CHARACTERISTICS AND CONSEQUENCES OF DUODENOGASTRIC REFLUX IN CHILDRENON TOTAL PARENTERAL-NUTRITION (TPN) FOR SEVERE GASTROINTESTINAL DISORDERS

This study was carried out to determine the frequency and composition (biliary and/or pancreactic) of duodenogastric reflux (DGR) in childre n with severe gastro-intestinal disorders on total parenteral nutritio n (TPN), and to assess its consequences in terms of gastric histology (gastric per endoscopic biopsies) and secretion (acid, pepsin and sial ic acid output). Sixteen children (mean age: 20 months) with severe ga stro-intestinal disorders requiring TPN (mean duration: 9.5 months) we re studied. DGR was demonstrated by measuring gastric choline and tryp sin outputs. Serum gastrin levels were measured in all patients. Seven children (44%) had a DGR, with a significant increase in choline outp ut (p < 0.02). Trypsin output was elevated in one patient only. Exudat ive gastritis and increased sialic acid output occurred in the presenc e and in the absence of DGR. DGR did not alter the basal acid and peps in secretions. The serum gastrin levels were normal except in one case . These results show that DGR occurs frequently in children suffering from severe gastro-intestinal disorders on TPN, that it is mainly of b iliary origin and that exudative gastritis is very frequent but not co rrelated with DGR. It suggests that DGR causes little injury in childr en on TPN, perhaps because of their decreased pancreatic secretion.