Pediatr Gastroenterol Hepatol Nutr.  2015 Jun;18(2):128-133. 10.5223/pghn.2015.18.2.128.

A Case of Visceral Autonomic Neuropathy Complicated by Guillain-Barre Syndrome Accompanied with Cyclic Vomiting Syndrome-like Disorder in a Child

• Hong SJ
• Choe BH

• KMID: 2315560
• DOI: http://doi.org/10.5223/pghn.2015.18.2.128

Abstract

We present a case of an 8-year-old boy with visceral autonomic neuropathy complicated by Guillain-Barre syndrome. In this pediatric patient, gastroparesis was the major symptom among the autonomic symptoms. Due to the gastroparesis, there was no progress with the oral diet, and nutrition was therefore supplied through a nasojejunal tube and gastrojejunal tube via Percutaneous endoscopic gastrostomy (PEG). After tube feeding for 9 months, the patient's gastrointestinal symptoms improved and his oral ingestion increased. The pediatric patient was maintained well without gastrointestinal symptoms for 3 months after removal of the PEG, had repeated vomiting episodes which lead to the suspicion of cyclic vomiting syndrome. Then he started treatment with low-dose amitriptyline, which resulted in improvement. Currently, the patient has been maintained well for 6 months without recurrence, and his present growth status is normal.

Keyword

Cyclical vomiting syndrome; Dysautonomia; Gastroparesis; Guillain-Barre syndrome; Child

MeSH Terms

Amitriptyline
Child*
Diet
Eating
Enteral Nutrition
Gastroparesis
Gastrostomy
Guillain-Barre Syndrome*
Humans
Male
Primary Dysautonomias
Recurrence
Vomiting*
Amitriptyline

Figure

• 

  Fig. 1 Supine anteroposterior abdominal radiograph after percutaneous endoscopic gastrostomy insertion.

Reference

1. van Doorn PA, Ruts L, Jacobs BC. Clinical features, pathogenesis, and treatment of Guillain-Barré syndrome. Lancet Neurol. 2008; 7:939–950.

2. Moulin DE, Hagen N, Feasby TE, Amireh R, Hahn A. Pain in Guillain-Barré syndrome. Neurology. 1997; 48:328–331.

3. Asahina M, Kuwabara S, Suzuki A, Hattori T. Autonomic function in demyelinating and axonal subtypes of Guillain-Barré syndrome. Acta Neurol Scand. 2002; 105:44–50.

4. Hasser EM, Moffitt JA. Regulation of sympathetic nervous system function after cardiovascular deconditioning. Ann N Y Acad Sci. 2001; 940:454–468.

5. Kloesel B, Hickson LJ. Severe hyponatremia as the initial sign preceding guillain-barr syndrome, an acute inflammatory demyelinating polyneuropathy: a case report. Case Rep Neurol Med. 2013; 2013:923602.

6. Saifudheen K, Jose J, Gafoor VA, Musthafa M. Guillain-Barre syndrome and SIADH. Neurology. 2011; 76:701–704.

7. Hoffmann O, Reuter U, Schielke E, Weber JR. SIADH as the first symptom of Guillain-Barré syndrome. Neurology. 1999; 53:1365.

8. Ramanathan S, McMeniman J, Cabela R, Holmes-Walker DJ, Fung VS. SIADH and dysautonomia as the initial presentation of Guillain-Barré syndrome. J Neurol Neurosurg Psychiatry. 2012; 83:344–345.

9. Singh NK, Jaiswal AK, Misra S, Srivastava PK. Assessment of autonomic dysfunction in Guillain-Barré syndrome and its prognostic implications. Acta Neurol Scand. 1987; 75:101–105.

10. Burns TM, Lawn ND, Low PA, Camilleri M, Wijdicks EF. Adynamic ileus in severe Guillain-Barré syndrome. Muscle Nerve. 2001; 24:963–965.

11. Asbury AK, Arnason BG, Adams RD. The inflammatory lesion in idiopathic polyneuritis. Its role in pathogenesis. Medicine (Baltimore). 1969; 48:173–215.

12. de Jager AE, Sluiter HJ. Clinical signs in severe Guillain-Barré syndrome: analysis of 63 patients. J Neurol Sci. 1991; 104:143–150.

13. Flachenecker P, Wermuth P, Hartung HP, Reiners K. Quantitative assessment of cardiovascular autonomic function in Guillain-Barre syndrome. Ann Neurol. 1997; 42:171–179.

14. Dimario FJ Jr, Edwards C. Autonomic dysfunction in childhood Guillain-Barré syndrome. J Child Neurol. 2012; 27:581–586.

15. Hund EF, Borel CO, Cornblath DR, Hanley DF, McKhann GM. Intensive management and treatment of severe Guillain-Barré syndrome. Crit Care Med. 1993; 21:433–446.

16. Drossman DA. Rome III: the new criteria. Chin J Dig Dis. 2006; 7:181–185.

17. Turchetti A, Guglielmi S, Fossati C, Matrunola M, Corrado G. Gastric emptying time in cyclic vomiting syndrome in children. Eur Rev Med Pharmacol Sci. 2004; 8:295–298.

18. Sim YJ, Kim JM, Kwon S, Choe BH. Clinical experience with amitriptyline for management of children with cyclic vomiting syndrome. Korean J Pediatr. 2009; 52:538–543.

19. Prakash C, Clouse RE. Cyclic vomiting syndrome in adults: clinical features and response to tricyclic antidepressants. Am J Gastroenterol. 1999; 94:2855–2860.

20. Yang HR, Ko JS, Seo JK. A study on the disease course and prognosis of cyclic vomiting syndrome. J Korean Pediatr Soc. 2001; 44:1141–1156.