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Darbari, A.1; Desbiens, J.2; Gulotta, C.3
1Pediatrics, 2Gastroenterology, Johns Hopkins University, 3Feeding Disorders Program, Kennedy Krieger Institute, Baltimore, United States
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Introduction: Antroduodenal Manometry (ADM) provides direct measure of gastrointestinal (GI) physiology, and an insight into the pathophysiology of GI motility disorders. Children with feeding problems have various underlying disease processes. Despite clinical reports of its importance in specific GI motility disorders, the clinical effectiveness and diagnostic yield of ADM in children with feeding problems is not well established.
Methods: We reviewed the 42 ambulatory ADM studies performed on children with feeding problems at our institution with the Konigsberg® solid state catheters and MMS® software between 2001 and 2003. The predominant indications of the study, the outcome and clinical impact were scored as the main outcome measures.
Results: Complete records were obtained from 42 studies in 39 patients (M:F 17:22) with median age of 7.2 (range 1–13) years. The most common indications for the study were vomiting and nausea (76.1%), including intolerance of tube feedings for this reason. Other indications included food selectivity, food refusal behaviors and distension/bloating. The median duration of symptoms before the test was performed was 6.4 (range 4.5–24) months. A normal study was noted in 11.9% of the studies. Non-specific motor abnormalities were noted in 38.1% of the studies with an abnormal outcome. The mean+/− SD duration of each study was 23.6+/−3.9 hours. Generalized antral hypomotility was noted in 47.6% and findings suggestive of neurogenic dysmotiity (antral and duodenal high amplitude contractions, reverse propagation, or non-propagating clusters) were noted in 26.2% studies. The features suggestive of pseudoobstruction (high amplitude and/or prolonged contractions with elevation of baseline) in absence of documented downstream obstruction was noted in 14.3% cases (Figure).
As a result of the ADM study, a new diagnosis was established in 78.6%, new therapy started in 42.8% and referral to other specialty services made for 11.9% patients. A positive clinical impact resulted from 61.9% studies.
Conclusion: ADM is an effective diagnostic tool, which has a positive impact on most children with feeding problems who undergo this testing. More widespread use of ADM is likely to provide improvement in clinical care of children suffering with debilitating symptoms of feeding problems. More prospective studies from specialized centers offering the test can provide confirmation of the high positive clinical impact noted in our preliminary study.
© 2004 Lippincott Williams & Wilkins, Inc.
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