In Duchenne muscular dystrophy, gastrointesgutinal problems can range from poor oral intake and dysphagia with possible aspiration episodes with advancing disease. More commonly patients are prone to constipation, but more important is the possibility of peptic ulceration and abdominal pain - this is more frequently associated due to the treatment with steriods.
Gastritis is also experienced by patients who are taking oral bisphosphonates for bone protection. If gastric reflux is suspected, then treat with proton pump inhibitors or H2 blockers, with prokinetics, sacrulfate and neutralising antacids as adjunctive therapies.
If presenting with abdominal pain, vomiting or frank haematemesis - patient needs urgent assessment.
Assess Airway, Breathing and Circulation.
If obvious ulceration, fluid replacement, treatment with anti-ulcer medication, including proton pump inhibitors, the urgent referral to the surgeons and gastro team is recommended.
Advise against NSAIDs.
- Poor oral intake and dehydration.
- Aspiration episodes.
- Peptic Ulceration - signs may not be obvious in younger boys on steroids.