'Antral dysmotility' - An unrecognized cause of chronic vomiting during infancy

Ten infants who were less than nine months of age and had chronic nonbilious vomiting were evaluated for gastroesophageal reflux. Upper gastrointestinal series in all showed delayed gastric emptying, a funnel-shaped antrum, absent antral peristalsis, and gastroesophageal reflux. None had evidence of anatomic obstruction in the stomach or duodenum. Manometric studies of the esophagus revealed either normal (4 patients) or elevated (6 patients) lower esophageal sphincter pressures. One-hour esophageal pH probe tests were negative in seven of the ten infants. This obstruction to gastric emptying appears to represent a disorder of antral motility. Medical management, which consisted of small frequent feedings and postural therapy, was successful in six of the infants. The remaining four patients required pyloroplasty. All of the infants are now asymptomatic and gaining weight at either a normal or accelerated rate for their ages. Familiarity with this previously undescribed disorder should prevent the incorrect diagnosis of gastroesophageal reflux secondary to lower esophageal sphincter incompetence and the resulting inappropriate surgical reconstruction.