Gastrointestinal motility disorders in children.

From 1991 to 2000, thirty patients with gastrointestinal motility disorders were diagnosed in Department of Pediatrics, Siriraj Hospital. They were divided into 3 groups ; in group 1, 15 patients had normal psychomotor development with chronic intestinal pseudo-obstruction (CIP) or intestinal dysmotility; in group 2, 9 patients had psychomotor retardation with CIP or intestinal dysmotility and in group 3, 6 patients had gastroparesis. Three cases in group 1 had underlying causes including megacystis-microcolon-intestinal-hypoperistalsis syndrome (MMIHS), SLE, and Strongyloid infestation. MMIHS was diagnosed during pregnancy. This patient did not respond to any medications and died at 5 months. Nine cases in group 2 and 1 case in group 1 were diagnosed as CIP due to their persistent symptoms of obstruction and radiologically demonstrated dilated intestine with air /fluid levels. The main presenting symptoms were abdominal distention (27 cases), constipation (14 cases), abdominal pain (13 cases), vomiting (9 cases), diarrhea (9 cases), and refusal of feeds (3 cases). X-ray studies were the most useful investigation to diagnose the disorders. All patients received cisapride as a prokinetic drug in order to improve the motility of the GI tract. A good response was obtained in14 cases, a fair response in 15 cases and a poor response in 1 case. GI motility disorder is not uncommon in Thai children. The severity of the motility disorder varied from mild to severe. The majority of cases had a good prognosis except in the cases with psychomotor retardation in addition.

Clinical trial comparing the efficacy of ursodeoxycholic acid and cholestyramine on idiopathic neonatal hepatitis.

common cause of neonatal cholestasis is idiopathic neonatal hepatitis. Several agents have been proposed to counteract the effects of accumulated toxic bile acid such as phenobarbital and cholestyramine. Ursodexycholic acid ( UDCA) is a choleretic agent used in chronic intrahepatic cholestasis. The aim of this study is to compare the efficacy of ursodeoxycholic acid and cholestyramine on hepatic function in idiopathic neonatal hepatitis. Twenty patients were enrolled in this study. The patients were randomized to receive UDCA or cholestyramine orally. There were ten patients in each group. The doses of UDCA and cholestyramine were 15 mg/ kg / day and 350 mg / kg/ day respectively. The duration of the study was 8 weeks. Conventional liver function tests were done initially and at 1,2,4, and 8 weeks. Any side effects of these medications were noted. The ursodeoxycholic acid group showed a significant improvement in levels of total bilirubin, direct bilirubin, and alkaline phosphatase ( P< 0.05). The cholestyramine group showed a significant improvement in levels of total bilirubin, and direct bilirubin ( P< 0.05). There was no significant difference on liver function tests between the groups at any time ( P> 0.05). No side effects were observed. The results showed that both drugs improved cholestasis resulting from idiopathic neonatal hepatitis. The results of this study suggest that UDCA would be an alternative choleretic agent in treatment of idiopathic neonatal hepatitis.

Effect cisapride on gastric emptying and dyspeptic symptoms in children with non-ulcer dyspepsia.

The aim of our study was to determine the effect of Cisapride on gastric emptying and dyspeptic symptoms in 10 non-ulcer dyspepsia (NUD) children with delayed gastric emptying during and after stopping treatment. Five boys and five girls aged 5-11 years underwent upper endoscopy which showed normal appearing mucosa and histology. Solid gastric emptying was measured by scintigraphy before and after an eight-week course of oral Cisapride. The dose of cisapride was 0.2 mg/kg/dose (maximum 5 mg) three times before meals for eight weeks and then gradually decreased and discontinued when the symptoms improved. Symptoms were show to be 87.4+3.4 percent and 82.9 (4.5 percent at 60 minutes and 90 minutes, respectively. After eight-weeks of treatment, repeated gastric emptying studies were shown to be 69.1+10.6 percent and 56.7+14.1 percent respectively. This was statistically significant (P=0.001, 0.0001). In all 10 children the symptoms improved after eight-weeks of treatment. Seven children were followed up after stopping cisapride for 3 to 17.5 months. The overall response were excellent in four patients, moderate in two Cisapride is effective in improving dyspeptic symptoms and gastric emptying in children with NUD.

Effect of cisapride on oesophageal pH monitoring and symptoms in children with gastro-oesophageal reflux disease.

The effect of cisapride on oesophageal pH monitoring and symptoms was studied in seven children with gastro-oesophageal reflux disease. They were treated with cisapride in a dose of 0.2 mg/kg/ very six hours. The comparative analysis of oesophageal pH monitoring between before and after the six-week treatment period showed significant improvements in the percentage of time pH<4, the number of reflex episodes (P=0.06). The symptoms, including pneumonia, cyanosis and asthma, were improved in all but one patient. The patients tolerated cisapride without any side effects.

Long-term treatment of ursodeoxycholic acid in paediatric cholestatic liver diseases.

Children with chronic cholestasis usually have pruritus, jaundice, failure to thrive and later, develop diliary cirrhosis. Ursodeoxycholic acid (UDCA) is a tertiary bile acid which has a positive effect on decreasing cholestasis. The aim of this study is to determine the efficacy of the drug on hepatic functions and symptoms in such patients. Nine children (six boys, three girls) diagnosed with biliary atresia (six cases), idiopathic neonatal hepatitis (two cases) and cryptogenic cirrhosis (one cases), received UDCA in a dose of 15 mg/kg daily for one year. Clinical features, symptoms and liver function tests were evaluated initially and at 1369 and 12 months after starting therapy. Seven patients had a complete 12-month therapy, but two patients were treated for only six months. Decreased cholestatis parameters were found including bilirubin from 11.7+ 4.9 to 7.7+ 3.2 mg/dl, GGT from 637.1+ 146.6 to 328.3+ 59.4 U/L, and AP from 1112.6+ 89.1 787.3+ 103.1 U/L., but there were no statistically significant results. Pruritus was improved in two of four patient with pruritus patients while four patients showed improved appetite.

Congenital hepatic with polycystic kidney: Report of 2 cases.

Two patients with congenital hepatic fibrosis with polycystic kidney are reported. One patient, a known case of polycystic kidney disease, presented with hematemesis and hepatosplenomegaly. The other had a problem of chronic pyronic pyrexia for 5 months. Both cases were diagnosed as congenital hepatic fibrosis by liver biopsy.