Effect of erythromycin on antroduodenal motility in children with chronic functional gastrointestinal symptoms
- 71 Downloads
- 40 Citations
Abstract
To evaluate the effects of erythromycin on antroduodenal motility in children with chronic functional gastrointestinal symptoms, we studied 35 consecutive subjects referred for diagnostic motility studies. We recorded fasting motility for >4 hr, then infused in random order either 1 or 3 mg/kg erythromycin intravenously over 1 hr and continued the study for another hour. Erythromycin induced phase III in 18 of 20 children who had phase III during fasting compared to only one of 15 who did not (P<0.001). The antral motility index increased after erythromycin (1596±323 vs 436±242 mm Hg/30 min before erythromycin,P<0.005) but the duodenal motility index did not change. The antral motility index was greater in children receiving 3 mg/kg than in those receiving 1 mg/kg (1968±391 vs 1226±285 mm Hg/30 min,P<0.01), but duodenal motility indices did not differ. Only one child receiving the lower dose erythromycin complained of abdominal pain, nausea, or vomiting vs 9 of 19 the children receiving the higher dose (P<0.02). In summary, in children with chronic functional gastrointestinal disorders, erythromycin rarely induced phase III in patients who did not have it during fasting. When different doses erythromycin are compared, 1 and 3 mg/kg are equally efficacious in inducing phase III episodes; the lower dose is associated with fewer side effects and the higher dose produces a higher antral motility index.
Key words
erythromycin gastrointestinal motility pediatrics motor migrating complexPreview
Unable to display preview. Download preview PDF.
References
- 1.Byrne WJ, Cipel L, Euler AR, Halpin TC, Ament ME: Chronic idiopathic intestinal pseudo-obstruction syndrome in children—clinical characteristics and prognosis. J Pediatr 90:585–589, 1977Google Scholar
- 2.Cucchiara S, Bortolotti M, Colombo C, Boccieri A, De Stefano M, Vitiello G, Pagano A, Ronchi A, Auricchio S: Abnormalities of gastroduodenal motility in children with nonulcer dyspepsia and in children with gastroesophageal reflux. Dig Dis Sci 36:1066–1073, 1991Google Scholar
- 3.Pineiro-Carrero VM, Andres JM, Davis RH, Mathias JR: Abnormal gastroduodenal motility in children and adolescents with recurrent functional abdominal pain. J Pediatr 1134:820–825, 1988Google Scholar
- 4.Hyman PE, Napolitano JA, Diego A, Patel S, Flores AF, Grill BB, Reddy SN, Garvey TQ, Tomomasa T: Antroduodenal manometry in the evaluation of chronic functional gastrointestinal symptoms. Pediatrics 86:39–44, 1990Google Scholar
- 5.Hyman PE, Di Lorenzo C, McAdams L, Flores AF, Tomomasa T, Garvey TQ: Clinical response to cisapride in children with chronic intestinal pseudo-obstruction. Am J Gastroenterol 88:832–836, 1993Google Scholar
- 6.Vantrappen G, Janssens J, Peeters TL, Bloom SR, Christofides ND, Hellemans J: Motilin and the interdigestive migrating motor complex in man. Dig Dis Sci 24:497–500, 1979Google Scholar
- 7.Peeters TL, Vantrappen G, Janssens J: Fasting plasma motilin levels are related to the interdigestive motility complex. Gastroenterology 79:716–719, 1980Google Scholar
- 8.Tomomasa T, Kuroume T, Arai H, Wakabayashi K, Itoh Z: Erythromycin induces migrating motor complex in human gastrointestinal tract. Dig Dis Sci 31:157–161, 1986Google Scholar
