piperidines and Duodenal-Obstruction

A 19-mo-old boy with cystic fibrosis presented with a lifelong history of feeding problems and constipation, and an 8-mo history of episodes of repeated retching, diaphoresis, dehydration, and somnolence after eating. Tests of esophageal motility and gastric emptying of a 5% glucose meal were normal. Antroduodenal pressure recordings during fasting demonstrated the presence of all phases of the interdigestive motor complex. After consumption of a 240-ml complex liquid meal, however, the contractile pattern that generally accompanies eating was absent and gastric emptying was markedly delayed. When bethanechol or metoclopramide was given 10 min before the complex liquid meal, there was a paucity of contractile activity, gastric emptying was slow, and symptoms of lethargy, diaphoresis, and retching were present. When cisapride was given, there was frequent irregular contractile activity, faster gastric emptying, and no symptoms of lethargy. During the past year treatment with cisapride has been a requirement in order to prevent recurrence of the symptoms. Antroduodenal pressure studies proved helpful in the identification of a treatable manometric abnormality that was associated with symptoms of delayed gastric emptying.

Topics: Bethanechol; Bethanechol Compounds; Cisapride; Cystic Fibrosis; Duodenal Obstruction; Duodenum; Esophagus; Fasting; Feeding Behavior; Gastric Emptying; Gastrointestinal Motility; Humans; Infant; Male; Manometry; Metoclopramide; Piperidines