Gastro-intestinal problems

Overview

Children, young people and adults with Down syndrome are more likely than the general population to have gastro-intestinal problems. In childhood gastro-intestinal problems account for 20% of hospital admissions for those with Down syndrome.

The main problems can be grouped as follows:-

Embryological and structural

  • Together these anomalies affect around 10 % of those with Down syndrome
  • Surgery in neonatal period – outcomes similar to those without Down syndrome but mat be complicated because of associated medical conditions
  • Oesophageal atresia/Tracheo-oesophageal fistula
    • 1% of those born with Down syndrome.
    • May be diagnosed antenatally or present with feeding problems as a neonate.
    • H-type tracheo-oesophageal fistula may present late with respiratory problems
  • Duodenal or jejunal atresia or stenosis
    • may be diagnosed antenatally or present with neonatal vomiting .
    • Partial atresia may present later
  • Anorectal anomaly (Imperforate anus or stenosis)
  • Hirschsprung’s disease
    • 2% of those with Down syndrome – 100 times more common than general population
    • Classic presentation with failure to pass meconium in 1st 24 hours
    • 50% of those with Down syndrome present after 1 month of age
    • short segment Hirschsprung’s disease should be considered as a possible cause of constipation beyond infancy
  • All Babies should be checked at birth for patent anus and passage of meconium.

Motility and co-ordination

  • Feeding difficulties
    • Feeding a baby with Down syndrome may be challenging due to poor oro-motor function, sleepiness, or associated health problems.
    • The rate of breast feeding is relatively low but health benefits are as for the general population and many can breast feed effectively given appropriate support
  • Gastro-oesophageal reflux
    • Extremely common because of lax musculature and delay in achieving upright posture.
    • Investigation may be required to confirm reflux and that symptoms are due to a structural abnormality.
    • Treatment is as for the general population.
  • Constipation
    • Common and may be related to low tone in abdominal muscles, and reduced exercise levels.
    • Important to exclude associated disorders leading to constipation such as hypothyroidism, coeliac disorder, or Hirschsprung’s disease.
    • Treatment for idiopathic constipation is as for the general population.
  • Toddler diarrhoea .
    • Loose frequent stools in a healthy thriving toddler may be attributed to Toddler diarrhoea
    • important to also consider associated disorders such as thyroid disorder or coeliac disorder
  • Gall stones
    • More common in those with Down syndrome
    • Evidence of dysmotility in the bile duct.
    • often found incidentally, are not necessarily symptomatic, and may not require treatment

Infection

As for all children, gastro-intestinal infection is common particularly in the pre-school years. There is no evidence that those with Down syndromehave impaired resistance to common causative viruses. Poor hand washing after toileting may contribute.

Nutrition

People with Down syndrome may have nutritional challenges related to associated medical conditions. There is no evidence to support the need for nutritional supplementation in well children and adults with Down syndrome, and research does not support the view that cognitive skills are improved by intervention with vitamin or mineral supplements.

Presentations at DSMIG Meetings


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Additional Resources

Gastrointestinal disorder. Article in Down’s syndrome association Journal .To be published Spring/Summer 2016

Gastrointestinal disorder – Down’s Syndrome Association Health Series leaflet

Last updated 2013

 

Book Chapter – Gastrointestinal Disorders

Patricia D Jackson,Peter Gillett and Sarah Almond

in
ds-current-perspectives-book-coverDown Syndrome – Current Perspectives

Edited by Richard Newton , Shiela Puri and Liz Marder