- 9.Janssens J, Peeters TL, Vantrappen G, Tack J, Urbain JL, De Roo M, Muls E, Bouillon R: Improvement of gastric emptying in diabetic gastroparesis by erythromycin. N Engl J Med 322:1028–1031, 1990Google Scholar
- 10.Di Lorenzo C, Lachman RK, Hyman PE: Intravenous erythromycin for postpyloric intubation. J Pediatr Gastroenterol Nutr 11:45–47, 1990Google Scholar
- 11.Janssens J, Vantrappen G, Annese V, Peeters TL, Tijskens G, Rekoumis G: Effect of erythromycin on LES function and esophageal body contractility. Gastroenterology 98:A64, 1990Google Scholar
- 12.Hyman PE, Di Lorenzo C, Hoon A, Krishnamurthy S, Dean P, Schuffler MD: Antroduodenal manometry and intestinal pathology correlate in congenital chronic intestinal pseudoobstruction. Gastroenterology 104:A525, 1993Google Scholar
- 13.Janssens J, Vantrappen G, Peeters TL: The activity front of the migrating motor complex of the human stomach but not of the small intestine is motilin-dependent. Regul Pept 6:363–369, 1983Google Scholar
- 14.Sarna SK, Soergel KH, Koch TR, Stone JE, Wood CM, Ryan RP, Arndorfer RC, Cavanaugh JH, Nellans HN, Lee MB: Gastrointestinal motor effects of erythromycin in humans. Gastroenterology 101:1499–1496, 1991Google Scholar
- 15.Weisbrodt NW, Copeland EM, Moore Ep, Kearley RW, Johnson LR: Effect of vagotomy on electrical activity of the small intestine of the dog. Am J Physiol 228:650–654, 1975Google Scholar
- 16.Marlett JA, Code CF: Effect of celiac and superior mesenteric ganglionectomy on interdigestive myoelectric complex in dogs. Am J Physiol 232:E432-E436, 1977Google Scholar
- 17.Sarna SK, Stoddard C, Belbeck L, McWade D: Intrinsic nervous control of migrating myoelectric complexes. Am J Physiol 241:G16-G23, 1981Google Scholar
- 18.Frantzides CT, Condon RE, Doumas BT, Garancis JC: Effects of enteric neural defunctioning on small bowel motility. Am J Physiol 259:G226-G232, 1990Google Scholar
- 19.Tomomasa T, Itoh Z, Koizumi T, Kuroume T: Nonmigrating rhythmic activity in the stomach and duodenum of neonates. Biol Neonate 48:1–9, 1985Google Scholar
- 20.Ittmann PI, Amarnath R, Berseth CL: Maturation of antroduodenal motor activity in preterm and term infants. Dig Dis Sci 37:14–19, 1992Google Scholar
- 21.Quigley EMM, Donovan JP, Lane MJ, Gallagher TF: Antroduodenal manometry. Usefulness and limitation as an outpatient study. Dig Dis Sci 37:20–28, 1992Google Scholar
- 22.Dooley CP, Di Lorenzo C, Valenzuela JE: Variability of the motor migrating complex in the human. Dig Dis Sci 37:723–728, 1992Google Scholar
- 23.Zara GP, Thompson HH, Pilot MA, Ritchie HD: Effects of erythromycin on gastrointestinal tract motility. J Antimicrob Chemother 16:175–179, 1985Google Scholar
- 24.Annese V, Janssens J, Vantrappen G, Willemse P, Peeters TL: Erythromycin accelerates gastric emptying by inducing antral contractions and improved antroduodenal coordination. Gastroenterology 102:825–828, 1992Google Scholar
- 25.Reid B, Di Lorenzo C, Travis L, Flores AF, Grill BB, Hyman PE: Diabetic gastroparesis due to postprandial antral hypomotility in childhood. Pediatrics 90:43–46, 1992Google Scholar
- 26.Vantrappen G, Janssens J, Hellemans J, Ghoos Y: The interdigestive motor complex of normal subjects and patients with bacterial overgrowth of the small intestine. J Clin Invest 59:1158–1166, 1977Google Scholar
- 27.Ohira Y, Hanyu N, Furukawa Y, Nakada K, Abe S, Aoki T: Effect of erythromycin derivative, EM523L on human interdigestive gastrointestinal tract. Dig Dis Sci 38:1026–1031, 1993Google Scholar