Multiple drugs

Abstract

Multiple drugs Lack of efficacy: case reportA 12-year-old girl exhibited lack of efficacy during treatment with erythromycin, domperidone, omeprazole, metoclopramide, ondansetron and botulinum toxin for idiopathic severe gastroparesis.The girl was referred with a lifelong history of vomiting. At the age of 12 years, she was diagnosed with idiopathic severe gastroparesis. She was treated with omeprazole, erythromycin, domperidone, metoclopramide and ondansetron; however, no response was noted. Her condition did not improved despite exclusive elemental diet and endoscopic pyloric injection of botulinum toxin [dosages and routes not stated]. She underwent laparoscopic pyloroplasty, resulting in temporary relief for 2 months; however, she continued to experience relentless vomiting. Subsequently, she started receiving exclusive nasojejunal feeding; this was welltolerated. Thereafter, a permanent surgical jejunostomy was placed, resulting in improvement. However, she developed a viral illness and her condition deteriorated again. She became completely jejunostomy feed dependent. She had intractable vomiting which was noted to be refractory to all the medical and dietary interventions. Gastric pacing was achieved by laparoscopic placement of The Enterra device at the age of 13 years. She started receiving unspecified antiemetics. A gradual reduction in vomiting frequency was noted. She had no further hospitalisations. She was able to tolerate liquid food and her vomiting had completely resolved. Her weight and quality of life had also improved.