Children vomiting.pdfVIP

Chronic Vomiting in Children: New Insights into Diagnosis Seema Khan and Carlo Di Lorenzo, MD Address Division of Pediatric Gastroenterology, Children’s Hospital of Pittsburgh, One Children’s Place, Pittsburgh, PA 15213, USA. E-mail: Khans@chplink.chp.ed Current Gastroenterology Reports 2001, 3:248–256 Current Science Inc. ISSN 1522-8037 Copyright ? 2001 by Current Science Inc. Introduction In children, chronic or recurrent vomiting is a common presentation of gastroesophageal reflux disease (GERD), peptic ulcer disease, anatomic anomalies, metabolic dis- orders, and other extraintestinal diseases. The wide appli- cation of endoscopy-assisted diagnosis has broadened the differential diagnoses to include eosinophilic esophagitis, eosinophilic gastroenteritis, celiac disease, Helicobacter pylori infection, gastroduodenal Crohn’s disease, and autoimmune gastropathies. It is also recognized that vomiting, like other gastro- intestinal symptoms, may be generated by disturbed gastrointestinal motility. Strong emotions, anger, and environmental stress influence motility. The mechanisms by which these factors cause symptoms are poorly under- stood, but the use of relatively new diagnostic modalities allows us to understand the pathophysiologic basis of some of the disorders and also paves the way for develop- ing more effective treatment strategies. We briefly review the pathophysiology of vomiting and the normal patterns of gastroduodenal motility and gastric myoelectric activity. Vomiting is a protective mech- anism against accidentally ingested toxins and occurs by means of closely integrated neural, hormonal, and chem- ical mediators. The somatic motor events are mediated by the autonomic nervous system and manifest as salivation, tachycardia, cutaneous vasoconstriction, sweating, relax- ation of the proximal stomach, and retrograde propulsive contractions in the upper small bowel. The complex reflexive events involve an afferent limb (receptor and pathway), central