title: Prevalence and management of gastrointestinal manifestations in Silver-Russell syndrome.
abstract: OBJECTIVE
  Silver-Russell syndrome (SRS) is an imprinted disorder characterised by intrauterine growth retardation, relative macrocephaly, failure to thrive, typical facial phenotype and frequent body asymmetry. Feeding difficulties are frequently noted, but no study described evolution of gastrointestinal signs during infancy and their management in SRS. The aim of this study was to describe these abnormalities in a large cohort of children with SRS.
  
  
  METHODS
  We included 75 patients (median age 24.3 months (5.1-135.2)) in the study. We retrospectively analysed nutritional status before growth hormone therapy, the frequency of gastrointestinal signs, such as gastroesophageal reflux (GER), vomiting, constipation and feeding difficulties, and nutritional management.
  
  
  RESULTS
  Maternal uniparental disomy for chromosome 7 was found in 10 patients and 11p15 hypomethylation in 65 patients. Malnutrition (defined as a weight/expected weight for height ratio <80%) was detected in 70% of the children. Gastrointestinal signs were found in 77%, including severe vomiting before the age of 1 year in 50% of cases, persistent vomiting from the age of 1 year in 29% of cases and constipation in 20% of cases. Severe GER was diagnosed in 55% of children by 24 h oesophageal pH-metry. Feeding difficulties were described in 65% of cases, with indications for dietary enrichment in 49%. Enteral nutrition by gastrostomy was indicated in 22% of cases.
  
  
  CONCLUSIONS
  Digestive signs (GER, constipation) and malnutrition are frequent in children with SRS. The systematic exploration and management of these signs are crucial to improve the nutritional status of these children before initiating growth hormone therapy.
authors.affiliation: Nutrition et Gastroentérologie Pédiatrique, AP-HP, Hôpital Armand-Trousseau, Paris, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Marsaud
authors.affiliation: AP-HP, Hôpital Armand-Trousseau, Explorations Fonctionnelles Endocriniennes, INSERM, UMR_S 938, CDR Saint-Antoine, Paris, France Université Pierre et Marie Curie-Paris 6, Institut National de la Sante´́et de la Recherche Médicale U 515, Paris, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Rossignol
authors.affiliation: Nutrition et Gastroentérologie Pédiatrique, AP-HP, Hôpital Armand-Trousseau, Paris, France Institut de Cardiométabolisme et Nutrition (ICAN), INSERM UMRS U872 (Eq7) Nutriomique, Université Pierre et Marie Curie-Paris 6, Centre de Recherche des Cordeliers, Paris, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Tounian
authors.affiliation: AP-HP, Hôpital Armand-Trousseau, Explorations Fonctionnelles Endocriniennes, INSERM, UMR_S 938, CDR Saint-Antoine, Paris, France Université Pierre et Marie Curie-Paris 6, Institut National de la Sante´́et de la Recherche Médicale U 515, Paris, France.
authors.forename: Irène
authors.initials: I
authors.lastname: Netchine
authors.affiliation: Nutrition et Gastroentérologie Pédiatrique, AP-HP, Hôpital Armand-Trousseau, Paris, France Institut de Cardiométabolisme et Nutrition (ICAN), INSERM UMRS U872 (Eq7) Nutriomique, Université Pierre et Marie Curie-Paris 6, Centre de Recherche des Cordeliers, Paris, France.
authors.forename: Béatrice
authors.identifier: http://orcid.org/0000-0003-2614-7556
authors.initials: B
authors.lastname: Dubern
mesh_terms: D002648:Child; D002675:Child, Preschool; D001068:Feeding and Eating Disorders / Q000209:etiology; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications* / Q000628:therapy; D006801:Humans; D007223:Infant; D008297:Male; D009752:Nutritional Status; D018529:Nutritional Support / Q000706:statistics & numerical data; D012189:Retrospective Studies; D056730:Silver-Russell Syndrome / Q000150:complications*
keywords: Silver Russell syndrome; digestive manifestations; failure to thrive; gastroesophageal reflux; malnutrition