients (46.5%, 74.3% and 6.5 respectively) compared to controls (66.17%, 89% and 8.3 respectively) (P < 0.001). Gastric emptying rate had a negative correlation with scores obtained for severity of symptoms (r = -0.63, P < 0.0001). Postprandial dominant frequency instability co-efficient (post-DFIC) was higher in patients than in controls (27.83% vs 18.3%, P = 0.0087), and correlated with the symptom score (r = 0.26, P = 0.045).
Conclusions: Gastric emptying and antral motility were significantly impaired in patients, indicating a possible role for gastric motility disturbances in the pathogenesis of childhood functional recurrent abdominal pain. Further studies, including therapeutic trials, are needed to confirm this association and for recommendation of prokinetic drugs in its management.
The exact mechanism of pain remains unclear in the majority of children and adolescents with functional recurrent abdominal pain (RAP) in whom no organic cause can be identified. The typical pattern of periumbilical pain, so characteristic of this condition, appears to be visceral in origin, probably originating in the gastrointestinal tract. The prevailing viewpoint is that the pathogenesis of the pain involves disordered gastrointestinal motility and visceral hypersensitivity.
Gastrointestinal motility disturbances are reported in some functional bowel disorders. Adult and paediatric patients with functional dyspepsia often have gastric myoelectrical abnormalities, antral hypomotility, wide gastric antrum and delayed gastric emptying for both solids and liquids. Recently, gastric accommodation disturbances have also been reported in these patients, and some patients have abnormalities of small bowel transit. Gastrointestinal myoelectrical and motility abnormalities are also reported in patients with irritable bowel syndrome. Other studies have failed to identify abnormalities in gastric electrical activity in patients with functional dyspepsia.
Very few studies have been done to investigate the association between gastrointestinal motility disturbances and functional RAP. These studies have demonstrated altered fasting gastrointestinal motility patterns, abnormal electrical activity and impaired gastric accommodation.
RAP is a common paediatric problem in Sri Lanka. A recent epidemiological study revealed RAP in 10.5% of Sri Lankan school children. Furthermore, more than 75% of them had non-organic or functional RAP. We conducted this study to assess the gastric myoelectrical activity and motility in Sri Lankan children and adolescents with functional (non-organic) RAP and to detect the association between motility abnormalities, and severity of abdominal pain and exposure to emotional stress.
Background and Aims: Recurrent abdominal pain is common among children and adolescents. The majority of the affected patients have no apparent cause for their symptoms. This study evaluated gastric myoelectrical activity and motility abnormalities in children and adolescents with functional recurrent abdominal pain.
Methods: Forty-two children with functional recurrent abdominal pain [19 (45.2%) males, mean 8 years, SD 3 years, 19 functional abdominal pain, 9 irritable bowel syndrome, 9 functional dyspepsia, 1 abdominal migraine, 1 aerophagia and 3 non-specific abdominal pain according to Rome III criteria] and 20 healthy children [10 (50%) males, mean 9 years, SD 2.7 years] from the same geographical area underwent electrogastrography (EGG), and ultrasonographic assessment of gastric emptying rate and antral motility.
Results: Average gastric emptying rate, amplitude of antral contractions and antral motility index were lower in patients (46.5%, 74.3% and 6.5 respectively) compared to controls (66.17%, 89% and 8.3 respectively) (P < 0.001). Gastric emptying rate had a negative correlation with scores obtained for severity of symptoms (r = -0.63, P < 0.0001). Postprandial dominant frequency instability co-efficient (post-DFIC) was higher in patients than in controls (27.83% vs 18.3%, P = 0.0087), and correlated with the symptom score (r = 0.26, P = 0.045).
Conclusions: Gastric emptying and antral motility were significantly impaired in patients, indicating a possible role for gastric motility disturbances in the pathogenesis of childhood functional recurrent abdominal pain. Further studies, including therapeutic trials, are needed to confirm this association and for recommendation of prokinetic drugs in its management.
The exact mechanism of pain remains unclear in the majority of children and adolescents with functional recurrent abdominal pain (RAP) in whom no organic cause can be identified. The typical pattern of periumbilical pain, so characteristic of this condition, appears to be visceral in origin, probably originating in the gastrointestinal tract. The prevailing viewpoint is that the pathogenesis of the pain involves disordered gastrointestinal motility and visceral hypersensitivity.
Gastrointestinal motility disturbances are reported in some functional bowel disorders. Adult and paediatric patients with functional dyspepsia often have gastric myoelectrical abnormalities, antral hypomotility, wide gastric antrum and delayed gastric emptying for both solids and liquids. Recently, gastric accommodation disturbances have also been reported in these patients, and some patients have abnormalities of small bowel transit. Gastrointestinal myoelectrical and motility abnormalities are also reported in patients with irritable bowel syndrome. Other studies have failed to identify abnormalities in gastric electrical activity in patients with functional dyspepsia.
Very few studies have been done to investigate the association between gastrointestinal motility disturbances and functional RAP. These studies have demonstrated altered fasting gastrointestinal motility patterns, abnormal electrical activity and impaired gastric accommodation.
RAP is a common paediatric problem in Sri Lanka. A recent epidemiological study revealed RAP in 10.5% of Sri Lankan school children. Furthermore, more than 75% of them had non-organic or functional RAP. We conducted this study to assess the gastric myoelectrical activity and motility in Sri Lankan children and adolescents with functional (non-organic) RAP and to detect the association between motility abnormalities, and severity of abdominal pain and exposure to emotional stress.