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Constipation and G-Tubes


An 11-year-old who had a Nissen Fundoplication is experiencing a lot of constipation and gas. He's tried Zantac, Mylanta, Prevacid, Reglan, and Enulose, all without effect. What other medications might provide him relief? Would Miralax be effective? What would you recommend for medications and are there any tests he should be having? He is also having difficulty with the area around the G-tube. Despite the application of different creams, antibiotics, keeping it is chronically inflamed. It had to be changed once already and the doctors are saying they won't put another one in. What do you suggest?

Answer of our experts

Miralax is a great medication for constipation. The laxatives he was on work by producing gas, so Miralax would probably be more effective for him.

I would go back to the surgeon who put in the g-tube to have it looked at. There are many reasons for red G-tube sites and the child should be seen by doctor to evaluate the g-tube site and course of treatment. Some hospitals use a stomal therapist for the difficult cases. CP/TK 7-13-10

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Consider always gastro-oesophageal reflux disease (GORD) in any individual with CdLS owing to its frequency and wide variability in presentation, which includes challenging behaviour.
Modification of nutrition and proton pump inhibitors (PPI) are the first-line treatments of GORD. Anti-reflux medications need to be used to their maximum dosage. Surgical interventions for GORD should be limited to those individuals with CdLS in whom nutritional and medical treatments have been unsuccessful or airway safety is at risk.
If GORD symptoms persist, endoscopy should be strongly considered whilst an individual with CdLS is still in paediatric care.
Surveillance for Barrett’s Oesophagus needs to be discussed with and decided together with the family, balancing the potential gain in health and burden for the individual with CdLS.


Feeding and Dental Difficulties

In every CdLS individual with prolonged and marked feeding difficulties, the multidisciplinary assessment (from healthcare workers across many disciplines) should consider (temporary) placement of a gastrostomy (surgical opening through the abdomen into the stomach) as a supplement to oral feeding.
In individuals with CdLS who have recurrent respiratory infections, reflux and/or aspiration (breathing foreign objects into airways) should be ruled out.
The palate should be closely examined at diagnosis. In case of symptoms of a (submucous) cleft palate, referral for specialist assessment is indicated.
Dental assessment and cleaning should take place regularly; a more thorough dental examination or treatment under anaesthesia may be necessary.

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