A normal gastrointestinal motility excludes chronic intestinal pseudoobstruction in children

Gastrointestinal manometry has gained wide acceptance in the approach to pa tients with suspected enteric neuromuscular disorders. However, performing gastrointestinal manometry in these subjects without a previous exhaustive diagnostic evaluation is unjustified. Twelve children (median age: 7.0 year s; range: 8 months-13 years), with clinical and x-ray features suggesting c hronic intestinal pseudoobstruction, were referred to our unit for gastroin testinal manometry. The latter was performed with a perfused catheter for 5 hr in the fasting state and for 90 min after feeding. Data were compared w ith those recorded in eight age-matched controls. In all patients and contr ols, interdigestive motor complexes with propagated phases III were detecte d; a regular postprandial antroduodenal motor activity was also recorded. P atients and controls did not differ for fed antral and duodenal motility in dexes, fed antroduodenal coordination, and length of duodenal phase III. Mo st of the patients showed short or prolonged bursts of nonpropagated activi ty in the fasting and/or fed states; in four cases fasting and/or fed susta ined phasic activity was recorded. Manometric evidence of migrating motor c omplexes and postfeeding activity did not support the diagnosis of intestin al pseudoobstruction and suggested redirecting the diagnostic evaluation. F inal diagnoses were: Munchausen syndrome-by-proxy (four cases), celiac dise ase (two cases), intestinal malrotation (two cases), Crohn's disease (two c ases), multiple food intolerance (one case), and congenital chloride-losing diarrhea (one case). It is concluded that in children with suspected chron ic intestinal pseudoobstruction manometric evidence of migrating motor comp lexes and fed motor activity excludes an enteric neuromuscular disorder and suggests a reassessment of the diagnostic work-up. Furthermore, if gastroi ntestinal manometry shows migrating motor complexes and postfeeding motor a ctivity, qualitative abnormalities of the manometric tracings do not indica te an underlying enteric neuromuscular disorder and must not be overemphasi zed. Patients referred for gastrointestinal manometry should previously und ergo an extensive diagnostic investigation to exclude disorders mimicking c hronic intestinal pseudoobstruction.