Intestinal motility and jejunal feeding in children with chronic intestinal pseudo-obstruction.
OBJECTIVE
Total parenteral nutrition is responsible for most of the morbidity and mortality of childhood chronic intestinal pseudo-obstruction (CIP). The aim of this study was to determine if there are manometric patterns associated with the success of jejunal feedings in children with CIP.


METHODS
Eighteen children with CIP (age range, 1-9 years; mean, 4 years; 11 boys and 7 girls) were studied. All patients required parenteral nutrition or failed to thrive while receiving gastrostomy feedings. All underwent an antroduodenal manometry before surgical placement of a jejunostomy. Continuous drip jejunal feeding with an elemental formula was subsequently initiated. Follow-up after jejunal feeding was 1.6 years (range, 6 months to 4 years). Jejunal manometry was performed 2 months to 1 year after jejunostomy.


RESULTS
Jejunal feeding eliminated the need for parenteral nutrition in all 9 patients with migrating motor complex (MMC) and in 3 of 9 patients without MMC (P < 0.01). The MMC was present or absent in both antroduodenal and jejunal manometry in 14 of 18 children (77.7%). In 10 of 18 children (55%), duodenal and jejunal manometry showed similar qualitative abnormalities.


CONCLUSIONS
In selected children with CIP who fail gastrostomy feeding, jejunal tube feeding is an alternative to parenteral nutrition. The presence of MMCs is associated with a successful adaptation to jejunal feeding.
Di Lorenzo
C
C
Department of Pediatrics, Harbor-UCLA Medical Center, USA.
Flores
A F
AF
Buie
T
T
Hyman
P E
PE
D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D004386:Duodenum / Q000503:physiopathology; D004750:Enteral Nutrition; D005260:Female; D005769:Gastrointestinal Motility; D006801:Humans; D007223:Infant; D007418:Intestinal Pseudo-Obstruction / Q000503:physiopathology / Q000628:therapy*; D007582:Jejunostomy; D007583:Jejunum / Q000503:physiopathology; D008297:Male; D008365:Manometry