AbstractsAstronomy & Space Science

Spectrum of Gastroparesis in Children

by Shamaila Waseem




Institution: University of Florida
Department: Medical Sciences, Clinical Investigation (IDP)
Year: 2009
Keywords: erythromycin, gastroparesis, intravenous, metoclopramide, motility, prokinetics; Clinical Investigation (IDP)
Record ID: 1846581
Full text PDF: http://ufdc.ufl.edu/UFE0025107


Abstract

Gastroparesis is a condition of abnormal gastric motility characterized by delayed gastric emptying in the absence of mechanical outlet obstruction. Symptoms include nausea, vomiting, post-prandial fullness, early satiety, abdominal bloating and weight loss. In adults, one third of gastroparesis is due to diabetes, one third idiopathic and one third is assumed post surgical. Delayed gastric emptying of a solid-phase meal assessed by radionuclear scintigraphy is considered the gold standard for the diagnosis of gastroparesis. The prevalence of gastroparesis is difficult to estimate due to the lack of a validated, widely available diagnostic test that can be applied in primary care. The extent of the problem with gastroparesis in children is unknown and there are no effective therapies for it. We studied a cohort of children with delayed gastric emptying, to identify symptoms, co-morbidities, possible risk factors, treatment and outcomes. Patients ranging from 0-21 years who underwent gastric scintigraphy from January 2002 to December 2008 at the University of Florida were identified. Retrospective analysis of 239 patients (52% female, mean age 7.9 yrs) was performed. Variables measured were: indications for gastric scintigraphy (symptoms); gastric empyting half-time (tone half) for gastric scintigraphy for solid vs. liquid test meals; response to IV erythromycin or metoclopramide observed during scintigraphy; demographics (age, gender, height/weight; other medical/surgical diagnosis and psychological diagnosis); identified etiologies ; complications; all therapeutic interventions (dietary modification, prokinetic/anti-emetic agents, nutritional support (enteral/parenteral), gastric electrical stimulation and others); and most recent follow-up encounter assessing gastroparesis symptomatology. Data were aggregated for frequency and percentage. The frequency of initial presenting symptoms included: vomiting (68%), abdominal pain (51%) nausea (28%), weight loss (27%), early satiety (25%), and bloating (7 %). The most common etiologies were: idiopathic (70%), cerebral palsy (16%), seizure disorder (15.5%), prematurity (13%), and developmental delay (10.5%), Thirty-five percent of patients responded to IV erythromycin injected during scintigraphy compared to only 8.4 % treated with IV metaclopramide during the same procedure. The majority (73.6 %) were treated with EES, while 41% received dietary modifications, 29.7% metoclopramide, 23% enteral feeds, 6.7% tegaserod, and 5.4% azithromycin. After an average of 24 months follow up, the most common complications from gastroparesis were esophageal reflux (67.4%), esophagitis (16.7%), gastritis (15%), and dehydration (3.7%). Nevertheless, by the end of the follow-up period a significant improvement in all symptoms was reported despite different therapeutic modalities over time. Appreciation of different etiologies, symptom presentation, complications, and outcomes of the patients is the basis for better understanding of the course and outcomes for children with gastroparesis.