Clinical Characterization of Pediatric Gastroparesis Using a Four‐hour Gastric Emptying Scintigraphy Standard

Abstract

Objectives: Four-hour gastric emptying scintigraphy (GES) is the recommended method to identify both adult and childhood gastroparesis (GP). Previous pediatric studies have, however, not used this standard. We sought to determine the characteristics and outcomes of children versus adolescents with GP using the 4-hour GES evaluation. Methods: We performed a retrospective chart review of pediatric patients diagnosed with GP by 4-hour GES (>10% retention at 4 hours). Demographics, body mass index, GP-related symptoms, comorbidities, etiologies, therapies (eg, medications), healthcare utilization, and response to therapy were captured systematically. Symptoms were compared from the initial versus last gastroenterology visit. Outcomes were categorized as no improvement; improvement (resolution of at least 1 symptom while remaining on therapy); and complete resolution of symptoms. Results: A total of 239 subjects (12.1 AE 4.1 years [mean AE standard deviation], 70% girls) were included. The identified characteristics of childhood GP were broad with idiopathic GP being the most common etiology. Outcomes over a median of 22 months (25%-75%: 9.0-45.5 months) were 34.8% no improvement, 34.8% some improvement, and 30.3% with complete symptom resolution. Compared to younger children, adolescents had a higher female predominance (P < 0.01) and were more likely to have nausea (P ¼ 0.006). Girls were more likely to have abdominal pain (P ¼ 0.001), nausea (P ¼ 0.03), and a documented diagnosis of dysautonomia (P ¼ 0.03). Boys were more likely to have regurgitation (P ¼ 0.006), gastroesophageal reflux disease (P ¼ 0.02), and rumination (P ¼ 0.02). Conclusions: Using the 4-hour GES standard, childhood GP has broad clinical characteristics and outcomes. There are several significant age-and sex-based differences in childhood GP.

PedsQL™ Gastroparesis Symptoms Module Domain and Item Development

“…Nevertheless, a broader spectrum of patients with more diverse race/ethnicity background characteristics is clearly indicated for future research. Further, in our center there were no children 5–6 years of age who were eligible for recruitment; however, the broader literature suggests that diagnosis of gastroparesis using the 4‐hour gastric emptying scintigraphy standard is uncommon in these younger ages (29,30). Additionally, only one male participant was included, in parallel with the literature and findings from our group indicating that girls are more commonly diagnosed with gastroparesis (2,30).…”

“…Further, in our center there were no children 5–6 years of age who were eligible for recruitment; however, the broader literature suggests that diagnosis of gastroparesis using the 4‐hour gastric emptying scintigraphy standard is uncommon in these younger ages (29,30). Additionally, only one male participant was included, in parallel with the literature and findings from our group indicating that girls are more commonly diagnosed with gastroparesis (2,30). Although male children may have more regurgitation than females, this should be captured by the existing scales within the module (30).…”

“…Additionally, only one male participant was included, in parallel with the literature and findings from our group indicating that girls are more commonly diagnosed with gastroparesis (2,30). Although male children may have more regurgitation than females, this should be captured by the existing scales within the module (30). Nevertheless, future research will need to include more male participants.…”

Postviral Gastroparesis Associated With SARS-CoV-2 Infection in a Pediatric Patient

“…Pediatric patients with gastroparesis most often present with symptoms of vomiting, abdominal pain, nausea, weight loss, and early satiety ( 2 ). Four-hour gastric emptying scintigraphy has proven useful in demonstrating objectively decreased motility, although it lacks standardization in how it is conducted and interpreted ( 3 , 4 ). The potential causes of gastroparesis in the pediatric population include idiopathic, postinfectious, dysautonomia, connective tissue disorders, fundoplication, and others.…”