Nutritional management of regurgitation in infants.

Infantile regurgitation is a frequently occurring problem. Throughout the world, anxious parents are imploring physicians to eliminate their infant's regurgitation. General practitioners, pediatricians and pediatric gastroenterologists strive to alleviate infantile regurgitation and its related parental stress. In this paper we define the scope of the problem and analyze the optimal, cost-efficient management approach to simple regurgitation in infants. The intent of this paper is to disseminate this information to practicing physicians and other health care professionals in an attempt to minimize the impact of this annoying problem of infancy and to eliminate confusion and expensive diagnostic tests and use of sub-optimal treatment modalities. Parental reassurance and dietary management by feeding thickened formula are important components in managing regurgitation in infants while maintaining optimal nutritional intake for adequate growth and development.

Intravenous fat emulsion (intralipid) delays gastric emptying, but does not cause gastroesophageal reflux in healthy volunteers.

The impact of overnight intravenous lipid emulsion (ILE) infusion on upper gastrointestinal tract physiology was assessed in 10 healthy volunteers. No changes in lower esophageal sphincter pressure (before infusion: 28 +/- 4 mm Hg; after infusion 20.5 +/- 3; p:NS), plasma concentrations of gastrointestinal hormones (gastrin: preprandial before/after lipids: 14 +/- 2.1/13 +/- 1.4 pM; postprandial before/after lipids: 28 +/- 2.7/30 +/- 3.4 pM, CCK: preprandial before/after lipids: 69 +/- 10/64 +/- 10 pM; postprandial before/after lipids: 96 +/- 11/95 +/- 12 pM; neurotensin: levels less than 6 pM in all samples; somatostatin levels undetectable in all samples) nor on pathologic gastroesophageal reflux episodes (% of time of pH less than 4, before/after lipids: 0.6 +/- 0.4/0.15 +/- 0.09), were found (p = NS). In contrast, technetium gastric emptying studies showed a significant delay when comparing pre- and post-lipid infusion values (37 +/- 4/54 +/- 4%) (p greater than 0.005). The mechanism of this effect remains unexplained.

Removal of a colonic foreign body by enteral lavage.

A 14-year-old boy was evaluated for the presence of a foreign body in the descending colon. It successfully passed after oral colonic lavage solution (Golytely), obviating endoscopic intervention. The approaches to colonic foreign body removal are reviewed.

Protracted hemorrhagic gastritis in an infant recovering from acute pancreatitis--successful management with prostaglandin E2 analogue.

This case report describes the course and management of a 10-week-old boy with idiopathic hemorrhagic pancreatitis who presented initially with ascites. His hospital course was complicated by severe recurrent intraperitoneal bleeding, requiring, in less than 5 days three exploratory laparotomies to control the hemorrhage. In the following 11 weeks he had five major bleeding episodes attributed to ulcers, gastritis, and esophagitis. Continuous infusion of H2 blockers, antacid drip, and sucralfate combined with Nissen fundoplication, elective vagotomy, and pyloroplasty were used unsuccessfully to control the bleeding until a prostaglandin E2 analogue at 18 micrograms/kg/day in four divided doses was given enterally. During the following 19 months, there has been no recurrence of bleeding.