Gastric Pacing in a Child with Severe Gastroparesis and Review of the Literature

Gastroparesis is a disorder characterised by symptoms of and evidence for gastric retention in the absence of mechanical obstruction. Symptoms include nausea and vomiting, early satiety, postprandial fullness, regurgitation and abdominal pain. Common causes of gastroparesis are diabetes, post-surgical and idiopathic. In some patients, gastroparesis can be very severe and refractory to medical therapy including anti-emetics, anti-reflux and pro-kinetic medications. Gastric electrical stimulation represents a novel treatment for severe gastroparesis by regulating gastric electrical dysfunction with a neurostimulator. In adult studies, vomiting frequency has been reduced by up to 81% from baseline. We report a case of a 13-year-old girl with life-long severe idiopathic gastroparesis who was successfully treated by gastric pacing

Obstructive Uropathy in a Child with Severe Chronic Constipation

Urinary symptoms are well-described in children with chronic constipation which include enuresis, urgency and recurrent urinary infections. Renal tract obstruction is a rare complication of severe chronic constipation. We describe a case of a 10-year-old boy with a history of long-standing constipation who presented with obstructive uropathy. Treatment strategies involved intensive medical therapy, parental education, behaviour modification strategies and close follow-up in a specialised constipation clinic. The obstruction was reversed and medications were discontinued after six months. Successful management of children with chronic constipation involves a multi-disciplinary approach in a specialised constipation clinic

Evidence for Low Residue Diet in the Management of Gastrointestinal Related Conditions

The low residue diet is commonly recommended for pre-colonoscopy bowel preparation as well as in the management of some gastrointestinal conditions including inflammatory bowel disease. There is no objective measurement for residue, resulting in poor standardisation of a low residue diet. This review examines the efficacy of a low residue diet in the management of gastrointestinal conditions. A literature search was conducted in Medline and the Cochrane Library, and eight randomised controlled trials with human subjects met the inclusion criteria. Six studied the low residue diet for pre-colonoscopy bowel preparation, the other two were conducted in Crohn's disease and post-gynaecological surgery, respectively. The low residue diet was comparable to the clear liquid diet for bowel preparation without increased side-effects. Post-gynaecological surgery, early feeding using low residue diet decreased nausea without increasing gastrointestinal symptoms when compared to the traditional feeding method. There was limited evidence on the advantage of a low residue diet over a normal diet in the management of acute, non-stenosing Crohn's disease. More rigorous studies are required to evaluate the efficacy of the low residue diet for the management of gastrointestinal conditions. In addition, substituting a low residue diet with a low fibre diet would be a more measurable and objective method to standardise guidelines both for research and therapy