Manometrics for preterm and term infants: a new tool for old questions.

OBJECTIVE: The purpose of this study was to use low-compliance, continuous-perfusion manometry to assess motor activity responses of preterm and term infants to three different methods of feeding commonly used in neonatal intensive care units. METHODS: All 48 infants who participated in this study were assigned to one of three feeding trials using a 20-calorie/oz formula. Trial 1 varied the mode of feeding, trial 2 varied the volume of feeding, and trial 3 varied the concentration of feeding. RESULTS: In trial 1, small intestinal motor activity changed similarly and significantly in response to intragastric (P < .005) and transpyloric feeding (P < .02). In trial 2, feeding containing a small volume (4 mL/kg) and a larger volume (10 mL/kg) elicited significant changes in motor activity compared to that seen during fasting (P < .005). In trial 3, motor activity differed in response to varying caloric density. Motor activity failed to change in response to feedings that contained one-third-concentration formula, but it did change in response to the feedings that contained two-thirds- and full-concentration formula (P < .02). Furthermore, the onset of the motor response to feeding was inversely related to the concentration of formula (P < .01), and the duration of the fed response also was related to the concentration of formula (P < .01). CONCLUSIONS: Gastric and transpyloric feedings are equally potent in eliciting an intestinal motor response to feeding. Furthermore, a volume as small as 4 mL/kg is sufficient to elicit such a response. However, preterm intestinal motility responses are affected significantly by changes in the caloric density of formula, suggesting that diluted formula may not provide an optimal stimulant for the preterm intestinal functional responses to feeding.

Home parenteral nutrition in chronic intestinal diseases: its effect on growth and development.

Nine children and adolescents with chronic intestinal diseases and growth failure were treated with home parenteral nutrition (HPN) for 7-63 months. All patients improved their growth velocities on HPN, with an average height gain of 9 cm. The mean growth velocity in six patients with Crohn's disease increased more than fivefold (from 0.67 +/- 0.4 cm/year to 3.8 +/- 1.09 cm/year), and they gained a mean of 11.4 +/- 3.4 kg/year. The three patients without Crohn's disease [intestinal pseudo-obstruction (two), severe short bowel (one)] increased growth velocity from an average of 2.9 +/- 1.1 cm to 6.1 +/- 1.34 cm/year and gained a mean of 10 +/- 2.84 kg/year. Patients without Crohn's disease grew faster on HPN than age comparable patients with Crohn's disease. Also, the two patients with Crohn's disease who were younger and had their disease for a shorter period (less than 3 years) grew better than older patients with Crohn's disease who had their disease for a mean of 8 +/- 1.3 years. All patients improved clinically, and three with Crohn's disease achieved complete remission. Five of the nine patients had psychosocial adjustment problems while on HPN. In conclusion, HPN is a relatively safe and effective means to stimulate growth in children and adolescents who cannot meet nutritional needs by the enteral route.

The rumination syndrome in adults. A characteristic manometric pattern.

The rumination syndrome is defined as a process in which a person chews regurgitated gastric contents and then either partially ejects or swallows them. We report 12 cases of rumination in which the clinical diagnosis was supported by esophageal and gastrointestinal motility studies. These patients showed a characteristic pressure spike-wave pattern that was associated with regurgitation and was recorded simultaneously at all manometric sites. These spike waves increased significantly in frequency (p less than 0.001) and amplitude (p less than 0.04) during the postprandial period. The underlying gastrointestinal motility was normal except for a small decrease in postprandial antral motility index, with mean (+/- SE) values of 13.2 +/- 0.3 for patients compared with 14.2 +/- 0.3 for eight healthy adult controls (p less than 0.03). Nine patients had significant personality disturbances, including six whose scores on the Minnesota Multiphasic Personality Inventory for hypochondriasis and depression were significantly above the reference population (p less than 0.02). The rumination syndrome should be considered in adult patients with long-standing postprandial vomiting. The manometric pattern is characteristic.