title: Gastrointestinal and nutritional problems occur frequently throughout life in girls and women with Rett syndrome.
abstract: OBJECTIVE
  We conducted a nationwide survey to determine the prevalence of common gastrointestinal and nutritional disorders in Rett syndrome (RTT) based on parental reporting and related the occurrence of these problems to age and methyl-CpG-binding protein 2 (MECP2) gene status.
  
  
  METHODS
  We designed a questionnaire that probed symptoms, diagnoses, diagnostic tests, and treatment interventions related to gastrointestinal and nutritional problems in RTT. The International Rett Syndrome Foundation distributed the questionnaire to 1666 family-based members and forwarded their responses for our review. We interrogated the Rare Disease Clinical Research Network database to supplement findings related to medications used to treat gastrointestinal problems in RTT.
  
  
  RESULTS
  Parents of 983 female patients with RTT (59%) responded and identified symptoms and diagnoses associated with gastrointestinal dysmotility (92%), chewing and swallowing difficulties (81%), weight deficits or excess (47%), growth deficits (45%), low bone mineral content or fractures (37%), and biliary tract disorders (3%). Height-for-age, weight-for-age, and body mass index z scores decreased significantly with age; height- and weight-, but not body mass index-for-age z scores were significantly lower in female subjects with MECP2 mutations than in those without. Vomiting, nighttime awakening, gastroesophageal reflux, chewing difficulty, and choking with feeding were significantly less likely to occur with increasing age. Short stature, low bone mineral content, fractures, and gastrostomy placement were significantly more likely to occur with increasing age. Chewing difficulty, choking with feeding, and nighttime awakening were significantly less likely to occur, whereas short stature was significantly more likely to occur, in female subjects with MECP2 mutations than in those without. Diagnostic evaluations and therapeutic interventions were used less frequently than the occurrence of symptoms or diagnoses in the RTT cohort.
  
  
  CONCLUSIONS
  Gastrointestinal and nutritional problems perceived by parents are prevalent throughout life in girls and women with RTT and may pose a substantial medical burden for their caregivers. Physician awareness of these features of RTT may improve the health and quality of life of individuals affected with this disorder.
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA. kmotil@bcm.edu
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Motil
authors.forename: Erwin
authors.initials: E
authors.lastname: Caeg
authors.forename: Judy O
authors.initials: JO
authors.lastname: Barrish
authors.forename: Suzanne
authors.initials: S
authors.lastname: Geerts
authors.forename: Jane B
authors.initials: JB
authors.lastname: Lane
authors.forename: Alan K
authors.initials: AK
authors.lastname: Percy
authors.forename: Fran
authors.initials: F
authors.lastname: Annese
authors.forename: Lauren
authors.initials: L
authors.lastname: McNair
authors.forename: Steven A
authors.initials: SA
authors.lastname: Skinner
authors.forename: Hye-Seung
authors.initials: HS
authors.lastname: Lee
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Neul
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Glaze
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001847:Bone Diseases / Q000150:complications / Q000453:epidemiology; D002648:Child; D015362:Child Nutrition Disorders / Q000453:epidemiology / Q000209:etiology / Q000235:genetics; D002675:Child, Preschool; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics; D006130:Growth Disorders / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000453:epidemiology / Q000209:etiology / Q000235:genetics; D008297:Male; D051783:Methyl-CpG-Binding Protein 2 / Q000235:genetics*; D009154:Mutation; D009748:Nutrition Disorders / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics; D010290:Parents; D015995:Prevalence; D015518:Rett Syndrome / Q000150:complications* / Q000235:genetics; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: C497392:MECP2 protein, human; D051783:Methyl-CpG-Binding Protein 2