BACKGROUND: In chronically ill @entity1 who refuse to eat, surgery to correct anatomic problems and behavioral treatments to overcome oral aversion often succeed. A few @entity1 fail with standard treatments. The aims of the study were to: 1) investigate motility and @entity1819 and 2) describe treatment that was individualized based on pathophysiology in @entity1 who failed surgery and behavioral treatments. METHODS: We studied 14 @entity1 (age 1.5-6; mean 2.5; M/F: 7/7). All had a lifelong history of @entity458 and @entity391 persisting after feeding therapy and fundoplication. All were fed through @entity5274 . We studied esophageal and antroduodenal manometry, and gastric volume threshold for retching. We identified when gastric antral contractions were associated with retching and @entity158 . A multidisciplinary treatment program included a variable combination of continuous post-pyloric feedings, drugs to decrease @entity3825 , @entity1319 , and behavioral, cognitive, and family therapy. We interviewed parents 2-6 months following testing to evaluate symptoms, mode of feeding and emotional health. RESULTS: We found a @entity1319 alone in 2, decreased threshold for retching alone in 5 and both motility and @entity3002 in 7. After treatment, 6 of 14 (43%) began eating orally and 80% had improved emotional health. Retching decreased from 15 episodes per day to an average of 1.4 per day (p <0.01). CONCLUSIONS: Upper @entity344 contributed to reduced quality of life for a majority of @entity1 and families with persistent feeding problems. A multidisciplinary approach improved symptoms and problems in these @entity1

XXXX and @entity3002 may contribute to food refusal in medically fragile toddlers.

@entity1 :: ('9606', 'Species') :: ['children', 'patients'] @entity1819 :: ('MESH:D013272', 'Disease') :: ['gastric sensory abnormalities'] @entity3825 :: ('MESH:D059265', 'Disease') :: ['visceral pain'] @entity391 :: ('MESH:D014839', 'Disease') :: ['retching or vomiting'] @entity3002 :: ('MESH:D009421', 'Disease') :: ['sensory abnormalities'] @entity458 :: ('MESH:D020018', 'Disease') :: ['food aversion'] @entity344 :: ('MESH:D005767', 'Disease') :: ['gastrointestinal motor and/or sensory disorders'] @entity5274 :: ('MESH:D005184', 'Disease') :: ['gastrostomy or gastro-jejunostomy tubes'] @entity158 :: ('MESH:D010146', 'Disease') :: ['pain'] @entity1319 :: ('MESH:D015835', 'Disease') :: ['drugs for motility disorders', 'motility disorder']
@entity344 :: (MESH:D005767,Disease) :: ['Gastrointestinal motility']
